Assalamualaikum Warahmatullahi Wabarakatuh.
Beta bersyukur ke hadrat ILAHI kerana dengan izin dan rahmat dari Nya juga, Beta dapat berangkat hadir untuk menzahirkan titah di Konvensyen Kesihatan Mental Perak kali ke-8 pada pagi ini.
Ladies and Gentlemen,
- Today is the 10th day of the 10th month of the year 2010. For centuries, the number 10 has been known to be the Pythagorean symbol of perfection or completeness. Humans have ten fingers and ten toes. A top score is called a perfect 10. Today is also World Mental Health Day. Therefore, I cannot think of a more perfect day to be with all of you.
- I was here four years ago to officiate at the 6th instalment of this conference, where I examined the mental health statistics globally and here in Malaysia. Since then, the 3rd National Health and Morbidity Survey had been conducted, which essentially revealed a higher prevalence of mental illness among Malaysians as compared to 10 years prior. Mental disorders are now present in 1 out of 9 adults and 1 out of 5 children. More alarmingly, the survey indicated that more than 40 percent of Malaysians are likely to have experienced some form of mental disorder at some point in their lives. Mental illness has become the second highest contributor to Malaysia’s disease burden, after ischaemic heart disease. But the vast majority of cases are neither diagnosed nor treated adequately.
- The biggest dichotomy that exists between mental illness and physical illness and disabilities is that, people with mental health conditions – such as schizophrenia, bipolar disorder, depression, epilepsy, substance abuse disorders and child and adolescent mental health conditions – are predisposed to a very high degree of economic and social marginalisation. They are habitually excluded from participation in society. They are excluded from income generation, employment and educational opportunities. They are subject to stigma and discrimination and are restricted from social activities. And they are not empowered to change what oppresses them. Over time, these factors can interact, leading to further marginalisation, diminished resources and greater vulnerability. Allow me to elaborate.
- Despite the widespread prevalence of mental health conditions, a large proportion of affected people do not receive treatment and care, unlike those with physical illnesses. In Malaysia, an estimated 60 percent of people with severe mental health conditions lack access to health and social services. Less than 2 percent of Malaysia’s total health budget is allocated to mental health. Patients are not entitled to free medical treatment in non-government facilities and health insurance plans do not cover mental illnesses. This disparity disproportionately affects those from lower income groups.
- Educational opportunities also typically bypass the mentally ill. The exclusion of children with mental health conditions from educational opportunities is not only discriminatory, it denies them social participation from a very young age. Those who are able to attend school or university frequently experience ridicule and rejection. Due to the lack of support, most of them perform poorly in school and many drop out. As in most of the developing world, the budget allocated for the education of the mentally disabled is disproportionately small. Special classes and schools that provide adapted curricula for children with disabilities are typically restricted to urban areas and larger cities. Many are privately run and too expensive for poor families. Similar barriers also exist in high-income countries. In the United Kingdom, for example, a survey by the National Autistic Society found that 1 in 5 children with autism and 1 in 4 children with Asperger’s syndrome were excluded from school. Given that approximately 20 percent of children suffer from a mental health condition, this means that up to 1 in 5 adults would later suffer due to poor educational access and outcomes, even if the illness does not persist into adulthood.
- Unemployment among people with mental health conditions is excessively high at between 70 and 90 percent, as compared to people with other physical disabilities or illnesses. Many studies have indicated the reluctance of employers to hire people with mental health conditions. Even those who are employed experience difficulty keeping their jobs due to discrimination in the workplace. Therefore, those with mental illnesses are at a heightened risk of descending into poverty, which in turn limits their access to care. And the downward spiral goes on.
- All of these inhibit the participation of people with mental illnesses in their societies. They do not have a voice. They are often denied even basic civility. In extreme instances they are subject to cruel human rights violations such as abuse, imprisonment and institutionalisation. The sad truth, however, is that their vulnerability is not inevitable, but rather brought about by their social environments.
- From a public policy perspective, it is paradoxical that, despite their vulnerability, people with mental health conditions are not typically regarded as a vulnerable group in most national development agendas, unlike the poor, the physically disabled, the elderly or indigenous and rural minorities.
