Article (Mental Disorders in Malaysia)

NORNATASYA ABDULLAH ELC2313A1 2021451018
MENTAL DISORDERS IN MALAYSIA: An Increase in Lifetime

Prevalence
By
SHAERAINE RAAJ, SUJESHA NAVANATHAN, MYELONE

THARMASELAN, and JOHN LALLY.
There is an increasing prevalence of mental disorders in Malaysia, with a growing

need to improve access to timely and efficient mental healthcare to address this burden.
This review outlines the current legislative framework and the challenges of delivering
mental healthcare and treating mental disorders in Malaysia.
Situated in Southeast Asia, Malaysia is a melting pot of cultures. The population

increased from 28.5 million in 2010 to 32.6 million in 2020, with 25.3 million people
living in urban areas and 7.3 million residing in rural areas.1Malaysia is known as an
upper-middle-income country and the majority of the population are indigenous Malay
(69.3%), with the remaining people either of Chinese (22.8%) or Indian (6.9%)
ethnicity; minority ethnic groups represent 1% of the population.1 The median age of
people in Malaysia is 30.3 years, with an average life expectancy of 73.2 years.1
Several policy reforms in the past decade have led to advances in the Malaysian
mental health system. From the initial development of the Lunatic Ordinance of Sabah
1951 to the more recently implemented Mental Health Act 2001, there has been clear
legislative, policy and organisational development to improve Malaysia's mental health
services delivery. However, there remain many obstacles in the delivery of affordable
and accessible mental healthcare.
The most recent epidemiological data, published in 2015 by the Malaysian

Ministry of Health, identified that the prevalence of mental disorders among adults was
29% (95% CI 27.9–30.5).2,3 This is a threefold increase in comparison with the 10%
prevalence rate identified in 1996.2,3 The rural region of East Malaysia had the highest
prevalence of mental disorders, at 43%, followed by the capital Kuala Lumpur, where
40% of the population fulfilled the criteria for a mental disorder.2 Rural regions have
1
more adverse socioeconomic conditions, with higher poverty and unemployment. This,
combined with increased stigma, reduced access to general and mental healthcare, and
the practice of seeking alternative care through religious practitioners or shamans, can
all contribute to an increased risk for the development and maintenance of mental health
problems.3,4,5
There has been a dramatic increase in the prevalence of mental disorders over
the past decade in Malaysia.2 Malaysia is transitioning from a middle-income country to
a high income country, with rapid cultural and lifestyle changes due to increased
urbanisation and globalisation, and associated increased levels of perceived stress. In
the context of cultural changes, many are still affected by sustained economic
difficulties, which contribute to social problems such as increased marital separation,
changes in traditional parenting styles and the structure of family units, and an increase
in alcohol and drug use. Further, increasing awareness of mental health problems by the
public and by clinicians has likely led to increased reporting and identification of mental
disorders. The National Health and Morbidity Survey of 2017 reported that the
prevalence of suicidal ideation during the previous 12 months among adolescents in
Malaysia was 10.0% (95% CI 9.2–10.8) and 6.9% (95% CI 6.2–7.7) of adolescents had
attempted suicide one or more times during the previous 12 months.6 These findings
suggest a fivefold increase in the prevalence of suicidal ideation among adolescents
compared with 2011, when only 1.7% reported suicidal ideation.6 Moreover, the survey
identified that suicidal behaviour was found to be highest among 13-year-old students,
10% of whom reported suicidal ideation, 9.0% had a suicidal plan and 10% had made a
suicide attempt in the previous 12 months.6 These findings may suggest that 13-year-old
students find the transition from primary school to secondary school stressful.7
Mental illness is one of the leading causes of disability and health loss in
Malaysia, accounting for 8.6% of total disability-adjusted life-years (DALYs).3 The
increasing prevalence of mental disorders in Malaysia is associated with an increased
economic burden, with an economic analysis finding that mental health problems in the
workplace were estimated to cost the Malaysian economy Malaysian ringgit1 4.46 billion
(£2.67 billion) in 2018.3
2
The Malaysian Mental Health Act was passed in August 2001 by the Parliament
in Malaysia and was implemented in 2010, following the Mental Health Regulation
2010.8 The provisions of the legislation include admission, detention, assessment,
treatment and protection of a person with a mental illness.8
A person suspected of being mentally ill may be admitted involuntarily on

application to the medical director of an acute psychiatry unit by a relative, police officer
or social welfare officer following a personal examination no more than 5 days before
the admission.8 The Malaysian Mental Health Act 2001 states that an involuntary patient
can be discharged at any time by the medical director and does not specify a provision
for an independent review of the detention.8 A Mental Health Tribunal provides a legal
framework to safeguard individuals subject to compulsory treatment under national
legislative and international human rights standards. The absence of a tribunal process
places the Malaysian Mental Health Act outside of the United Nations universal right to
exercise legal capacity identified in Article 12 of the UN Convention on the Rights of
Persons with Disabilities. Limited attention was given to the legal obligation mandated
under the United Nation's international human rights law while drafting the Malaysian
Mental Health Act 2001.
A study in 2018 reported that Malaysia had a significant deficit of psychiatrists

