Earlier this year, when attempted suicide is still considered a crime, a parent of a teenage child who attempted suicide through overdosing medication stated that the government hospital urges a police report to be made as part of the procedure.
“The police immediately wanted to come and interview my child, but I managed to convince them it was not an attempted suicide but merely a cry for help,” a parent, who declined to be named 
Headlines often cover the plight of university students who have difficulties manoeuvring life stressors such as peer pressure, fitting in and exams. However, mental health issues are not only prevalent among youth, but also younger children below the age of 12 years old.
Children are suffering in silence and data shows it:
- The 2019 National Health and Morbidity Survey (NHMS) highlighted that 424,000 children and adolescents suffer from mental health problems in Malaysia 
- 2 – 3 % of children ages 6 to 12 years old can have depression .
- At least 1-2% of children as young as 3 years old are depressed 
- More than 7% of children aged 3-7 years old have anxiety disorders 
With the school reopening its door, the lives of the children are set to transform again, and adapting to a new environment is potentially overwhelming for many of them.
“The whole mental healthcare system in Malaysia seems to be behind the times”. Dr. Alvin Ng, Associate Dean (International) for the School of Medical and Life Sciences, Sunway University, Malaysia. 
The two known enemies: stigma and shortages
Mental health issues in Malaysia have been pervasive on our newsfeed and part of mainstream media. Perhaps, the ongoing fight addressing the stigma and ensuring the adult population to seek help had overshadowed its severity amongst our youth. At the same time, we have often heard nonchalant phrases such as, “Oh, you are still growing up, you’ll get over it,” or “It’s just normal to have stress” when it comes to children and adolescents sharing their problems.
The cry for help of children and adolescents who require mental health assistance isn’t necessarily reachable on school grounds as the prevailing stigma of counselling unit visitors are problematic students. To reach out to hospitals, a child or an adolescent would require parents’ consent and the shame society has ascribed to mental health had only made them hesitant to seek much-needed help.
“They don’t want to be seen walking in and out of a mental health facility.” Simpson Khoo Sing Shern, community education worker 
In tackling mental health issues, our ongoing fight is also against the shortages of qualified mental health practitioners.
As our mental healthcare system remains inadequate, the victims are the youth of today whose access to mental healthcare is a battle on its own. We have a limited number of school counsellors; our first line of defence that could ensure children and adolescents’ receive help for their daily stressors.The number of mental health care front-liners who are qualified and equipped to intervene in mental health issues of our younger generations paints a bleak picture:
- The current ratio of students to school counsellors in primary schools is 350:1 and in secondary schools 500:1 . In 2019, reportedly, there are 9,522 counsellors in schools with an additional of 326 in education offices nationwide. 
- There are 309 psychiatrists in Malaysia, but only 30 that specialise in children and adolescents care and most are in Klang Valley  .
- There are approximately 300 qualified clinical psychologists, but only 200 are practicing at the moment giving the ratio of 1: 980,000 citizens, when the ascribed ratio by World Health Organisation is 1:5,000 .
School Counsellors Should Be The First Line Of Defence
A counsellor is often solicited when it comes to general life difficulties, for example relationship problems, handling grief or anger management. Putting them on the forefront of the mental health care chain, a student will be able to learn to cope with life challenges better, not just with one-to-one consultation but also through instilling mental health literacy among school students.
Strengthened with better coping mechanisms and stress management, it is safe to say it would combat larger mental health concerns such as depression or anxiety.
Early childhood educators must be able to detect problems in children, have the knowledge and skills to deal with them and alert parents early to take appropriate action. The saddest thing today is that when teens have problems they can’t even approach their guidance counsellors because of a sense of helplessness and low self-worth. – Professor Datuk Dr Chiam Heng Keng, leading figure in child and adolescent psychology and early childhood education 
However the existing school counsellors are serving a huge number of students in a school, with one student counsellors assigned to 350 students in primary schools and 500 students in secondary schools. Despite the call for more qualified and improved quality of school counsellors – we are still facing shortages.
In 2019, the Malaysian Board of Counsellors (LKM), a governing board of licensed and registered counsellors in Malaysia did not manage to achieve a target of 11,000 licensed counsellors in Malaysia falling short of 2,945 . The pandemic had only aggravated the situation as lesser counselling postgraduate students can graduate on time due to the Board’s insistence of acknowledging only face-to-face contact hours.
The decision was untimely, as most countries such as the United Kingdom have shifted to an online-counselling method to cater for the rising mental health issues among the society. Coupled with the school closure, where else can students seek the assistance of mental health professionals?
Overarching shortages of mental health care professionals
If the issue is beyond the scope of the school counsellors, a multi-disciplinary action should be in place, involving parents, teachers, counsellors, psychologists and depending on the severity; the involvement of a psychiatrist especially if medication is required when it comes to interventions.
