Helmy Haja Mydin The Covid-19 pandemic has highlighted the global importance, as well as the lack of investment, in issues related to public health.
Ensuring a fair and sustainable healthcare service is a goal that all countries must achieve in order to improve the well-being of their citizens.
This monthly column, Health Matters, seeks to highlight how healthcare should not be viewed in isolation, as outcomes are very much dependent on socioeconomic issues and systems that are in place.
One could even go so far as to say that your health and death is very much a function of your wealth.
As today is National Day (Aug 31,2020), it would be fitting to start off the column on the theme for this year’s Merdeka and Malaysia Day celebrations: Malaysia Prihatin.
When launched by Prime Minister Tan Sri Muhyiddin Yassin, he said that the theme emphasised the spirit of patriotism, unity and love for the country.
“Prihatin” in Bahasa Malaysia also means “paying attention”.
In the context of the Covid-19 pandemic, it is about paying attention to those who have unduly suffered from the impact of the SARS-CoV-2 virus.
From Australia to Mexico, New York City to Kuala Lumpur, the events of the past few months have upended lives and disrupted not only our daily activities, but also the manner in which we view our present and future.
While public health and economic disruptions have been obvious for all to see, there are other more pernicious issues that have developed since the start of the pandemic.
Few have been more impactful than that of our mental health.
Mental health disorders have been on the rise even before the Covid-19 pandemic.
The 2019 National Health and Morbidity Survey (NHMS) reported that half a million Malaysians suffer from depression, with the highest numbers recorded in Putrajaya, Negri Sembilan and Perlis.
Children were not excluded – a total of 424,000 children were reported to have mental health problems.
These were mainly caused by interaction issues with peers, and behavioural, emotional and hyperactive-related problems.
The rate of suicide is also a surrogate marker of underlying mental health disorders.
More than 90% of those who attempt to commit suicide suffer from major psychiatric illnesses such as bipolar disorder and clinical depression.
Even if you do not have an underlying mental health disease, the changes we are experiencing have a profound effect on our psyche, e.g. anxiety about contracting Covid-19, worry about placing food on the table for the family, the loneliness of social isolation and the guilt of possibly passing on the SARS-CoV-2 virus to an elderly loved one, to name just a few.
Those in cramped spaces may also end up lashing out at one another, both verbally and physically.
The consequence for adults may be obvious, but less so on children.
Recently published research has demonstrated that even witnessing abuse carries the same risk of harm to a child’s mental health and learning as being abused directly.
Children were also affected as a consequence of schools being shut and a change in their normal interactions with friends and peers.
In fact, while we are busy dealing with the immediate consequences of these changes, nobody really knows how our psychological and social growth will be affected in the long term.
There are many options when it comes to treating and improving mental health, but these require acknowledgement of the scale of the issue, as well as improving access for those who require treatment.
Although local data is not available, it is very likely that the pandemic has delayed access to treatment for many who require the services of psychologists, counsellors and psychiatrists.
This is as a consequence of both the physical lockdown, as well as the diversion of healthcare resources required to address the pandemic.
There are three things that I would urge the government to address in order to help alleviate the suffering of those with mental health disorders:
> Decriminalise suicide
Section 309 of the Penal Code states “whoever attempts to commit suicide, and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine or with both”.
This is an archaic approach to individuals who are suffering from a disease. A Magistrate’s Court recently fined an unemployed man RM3,000 for attempting to commit suicide. A few months ago, a 42-year-old man who attempted suicide by stabbing himself with fragments from a broken glass window was sentenced to one month in prison.
A recent paper by science communication PhD student Eudora Ribeiro highlighted how severe global recession and substantial increases in unemployment and indebtedness are important risk factors for suicide. The paper highlighted examples from past crises, e.g. the 1997-1998 economic crisis saw more than 10,000 excess suicides in Japan, Hong Kong and Korea, and similar figures were associated with the 2007-2008 recession.
Individuals who attempt to commit suicide are often at the end of their tether.They should be given prompt access and treatment to the care that they need, not be burdened by further punitive action.There should also be more effort to highlight the availability of suicide prevention services, e.g. Befrienders Malaysia.
> Ringfence the budget for mental health services
With the economic crisis we are facing, the temptation to reduce funding is likely lurking at every corner of the government.However, any Bill or supplementary/annual Budget that addresses the impact of Covid-19 on the rakyat should be done in a holistic fashion, and this includes ensuring that the mental health of our citizens is well looked after.
Ensuring the availability of appropriate treatment involves not only the purchase of medication, but also a budget to train more psychologists, counsellors and psychiatrists. These are services that can be made more readily available online, as the need for physical examination is less, compared to physical ailments.
These initial costs will translate to larger long-term savings. For example, there will be a decline in physical healthcare needs when individuals improve from mental illnesses. It is also worth noting that mental health disorders are a major cause of death among those of working age. With recovery, there will not only be improved productivity, but also reduced absenteeism.
Just as with physical ailments, those who recover well will work better, thereby playing a more active role in the recovery of the economy.
> Improve digital connectivity
The pandemic has inadvertently brought digital disruption to the fore, including increased utilisation of digital technology in addressing mental health challenges. Telemedicine provides access to professionals based on a patient’s needs. Anecdotally, companies that provide telemedicine have seen a higher rate of use among those with mental health problems, as it provides more convenience and privacy.
There are apps that not only monitor symptoms, but can also predict impending psychological breakdown. However, not everyone has the same level of digital access.
There are significant financial and resource disparities within and between communities, and this can lead to significant gaps. I will address this in more detail in my next column (available online Sept 28,2020).
It is unlikely that the changes forced upon us by the pandemic will dissipate anytime soon. The term “new normal” is being thrown about all the time, but it really is an apt description of how the manner in which we interact will not return to how it was even a year ago.
Malaysia Prihatin appears to be a fitting theme for this year’s National Day and Malaysia Day celebrations. as we should not only be more aware of the disruptions our loved ones and neighbours are facing, but also be more empathetic towards them. This empathy should extend to not only those facing physical and socioeconomic challenges, but also those struggling psychologically, oftentimes in silence.
This article was originally published in The Star Online.