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On January 23, a heartbreaking news was reported: a 66-year-old man is believed to have resorted to taking his own life after feeling disheartened by a second Covid-19 positive test result and an allegedly hefty medical bill. Indeed, the impact of the Covid-19 pandemic has taken a great toll on many people’s physical and psychological well being. Malaysia has seen a rise in suicide cases or near-suicide cases during the pandemic as prolonged uncertainties have put many under immense distress: lockdown, economic downfall, losing job, domestic violence, grief of losing loved ones to the disease – these are only a few of the many sequelae of the pandemic, and they are crushing people everyday.
However, the deterioration of Malaysian’s mental health precedes the arrival of Covid-19. The National Health and Morbidity Survey (NHMS) 2019 found that 2.3% of adults in Malaysia have depression, while 7.9% of children 5 to 15 years of age were found to have mental health problems, mainly due to poor interaction with their peers. Some experts believed that the numbers are likely to be underreported due to the stigma that surrounds mental health. Stigma surrounding mental health issues cause people to downplay them to “mood swings”, when in reality what they need is professional help from counsellors or psychologists. Destigmatizing mental health is not an easy task. But we can start by talking about it and embracing mental health as much as we do with our physical health.
Just like physical health issues, mental health issues come in different forms and severities. Sadly, the stigma tends to link mental health issues to ‘being crazy’ and seeing a therapist means that you are close to ‘being admitted into a mental health institution’.
This is not at all an accurate representation of the mental health issues most people struggle with. It is true that some mental health problems can be serious and may pose threat to the sufferers themselves and people around them. However the majority of the mental health issues Malaysians grapple with are way more subtle than that. They may behave perfectly normal on the outside but struggle with mental health problems secretly. This is why detecting mental health issues is not as straightforward as physical health problems.
In general, types of mental health issues in Malaysia include:
Image credit to National Alliance on Mental Illness
What comes into your mind when you think about treatments for mental health issues? Medications? A one-on-one talking session with a therapist? Electroconvulsive therapy?
(Contrary to its portrayal in the media, electroconvulsive therapy is safe and rarely causes any other complications. The modern use of anesthetics and muscle relaxants has greatly reduced any risk.)
These are all treatments used for mental health issues, and they are often used in combination. Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical health disorders.
In this article, we focus on one modality of the mental health treatment called psychotherapy.
Psychotherapy is commonly known as the talk therapy. It is often depicted in pop cultures by people in certain movies or TV shows who talk about their past trauma and emotional difficulties with a professional called the therapist. Beside the conventional heart-to-heart talk we often see, psychotherapy can also be conducted in an individual, family, couple, or group setting, and can help both children and adults.
There are in fact many problems that can be helped by psychotherapy, such as difficulties in coping with daily life; the impact of trauma, medical illness or loss, like the death of a loved one; and specific mental disorders, like depression or anxiety.
Mental health professionals use psychotherapy as a roadmap to understand clients and their problems and develop solutions. There are five approaches to psychotherapy:
Psychoanalysis and psychodynamic techniques. This approach focuses on changing problematic behaviors, feelings, and thoughts by discovering their unconscious meanings and motivations.
Behavior therapy. This approach focuses on learning's role in developing both normal and abnormal behaviors.
Cognitive therapy. Cognitive therapy emphasizes what people think rather than what they do.
Humanistic therapy. This approach emphasizes people's capacity to make rational choices and develop to their maximum potential. Concern and respect for others are also important themes.
Integrative or holistic therapy. Many therapists don't tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client's needs.
Psychotherapy can be provided by a number of different types of professionals including psychiatrists, psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, psychiatric nurses, and others with specialized training in psychotherapy. Psychiatrists are also trained in medicine and are able to prescribe medications.
Many of our understanding about medical treatment is limited to the medicines that we ingest. That is why many people are sceptical about the effectiveness of psychotherapy. Well, the truth is, the evidence for the efficacy of psychological treatment is indisputable.
A re-analysis on the effectiveness of psychotherapy for depression published in 2018 reveals that psychotherapy for adult patients diagnosed with depression is effective. A systematic and critical review published in 2013 showed that psychotherapy is linked to positive changes in brain structure, in addition to improvements in patients’s moods, beliefs and behaviors. In some instances, the results produced by psychotherapy are often comparable to or better than the effects produced by medication treatments for the same disorders without the potential for harmful side effects that antidepressants often carry. Cognitive behavioral therapy (CBT), a type of psychotherapy, is found to be beneficial for depression even when it is only delivered in the form of CD-ROM, DVD or the Internet. A good news during a pandemic where movement is limited. Nevertheless, scientific evidence (1,2,3) shows that a combination of psychotherapy and medications is often the most effective approach in treating mental health issues, especially depression and anxiety.
If you think you would benefit from psychotherapy, how should you go about this? Surprisingly, it is easy to seek help for mental health issues in Malaysia. Shoutout to https://mentalhealth.my/ for this awesome illustration!
For a list of private psychiatry care, this list provided on the Malaysian Psychiatric Association might be helpful.
Pusat Kesihatan Mental Masyarakat (MENTARI) is an initiative from the Ministry of Health to improve outreach and re-integration of people with mental health problems. However, it only receives patients who already visited mental health consultation at a government facility before. So you cannot walk-in but instead have to get a referral letter from a doctor at any government health facility first.
Don’t feel ready to see a doctor or therapist in person just yet? Thanks to technology, you can also enjoy online psychotherapy at affordable rates offered by:
Malaysian Mental Health Association (MMHA) sets up a Free Emotional Support (FES) programme during this pandemic.
Non-psychotherapy related support services:
Women’s Aid Organization (WAO) provides free and confidential services to survivors of domestic violence, rape, and other forms of violence. You can call WAO at +603 7956 3488 or SMS/WhatsApp at 6018 988 8058 (Tina).
Remember, it is never too late to ask for help. When we talk about our feelings, they become less overwhelming, less upsetting, and less scary.
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