Most of the funding is allocated to procure medical supplies, consumables, reagents and vaccines, and build more health facilities nationwide 

by AZALEA AZUAR 

HEALTHCARE practitioners and patients alike were hoping that Budget 2024 would have a specific allocation to improve Malaysia’s mental healthcare system, but alas to no avail. 

In the budget announcement by Prime Minister (PM) Datuk Seri Anwar Ibrahim on Oct 13, the Ministry of Health (MoH) has the biggest increase in allocation for next year with an overall RM41.22 billion. 

Most of the funding is allocated to procure medical supplies, consumables, reagents and vaccines, while a large chunk of it is to be used to improve and build more health facilities nationwide. Anwar also announced the extension of the Madani Medical Scheme with an allocation of RM100 million, an additional RM50 million allocated for medical device reimbursement. 

Nevertheless, none of these were given on improving mental healthcare despite the increased allocation. 

Although it was announced that the government has allocated some RM15 million for the newly-built National Centre of Excellence for Mental Health (NCEMH), some non-governmental organisations (NGOs) claimed it was not specifically used to improve the country’s mental healthcare needs — rather for grassroot activities between the centre and NGOs at the community level. 

On Nov 2, an online news portal reported that the Malaysian Mental Health Association president Dr Andrew Mohanraj said the budget tabled by Anwar last month did not specifically allocate funding to support the operational needs of NGOs engaged in the field. 

“It was not intended to provide financial assistance on mental health NGOs, which are largely struggling to stay above water,” he was reported as saying. 

Mental Illness Awareness and Support Association president Anita Abu Bakar echoes the sentiment, saying mental health NGOs are in dire need of funds to sustain their operational expenditures. 

Anita says mental health NGOs are in dire need of funds to sustain their operational expenditures (source: Anita’s LinkedIn)

More Focus on Mental Health

Meanwhile, The Alliance for A Safe Community chairman Tan Sri Lee Lam Thye emphasised the need for an increased advocacy on mental health, given its longstanding persistence over many years. 

To make things worse, Malaysia is currently facing a shortage of mental healthcare professionals. 

According to Malaysian Medics International’s (MMI) policy, there are only 479 registered psychiatrists as of February 2022 in the country. 

The policy also stated that Malaysia is mandated to have one psychiatrist or psychologist per 10,000 people, resulting in approximately 3,000 mental health practitioners. 

The patients, meanwhile, also expressed disappointment on how Budget 2024 left out mental health initiatives. 

“It’s absolute insanity in itself that the already embarrassing, miniscule mental (and quite frankly, pathetic) health budget was reduced even further,” said attention-deficit/hyperactivity disorder (ADHD) patient Sarah Joan Mokhtar. 

She added that the opposition of the matter was not so loud as Malaysians who are excruciatingly crippled by mental health issues will be the least empowered and energised to speak up against this flagrant disservice and dismissal of their suffering. 

Recounting her ordeal to The Malaysian Reserve (TMR), she said undiagnosed and untreated mental health issues can lead to unfavourable consequences such as child abuse, brain drain and unemployment issues. Therefore, effective and timely attention can prevent such problems. 

Sarah Joan said after the COVID-19 pandemic, the need for self-care and mental health were seen as crucial due to increased stress levels and grief felt by Malaysians and that the budget would enhance Malaysia’s capacity to produce more psychiatric medicine and make all its websites disability friendly. 

“Ongoing outreach to schools and private workspaces, in a sensitive and encouraging way to reduce stigma, to stigmatise against mental health topics, to teach us how we can be more supportive to those on a mental health journey, and to reduce fear and encourage early intervention,” she explained. 

Sarah Joan was diagnosed with ADHD back in 2021, and she had to wait for months for treatment at a government hospital. 

However, her husband suggested visiting a psychiatrist at a nearby private hospital instead. 

She later felt that it was “absolutely the best decision”. 

“That nearby private psychiatrist recommended my current private psychiatrist and warned me against going to the government hospital because he had heard many unpleasant things, and feared I would be ‘passed around like an object of curiosity’ from doctor to doctor. 

“It sounded like a nightmare that I narrowly avoided. 

“That said, even with his recommendation and going private, it still took more than a month for me to get my first appointment with my current psychiatrist,” she explained. 

The budget was not intended to provide financial assistance on mental health NGOs, which are largely struggling to stay above water, says Dr Mohanraj (source: Dr Andrew Mohanraj)

Lack of Awareness in ADHD

As an adult when she was diagnosed with ADHD, Sarah Joan was thankful that her diagnosis was a swift process. 

However, she drew her concern that there are many doctors who still think that ADHD is only for children and that people who are able to secure jobs and academically excel do not have ADHD. 

“I learned later that many undiagnosed ADHD are utterly unprepared even after getting an appointment, and it may take many months and misdiagnosed before getting an ADHD diagnosis. 

