Addressing Malaysian adolescent mental health woes
The newly-released National Health and Morbidity Survey (NHMS) 2023 has highlighted several key mental health issues that are of significant concern.

One million individuals, or 4.6% of people in Malaysia, aged 16 and above display symptoms of depression.

This is double the figure obtained from the earlier 2019 NHMS.

What is more alarming is that half of this population, or 500,000 Malaysians, reported having thoughts of hurting themselves or being better off dead.

Teenage troubles

Mental health problems have become more widespread in recent years with notable increases in not only depression, but also anxiety and stress, among various demographics.

In Sarawak, for example, 35.8% of the population aged 16 and above reported mental health issues, with the highest occurrence among the Bumiputera community​.

This demonstrates that mental health issues are not necessarily confined to challenges of urban living in the Klang Valley.

The mental health of adolescents is particularly alarming.

The survey revealed that 18.5% of teenage girls reported experiencing suicidal thoughts, compared to 7.6% of male adolescents.

Additionally, 13.4% of teenage girls had attempted suicide, more than double the 5.7% rate among boys.

A significant 25% of teenagers reported having feelings of depression, with the rate being twice as high among girls compared to boys.

High rates of verbal and physical abuse at home were reported, affecting the mental health of adolescents.

Around 41% of teenagers experienced verbal abuse, with higher rates among females than males.

Additionally, 7.5% reported physical abuse, again with a higher prevalence among females.

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Bullying remains a significant issue, with 8.6% of adolescents reporting being bullied, particularly during the early stages of secondary education.

Cyberbullying is also prevalent, with one in five teenagers experiencing bullying through digital platforms, affecting more males than females.

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These findings underscore the urgent need for comprehensive mental health support and interventions, particularly for young people and vulnerable communities in Malaysia.

Actions to take

Addressing these issues involves promoting a safe psychological environment and implementing targeted mental health programmes and policies.

Based on the 2023 NHMS findings and other related studies, several targeted interventions can be recommended to address the alarming mental health issues in Malaysia:

> Enhance mental health services

We need to improve access to mental health services, especially in rural and underserved areas.

This includes expanding the number of mental health professionals available and integrating mental health services into primary healthcare settings.

While this is an acknowledged challenge in the short term, immediate mitigation can be done through short courses in mental health for primary care doctors to help improve their skills and knowledge.

Telehealth and online mental health services can be developed and promoted to reach those who cannot access traditional in- person services due to geographic or social barriers​.

This has been done successfully in many countries, including Australia, which reported high satisfaction in telehealth services.

Investment in user-friendly platforms, telehealth infrastructure and organisational guidelines are needed for the successful integration of video-conferencing in public mental health systems in Malaysia.

> Initiate school-based mental health programmes

Comprehensive mental health education in schools can be implemented to raise awareness and reduce stigma.

This can include teaching students about mental health, emotional regulation and coping strategies.

Schools should have adequate counselling services and trained mental health professionals to support students facing mental health challenges.

Several schools in Malaysia have embraced the highly-acclaimed Mental Health First Aid Course, but this needs to be further promoted to cover more schools.

> Conduct community support and awareness campaigns

Nationwide campaigns to raise awareness about mental health issues and reduce stigma can be launched.

These campaigns should focus on educating the public about the signs and symptoms of mental health disorders and the importance of seeking help.

This should be the mandate of the newly-established National Centre of Excellence in Mental Health, in collaboration with other stakeholders like non- government organisations (NGOs) and research bodies.

> Initiate community programmes

Community-based programmes that provide support and resources for individuals dealing with mental health issues can be implemented.

This can include peer support groups and community workshops.

This is already being done through the government-established Mentari Community Mental Health Centres.

There are more than 30 such centres throughout the country, not including those run by NGOs such as the Malaysian Mental Health Association, but this initiative should be further expanded for nationwide coverage.

> Implement targeted interventions for vulnerable groups

Create targeted mental health programmes for adolescents, addressing issues such as bullying, cyberbullying and abuse.

These programmes should provide safe spaces for youth to discuss their experiences and receive support.

There should be novel interventions to combat cyberbullying, which has become a pervasive phenomena.

Also, gender-specific interventions that address the higher frequency of mental health issues among teenage girls need to be introduced.

Such interventions should focus on empowerment and building resilience.

> Have early intervention and prevention

Regular mental health screening in schools and primary care settings should be implemented to identify individuals at risk of mental health issues early, and thus, provide timely interventions.

This can be done by training teachers, school staff and primary healthcare providers to recognise the early signs of mental health problems, and to provide initial support and referrals​ in collaboration with the local primary healthcare facilities.

Again, immediate capacity-building of school staff and primary healthcare providers is needed, rather than focusing on increasing the number of formally-trained mental health professionals.

> Address abuse and violence

Comprehensive support services for children and adolescents who experience verbal and physical abuse need to be provided.

This includes counselling, legal support and safe shelters.

Preventive measures should include programmes aimed at preventing abuse and violence in homes and schools.

This can include parenting workshops and school policies that promote a safe and supportive environment​.

> Take policy actions

Strengthen national mental health policies and ensure they are adequately funded and implemented.

This includes policies that promote mental health, prevent mental illness, and provide care and rehabilitation services, expanding from the usual focus on only curative care.

> Enable protective legislation

Laws and regulations that protect children and adolescents from abuse and bullying, both offline and online, need to be enforced.

This can involve stricter penalties for perpetrators and better protection mechanisms for victims​.

In line with international conventions and practices, the government may need to look into the setting up of a Mental Health Commission to help facilitate this.

Working together

Implementing these interventions requires a multi-faceted approach involving collaboration between government agencies, healthcare providers, schools, and organisations representing service users and caregivers.

By addressing these issues comprehensively, Malaysia can significantly improve the mental health and well-being of its population.

Aside from mental health conditions, the 2023 NHMS also highlights worrying statistics about chronic physical diseases such as hypertension (high blood pressure), obesity and high cholesterol levels.

These conditions can also lead to psychological stress, affecting quality of life, which can in turn contribute to depression.

On the other hand, depression itself can lead to behaviours that worsen our physical condition, such as poor diet, inactivity and neglect of medical treatment.

Therefore, addressing mental health in individuals with diabetes, obesity and high cholesterol is paramount.

Integrated care that combines physical and mental health treatments can reduce the risk of depression in this group.

In conclusion, the alarming rise in mental health conditions in Malaysia demands our immediate and unwavering attention.

The data paints a sobering picture, yet it also ignites a beacon of hope and a call to action.

The responsibility lies not only with the government, but also with each and everyone of us.

Employers, educators and community leaders all have pivotal roles to play in creating environments that promote mental wellness.

Together, we can transform the mental health landscape of Malaysia, ensuring that every mind is valued, every voice is heard and every soul finds solace.

The time to act is now.

Let us rise to this challenge with the urgency and dedication it so profoundly deserves.

Prof Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and Taylor’s University Impact Lab on Mental Health & Wellbeing director. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Matters of the Mind,Mental health,National Health and Morbidity Survey,NHMS 2023,teenagers
The 2023 NHMS reported a significant increase in older teenagers experiencing mental health issues.