Tanjung Rambutan: A Legacy Left Behind As Malaysia Improves In Mental Health Services

The name Tanjung Rambutan immediately evokes images of an asylum filled with “lunatics”—a generational stigma rooted in the institution’s early days that still echoes in schoolyard taunts. 

Formerly known as the Federal Lunatic Asylum, it is one of four existing psychiatric hospitals in Malaysia that has long struggled to shake off its unfortunate reputation^[1].

In 1928, following pressure from the medical community to counter negative perceptions, the facility was renamed Hospital Tanjung Rambutan. 

By the mid-1970s, it underwent another rebranding, becoming Hospital Bahagia Ulu Kinta (HBUK). Yet despite these changes, societal attitudes toward the town and institution remain difficult to alter.

This lingering stigma is not unique to Tanjung Rambutan. Similar connotations persist with other psychiatric hospitals like Hospital Permai in Johor, Hospital Mesra Bukit Padang in Sabah, and Hospital Sentosa in Sarawak. 

Despite this, these institutions have endured and stand as living monuments to the evolution of mental health services in Malaysia.

From Psychiatric Hospitals To Mental Health Day Centres 

The history of mental health services in Malaysia dates back to the late 1700s, beginning in Penang primarily to serve colonial sailors. 

By the 1800s, a mental hospital was established in Taiping, followed in 1911 by the opening of the Federal Asylum in Tanjung Rambutan, which became the largest psychiatric facility in the country, accommodating 4,000 patients^[2].

Later, another major institution with a 3,000-bed capacity was built in Tampoi, Johor Bahru, now known as Hospital Permai. 

In East Malaysia, a 300-bed facility was established in 1933 on Penrissen Road, Kuching, now called Hospital Sentosa. In Sabah, a smaller 50-bed mental hospital was originally built in Buli Sim Sim, Sandakan, but later relocated to a larger facility at Bukit Padang, now known as Hospital Mesra^[2].

With major revisions in healthcare that followed independence, and emphasis on community care and rural healthcare, the district or general hospital psychiatric units started to come on stream and efforts at deinstitutionalisation began. – Excerpt from Psychiatry and Mental Health in Malaysia^[2]

Under British rule, mental healthcare in Malaysia was primarily institutional and custodial, with patients confined to psychiatric hospitals. 

This began to change in 1958 with a shift toward deinstitutionalisation and community-based care, starting with the establishment of the first psychiatric unit in a general hospital in Penang.

Initially, short-stay psychiatric care units in general hospitals were slow to gain traction, serving mainly as temporary stops, while large mental institutions remained the primary treatment centres for mental illness. 

By the 1970s, these institutions were severely overcrowded, with some housing between 4,000 and 5,000 patients. Over time, these numbers were reduced to between 1,200 and 2,000, while smaller hospitals now accommodate 200 to 300 patients each^[2].

Today, the four major psychiatric facilities collectively provide just under 4,000 beds, but the bulk of mental healthcare is now delivered through the 47 psychiatric units in general and district hospitals. 

These units offer around 1,000 beds for acute care, staffed by one to three psychiatrists along with teams of occupational therapists, social workers, and psychiatric nurses. 

Many units also have community teams that visit high-risk patients at home and run outreach clinics in nearby health centres and hospitals without psychiatrists.

It is also happening in Malaysia with our main psychiatric care facilities such as Hospital Permai in Johor and Hospital Bahagia in Perak reducing the intake for institutionalised care. The government has set up psychiatric units in regular government hospitals to normalise mental healthcare and make it easily available. – Datuk Dr Andrew Mohanraj, Malaysian Mental Health Association (MMHA) president^[4]

The outdated practice of institutionalising patients has become a thing of the past, as mental healthcare has shifted toward community-based care. 

A Peek Into A Mental Health Institute 

Once viewed as fearful places where occupants were confined behind bars, mental institutions like Hospital Bahagia Ulu Kinta (HBUK) have recently opened their doors to the public. 

