Read part one here.
IN case you are unaware, there has been a surge of interest on mental health indicators for the monitoring of the population's wellbeing as of late.
A representative from the mental health NGO Befrienders Kuala Lumpur explains, “Psychological issues are mental health related issues, which includes depression, anxiety, bipolar, OCD, ADHD, etc. An example can be someone developing anxiety because of the prolonged lockdown, unable to cope with it, and not sure how to get help for it”.
“Family issues concern the relationship dynamic between family members. An example can be a daughter not getting along well with the mother and being subjected to emotional abuse. While relationship issues mainly focus on male-female relationships (mostly young couples).
“Job issues can be someone struggling or being bullied at work, including those having difficulties looking for a job.
“Social issues encompass a wider spectrum and can include students having problems with friends at school, gender inequality, and immigration issues among them”.
On whether there are anecdotal examples of financial distress linking to suicide ideation from the calls, “... without revealing too much as calls are treated private and confidential, a common example is someone unable to provide for the family where income instability may lead to stress for the lack of support received”.
A domino effect
According to psychologist Dr Joel Low, “A lot of people do think about death on a regular basis and the thoughts can purely be part of the existential question and are not necessarily malicious or intentionally conjured to harm oneself”.
That said, he does note that the current isolation the pandemic has brought about has allowed for recent statistics to balloon.
“By design humans are social creatures, and this extended period of physical distancing certainly impacts us in more ways than one,” he said.
“While we have worked our way around communication channels by having calls done via online platforms such as Zoom, not a lot of people are tech savvy. Half of the population (or even slightly under) have the means to access similar types of tools regularly.
“The challenges to retain mental and emotional resilience is not boiled down to one cause contributing to the statistics. The restriction of social interaction is part of a domino effect across the board,” added Low.
“Of course, from a purely clinical perspective – the psychological aspect is at play but to date, the external environments may fuel excessive sadness and helplessness to take place, which are two distinct characteristics that define depression."
On whether there is a link between the clinical disorder and desperation that a struggling individual faces, “... there are many different ways to define it and certainly the current economic struggles that people are going through can push one to become desperate”.
“Will desperation lead to depression? Perhaps, but not all the time because there are still individuals who are able to seek ways to bounce back from the adversity faced,” shared Low.
“Then again, we have to be mindful that it’s easy enough for a person to rise above it because a good support system exists – so the situation may be a bit different for others otherwise.
“However, I would like to note that we have to be very careful about simplifying the effects / causes of suicide in particular,” he highlighted.
“There are so many intricate factors that need to be considered, and one of which is the personality aspect.
“For instance, take three kids with a history of an abusive upbringing, not all are going to become abusers themselves when they grow up.
“Quite frankly, it is not a simple ‘x+y=z’ equation, meaning if I am desperate therefore suicide is a thing on the cards,” shared Low.
Available support and beyond
“To clarify – I am not a medical doctor, but a clinical psychologist with a PHD and unlike a psychiatrist, I work primarily with psychotherapy and counselling to help clients,” shared Low.
“For premeditated cases of suicide attempts/inclinations, there are two aspects that are deemed important. First being a patient’s willingness to accept the help.
“If there is no participation from the patient, then the process is not going to work well because they would not want to talk about the situation or the troubles that they are going to,” he shared.
“Assuming that a person does want to be helped – the second aspect is to understand where the source of despair comes from. Nothing exists in a vacuum, and identifying the emotional triggers are key.
“For cases that have no premeditated history of self-harm or suicidal inclinations, the process is much harder,” highlighted Low.
“Quite a number (although not all) of attempted suicides, see the action as a last-ditch attempt. Patients do not have the intent to die, but instead do not know what to do because their circumstances have put them on the edge.
“There are also multiple scenarios where a survivor coming out of the incident will face. Some fall in a deeper rabbit hole, while others come out with a better outlook of their lives,” shared Low.
“Those that are still in a state of despair where the risk is still prevalent, there can potentially be psychiatric intervention involved. This is solely offered to make sure patients are cared for with regards to health and safety,” he added.
Sharing the importance of having the different services to work together to help patients, professor of psychiatry Dr Phillip George shares, “The monitoring and intervention for the recovery must be done in a holistic way where treatments are dependent on the risk levels – low, medium and high.
“Assessments consider the physical, psychological (mental) social (networks and support) aspects where all of the determiners play a role in the risk evaluation.
In most developing countries, satisfying our basic needs (food, water, shelter, clothing) is seen as part of emotional security and when we are deprived of it, either by losing our jobs or having to deal with pay cuts and dealing with related domestic issues as a result, “... any sense of protection and safety is lost,” noted George.
“The question of sustenance comes to mind and if it is left vulnerable, then it will definitely trigger emotional risks.
“Hence, we cannot just look at providing psychological support alone. There is a need for the physiological aspect to also be done in tandem,” shared the professor.
How can we better our approaches?
Mental health resilience is an important part of human development and it has to start from a young age.
Understanding this importance, George is part of an initiative to push for the need for children to learn how to build mental strengths, which includes a youth focused collaboration with the national coalition of mental well-being.
“It is an effort done in support of youth helping youth via tertiary education to raise awareness and learn about mental health and develop the skills needed,” he added.
