Are we sitting on a mental health time bomb?

Like many Malaysians, I have a great fascination for the macabre and morbid, and strongly believe that the Western paranormal has nothing on ours.

Our pontianaks, langsuirs, toyols and black magic can obliterate vampires, demons and all. All these have inadvertently made the Malays who they were before religion took hold of them.

One of my favourite ghost stories would be those involving saka – spiritual inheritances.

I’m sure you have some stories of your own: of relatives not being able to die peacefully and properly, and despite the flat line on the ECG machine, that relative would croak for water right during Maghrib prayers.

Then there was that older relative who’d wake up after Asar and walk over to a tree and vomit blood, before retiring to her bed and the whole process would be repeated until a bomoh was found, a roof was opened and whoosh! The saka left the body and the relative died.

But the story does not end there. In the olden and golden days of pre-independence Malaya, when we toiled the earth and hid our fortunes in the ground, and had too many daughters, more than sons, we Malays relied on our spirit imps and friends.

Protect us and our wares, we asked these beings and bartered. Most times these djinns agreed, but with a price. K.M. Endicott’s An Analysis of Malay Magic is a wonderful book that details the capers of our ancestors and their spirit friends.

So if you have a strange spouse, or a family of unwed female relatives, or that you face misfortune after another, you blame it on that imp that your ancestor made an unholy alliance with, and thus begins a spiritual merry go round as you look for a shaman or Ustaz to help you get rid of it.

I love these stories, and I am sure you have your fair share too.

In this time and age, many of us, including myself, are more predisposed to the thought that saka really is psychological trauma or behaviour. 

That weird tic or eccentric behaviour your uncle has? It’s not because of some weird juju, but maybe an inherited behaviour from a great great granduncle many times removed.

(Yes, trauma can be inherited.)The Telegraph reported, “Psychologists have known for some time that trauma can cause behavioural disorders, such as depression, which can be passed down from one generation to the next.

TedX Amsterdam also reported that trauma is not only experienced individually, but shared through generations as well.

Mental well-being and the realms of psychology and psychiatry have become my little pet cause, because after seeing and witnessing people dear to me suffering from depression, trauma from abuse and committing suicide, and performing self-harm, I have come to realise that mental health in Malaysia is a hidden killer, and its impact on caregivers and patients is devastating.

The 2013 Asian Social Science Journal reported that, “Malaysia sits at the heart of South East Asia with a population of 23 million people of diverse ethnicity, cultures and religious backgrounds. In 2000, it was reported that about 10.7% of the population had been diagnosed with mental illness (Jamaiyah, 2000). These numbers are quite high and only based on hospital figures.

“Therefore, the actual number of people living with mental illness nationwide remains unknown. However, the findings of some other studies carried out in both urban and rural areas in Malaysia, have also placed the prevalence of mental illness in the population between 9.6% and 35%, respectively." (The Mental Health Development in Malaysia: History, Current Issue and Future Development by Sheau Tsuey Chong, M. S. Mohamad & A. C. Er)

Mental illness in Malaysia is rising, especially in Southeast Asia. About one in 10 people (the number is increasing though) is found to have mental problems. The National Health Morbidity Survey (2011) showed that 12% of Malaysian adults aged 18 years and older have mental health challenges.

With a very uncertain economic and political climate, there will be more environmental stress among Malaysians. And yes, an increase to visits to healers. This is very worrying as the impact on productivity and a country can be damaging.

Malaysian mental healthcare experts and providers, and contacts who work with youth have expressed concern over the number of youths who are on anti depressants and commit self-harm.

This goes across the board: Chinese Malay Indian, poor middle class rich – our young are facing an emotional and mental crisis despite modern day accoutrements. Despite the many ‘friends’ they have on social media, they are unable to create and sustain friendships in real life.

Malaysian adults too undergo through depression, post traumatic stress disorder and trauma, to name a few.

Two friends – Dr Amer Siddique and Dr Irma Ismail – who work in public universities and are mental health experts are concerned about the current state of treatment and research in Malaysia, especially budget cuts.

According to Dr Amer Siddique, “In Malaysia, a very small proportion of the health budget is spent on mental health (1% or less). Any cuts therefore will strain an already depleted service. Reduction in budget will either stagnate existing services or result in lesser activities to be conducted. According to the study by Murray and Lopez regarding health disability, by 2020, depression will be one the leading health problems worldwide in developing and developed nations. In spite of this, the budget to tackle this condition and other mental health conditions is very small.

“All healthcare providers need access to information and the latest the better. As an academic psychiatrist, reducing access to libraries is dangerous as we might not be able to access the latest information to assist in the management of our clients. Often in tertiary level facilities, we are the last line and therefore we need as much access to information as possible.” 

Dr Irma said the overall view of mental wellness in Malaysia and how it is treated in public hospitals ia still mostly associated with severe mental illness.

"Mental wellness or mental wellbeing is a concept that highlights living to full potential, not just living without illness, this is still relatively new. Public hospitals are overburdened, not enough specialist centres. We need to free up space in hospitals by providing primary and secondary intervention at primary care levels (for those on the mild-moderate end of the spectrum).

“Why are these budget cuts detrimental to mental healthcare? When you compare to more life long threatening illnesses such as cancer, these cuts are detrimental especially for chronic cases/lifelong conditions such as schizophrenia, bipolar... need continuous integrated care (both pharma and psycho-social support), medication very expensive.”

Severe mental illnesses such as schizophrenia and bipolar require life-long medication.

Depression being the more common mental health condition with an increasing risk of morbidity requires early detection and treatment of which pharmacotherapy is effective, safe and quick. Any cuts to this budget will reduce options for patients especially in government hospital and might lead to relapses or inadequate treatment.

Some patients may not be suitable for one type of medication and therefore hospitals need to keep a few types of hospitals to ensure that these patients will get optimum care.

Cuts also result in certain medications becoming generic compared to the originals. Although in essence there should be no different between the two, however, clinically we observe a difference and some patients will relapse due to this switch as a result to budget cuts.

For those with treatment resistant schizophrenia where their choice of medication is severely limited to clozapine, changing from generic from original can cause relapses which are difficult to reverse.

“In Malaysia we have one psychiatrist to a population of 115,000, which is admirable, although ideally, as per the WHO recommendation, it should be one psychiatrist to a population of 50,000.

"We are improving in terms of access with psychiatrists available in smaller district hospitals allowing mental health to be catered for to a larger group of Malaysians. The emphasis on community mental health facilities have led to an increase in these facilities in recent times, however, their number is still not enough to cater for the increasing population of mental health conditions,” Dr. Amer said.

As I witness more friends falling into depression, and coping with past trauma, and observe these challenges among the people I meet and interview through work, and friends with, I am even more convinced that our current political misdeeds will impact the whole country even more, and we will not just be facing an economic crisis, but a people with a loss of identity and ‘home’.

We may just end up more than being a Prozac nation, and you can’t use saka as an excuse.  – October 2, 2015.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.