Mental Healthcare – Moving from Custodial to Community Care

Cover Story

By A. Jeyaraj

According to the 3rd National and Health Morbidity Survey (NHMS) 2006 (published 01 Dec 2008), 11.2% of the adult population in Malaysia has some form of psychiatric morbidity, with the Chinese population experiencing the highest prevalence at 31.1%; more females than males have psychiatric problems, with 55% of them females and 45% males; psychiatric morbidity is higher among the urban population than rural, 12.6% for urban population versus 8.5% for rural population; higher among those with no education or primary education, 15-16% versus 10% for those with tertiary education and it is higher among divorcees (13.6%); followed by singles (13.1%) widow/widower (12.2%) versus those who are married (10.5%).

Champions and leaders needed to bring mental health to higher ground…

Many people have mental health concerns from time to time. This concern becomes a mental disorder when on-going signs and symptoms cause frequent stress and affect your ability to function. Signs and symptoms of mental disorder can vary, depending on the particular disorder, circumstances and other factors.

Some examples of signs and symptoms include, feeling sad or down; confused thinking or reduced ability to think; excessive fears or worries; extreme mood changes of highs and lows; withdrawal from friends and activities; detachment from reality (delusions), paranoia or hallucinations; inability to cope with daily problems or stress; alcohol or drug abuse; major changes in eating habits; sex drive changes; excessive anger, hostility or violence; suicidal thinking; an unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty performing familiar tasks; problems with concentration, memory or logical thought and speech that is hard to explain; loss of initiative or desire to participate in any activity; apathy; uncharacteristic, peculiar behaviour; rapid or dramatic shifts in feelings or “mood swings”.

Sometimes symptoms of a mental health disorder appear as physical problems, such as abdominal pain, back pain, headache, or other unexplained aches and pains.

Deinstitutionalisation of Mental Health Care

Dato’ Dr Suarn Singh informed that after the implementation of the Mental Health Act 2001 and Mental Health Regulation 2010 which came into operation in 15 June 2010, mental health care in the country has been streamlined. Mental health services have undergone changes away from the traditional custodial care in mental institutions towards more effective and comprehensive care in the community. The new Act legislates for the first time for residential programs and community treatment. Community mental health services are expected to grow at a faster pace with the withering of services in mental hospitals.

Facilities available for mental health care have been classified into three groups which can be run by the government or the private sector. The first is Psychiatric Hospital, where any hospital with a psychiatric ward is classified as a psychiatric hospital; the second is Psychiatric Nursing Home which provides stay-in care for patients with psychiatric conditions, including nursing and medical care, as well as therapy services and thirdly, a Community Mental Health Centre (CMHC), a non-residential centre with services for the screening, diagnosis, treatment and rehabilitation of any person suffering from any mental disorder.

Recognising Mental Disorder and Treatment

Dr Suarn said that regrettably, often when family members or friends become aware that a person has a mental disorder they go for alternative treatment and seek medical advice only when the patient is at an advanced stage. With advancement in medical science, if patients are brought in early they can be cured.

There are basically three forms of treatment: Medication; Psychological Therapy – a method in which a mental health professional and the patient discuss problems and feelings; and thirdly, encouraging social aspects – having social relationship with family, friends and society.

Primary Caregivers

The current mental health policy supports the continuing process of deinstitutionalisation, that is, the move from institutional to community care. The government is promoting families to take care of their relatives with mental disorders so that the patients can continue living in the community. This is to ensure that people with a mental disorder can live efficiently in the community.

Hospital Bahagia Tanjung Rambutan

Public Attitude towards Mental Illness

However, what hampers the progress of mental health care in Malaysia is public attitude towards mental illness. A study in Malaysia (Yeap and Low, 2009) found that 62.3% would not let others know; 61% believed sufferers are to be blamed for their own condition; 51.7% believed people with mental illness are often dangerous and violent; and 76.5% don’t believe that anyone can suffer from mental illness.

Mental Illness Education Must Start in Schools

Dr Majumder stressed that our society has many misconceptions about mental disorders which in turn result in patients being stigmatised, ostracised and marginalised, including those who have recovered or are recovering from mental illnesses. The stigma associated with mental illness is still very strong and many people are shunned by society or denied jobs because of mental illnesses although they may have recovered from it.

Mental illness education must be started in schools to enable children to become aware of it. Education about mental illness and what is happening in the brain can help individuals and families understand the significance of symptoms, how an illness might develop, and what can be done to help. For example, families can learn the harmful role that stress can play in accelerating symptoms, and ways to reduce it.

Role of NGOS

NGOs play a vital role as advocates in bringing mental health to the forefront. To be effective, NGOs need committed and passionate champions. Strong leadership is needed to set the pace and direction, and more public health professionals should be involved as mental health advocates.

Helping a Loved One

If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go along to the appointment.

Finally, just as with other medical illnesses, early intervention can make a crucial difference in preventing what could become a lifelong and potentially disabling psychiatric disorder.


Mental health is a huge public health burden in the world today.

  1. People with mental illness experience high impairment to their role function.
  2. There is still much stigma and shame associated with mental illness.
  3. Not enough is being done to promote mental health.

Malaysia must invest more in mental health. Champions and leaders are needed to bring mental health to higher ground.

