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Introduction
In recent years, suicide rates in Malaysia have risen significantly, with over 1,800 suicide occurrences in 2019 alone. This is a 17.8% increase since 2014 and amounts to approximately five lives lost per day. Concerningly, Malaysia’s suicide rate is higher than other ASEAN countries such as Brunei, Indonesia and the Philippines. A major contributor towards suicide risk is poor mental health.
During the Covid-19 pandemic, the mental health of Malaysians, like others worldwide, has unfortunately only worsened. Although individual awareness of the importance of mental health has increased since the pandemic, systemic issues, such as the availability of mental health resources, remain unaddressed.
This article aims to highlight the issue of insufficiency within the public health system in addressing the population's mental health needs.
The Burden of Mental Health
According to the Ministry of Health, the mental health-related burden makes up approximately 37% of total disability in the country. The most common forms of mental disorders among the working-age population in Malaysia include anxiety and depression.
In 2019, over 470,000 Malaysian adults over the age of 18 suffered from depression, whereas more recent data from 2022 showed that over 550,000 adolescents aged between 13–17 years old were depressed. Additionally, among children aged 5–15 years old, mental health problems such as peer problems and conduct problems have been on the rise between 2015 and 2019.
Overall, the data paint a grim picture of the mental health trend, regardless of age group. There is also a disproportionate burden of mental health issues seen across the population. For example, those living on lower household incomes tend to have poorer mental health, as shown in a previous KRI report.
From an economic standpoint, evidence suggests that poor employee mental health has adverse effects as well. In 2018, a study by RELATE Malaysia estimated that the cost of mental health issues in the workplace to the economy was RM14.46bn, with costs caused by absenteeism (RM3.28bn), presenteeism (RM9.84bn) and staff turnover (RM1.34bn).
Mental Healthcare Workers in MOH Facilities
In terms of care provision for mental health, the general recommendation by the World Health Organisation (WHO) is that a country should have a ratio of one psychiatrist per 10,000 population. However, Malaysia’s ratio in 2021 for public facilities was 0.8 to 100,000 population. Given that there were approximately 580,000 new and follow-up cases from the Covid-19 pandemic, this would have resulted in one Ministry of Health (MOH) psychiatrist handling over 2,000 cases on average.
When taking into account psychiatrists in the private sector as well, Malaysia’s ratio improves to 1.4 per 100,000 but this is still far from WHO’s recommendation. A comparison of psychiatrist ratios in ASEAN countries shows that Malaysia is doing better than countries such as Thailand and Myanmar but still lagging behind Singapore and Brunei.
The issue of understaffing in public facilities leads to longer waiting times for patient appointments and lower quality of care. Importantly, the breakdown of MOH psychiatrists per state varies substantially. Data from 2018 shows that while states such as Kuala Lumpur and Selangor had a psychiatrist to 100,000 population ratio of 1.2 and 5.2, respectively, other states such as Pahang, Kedah and Sabah had a ratio of less than 1.
Increasing the number of mental healthcare workers may not necessarily entail increasing only the number of psychiatrists. For example, other types of mental healthcare workers such as psychotherapists and counsellors could help meet Malaysia’s demand for mental healthcare workers. However, only psychiatrists are licensed to prescribe medication.
Mental Healthcare Data
Existing mental health-related data collection is often fragmented, not streamlined and not accessible to the public. Due to inconsistent and outdated data, researchers, including public health policy researchers, lack an up-to-date understanding of the mental health landscape in Malaysia.
Malaysia has previously attempted to establish mental health registries such as the National Mental Health Registry (NMHR) and the National Suicide Registry (NSRM). Unfortunately, the NMHR was discontinued after 2007 due to administrative constraints. The NSRM was also discontinued in 2011 as it ran out of funding and faced issues of insufficient manpower to monitor data collection.
Instead of attempting to revive incomplete registries that may risk patient privacy due to the level of detail, focus should be given to creating a publicly accessible, streamlined, and timely database of aggregated mental health data. Such a database would provide an up-to-date epidemiological understanding of mental health throughout Malaysia, particularly as cases relate to social determinants of health, including location, age, gender, income and education levels.
Mental Healthcare in Malaysia’s Total Health Budget
The availability of dedicated financial resources for mental health is critical in developing, implementing and maintaining mental health services. Budget 2024 has allocated approximately 0.89% of the healthcare budget specifically towards mental health. However, this is a drop from the previous 1.11% in Budget 2023.
Malaysia still falls short of the recommendation in WHO’s “Investing in Mental Health: Evidence for Action” 2013 publication, namely that upper middle-income countries spend an average of 2.40% of their health budget on mental health.
Conclusion
With the pandemic leaving lasting effects on the Malaysian population, the government needs to sufficiently address the needs of those affected during this sensitive time of recovery by ensuring there are enough healthcare workers. Sufficient evidence is necessary for the government to determine the most efficient strategy to tackle the burden of mental health. A publicly accessible, streamlined mental health database could provide such evidence.
