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COMMENT | The Covid-19 pandemic has caused more than 1,700 deaths and 445,000 cases in Malaysia so far (as of 10 May 2021). Beyond the staggering numbers, this pandemic is also causing a significant mental health crisis that is even more palpable after a year. As Malaysia starts MCO3, we must act now to prevent a mental health crisis precipitated by MCO3.

In this article, we share three sobering statistics to demonstrate the impact of Covid-19 and MCOs on mental health in Malaysia, provide three reasons why mental health is deteriorating, and propose three systemic solutions to improve our mental health infrastructure in Malaysia for this pandemic.

In statistical terms, the effects of the Covid-19 pandemic have been stark. A study of 1,163 respondents by Universiti Malaya showed a consistent increase in the prevalence of depressive, anxiety and stress symptoms across four different movement control orders (MCO) in Malaysia.

The highest rate of depressive and anxiety symptom was recorded at 59.2 percent and 55.1 percent respectively, between August and September 2020. The Malaysian Mental Health Association (MMHA) recorded a more than two-fold increase in people seeking help related to stress throughout 2020 compared to 2019. In 2020, one in three calls that Befrienders received were suicidal in nature, as compared to one out of 10 calls in 2018. The government’s psychosocial hotline recorded 37,709 calls between April and September 2020, half of them related to emotional distress worsened by the pandemic and MCO. These statistics are sobering and indicate a deterioration of mental health over time.

There are three systemic reasons why the mental health landscape has deteriorated. Firstly, the pandemic has drawn resources away from mental healthcare towards pandemic care. According to a Ministry of Health report in 2016, the scale for people with mental health conditions has been tipped well before Covid-19, but this pandemic worsens it.

With more resources concentrated on the pandemic, less acute services like mental healthcare facilities are displaced. Access to psychiatric services like walk-in appointments or hospital visits is drastically reduced during the pandemic, to adhere to the social distancing measures. This is worsened by the geographical maldistribution of psychiatric services in Malaysia.

Secondly, mental health is worsened by the rapid changes brought by the pandemic, including MCOs, isolation and social distancing. The public is affected by sudden and prolonged uncertainty brought by the pandemic, and this amplifies their anxiety, depression, and fear of illness.

Besides clear disruption of daily activities, MCOs also compound other factors like enforced separation from family and friends. Furthermore, exposure to fake news and disinformation regarding Covid-19 and vaccinations increase anxiety and fear. The younger generations are evidently more affected, with more than half of respondents from the age of 18 to 34 reporting worse mental well-being in 2021 compared to 2020, as reported by The Centre.

Thirdly, loss of livelihoods predisposes the individual to mental stress. The economic repercussion of the Covid-19 pandemic is widespread and deep. The unemployment rate was 4.9 percent in January 2021, much higher than the 3.2 percent rate recorded in January 2020. Financial hardship, unemployment and lower socio-economic status are risk factors to develop mental health conditions. The impact of the Covid-19 outbreak on the livelihood of the lower-income group is extreme, worsened by the inability to maintain nutrition, subsistence and physical welfare. All of this causes an increase in anxiety, depression or mental health conditions.

 We would like to propose three systemic solutions to avert an imminent mental health crisis, precipitated by MCO3. Our first systemic solution is in the risk communications of the public health response to Covid-19. It should provide clear, concise, and accurate information about quarantine, infection rates, healthcare capacity and vaccination roll-out. Health communication in a dynamic situation like this should signal confidence and honesty, to reduce uncertainty in the population. An organised and standardised national approach to Covid-19 management is paramount to improve the citizens’ sense of coherence and manageability, which are major sources of resilience.

Our second systemic solution is in the mental healthcare system, which needs to be expanded and be more resilient to manage this crisis. Easier access to mental healthcare, including widespread use of telehealth for services like counselling, psychotherapy, medication management and vocational interventions should be developed. It is important to develop the needed digital infrastructure and regulations that enable the digital health framework and delivery.

Task shifting, a process of delegation where tasks are moved from highly-specialised to less-specialised health workers, has been proven to be beneficial, especially in low-resource areas. Upskilling the current workforce in mental health services and delivery is another useful strategy, especially when there are multiple avenues in Malaysia, including the private, non-governmental and civil society avenues. Access to courses like Mental Health First Aid can be subsidised to increase its reach to the general population, and to perhaps have a “Counsellor in Every Community” project.

Our final systemic solution to strengthen mental health in Malaysia is to strengthen the social protection and wage support system to address the risk factors of mental health issues. Urgent, targeted and flexible measures to support vulnerable groups like those in the informal economy and areas highly affected by the pandemic should be implemented with frameworks and benchmarks from international labour standards. 

Cash transfers programme like Bantuan Prihatin Nasional has been implemented as a part of social protection method, but long-term recovery plan should be crafted to maximise the economic impact of such stimulus. Besides, maintenance of food security in areas with restricted access can be improved with the help of local government, which can be more responsive than the federal government as they are closer to the ground.

To conclude, the mental health effects of Covid-19 are massive and mitigating them is a national public health priority. The increase of Covid-19 cases in recent months makes it easy to overlook the invisible mental health aspect of this pandemic, but this unseen crisis can be catastrophic and can worsen the physical pandemic of Covid-19. The right government policy responses are needed to save Malaysians from the mental anguish that Covid-19 is causing. We must act now to avert a mental health crisis.

DR NUR NABILA NASHRUDDIN is from the International Medical University while DR KHOR SWEE KHENG specialises in health systems and policies

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.