HBUK is now the only hospital in Malaysia with a museum on its grounds, showcasing its rich history and significant role in the nation’s mental healthcare.

Nestled in the heart of Tanjung Rambutan town, this historic hospital stands as one of Malaysia’s four major mental health facilities. 

Completed in 1911, it proudly holds the title of the oldest psychiatric institution in the country, blending rich history with a commitment to evolving mental healthcare.

We have universities and school students, even companies, visiting the hospital. They were surprised to see what the hospital looks like. – Dr Ahmad Qabil Khalib, deputy medical director at HBUK^[5]

One individual fortunate enough to explore the building is Shalni S. Sami, who noted its antiquity and had the opportunity to interact with its residents. 

By the end of her tour, she realised that the institution wasn’t as frightening as many had believed. With her background in psychology, the experience proved to be eye-opening.

I was shocked to hear that at first. As a psychology student, I have been exposed to so many psychological disorders and my lecturers have told me that the symptoms will be bizarre. However, when it comes to hearing it for myself from a person who has gone through such experiences, it took me a while to digest the information that was shared with me. – Shalni S.Sami^[6]

HBUK has experienced a decline in its long-term occupants in recent years, with around 1,600 patients admitted annually. Additionally, psychiatric hospitals in Malaysia have adopted a more holistic approach to care.

As the hospital opts for a holistic approach, we have a section for agro-therapy where patients raise farm animals, plant trees, and even sell the produce at our small farmer’s market and drink stall. Patients engage in activities such as growing bananas, eggplant, lemongrass, and sugar cane, as well as caring for ducks, chickens, and fishing ponds. – Dr Ahmad Qabil Khalib, deputy medical director at HBUK^[5]

How Are Individuals Admitted To Mental Health Institutions? 

Under the Mental Health Act 2001, individuals can be admitted to psychiatric hospitals either voluntarily or involuntarily. Voluntary admissions occur when patients consent to treatment, which can sometimes be mandated by court orders. 

In contrast, involuntary admissions happen upon an application from a relative or a recommendation from a medical officer or registered practitioner following a personal examination^[7].

Clause 11 of the Mental Health Act 2001 and Mental Health Regulations 2010 seeks to empower any police officer or social welfare officer to apprehend any suspected mentally disordered person and to produce him for examination at a government or gazetted private hospital. – Datuk Seri Dr Hilmi Yahaya, former Deputy Health Minister^[8]

In recent court cases, such as the landmark example involving Acacia Diana, her stalker underwent a psychiatric assessment at HBUK. 

According to the Mental Health Act 2002, only psychiatric hospitals are authorised to admit and detain individuals under specific sections of the Criminal Procedure Code (CPC). Those admitted are placed in a forensic ward for further evaluation and care.

However, institutionalisation is now reserved for more severe cases, typically involving patients assessed to be at stage 3 or beyond, who require long-term monitoring. 

At HBUK, patients are accommodated in three distinct settings: full-time supervision, semi-supervised care, and independent living environments.

There are also patients who have recovered (still needing medication), but because their families are not around or unable to care for them, we have to take in such patients… they can work and lead a normal life. Among the mental illnesses suffered by patients here are Schizophrenia, Bipolar, and Depression. – Dr Rabaiah Mohd Salleh, Director and Consultant Forensic Psychiatrist of Hospital Bahagia Ulu Kinta^[9]

Increasing Outpatient Care to Tackle the Mental Health Crisis

A notable trend at HBUK is the growing preference for outpatient treatment, allowing patients to receive consultations and therapies while staying within their communities. 

Similarly, Hospital Sentosa in Kuching experienced a significant increase in outpatient visits, rising from 14,698 in 2018 to 16,216 in 2019^[10]. 

One person profoundly affected by this shift was Zaleha*, a school teacher who had been in her role for over three years. 

Zaleha* began struggling with insomnia and a lack of motivation to attend work, along with frequent headaches. After taking six months of unpaid leave, a medical officer referred her to HBUK, where she revealed that she was hearing discouraging voices, which had made it difficult for her to continue working. 

