Wires crossed over ailment
Date: 15 July 2009
The social stigma of being branded mentally ill is deep-rooted, and bad enough that it can hamper sufferers from receiving the proper care and treatment they need.
IN Malaysia, it is estimated that 11.2% of the adult population has some form of mental problem or disorder. That figure is startling in itself, but when it comes to children and adolescents, 20% are similarly afflicted, according to the National Health and Morbidity Survey (2006).
The worrying aspect is that the incidence of mental health problems appears to be on the rise. During a recent conference, the Malaysian Psychiatric Association (MPA) vice-president Dr Abdul Kadir Abu Bakar said that the number of mental health patients aged 18 and below increased from 13.7% in 1996 to almost 20% in 2006.
At the same conference, Health Minister Datuk Seri Liow Tiong Lai said 400,227 patients sought mental health treatment at government hospitals in 2008, a 15.6% increase compared to 346,196 in 2007.
“The increase in stress levels and complex social responsibilities are among factors causing more people to develop mental disorders,” he said.
There is a prevalent social stigma attached to being mentally ill – and it is the same around the world.
The situation is not helped by the fact that mental illness is a broad term that covers all forms of mental health-related conditions – from depression to obsessive-compulsive disorders (OCD) right up to severe forms like schizophrenia and mental retardation.
“Mental illness consists of many different types but very often, it is associated with schizophrenia, a more severe form,” says Malaysian Mental Health Association (MMHA) president Datin Dr Ang Kim Teng.
Some believe that depression is not a form of mental illness, but MPA president Dr Yen Teck Hoe disagrees.
“Depression is a mood disorder, and there are other conditions that affect mood,” he explains.
“Mental illness is a general term, and under that you have depression and OCD, for example – so it is just one form. Some want to declassify it as a mental illness, but changing its name will not cure you of it,” says Dr Yen.
Mental illnesses such as depression are multi-factorial, he explains.
“There is an interplay of genetic and environment factors. If you work in a stressful environment, there is a higher chance you might get it. But then again, some are able to take it, as they are more resilient to stress.”
Dr Benjamin Chan, a member of the Mental Health Foundation’s board of directors and former director of Hospital Permai in Johor Baru, explains that depression can present in mild, moderate or severe forms. Transient and milder depression may occur in students when facing exam stress, or when a romantic relationship fails.
He says that in milder cases most return to their normal selves after a while. In more severe forms of depression, patients may experience relapses for many years.
He also says mental health issues can afflict people in various stages of their lives.
“Young children will have different problems from young adults, mature adults and the elderly,” says Dr Chan.
The more common types of disorders are things like anxiety disorders (which include panic attacks, phobias, obsessive-compulsive disorders), sleep disorders, eating disorders, and personality disorders (psychopathic and schizhoid personalities), says Dr Ang.
However, there are also psychotic conditions such as schizophrenia, she adds.
“This group is characterised by the disturbance of the thought process. The sufferer is not able to perceive, think and reason logically and this gives rise to symptoms like hallucinations and delusions.”
In some cases, it is not obvious that people are suffering from mental illnesses. Giving the example of depression, Dr Ang says: “Their thought process is intact – they can think, reason and talk logically, including engaging in intellectual pursuits. (The late Sir Winston Churchill is a good example of this. He suffered from manic depression yet still managed to lead Britain during the Second World War.)
“But when they are depressed, they may lose interest in their normal daily activities, lack initiative, and they can even be suicidal.”
Dr Chan says that treating depression usually has a very good outcome.
“It is a highly treatable condition, but unfortunately it is under-diagnosed and under-treated, sometimes with disastrous outcomes like suicide. By then it is too late,” he says.
The revelation of the conditions in the Taman Sinar Harapan home in Kuala Kubu Baru, caused quite a stir. Malaysians were shocked and appalled by the poor conditions and level of care patients were receiving – or not.
Based on his experience conducting a research project on similar patients and the reports in The Star, Dr Chan believes that the residents there probably have severe learning disability (profound mental retardation) with some other psychiatric complications.
“These people may also have neuro-muscular problems (spastic) or epilepsy. There is the possibility they are so severely retarded, they do not have any speech development or even self-care skills,” says Dr Chan.
If that is the case, he says, they may be unable to dress or feed themselves, and in some severe cases cannot even stand and walk normally. On top of that, they may have other psychiatric problems as well.
“What they require is very specialised care,” he says.
Dr Yen also believes the level of care given at the home is inadequate.
“Modern medication is so advanced that we can medically restrain them, rather than doing it physically with chains. This is counterproductive and inhumane,” he says.
But there are situations when physical restraint is sometimes required, he admits.
“To prevent injury, you may need to restrain them temporarily until the medication starts to work.”
Dr Yen believes that in order for the home to function properly, it needs a doctor with mental health training.
“There is a shortage of psychiatrists in Malaysia, but at least they should contact other people from the mental health profession for advice and guidance.
“There are only about 190 psychiatrists in Malaysia to cater for a population of 27 million,” he informs.
Dr Yen believes that Government facilities are doing the best they can given the constraints of budget and resources. But he says the situation is possibly similar in other homes – even private ones.
Dr Chan agrees and adds that purpose-built centres with customised facilities are needed to cater for this special-care group.
“We must not put them in cages and turn the centre into a prison. They may become even more agitated, and might end up being locked up 24 hours a day,” he says.
There are currently four hospitals in Malaysia dedicated for mentally-ill patients, says Dr Chan. These are Hospital Bahagia in Tanjung Rambutan; Hospital Permai in Johor Baru; Hospital Sentosa in Kuching; and Hospital Mesra Bukit Padang in Kota Kinabalu.
He says that mental health services in developed countries are more advanced, naturally.
“The Government allocation of funds for mental healthcare services in developed countries is fairly substantial, but in Malaysia it is very minimal – only about 2% of the total healthcare budget,” he says, adding that the issue is one of priority.
He opines that funds are deployed to more physical needs such as acute care or more high-profile areas like organ transplants and cancer treatment.
“Patients in psychiatry do not drop dead, and we tend not to get as much coverage,” he says.
This article was first published in www.thestar.com.my on 12 July 2009.
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