The New Straits Times, October 27, 2000
By Prof Dzulkifli Abdul Razak
THE recent spate of events involving mental health-related violence puts to question the stress levels of our social environment. A 1996 study found that 10.7 per cent of Malaysians are suffering from some kind of mental illness (NST, Oct 23).
This is serious enough an indication as to how stressed our social environment is.
Moreover as mentioned by Datin Seri Endon Mahmood, wife of Deputy Prime Minister Datuk Seri Abdullah Ahmad Badawi, children and youth mental health is still under-diagnosed, unrecognised or mislabelled and under-treated (NST, June 7).
The seriousness of the situation cannot be overemphasised. Poor mental health has powerful adverse effects on critical life course transitions such as educational achievement, peer pressure and marital instability leading to violence such as amok, rape and murder.
Some of these are now slowly rearing their ugly heads. The present situation in fact has been described as "serious" by the Malaysian Psychiatrist Association (Oct 22).
To add to our concern, there are still insufficient mental health programmes for children and youths in particular.
This problem is global in nature. In May, the World Health Organisation identified mental health as one of its main priority areas. It quoted an international psychiatric study stating that mental disorders are becoming more common, often beginning in the teenage years and afflicting many sufferers for the rest of their lives.
Almost half of those who are ill do not seek help, most are not treated at all, and often the treatment is inadequate, even though effective therapies exist, the study shows. The findings were published in the April issue of WHO's The Bulletin.
In an accompanying editorial, WHO director-general Dr Gro Harlem Brundtland says: "Mental illness suddenly bulks very large indeed. All predictions are that the future will bring a dramatic increase in mental problems. It is a crisis of the 21st century."
The study shows the median age of onset for anxiety disorders is just 15 years, 21 years for substance use disorders and 26 years for mood disorders.
All three classes of illness are most common in disadvantaged sectors of society, and linked particularly to people with low income and below-average education, or who were unemployed or unmarried. These are among the "toxic social environment" that must be dealt with utmost urgency.
The study adds: "It is discouraging to find that the vast majority of recent cases, even those who report substantial impairment, are not in treatment." Delays in seeking treatment are especially pervasive among people with early onset of symptoms.
Dr Brundtland, in her editorial, lists several reasons why effective treatment for disorders such as depression is not provided. "The main reasons are the low priority given to mental health, the traditional centralisation of mental health services in large, ineffective and often downright harmful psychiatric institutions, and poor application of cost-effective mental health strategies."
There is also the stigma of mental illness, which inhibits sufferers from seeking treatment, and which may even limit the willingness of mental health care providers to intervene. The WHO International Consortium in Psychiatric Epidemiology examined data from 30,000 people in seven countries: Brazil, Canada, Germany, Mexico, the Netherlands, Turkey and the United States. The study found that those who experienced at least one disorder in their lifetime, ranges from 48 per cent of those studied in the US to 12 per cent in Turkey.
Meanwhile, a report from a survey in the US published in the July issue of American Psychologist stated that in 1996, more than 26 per cent of adults surveyed said they had felt an impending nervous breakdown, up from 19 per cent in 1957.
In the latter survey, most people said health problems had caused them to feel close to a breakdown. Nine years later, in 1996, the most frequently "toxic social environment" cited were relationship problems, including divorce, separation and other marital strains.
Whereas it is not yet known whether early treatment could prevent the adverse life course effects of mental disorders that have early onset, researchers say it is "critically important" that early "outreach treatment" efforts are refined, implemented and evaluated.
In this respect Malaysia has still some way to go. Aptly, the Mental Health Act 1952 (or the so-called "lunatic laws" in East Malaysia) will soon be amended (NST, Oct 23). So too should others like the Vagrants Act 1977 (Act 183) that provides no provision for the Social Welfare Department to deal with mentally-disturbed persons.
The department apparently does not have a particular centre to place such persons. The most it can do is to find them temporary homes when alerted to specific cases.
Concern expressed recently is directed towards those borderline cases who are not a danger to society but are still a problem. Left on their own devices, they spend most of their time "unattended" at home and the community - loitering in public places and streets. The police can only get involved if there is an offence being committed and a report lodged.
Without doubt mental health is an important agenda that the nation and its people must keep abreast with. The body of knowledge about it has changed many times over and can no longer be relegated to the back seat.
For example, WHO has decided to focus on this issue in its annual report, The World Health Report, for year 2001. After all as mentioned by WHO, "Mental health depends on some measure of social justice, and mental illness, given its scale, must be treated effectively at primary level where possible."
Equally important, the increasingly 'toxic social environment' must be neutralised as an effective long-term preventive strategy.
Recommended website: http://www.mentalhealth.com
