Sadly, critical funds for mental healthcare have been diminishing.
On July 8, 2016 my friend jumped from the 15th floor of his apartment block. We were buddies in primary school and lived in the same neighbourhood – one that was not the kindest around. Gangs flourished there, a common enough phenomenon in any low-income community.
In Standard 4 I got a lucky break and was put in the first class at school. Life, companions and interests in the first class are distinctly different from the second-last class. For the next 15 years I pursued my education and got my first job. My friend, on the other hand, fell further and further down the spiral: gangs, crime, lockups.
Ever thought about how our achievements aren’t entirely ours? My family always had my back; my friends and teachers were there for me; my cousins paid for my Form 5 tuition. They were good influences and provided a conducive environment for me to grow up in. If we shouldn’t take the entire credit for our success, we shouldn’t absorb all the blame for our failures either.
I've been asked, and I've asked myself this too: when and where did it all go wrong for my friend? It’s not that people like him have many choices – it’s a problem of our society. Those who drop out of the system – people like my friend who flunked school, whose parents divorced and whose mother ran away with his sister – are left to fend for themselves.
It’s a vicious cycle – one bad thing reinforced another and he plunged to a point where he could not be reached.
Youth suicide is increasing at an alarming rate today. It is still a stigma to talk about suicidal feelings, making our society ill-equipped to understand and react to its symptoms. Access to affordable mental healthcare is restricted and psychiatrists are overloaded with patients. Recent budget cuts will compound the problem, particularly among high-risk groups.
According to the World Health Organization, one in four people suffer from some form of mental illness. An estimated one million people commit suicide annually. Mental health disorders, especially depression and substance abuse, account for 90% of the cases.
Suicide is the second leading cause of death for youths aged between 10 and 24. Suicide attempts are 20 times more common than completed suicides. Females are more likely to attempt suicide but males are more likely to die because of their disposition toward more violent means, for example preferring to use a gun or jumping from a height instead of consuming pills.
“The first line of intervention is to detect hints or suicidal signs,” says Dr Prem Kumar Chandrasekaran, a consultant neuropsychiatrist at Penang Adventist Hospital. “They isolate themselves, appear guarded and drop hints like saying, ‘I don’t want to live anymore’ or ‘sorry for burdening everyone’. These are signs and almost all victims leave a trail of hints. It’s all there.”
What’s important, according to Prem, is to start educating society from a young age to destigmatise mental illness. School-based awareness should educate people to understand symptoms of mental illness, shatter the shame that prevents people from seeking treatment, and make people aware of what effective prevention and treatment resources they have access to.
Crisis centres, such as Befrienders, are where people can seek immediate help. Not only can they provide an ear to talk to and are equipped with basic training in dealing with people in distress, they can also refer people to the right resources and help. Prem also advocates safer building designs and reduced access to potentially fatal methods of suicide, e.g. weed poison.
Dr Prem Kumar Chandrasekaran.
In 1897 Emile Durkheim wrote a study on suicide as a social phenomenon. Durkheim, who is one of the three founding fathers of social science and sociology, argued that suicide is not an individual issue but a combination of societal factors.
This corresponds both to Prem’s experience and my friend’s story – suicide victims tend to be socially isolated, meaning they either suffer from societal oppression or have failed to be integrated into society.
Gender and sexual minorities, by virtue of being the most marginalised groups in society, are highly vulnerable. Young, single and unemployed males are also in the high-risk group; the risk increases if they have a history of substance abuse – usually drugs or alcohol.
The role of family and religion also testifies to the effects of societal influences on suicide and mental health. A stable and cohesive family attests to a high degree of societal integration, while most religions forbid followers from taking their own lives.
Currently, suicide attempts are against the law. Section 309 of the Penal Code states that any individual who attempts to commit suicide is punishable with up to a year in jail, or a fine, or both. Many countries, such as Canada, Germany, Denmark, Spain, India and Indonesia, have decriminalised suicide attempts. Those supporting the decriminalisation of suicide attempts say that these attempts are a cry for help and the legal penalty is not only ineffective, but will fail to provide real and necessary clinical treatment.
Taking Mental Healthcare Seriously
Due to the lack of funding, Malaysia’s suicide registry is no longer properly maintained and updated. The government simply does not invest enough money in mental healthcare. Lim Su Lin, a research analyst from Penang Institute in Kuala Lumpur, concurs; her research, “Evaluating Mental Healthcare in Malaysia”, found that Malaysia’s spending on mental health (RM332.11mil in 2015) is half of the calculated global average.
Though allocation to mental healthcare has been on the rise (prior to this year’s budget cut to the Ministry of Health), there is a critical lack of clinical psychologists and psychiatrists. Based on data derived from the National Specialist Register, the Psychiatric and Mental Health Services Operational Policy 2011 and the federal government’s Estimates of Expenditure, Lim calculated that clinical psychiatrists are only available at approximately 28 public hospitals, 18 private hospitals and 22 private clinics nationwide. And these psychiatrists are overloaded with patients.
Graffiti marks the tough neighbourhood my friend and I grew up in.
With a total of 190 psychiatrists working in public hospitals and 604,590 outpatient encounters, a psychiatrist’s daily caseload is 13 patients per day. This means spending an average of only 37 minutes with each patient. Private hospitals are also overloaded and charge higher fees, further restricting mental healthcare access to those who really need it.
Currently, suicide attempts are against the law. Those supporting the decriminalisation of suicide attempts say that these attempts are a cry for help and the legal penalty is not only ineffective, but will fail to provide real and necessary clinical treatment.
The shortage of human resources is a major burden impacting the quality of mental healthcare service in Malaysia. What’s worrying is that the shortage will be more severe as mental health conditions deteriorate. The National Health and Morbidity Survey (NHMS) reported in 2015 a threefold increase in mental health conditions among Malaysian adults, from 10.7% in 1996 to 29.2% in 2015. Sabah, Sarawak, KL and Kelantan have the highest prevalence of mental health problems. The same survey also reveals youths aged 16-24 have a slightly higher risk of developing mental illness and the prevalence of suicidal thoughts.
In the most unfortunate event, how do we deal with the family of the suicide victim and the aftermath? Experts suggest that one should not minimise the loss, give unsolicited advice, ask painful personal questions, or worse, imply blame on either the victim or his/her survivors. Sometimes less is more, and in such extremely personal circumstances, we can express our condolences, be there to show that we care, listen if they want to talk, and importantly, respect their space to grieve.
The last time we met, my friend asked me for money. If I had known how things would turn out for him, what would I have done differently? Maybe I would have asked about his ambitions and what he wants to do in life. Maybe it wasn’t money that could have saved him. It isn’t just about individual choices, but also the situation, environment, support and help from others, and the lucky breaks that separate our fortune.
If it takes a village to raise a child, it also takes a village to destroy a child.
If something is causing you to have frequent anxiety and depression and you feel like talking, reach out to:
Hotline: +604 281 5161/+604 281 1108 or
Lifeline Association Malaysia
Hotline: +603 4265 7995 or