NGOs Role in Mental Healthcare Thwarted by Lack of Funding

Perak Society for the Promotion of Mental Health

Dato’ Dr M. Majumder, President of the Society said that it was established in 1970 and has its own building in Batu Lapan, Ulu Kinta. She stressed that this is not a Community Mental Health Centre, but a Rehabilitation Centre which is not covered under the Mental Health Act 2001 and as such, is not recognised by the Ministry of Health. The objective of the Society is to rehabilitate emotionally disturbed persons and those with psychiatric disorders and help them to reintegrate into their communities and recover from the symptoms that have excluded them from leading productive lives; assist those who have been treated for psychosocial disabilities to gain and develop the skills and resources necessary to live in the community and to promote mental health awareness among Malaysians.

Pusat Pemulihan Jiwa - Day Care Centre

There are some hundred full-time female residents and day patients (male/female) who come on a daily basis. The patients must be recommended by psychiatrists. They have 30 full-time staff and provide social and occupational rehabilitation, counselling, medical supervision by hospital-based psychiatrists and administration of prescribed medication by staff.

The Society also runs two community homes, one in Cempaka and the other in Tambun which are financed by the fully rehabilitated residents who stay there and have full-time jobs. A supervisor visits the centres on a weekly basis.

Dr Majumder said her main worry is getting sufficient funds to run the place. They need a minimum of RM850,000 per year and from inception, a lot of administrative time is spent on raising funds. The welfare department used to give them an annual grant, but stopped doing so from this year stating that they should apply for a grant from the Ministry of Health. It would be of great assistance if more corporate bodies would provide financial aid. Till now the centre is run by the funds raised by organising various charity programmes.

In the past, doctors used to come to the centre to treat the patients, but now the patients must be taken to the hospital which incurs additional expenditure and manpower. The two vans they own are old. Dr Majumder hopes one of the well-wishers would donate a van.

The centre needs a trained psychologist, but is not in a financial position to hire one; they also need supervisors and caregivers and with their current cash-strapped position they are unable to hire trained personnel. Other issues include difficulties in getting employment for rehabilitated patients who are trained to do candle threading, plastic bag packing and ceramic projects in the centre for which they are paid.

Fees are determined by a sliding scale according to the individual’s ability to pay, but many do not pay. For further information and donations call: 05 533 2167.

Community Mental Health Centre

This centre is located in Kg Simee Clinic and was opened in July 2012. The setting up of this clinic is part of the process to move from custodial care to community care for people with mental illness. It is a day-care centre for patients with a mental disorder who have been referred by doctors. It has a staff of four including a doctor and occupational therapist. The centre is opened on weekdays from 8.30am-3.30pm.

The centre carries out screening, diagnosis, treatment and rehabilitation. The activities include, cooking, gardening, games, education, self-awareness, etc. Once a week a nurse visits the homes of the patients.

For further information call: 05 543 9467 Ext 13.

Simee Community Mental Health Centre

The Dementia Society, Perak

Dr Esther G. Ebenezer, Chairperson of Dementia Society said that dementia is a progressive brain dysfunction which results in a restriction of daily activities and, in most cases, leads to long-term care. People with dementia suffer mainly from poor memory and orientation, limitation of concentration and later develop personality changes. Dementia is a progressive condition that cannot be cured. Medicines are available to slow down its progression.

The day-care centre was opened in September 2012 and is located at 15 Jalan Foo Choong Nyit and is opened five days a week from Monday to Friday from 9am to 3pm. It offers respite for the caregivers and stimulating activities for people with dementia. The patients are also taken out for short trips to the local museum and other places of interest.

The centre also organises support group meetings to provide opportunities for the caregivers to get together and share their experiences, suffering and pain they are going through. The main emphasis is on social interaction and exchange of practical tips. The aim is to make the caregivers realise that they are not alone in their struggle to cope with life and challenges ahead of them.

Their charges are affordable and based on the number of days a person comes to the centre. Transport services are available for those who need to attend the day care. For further details call: 05 241 1691.

Befrienders Ipoh

The motto of Befrienders is “If you think you have a problem…call”.

Befrienders are anonymous caring volunteers whose aim is to provide emotional support to anyone feeling despair, depressed or suicidal. They believe that everyone has the right to control his or her own destiny – they offer confidential emotional support and will help anyone of any race, colour or creed.

Their belief in providing this service is that people in trouble may need someone to talk to, in a supportive and compassionate manner when no one cares and no one listens. The main method of service is through telephone. The service is free and confidential. Nothing their callers say ever goes beyond their centre – whatever the circumstances, age of the caller or state of mind.

If a person is worried that his friend or co-worker may be suicidal, he is encouraged to get the person concerned to call Befrienders personally.

The volunteers are carefully selected and trained to offer emotional support in a crisis. Befrienders Ipoh is looking for volunteers. The centre receives more calls during weekends than normal days.

Operational hours: 4pm to midnight daily and for 24 hours on Sundays.
Call: 05 547 7933 or 05 547 7955.

St John Community Health Centre

St John Community Health Centre provides counselling services to people with any problem. After discussions with the persons they are referred to an appropriate specialist for further consultation.

Operational hours: Tuesdays – noon to 6.30pm
Saturdays: 9.30am to noon
For further details call: 05 254 8146.

Perak Women for Women Society (PWW)

Perak Women for Women Society provides counselling for women. It has a psychiatrist who co-ordinates a support group for women.

For further details call: 05 546 9715.
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