Ladies and Gentlemen,
- The theme of this year’s convention is ‘Working Together for Mental Health’. Indeed, a proactive mutual commitment by the government, civil society, families, the medical fraternity, academic and research institutions, the media and private foundations is vital in engendering fair and humane treatment of individuals with mental disorders.
- I understand that since 1998, much progress has already been made with regard to increasing access to care. Psychiatric services have been decentralised into general hospitals. And there are ongoing efforts to integrate mental healthcare into the primary healthcare system. There is also more emphasis on the training and recruitment of mental health professionals. And I understand that primary healthcare practitioners are beginning to equip themselves with adequate knowledge to be able to recognise mental illnesses in their patients.
- What is more pressing now is for those suffering from mental disorders to be included in the national development agenda. They do, after all, fulfil the criteria to be regarded a vulnerable group. If they can be recognised as such, then their needs can be prioritised, along with those of other vulnerable groups. This is consistent with the recommendations put forward by the World Health Organisation (WHO) in their recent report entitled, “Mental Health and Development: Targeting people with mental health conditions as a vulnerable group”. WHO is urging development stakeholders to highlight issues of unmet need, vulnerability, and human rights, in people with mental health conditions, and include these issues in national health and human resource development policies.
- In this regard, the most important stakeholder is the government, for only they have the ability to approve policy and enact and implement legislation. They also play a direct role in determining the quality and quantity of such services as health, education, social services and poverty alleviation – all of which affect those with mental disorders. But governments are also constrained by budgets and other pressing national demands. Other stakeholders must play a strong advocacy role.
- One persistent stumbling block that urgently needs to be overcome is stigma. I recently found out that the word ‘stigma’ comes from 16th century Greek to mean a mark of disgrace, made by pricking or branding animals. Social stigma remains a persistent barrier to good mental health. It is present because of misconceptions about the causes and nature of mental illness, where they are often viewed as manifestations of personal weakness or involving supernatural forces. Such views are prevalent all around the world, but in Asia and in less-developed countries, they are more intense.
- Stigma prevents people from coming forward to seek help. According to the Schizophrenia Registry Report for 2003-2005 of the National Mental Health Registry of the Ministry of Health, patients took an average of 28 months from the time the symptoms first appeared to seek treatment. In most cases, the illness had reached a critical phase. But who can blame them? People with mental disorders are habitually scorned, ostracised and discriminated against. They are thought to bring shame to their families. I think we can all agree that stigma has no place in Malaysian society.
- In order to dispel the stigma, there is great need for a higher degree of awareness in society about mental illness. This is where all stakeholders have a role to play. The healthcare fraternity should be committed to disclosing full information to patients and their families about the illness in order to eliminate any negative attitudes that may be present. The government, non-governmental organisations and charitable foundations should conduct focused outreach programmes to educate society about the true nature of mental illness.
- Ideally, schools should be the starting point. Because negative attitudes are entrenched early in life, children should be taught from a young age to recognise the symptoms of mental conditions and to appreciate the struggles of those around them who are afflicted.
- Information dispels fear. The Malaysian public should be guided to view mental illness as no different from any other illness. And to respond not with prejudice, but with compassion.
- I congratulate Hospital Bahagia Ulu Kinta, Hospital Ipoh, the Perak Society for the Promotion of Mental Health, the Rotary Club of Greentown, the Patients Welfare Association of Hospital Bahagia, Hospital Raja Permaisuri Bainun and Pertubuhan Pendidikan Perubatan Anggota Hospital Bahagia for organizing this important gathering. I am confident that this convention will generate productive outcomes.
I thank you all for your dedication towards improving mental healthcare in Malaysia.
Wabillahi Taufiq Walhidayah
Wassalamualaikum Warahmatullahi Wabarakatuh.
- The Star, “Whither Mental Institutions”, 19 July 2009. ↑
- Batten A et al. (2006), Make school make sense. Autism and education: the reality for families today, National Autistic Society. ↑
- World Health Organisation (2010), Mental Health and Development: Targeting people with mental health conditions as a vulnerable group. ↑