How should the Malaysian government address children's mental health?

By D. KANYAKUMARI

ACCORDING to official statistics by the Institute for Public Health, approximately 424,000 children in Malaysia struggle with mental health issues.

Also, one in eight adolescents aged 10–19, and one in 20 children aged 5–9 years are believed to suffer from mental disorders.

But of particular concern is that violence, peer victimisation, bullying, loneliness and social isolation are especially prevalent. And a large number of young people affected by these have had suicidal thoughts and/or attempted suicide.

It is an alarming state of affairs.

Thankfully, however, the government is finally moving to address the situation. And as Health Minister Dr Zaliha Mustafa revealed in October, that will begin with the development of a mental health action plan for children and teenagers.

But what exactly should go into this important initiative, what areas should be considered, and how do we increase mental health awareness?

For Dr Andrew Mohanraj, president of the Malaysian Mental Health Association (MMHA), it must start with appreciating the pressures, risks and threats children face, and understanding how these lead to some taking their lives.

A comprehensive approach

"Youths are in the process of developing into adulthood. Therefore, the mental health challenges can be unique," said Dr Andrew.

"As such, the government's promised action plan needs to look into the promotive aspects of mental health for those in this age group, including the role of social media, the threat of substance abuse, academic challenges and dilemmas, relationships, social interaction and family support."

What is also necessary, the consultant psychiatrist and mental health development adviser says, is for the government to consider a multisectoral approach involving various agencies as well as clear but revisable targets.

"For far too long, mental health, including youth mental health, has been seen as a medical issue. But clearly, it has social determinants that need to be addressed, with the Health Ministry taking the lead," Dr Andrew added.

Coming together

One potential stumbling block to the government's efforts, however, is ensuring that there are enough experts and qualified persons to handle both patient care and the raising of awareness.

"In Malaysia, the ratio of psychologists to the general public is one to 15,000, and for psychiatrists, it is one to 130,000. And this is just for adults," said Mahisha Naidu, child and adolescent services clinical lead at The Wave Clinic.

"For children and adolescents, meanwhile, there are only 30 psychiatrists nationwide. So that is a one to two million ratio."

As such, it is imperative for the Health Ministry to collaborate with specialist organisations, she said.

Dr Andrew concurs. He added that a comprehensive strategy must also go beyond detection and identification of mental health problems and involve the building of a robust support system.

He said, "The focus up to now has been on detection of mental health conditions and directing those needing treatment to the appropriate pathways. Yet, that can be very challenging (for youths) as schools and universities may not always have the expertise to do this."

A solution, thus, would be a collaborative framework of various stakeholders that prioritised the safety and welfare of children and youths. That way, help can be given as soon as possible.

Early intervention

According to Dr Andrew, research indicates that 50 per cent of adults with mental health conditions show some traits before the age of 14. Hence, children, from primary school all the way to secondary school and university, ought to be afforded adequate care.

But what might also be needed is for the government to look into the mental wellness of parents and parents-to-be.

The Wave Clinic's Mahisha explains that a general assumption about child mental healthcare is that children should be treated as soon as they exhibit signs of mental health issues. Yet, while that is true, it is a fact that adult caregivers are just as vulnerable.

This is why some experts believe that an effective mental health plan must take into account the needs of parents as well as those who are thinking of having children.

"We must understand that there's no specific age where these things get worse for a child. So, parents need to be getting support as well. (As for parents-to-be,) they should be guided about what it takes to be parents and how to secure safe environments for their children.

"Unfortunately, Malaysia's adult mental health support system is just as underfunded (as it is for children)," said Mahisha.

For the record, the government has introduced several initiatives to address mental health concerns in recent years, among them specialised modules and programmes as well as a new feature on MySejahtera, Malaysia's COVID-19 tracking app, that offers access to a helpline and screening services.

That said, strategies for dealing with child and teen mental health necessitate more clarity and streamlined processes.

Time will tell if that is part of the plan.

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