However, our hospitals are inhabiting a limited number of psychiatrists and clinical psychologists. Not only that, our mental health professionals are suffering from burnout as the demand rose exponentially with many struggling to cope with the unexpected hurdles the pandemic had thrown them into.
Most psychiatrists and psychologists may have also resorted to private practices situated in the urban areas i.e. Klang Valley, their services had become less accessible and affordable to those who require dire help.
The lack of psychiatrists in Malaysia further extends to a limited number of child psychiatrists. However, it is due to the lack of uptake by the doctors themselves as a speciality option.
A lot of prejudice, taboo and stigma when it comes to the psychiatry field both from family members and the healthcare fraternity at large. It’s not easy to find those who are really interested in taking up psychiatry. There are those who think that surgeons are at the top, and when you go down the rung, there are psychiatrists. It’s a perception thing. – Professor Phillip George, Head of Psychological Medicine at the International Medical University 
The shortage of clinical psychologists in the government-run facilities was due to the quota of only 15 clinical psychologists when in fact 45 government hospitals in Malaysia offer psychiatric services . A clinical psychologist provides assessment and early intervention which could have put the cap on the bottle when it comes to exacerbating mental health issues.
With only one clinical psychologist or “psychology officer “ at a government-run facility, there is a heavy load of cases that need to be attended to. Most often those with severe manifestations would be addressed first leaving those who are considered moderate, prolonging their silent plea for help.
“I’ve personally seen a patient experience more intense symptoms, which could have been prevented or [had] better treatment outcomes if the assessment, treatment or intervention had been provided earlier.” Ellisha Othman, director of SOLS Health 
Everyone needs to be involved
What we are facing, and shown by the numbers, is an onslaught of shortages in all disciplines and at the same time there is a high demand for mental health care practitioners i,e, school counsellors, child psychiatrist and clinical psychologist. However, a child or an adolescent may not even recognise if they are currently suffering from a mental health issue. Even if they do, they need the helping hand of others.
With this in mind, the first step to seek help for children and adolescents is from those who are closest to them. Parents and teachers spend considerable amounts of time with children and adolescents at school and at home. It is increasingly important for parents and teachers to be vigilant with the slight changes in a child’s emotional and social functioning. Mental health problems are tricky to detect even in a normal adult, not to mention how difficult it would be to identify if a child or adolescent requires professional help.
Parents should notice the behaviour patterns of their children. When you sense that something is amiss, don’t try to extract information from your child. Slowly coax him to speak up; otherwise, he will clamp up even more. – Peggy Ho, a single mother’s opinion on the role of parents when it comes to mental health issues 
The number to remember is this: there are at least 424,000 Malaysian children and adolescents out there suffering from mental health problems . What we don’t know is how many more out there are unknowingly crying out for help within the four walls of their bedroom – until it’s too late. Mental health issues can creep up on anyone and we should all be prepared, for our own sake and the sake of those we love.
If you are a teacher or a family member concerned by the state of mental health of children and adolescent around you, be fortified with the knowledge on mental health issues. Help is just one click away!
This article addressed the dire state of mental health problems in school children and the overarching shortages of mental health professionals. In the second part, we explored the adequacy of school facilities in tackling mental health issues despite the shortages of mental health professionals through our conversations with school counsellors. At the same time, parents would benefit from understanding the signs to look out for when mental health problems manifest in their children and adolescents.
Explore our sources:
- H. Hassan. (2021). Malaysia sees rise in suicides and calls to helplines amid Covid-19 pandemic. The Straits Times. Link.
- Ministry of Health Malaysia (2019). National Health and Morbidity Survey 2019. Link
- P.Klass. (2021). How to Spot Depression in Young Children. The New York Times. Link
- L.M.Foong. (2018). Behind The Times: Malaysia’s failing mental healthcare system. SouthEast Asia Globe. Link
- M.Chiew. (2011). A cry for help. The Star. Link
- R. Rajaendram. (2019). More counsellors needed at schools. The Star. Link
- N.Daim. (2019). Education Ministry to increase counselors to help teachers, students deal with stress. New Straits Times. Link
- The Star. (2021). One psychiatrist for 100,000 people in Malaysia now, says Health DG. The Star. Link
- Starpicks. (2017). Clinical psychologists: The future of mental health care in Malaysia. The Star. Link
- S.Pillay. (2017). Suicide on the rise among Malaysian youth. New Straits Times. Link
- K.Iman. (2021). The Sad Reason Why Malaysia Faces A Shortage Of Mental Health Counsellors… Again. CiliSos. Link
- J. Thomas. (2021). Psychiatrists explain why their numbers are low. Free Malaysia Today. Link