“What’s even worse is that I often read about Malaysian ADHD patients having to switch from government to private because some doctors are terribly outdated and still believe that ADHD only affects children and not capable adults or bright students,” she said. 

Sarah Joan also shared that she knew of an ADHD patient who was discouraged from applying for an “Orang Kurang Upaya” (OKU) card by his psychiatrist, but was later informed that the card would help him to re-enter university and continue his postgraduate education that was disrupted by his challenges instead of giving a “free money” or “laziness” excuse. 

“People who are diagnosed with mental health problems are already finding it challenging to cope due to the country’s unpreparedness in that area which leads to more frustration. 

“ADHD is an invisible disability as adults with them are often unemployed or fearing job loss, so they have to cope by ‘masking’ their condition and pretend everything is well from the outside,” she said. 

More Mental Health Facilities

Budget 2024 is looking at building more hospitals and developing more health facilities. 

These include building the first phase of Universiti Sains Malaysia Teaching Hospital Complex (USIM) in Kota Tinggi, Johor and preliminary works on Sultanah Aminah Hospital 2 in Johor Baru. 

An additional Pathology Block at Raja Perempuan Zainab II Hospital in Kelantan and a building for the Emergency and Trauma Department’s Sultan Abdul Aziz Shah Hospital in Universiti Putra Malaysia (UPM), Serdang will also be built. 

Furthermore, the government plan to allocate a total of RM150 million to build five new clinics in Rantau (Negri Sembilan), Kuala Tahan, Jerantut (Pahang), Kuala Jengal, Dungun (Terengganu) and Mantanani Island, Kota Belud (Sabah). 

Another ADHD patient Muhammad Irfan Mahayudin hopes that this budget will build new facilities as he noticed that mental health patients are easily stressed in crowds. 

Moreover, he also calls for a better improvement in the appointment system, especially for those who are suffering from mental disorders. 

“There was one time that I came one day later for my monthly appointment due to my condition and I have to wait another three months before there is an opening date, basically, I had to start my monthly visit from scratch. 

“The appointment date always stresses me out because I can’t do anything else and it’s a real struggle,” he recounted his problems. 

Muhammad Irfan was diagnosed with ADHD at 34 years old and has been treated as an inpatient and outpatient of a private psychiatrist centre due to the long waiting list in government clinics. 

As a result, he had to fork out a huge sum of his money to visit private health centres. 

“Using the government system is free but the circumstances left me with no choice but to seek a private session which costs around RM200 per session. 

“I did almost every month for a year until I was fully diagnosed, and even then, the prescription I had to buy at the local pharmacy ranged between RM80 to RM160 (maybe more) as the medicine could only be prescribed by certain doctors,” he said. 

Struggling to obtain a prescription from various pharmacies in the Klang Valley, he ended up spending at least half a day at the government hospital. 

Need to Raise Awareness 

As a mother to an autistic son, Dr Che Ann Abdul Ghani said she was also left in the dark as MoH’s budget allocation for mental health services is unclear. 

She said mental health is a prevalent issue in the country and a silent killer not widely understood, with many succumbing to the threat of becoming mentally ill and was hoping that the Budget 2024 would raise awareness on mental health illnesses. 

“Educating society for early signs of depression; and teaching preventive measures to address mental illness at home is crucial for the sufferer, as well as for his family. 

“Next, organising open discussions; utilising social media; establishing support mental health organisations; providing mental health aids; removing stigma; encouraging self-care; and a host of other measures,” she explained. 

Dr Che Ann who works as an associate professor at UPM also contributed with her academic endeavours and support to raise awareness for the matter. 

Currently, Malaysia’s treatment for autism is expensive due to limited government support which ranges from RM3,000 to RM4,500 per diagnosis. 

Dr Che Ann believes that autism is characterised by a physiological disintegration and it is rather a condition rather than a mental illness, offering numerous benefits to individuals with the condition. 

“As autism is more of a neurological disorder, it is often not recognised as a mental illness because it is a condition that is irreversible, rather than acquired like mental illness. It requires different forms of approaches,” she said. 

In the 2023 Budget, the government announced RM34.5 million for the establishment of the NCEMH and the strengthening of mental health and psychosocial support services to address mental health problems more seriously. 

The centre is currently operating with a capacity of 46 personnel and also coordinates Mental Health and Psychosocial Support Services (MHPSS) at the community level, said the MoH in a statement. 

“Through the MHPSS programme, various services are being provided to the healthcare workers and community which include psychological first aid, psychoeducation, counselling services, and training of healthcare workers and volunteers. 

“To date, every district has at least one MHPSS team to provide the service,” said the statement. 

Previously, former health DG Tan Sri Dr Noor Hisham Abdullah estimated that only 20% of people with mental health issues seek professional help, attributing the low figure to the social stigma attached to the condition and a lack of education in the area. 

• This article first appeared in The Malaysian Reserve weekly print edition