and psychologists, with a ratio of 1.27 psychiatrists per 100 000 population.4 There were
410 registered psychiatrists working in private universities, private clinics, public
universities and government hospitals.4 The proportion of psychiatrists in Malaysia is
higher than in other Southeast Asian countries such as the Philippines, with 0.52
psychiatrists per 100 000 population,9 but lower than in neighbouring Singapore, with
3.48 psychiatrists per 100 000 population.4 The capital of Malaysia, Wilayah
Persekutuan Kuala Lumpur, has the highest ratio of psychiatrists, at 5.24 per 100 000
population, followed by Putrajaya at 3.38 per 100 000 population.4 Malaysia's rural
states have the lowest number of psychiatrists, with 0.55 per 100 000 people in Kedah
and 0.54 per 100 000 people in Sabah.4 Rapid urbanisation contributes to the uneven
geographical distribution of doctors, with a decrease in numbers of psychiatrists in rural
areas.4 There is a need for a uniform distribution of psychiatrists between all
geographical locations within Malaysia, and Malaysia needs at least 3000 registered
3
psychiatrists to meet the World Health Organization (WHO) recommendation of 10

psychiatrists per 100 000 population.4
The current model of care is divided into in-patient and community care. The
primary care model is community-based, with 22 established community-based
specialised mental health services (MENTARI) and 958 mental health day
centres.10 Additionally, Malaysia has four mental health hospitals and 47 psychiatric in-
patient units attached to general hospitals.10 Malaysia has used a more pragmatic
approach to establish 38 in-patient units designated for children and adolescents.
A study in 2018 reported that Malaysia had a significant deficit of psychiatrists

and psychologists, with a ratio of 1.27 psychiatrists per 100 000 population.4 There were
410 registered psychiatrists working in private universities, private clinics, public
universities and government hospitals.4 The proportion of psychiatrists in Malaysia is
higher than in other Southeast Asian countries such as the Philippines, with 0.52
psychiatrists per 100 000 population,9 but lower than in neighbouring Singapore, with
3.48 psychiatrists per 100 000 population.4 The capital of Malaysia, Wilayah
Persekutuan Kuala Lumpur, has the highest ratio of psychiatrists, at 5.24 per 100 000
population, followed by Putrajaya at 3.38 per 100 000 population.4 Malaysia's rural
states have the lowest number of psychiatrists, with 0.55 per 100 000 people in Kedah
and 0.54 per 100 000 people in Sabah.4 Rapid urbanisation contributes to the uneven
geographical distribution of doctors, with a decrease in numbers of psychiatrists in rural
areas.4 There is a need for a uniform distribution of psychiatrists between all
geographical locations within Malaysia, and Malaysia needs at least 3000 registered
psychiatrists to meet the World Health Organization (WHO) recommendation of 10
psychiatrists per 100 000 population.4
The current model of care is divided into in-patient and community care. The
primary care model is community-based, with 22 established community-based
specialised mental health services (MENTARI) and 958 mental health day
centres.10 Additionally, Malaysia has four mental health hospitals and 47 psychiatric in-
patient units attached to general hospitals.10 Malaysia has used a more pragmatic
approach to establish 38 in-patient units designated for children and adolescents.
4
Overall, there have been significant reforms to mental health legislation in

Malaysia, with service-level transition from custodial care to community care, and the
development of a foundation of research and organisational development to improve
mental health service delivery. Epidemiological studies are required to better
understand causative factors for the increased prevalence of mental disorders in
Malaysia, and to understand the contribution to this of emerging social changes in the
context of increasing urbanisation. Broader policy changes may be required to
incorporate consideration of the mental health impact of continued cultural and social
development to promote security, education and social safety nets to enhance mental
health. Social stigma and lack of awareness about mental health problems remain
significant barriers to improving mental healthcare, and national mental health
education programmes are required to address this. Increased mental health spending
provision will be needed to address deficiencies in service availability and delivery and
to increase the proportion of psychiatrists and mental health clinicians in Malaysia.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554924/

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NORNATASYA ABDULLAH ELC2313A1 2021451018

MENTAL DISORDERS IN MALAYSIA: An Increase in Lifetime

SHAERAINE RAAJ, SUJESHA NAVANATHAN, MYELONE

There is an increasing prevalence of mental disorders in Malaysia, with a growing

Situated in Southeast Asia, Malaysia is a melting pot of cultures. The population

The most recent epidemiological data, published in 2015 by the Malaysian

A person suspected of being mentally ill may be admitted involuntarily on

A study in 2018 reported that Malaysia had a significant deficit of psychiatrists

psychiatrists to meet the World Health Organization (WHO) recommendation of 10

A study in 2018 reported that Malaysia had a significant deficit of psychiatrists

Overall, there have been significant reforms to mental health legislation in

Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554924/

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