THE PANDEMIC HAS been a bewildering time for most of us; and some have also experienced a decline in mental health. In response to this new crisis, mental health professionals and institutions in Malaysia came up with a practical way to help them: online therapy. Granted, this approach is not new and has its unique set of challenges, according to five experts that Penang Monthly interviewed.
There was a marked increase in the number of patients and cases during and after the Movement Control Order (MCO). Christina Maragkaki, a licensed psychotherapist, hypnotherapist and life coach, estimates the increase in her caseload to be about 40-50%. At the same time, school and crisis counsellor with the Talian Kasih helpline, Ng Jun Kiat, says that he went from seeing two clients a week to eight during the second and third phases of the MCO. Talian Kasih as a whole received a record-breaking 3,308 calls on April 16,1 up from its daily average of 145 calls.
Surprisingly, several of the experts detail an initial decrease in patients, only to experience a spike later on. Liana Mohd Nawi, clinical psychologist and director of the Employee Assistance Program at SOLS Health, says that her organisation went from receiving 19 cases per month pre-MCO, to 11 during the initial phase. The same phenomenon was observed by Celine Tan, a counsellor and public awareness advocate at the Life Line Association Malaysia, who attributes this reduction to the switch that had had to be made, from face-to-face to online counselling.
An Innovative Approach
Many Malaysians are unaware of online counselling, and even if they are, Ng thinks that “it’s a big change to adjust to. The clients will not necessarily be taken with the idea, making it difficult to build rapport and good dynamism.” Unstable internet connections and difficulty in reading the client’s body language are also cited as additional downsides to online counselling. Furthermore, no extensive research has been conducted to ascertain the effectiveness of online counselling in Malaysia and to determine its full spectrum of benefits.
But there are positives. Online counselling opens up the possibility for individuals living in areas with limited access to mental health services to get the help they need. “There are also those who prefer to have the sessions at home. The comfort of their surroundings is relaxing to them, it makes them want to open up more. Online therapy is not that different from faceto- face therapy, as long as you are ready and willing to commit,” says Maragkaki.
I hope that this advocacy for mental health continues. I don’t want us to wait for another pandemic for the next step to be taken.”
Still, there are others like visiting clinical psychologist Bing Shu Leng at Universiti Kebangsaan Malaysia who worry about the stigma surrounding online counselling. “People quarantining with their families would opt for shorter sessions, or skip them altogether because they are afraid of being ‘found out’,” he explains. He also highlights how, without addressing the matter at hand, it is unlikely that increased accessibility alone will remedy some of the structural issues in Malaysia’s mental healthcare system.
The Accessibility of Mental Health Services
Before Covid-19 helped to popularise online counselling, the availability of mental health professionals and organisations was concentrated in the more developed states of Malaysia.
A 2018 study on mental health services recorded 410 registered psychiatrists in Malaysia, with the psychiatrist to population ratio being 1.27 per 100,000 population. This figure is even more jarring in states like Sabah and Kedah which have the lowest ratios of 0.54 and 0.55 per 100,000 respectively2 . Indeed, online counselling does increase the accessibility of mental health services in those areas, but the supply of professionals still falls short of matching the demand.
Some hotlines like the Life Line Association Malaysia, though technically offering free services, require patients to use their phone data or to have a working internet connection to get in touch. For lengthy counselling sessions, the cost can quickly be significant.
According to Tan, more collaboration between the government and mental health organisations can lead to such calls being made free-of-charge, further increasing accessibility. “The government has provided great pricing fees for mental health services,” says Liana. But the long waitlist – which can go up to a year – at government-funded mental health centres limits its effectiveness. This is worsened still by the fact that mental health is often not covered by insurance. Currently, AIA is the only insurance provider that accepts mental health conditions such as Major Depressive Disorder, Schizophrenia and Bipolar Disorder, to name a few3 .
Mental Health and the Government
The general consensus among the five professionals interviewed is that the government can do more to improve the mental health situation in Malaysia. They agree that mental health education and awareness go hand-in-hand in reversing and eventually, erasing the negative stereotypes Malaysians hold of mental health treatments. “It’s a cliché to think that counselling can miraculously fix one’s mental health after just a few sessions. Or worse still, having the people you know think you’re off your rocker because you’re seeking help,” says Ng, adding that mental health is still not yet a part of the curriculum in our primary or secondary schools.
This situation is further worsened by the general lack of government funding. According to the Malaysian Health System Research Study by Harvard and the Ministry of Health in 2015, Malaysia spent only 1.3% of the government health budget on mental health as compared to the international average of 2.8%4 . No doubt, an increase in funding would bring significant improvements. “Currently, only 0.1% of the national budget goes to mental health. This is not sufficient,” says Bing. Likewise, government hospitals are still relatively understaffed, especially where registered psychologists are concerned.
The Future of Mental Health
Despite these shortcomings, there is hope. Covid-19 has shone a spotlight on the mental health situation in the country, and change is slowly but surely happening. Ng predicts that in the future, training mental health experts in online counselling will become far more common. “In the past, counselling services require face-to-face interactions, but there is now the option of online counselling as well.”
When quizzed if the current awareness levels are ephemeral, both Ng and Liana are hesitant yet hopeful. “I think awareness has increased. I hope that this advocacy for mental health still continues. I don’t want to wait for another pandemic to take another step.” Liana says.
1 Junior, J., 2020. Malaysians Experienced Much Distress Due To Pandemic. [online] The Star Online. Available at: https://www.thestar. com.my/news/nation/2020/06/26/malaysians-experienced-muchdistress- due-to-pandemic#cxrecs_s.
2 Midin, M., Zainal, N., Lee, T. and Ibrahim, N., 2018. Mental Health Services in Malaysia. Taiwanese Journal of Psychiatry, 32(4), pp.281-293.
3 Povera, A., 2019. Include Mental Health Treatment In Insurance Coverage, Says MPA | New Straits Times. [online] NST Online. Available at: https:// www.nst.com.my/news/nation/2019/05/490498/ include-mental-health-treatment-insurance-coveragesays- mpa#:~:text=KUALA%20LUMPUR%3A%20The%20 Malaysia%20Psychiatric,included%20in%20health%20 insurance%20premiums.
4 Lee, L., 2019. Mental Health Strategy Must Include Funding and Commitment | New Straits Times. [online] NST Online. Available at: https://www.nst.com.my/opinion/letters/2019/10/531227/mentalhealth- strategy-must-include-funding-and-commitment.
Kim Evers is a student of International Relations and Politics with various interests in other fields such as Psychology, Philosophy and Media studies.