With the help of counselling and appropriate medication, these voices stopped, enabling her to move forward in her recovery.

I always remind visitors who come to this hospital that if they notice any unusual behaviour or sudden changes among family members, relatives, or friends, they should quickly refer them to a psychiatrist. I informed them that we can accept patients as outpatients because not everyone needs to be admitted to the hospital. – Dr Rabaiah Mohd Salleh, Director and Consultant Forensic Psychiatrist of Hospital Bahagia Ulu Kinta^[9]

Outpatient cases of psychosis, depression, and anxiety are on the rise, especially among children and adolescents, many of whom also struggle with neurodevelopmental disorders such as autism and ADHD. 

Meanwhile, hospital admissions are primarily due to psychosis, drug-related issues, and emotional disorders, though recent trends show a decline in these categories^[5].

At HBUK, patient care is rooted in extraordinary compassion, with staff treating individuals as they would their own family members. This ethos is deeply ingrained across all levels of the hospital. 

Shairy Abdul Aziz, a retired Medical Assistant at HBUK, underscores the importance of treating patients as equals. 

He notes that patients’ experiences and perceptions differ from the general population, making their behaviour unpredictable—ranging from silence to aggression. The ability to adapt and think quickly is a key aspect of working in such an environment.

I have to be good at persuading them… If someone gets aggressive, I will calm them down gently. The only taboo here is raising your voice… We must accommodate their wishes as much as possible, and if not possible, we have to persuade them to understand. – Shairy Abdul Aziz, a retired Medical Assistant at HBUK^[9]

Patients With Mental Health Problems Can Live Fulfilling Lives 

Former Assistant Medical Officer Zulkiflee Hussain aims to challenge the societal stigma that labels mental health patients as dangerous, uncontrollable, and troublesome. He shared that the perception often stems from untreated patients in the community, but it doesn’t reflect the reality at HBUK. Patients who have undergone treatment and recovered can socialise and interact just like anyone else^[9].

Like many non-communicable diseases, severe mental health disorders cannot be permanently cured. However, with the right medication and attentive care, they can be effectively managed, allowing patients to return to their families or reintegrate into society once their psychiatric assessments indicate stability. A crucial part of this rehabilitation process is job placement programs.

The community should understand that mental illnesses can be treated but not cured. For example, in diabetes where symptoms disappear when taking medication, but return if the medication is stopped. Most mental illnesses cannot be cured unless early treatment is sought… early intervention can lead to recovery. – Dr Rabaiah Mohd Salleh, Director and Consultant Forensic Psychiatrist of Hospital Bahagia Ulu Kinta^[9]

For example, HBUK introduced employment initiatives in the 1990s to help patients re-enter the workforce. 

Today, 48 patients from the male forensic mental health ward actively participate in the program, while others benefit from a variety of in-house training initiatives^[11].

In the past, we received feedback that they were struggling to be accepted back into society, with many claiming that they were shunned by their families.  That’s when we realised we had to do more for them. – Dr Norhayati Nordin, HBUK director^[11]

At Hospital Sentosa, residents like Jen Pin* are given opportunities through programs such as Peers’ Bakers, a peer specialist initiative that offers baking training^[11].

Jen Pin* began experiencing symptoms of mental illness at 14, developing persistent beliefs that his classmates were gossiping about him, which led to feelings of paranoia and mistrust. 

These perceptions eventually extended to his teachers and family members, causing social withdrawal, depression, and mood swings. However, with consistent treatment and medication, Jen Pin has made significant strides in managing his condition.

As for me, being selected to attend the bakery course has given me more self-confidence. I hope more of the other Hospital Sentosa clients or patients can also be given the chance to attend any programmes suitable for them. – Jen Pin*, Hospital Sentosa resident^[12]

For some, their entire adult lives are spent within the confines of these hospitals.

In some cases, despite a satisfactory assessment, these patients have no surviving next of kin to return to.

