Continue caring for the rakyat's well-being during the new normal

WHEN the Malaysian government re-introduced lockdown measures to curb the spread of the COVID-19 infections in mid-January and June this year, the tourism sector, small and medium enterprises (SMEs), and the low-income and vulnerable groups were very concerned over the unintended consequences of these (partial) restrictions.

Now, many are still struggling to recover from the effects of the first Movement Control Order (MCO 1.0). As a consequence, there has been a rising number of suicide cases in the country.

Tragically, as they could not overcome the ongoing financial distress arising from the prolonged lockdown, more Malaysians chose to commit suicide as the way to end their lives.

During the first seven months of 2021 alone, there were 638 suicide cases – a staggering 143% increase compared to 262 for the same period last year. This period even surpassed the total number of cases reported in 2019 (i.e., 609) and 2020 (i.e., 631).

The Ministry of Health Malaysia (MOH) also reported that a total of 1,080 cases of suicide attempts have been referred to government hospitals for treatment in 2020 alone.

Out of the 411 suicide attempts reported between March 2020 and August 2021, 190 cases were recorded from March to December 2020, whereas 221 cases were reported between January and August 2021.

As of September 19, 80.8% out of 223,990 calls to the Psychosocial Support Line required emotional support and counselling.

The issues included job loss, zero source of income, family conflicts, interpersonal relationship problems, the stigma of being infected of Covid-19, isolation and insufficient access to aid and assistance during the MCO.

Although more Malaysians experience mental illness due to the COVID-19 pandemic, the commitment from the current administration in expanding mental health infrastructure provides an avenue for those suffering to reach out and seek help from the community.

For instance, the recent decision by the government to decriminalise (attempted) suicide (i.e., abolish Section 309 of the Penal Code, which carries a penalty of up to one year in prison, with or without a fine, on individuals who survive suicide) is welcoming.

In addition, the Mental Health Strategic Plan (2020-2025) – that was launched in conjunction with the World Mental Health Day on October 10 – provides ample opportunity for Malaysia to improve the country’s mental health services.

Following are eight main scopes under the MOH’s Mental Health Strategic Plan (2020-2025):

1. Improving the governance and regulatory framework;

2. Strengthening the mental health control system;

3. Ensuring the availability and accessibility of comprehensive mental health services;

4. Strengthening mental health resources;

5. Enhancing cross-sectoral cooperation;

6. Promoting mental well-being and health;

7. Strengthening preparedness during emergencies, crises and disasters; and

8. Suicide prevention.

Moreover, the government’s plan to incorporate counselling services via the MySejahtera application is another good initiative. The users who struggle with mental illness could receive advice and prescriptions from certified mental healthcare providers via text messaging or video calls.

However, to ensure mental health and counselling services are accessible to everyone, the government needs to set a clear implementation timeline for all proposed policies to implement by 2025.

As suggested by Bandar Kuching Member of Parliament (MP) YB Dr Kelvin Yii, the government must prioritise the repeal of Section 309 of the Penal Code in the upcoming Budget parliamentary sitting at the end of October 2021.

Once the policy of decriminalising suicide comes into effect, suicide survivors do not need to undergo imprisonment or jail term. They could find other ways to start all over again. These individuals would then have the space and support to realise how detrimental their loss would be to their immediate family, friends and the wider community.

So, if the individual perceives that the value of living is higher than dying, the chances of committing suicide will decrease.

Nevertheless, it may not be easy to see signs of someone with suicidal thoughts. When someone behaves out of character, we could learn to recognise the warning signs of suicidal thoughts so psychological first aid-based helplines could extend to those who desperately need help immediately.

Losing interest in daily activities, having difficulty focusing and carrying our daily tasks, consuming more drugs or alcohol (than usual), isolating themselves from others and expressing a desire to commit suicide on social media are some of the symptoms of someone contemplating suicide.

However, the number of registered psychiatrists in Malaysia (410 psychiatrists in 2018) is far from the World Health Organization (WHO)’s recommended ratio of one psychiatrist per 10,000 people. Therefore, the current administration could consider the concept of “burden-sharing” – equip non-medical professionals to recognise the warning signs of mental illness.

For instance, MOH could take the lead to empower local community leaders, religious leaders and non-governmental organisations (NGOs) in detecting individuals with mental health issues, providing necessary support and assisting them to receive help appropriately.

Towards this end, EMIR Research urges the government to continue caring for the mental well-being of Malaysians by:

1. Establishing a centralised body to conduct and streamline the country’s mental health research, education, training and awareness programmes the soonest possible.

The recent proposal by MOH to establish a National Centre of Excellence for Mental Health marks a good beginning. It is crucial to conduct research into specific topics at the national level and share updated data from across the country. The current administration perhaps could modify Singapore and Thailand’s approach in forming its own mental health centre;

2. Increasing the funding allocation of mental healthcare by equipping other healthcare professionals (i.e., general practitioners and family care physicians) with the necessary knowledge and updated treatment in psychiatry.

Thereby, they could help to diagnose early symptoms of mental illness among urban and rural communities;

3. Work closely with non-governmental organisations (NGOs) to organise door-to-door visits to understand the needs and problems of the citizens, particularly among the low-income groups and rural communities, in addition to providing psychological first aid-based helplines for them to express their psychosocial concerns.

Community groups could work with social workers, counsellors, psychiatrists and clinical psychologists to address early symptoms of depression through peer assistance groups;

4. Provide mental health guidelines such as mental health literacy, coping skills and help-seeking pathways to workplaces and schools.

As Malaysia is preparing to move towards the endemic phase, employers could assist employees in adjusting to the workplace environment once again while teachers could guide students to follow up on their syllabuses in a physical learning setting; and

5. Reviving the National Suicide Registry Malaysia (NSRM) to address the gaps in suicide prevention in collaboration with the Department of Statistics Malaysia (DOSM) and mental health organisations.

With a quality data collection system that includes age, gender, ethnicity, state and methods of suicide, the current administration could prevent more suicide cases from happening at both state and national levels.

In a nutshell, the government should not lose sight of the mental well-being of Malaysians during this new normal despite there being a relaxation of standard operating procedures (SOPs).

The rakyat still require time to adjust back to pre-COVID times and find new ways to recover from the loss of loved ones, jobs and income.

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Amanda Yeo is Research Analyst at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.