On the challenge to ensure the nation and decision-makers to talk about issues related to mental health and suicide prevention with more acceptance: “I think at the very least – we need to start by having more conversations and not be embarrassed to ask questions.
“The stigma, or apprehension towards a certain issue arises when there is no knowledge,” said Low.
“It is only by having reached a safe space that we are able to get the ball slowly rolling for people to become more comfortable addressing their emotions.
“The Asian culture is a very face-saving culture, and while it’s getting better – the change is not going to be an overnight effort,” he added.
While there have been endeavours done by the state in wanting to try and increase resources for people to support mental health concerns, “The current lack of mental health professionals in supporting the training is what’s causing the bottleneck today”.
“We need to start on a more achievable approach, and this could be via reviewing existing policies to be more compassionate towards mental health,” shared Low.
“Take health insurance for example, I am not sure if this is still in practice but a lot of the reason that deters an individual from having to apply for one is that having a pre-existing mental health condition exempts them from a full coverage,” he added, noting that subtle discrimination even in workplaces needs to be looked into.
Ways to navigate the disputes around providing attention to suicide and issues related to it with critics, such as changing the messaging to reduce the stigma – including guidelines for the mass media to uphold – can be tricky.
But George expressed: “In the public domain, apart from being visible to the data an emerging public health issue, people should also be made equally aware of the preventive care and services available to deal with suicide and illnesses related to it.”
The professor of psychiatry notes that the information or reporting should be done comprehensively.
“Past news reports are done in silos and may not help in aiding the distress who are going through either emotional, social and even financial issues thoroughly.
“As we push forward, we have to ask ourselves – how much of the information provided are actually able to help support and equip individuals in dealing with their struggles?” he said.
“Additionally, there should be an importance placed for the existing statistical reports to be done with clinical assessment and participation by healthcare professionals,” he further stressed.
Need for better visibility
George also shared that the establishment of the National Suicide Registry Malaysia (NSRM), initiated in 2007, was a great effort in understanding public health conditions to build the required resources and manpower to curb the stressors. However, the initiative was cut short and dismantled a year later.
“Without us not knowing the actual baseline and demographic details and issues behind these cases, we are at a big loss to prevent the statistics from rising.
“We cannot afford to pretend that the issue is not important or does not exist (on a national scale) when globally, it is already a pressing health concern,” he stated.
Earlier this week, the Human Rights Commission Of Malaysia (Suhakam) called for the revival of the registry in a press statement. The call was followed by the alarming rise of suicide and attempted suicides, which seem to coincide with the start of the Covid-19 pandemic early last year.
The statement reads: “Quality data collection system that includes age, gender, ethnicity, state, and the manner in which the suicide is carried out, will facilitate the development of effective policies and long-term solutions in preventing suicides in the society”.
“In the interest of reducing socio-economic pressures on the society during the Covid-19 pandemic, Suhakam calls for expedient vaccination rollout, expansion of voluntary testing and early detection, and targeted movement control orders.
"This will allow for more sectors of the society to regain access to work and livelihoods, resumption of schools and return to some normalcy in their lives, and possibly to a reduction in the incidence of suicides”.
Is the line between depression and desperation blurring?
Going back to the overarching theme that touches on the relationship between phsychological and socio-economic factors grappling the people, accounts of attempted suicide on social media and in mainstream news in recent weeks – as anxieties heighten due to economic hardships – cannot be ignored.
Sharing his take on the question at hand, UM professor of economy Datuk Dr. Rajah Rasiah says, “It seems to be that this may be true especially among those whose earning opportunities have been completely shut down”.
Reiterating the areas of prioritisation that the government should look into: “Vaccination rates must go up; organise public essential food supplies to areas where the poor live; set up assistance hotlines to assist those facing serious stress from the calamities that have come with the Covid-19 pandemic; the dichotomy of essential and non-essential items in general must be ended (Instead, it should only be imposed in MCO areas as a lot of non-essential items are needed to produce essential items); and offer special pass for small farmers and operatives to function as they are critical in sustaining the supply of essentials, which is critical not only to ensure that there is adequate supply of essential goods but also to check inflation."
Further noting on how we can provide enough attention to small businesses in the country, “Micro, small and medium businesses have always had a tough time in the developing countries”.
“While we have the SME Corporation and several programmes to assist them, they are still confronted with a whole lot of problems, including access to finance.
“Nevertheless, those registered and are functioning formally are better off compared to the informal ones,” noted the professor, adding, “there is a serious need to assist the informal businesses first by convincing them to register and to engage in supporting their activities”.
“Given the pressure the PN government is currently facing over the surge in Covid-19 infections and deaths, I am (still) hopeful that it will craft strategies more carefully to stop the surge."
That said, Dr Rajah notes the strategies do not require rocket science solutions as the intensification of vaccinations is one of the solutions, which has reversed the huge surge in countries, such as the UK and the USA.
“While Malaysia was heralded by the WHO (with our MOH DG even winning an award) over the first three months of 2020, Malaysia now holds the worst Covid-19 infections record per million persons.
“Let us also look at the successful countries for lessons, as they have managed the crisis well lately." – The Vibes, July 4, 2021