Breaking The Stigma And Championing Better Mental Health

The four psychiatric hospitals have outgrown their original architectural designs, each built to meet the needs of its time. HBUK, the oldest, has stood for over a century, while Hospital Mesra, the newest at around 43 years old, was operating at full capacity by 2018. 

This rising demand underscores the urgent need for a new hospital to be built on the East Coast of Sabah.

The current hospitals are insufficient, thus they have to accommodate more than double the number of mental health patients than their actual capacity allows. – Norazlinah Arif, Former Deputy Minister of Health and People’s Welfare^[14]

Established in 1957, Hospital Sentosa has seen better days. Dr Lau Kim Kah, its former director, emphasised the urgent need to upgrade the hospital’s facilities to meet modern standards.

The facilities were built in 1957 to cater for the needs of that era, as we progress we need to upgrade our facilities to better serve those who need mental health care services. – Dr Lau Kim Kah, former director of Hospital Sentosa^[15]

What remains more difficult to change, however, is the stigma and negative perceptions the public holds toward these institutions and those admitted to them, like Jin Peng*.

I knew everyone thought Hospital Sentosa was a place for mental patients. So when I was made to stay there, I really felt very down because I was afraid of how people would view me. I also dreaded thinking of how my friends and relatives would look at me. – Jen Pin*, Hospital Sentosa resident^[12]

Changing the names of the hospitals and giving the old establishments a new lick of paint might inject a dose of positivity. However, altering deep-seated societal perceptions is far more challenging.

Patients can recover, but changing societal stigma takes a long time. – Zulkiflee Hussain, former medical assistant^[9]

Beyond their physical structures and the notorious status they hold among those familiar with their histories, the four historic psychiatric hospitals serve as reminders of the evolution of mental healthcare in Malaysia. 

Despite their ageing façades, the care they provide to the community continues to modernize, and they play an active role in reshaping attitudes toward mental health. 

Perhaps it is our responsibility as the Malaysian public to normalise mental health issues and speak openly about them. If treatment is needed, we should encourage individuals to seek help without fear of stigma, fostering an environment where mental health is viewed with the same importance as physical health.

*Not their real names as names have been modified to protect their privacy and identity. not real names 

Explore our sources:

1. Povera, A. (2019). Cosy town – Harmony and duty in Tanjung Rambutan. New Straits Times. Link
2. Deva, M.P. (2005). Psychiatry and mental health in Malaysia. Int Psychiatry. 2005 Apr; 2(8): 14–16. Link 
3. Raaj, S., Navanathan, S., Tharmaselan, M and Lally, J. (2021). Mental disorders in Malaysia: an increase in lifetime prevalence. BJPsych Int. 2021 Nov; 18(4): 97–99. Link
4. Muthiah, W. (2024). Keep mental healthcare up to date. The Star. Link 
5. The Star. (2024). Modern outlook for Hospital Bahagia Ulu Kinta. Link 
6. Tang, R. (n.d.). How Are Patients Treated In Tanjung Rambutan? I Went To See For Myself. SAYS. Link  
7. RELATE. (n.d.) MENTAL HEALTH LAWS & GUIDELINES. Link 
8. The Sun. (2018). Four mental institutions, 33 government hospitals provide psychiatric facilities. Link 
9. Mohd Ali, A.J. (2015). Pesakit mental boleh sembuh jika dapat rawatan awal. Berita Harian. Link 
10. Sinar Harian. (2020). Pesakit mental di Hospital Sentosa Sarawak meningkat. Link 
11. Baha, Intan. (2017). Getting a second chance at life. New Straits Times. Link 
12. Heng, E.S. (2018). A second chance to get back on their feet. The Borneo Post. Link 
13. Mohamed Nor. (2023). ‘Ada yang sudah sihat, tapi tiada keluarga di luar sana’. KOSMO. Link 
14. Anuar, A. (2018). Sabah perlukan hospital penjagaan mental baharu. Utusan Borneo Online. Link
15. Lim, C., & Sibon, P. (2015). Struggling to meet demands. The Borneo Post. Link