The World Health Organisation (WHO) constitution states that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
Health is wealth, and without mental health, there is no health, as WHO pointed out. While it may not be as widely discussed as physical ailments, the struggle is real.
In particular, the WHO reported last year that depression was increasing worldwide, with more than 300 million people now living with depression, suggesting an increase of more than 18% between 2005 and 2015. Alarmingly, it was also the leading cause of ill health and disability worldwide.
Seeking professional help
Anyone can suffer mental health issues at any point in their life. Suffice to say, just as it is important to take care of our physical health, it is important to invest in our mental health. Leaving aside the stigma of contending with mental health issues, the prohibitive cost could exacerbate a patient’s dilemma.
Even if you have been diligently paying your health insurance premiums, they do not cover the cost of psychiatric services should you require them, observes Lim Su Lin, a policy analyst with Penang Institute in Kuala Lumpur who studies the Malaysian mental healthcare system.
This includes the cost of purchasing medication, consultations with a medical specialist such as a psychiatrist, and psychological therapy sessions.
Lim adds that charges vary widely, depending on the provider and the type of service needed. “In most private centres offering psychological services, rates for a single psychotherapy session with a psychologist can range anywhere from RM250 to RM800, and these figures merely represent the cost for one type of treatment.
“Patients with illnesses that require medication will incur even higher costs, since they need to pay for separate consultation visits to a psychiatrist and make purchases for drugs,” she wrote in an online media platform.
One way to circumvent the high cost is to opt for e-counselling. Dr Khairi Rahman, a psychologist at Pantai Hospital Kuala Lumpur who is available on online healthcare-related platform Teleme, points out that compared with traditional counselling, e-counselling can be more affordable, as it doesn’t require the mental health professional to rent a commercial space and incur overhead or administration costs for face-to-face counselling, he says.
Teleme is an online platform that allows users to access doctors via video consultation, and have their medication delivered to them.
Patients are able to do online consultation either through messaging, voice call or video call from the privacy of their home without having to confront the stigma of having mental health issues. It also breaks down the geographical barrier for those who live far away from mental health professionals.
Teleme points out that it’s up to their practitioner to set the consultation charges. For consultation via video call, the charges range from RM10 to RM200, although some practitioners do not impose a fee. Normally, it would take around 15 minutes for a video call, but consultation can still continue if both parties need more time.
Meanwhile, for chat messenger with a specialist, the standard price is RM20, although the specialist can also waive the fee. The chat is unlimited for seven days, and either party can end the chat once issues are resolved.
These charges, however, do not encompass medical prescription and health lab screening, which will be prescribed by doctors.
While more accessible and affordable, Dr Khairi stresses that Teleme’s platform does not replace physical consultation and examination. Rather, it offers healthcare professionals another means to engage and help their patients in good health and illness.
Dr Khairi believes that whether or not e-counselling is better for patients will depend on a case-to-case basis. He points out that an extensive study conducted by the Berkeley Well-Being Institute suggested that e-counselling is a viable alternative to face-to-face counselling based on the BetterHelp case study, which is one of the largest e-counselling platforms worldwide.
Acknowledging that there may be limitations on gauging a patient’s voice tone, facial expression, body language and eye contact when it comes to online consultation, Dr Khairi says meeting patients face-to-face for thorough examination or observation at the clinic can be arranged by the mental health professionals where necessary.
Opting for public healthcare
Associate Professor Dr Muhammad Muhsin Ahmad Zahari, a consultant from Universiti Malaya’s Department of Psychological Medicine, Faculty of Medicine, says it generally costs RM15 to see a specialist in a government hospital.
Many of us are only doing what’s required to survive, we are not taking care of our emotional state, says Dr Muhammad Muhsin
Medication, however, usually costs more than the consultation fee. For instance, it can cost RM100 to more than RM300 for one month’s supply of anti-depressant medicine, and about RM400-500 for antipsychotic – a medication required by those with auditory hallucination and irrational belief.
Compared with the conventional platform, Dr Muhammad Muhsin agrees that the online platform enhances the accessibility of mental healthcare providers. “It’s good for screening purpose – if a patient needs to talk to someone, the online platform makes getting help more accessible. It is better than having patients think: ‘I don’t want to see a psychiatrist and I don’t need help.’ You can do screening – if the results turn out to be positive, you can go and seek help,” he says.
An online platform, he adds, is helpful in picking up patients with a lower level of mental health disturbances, which may encourage patients to see a doctor for the next level of medical help.
“In their next interview, the healthcare provider will get a very thorough picture of the patient, such as taking into consideration the circumstances the patient is living in, his financial status, the nature of his job, sensitive information like whether someone is taking drugs (to cope), which they may not reveal when talking online,” he adds.
As to the time it takes to treat mental illnesses, it varies based on the complexity. “If it’s transient by nature, it takes six months to one year. For example, if you have a clear-cut problem, such as a relationship problem with your spouse and family, once the issue is resolved, you follow up with medication for six months to one year,” he explains. At the other extreme, if your mental illness is related to genetics, it requires lifelong treatment, he says.
Maintain a healthy lifestyle
Assuming one has not reached a critical stage, there are more cost-effective (and arguably more pleasurable) ways to maintain your mental wellbeing on a day-to-day basis.
Our interviewees generally agree that these can be as simple as talking to good friends, reading self-help books, taking a break, travelling and going for meditation classes.
“People can try different ways to see what works for them. It can be as simple as spending five minutes with their pets, or taking a short walk around the park,” says Dr Ng Siew Li, psychology lecturer at HELP University Sdn Bhd.
Just as adequate sleep, regular exercise and a healthy diet is important to our physical health, mental health would benefit from the same care, too, says Dr Ng. “For example, there are research studies that found that when people exercise, they are more likely to have better mental health. Physical and mental health typically go hand in hand.
Physical and mental health typically go hand in hand, says Dr Ng
“In addition, spending some time on ourselves and doing things that we enjoy are also important. For instance, it can be in the form of sports, reading, or doing a relaxing spa. Having enough rest each day would be good,” she says.
Universiti Malaya’s Dr Muhammad Muhsin concurs that investing in a healthy lifestyle is good for one’s mental health. “Mental health is how you live your life,” he sums up.
“Research says physical illness gives you low quality mental health (by impairing the quality of your life), compared with those with no physical health issues – they are interlinked. Mental health takes into account many factors.”
Build up good memories
Not surprisingly, quality sleep, which is at the core of a healthy lifestyle, has a bearing on your mental wellbeing. Dr Muhammad Muhsin advises that to cultivate sleep hygiene, one should not exercise too close to sleeping time, or take caffeinated drink before night time, or do work on the bed or play with your smartphone as the bright light of gadgets disrupts melatonin, a hormone that regulates sleep.
It also helps to apply positive psychology. “For instance, you should train yourself to build up good memories. These include sharing good moments on your social media and in real life, self-congratulating yourself when you do something good – doing so will at least build up a buffer to make you more resilient towards negative emotions, and makes it harder for you to develop mental health issues,” Dr Muhammad Muhsin says.
Practising mindfulness is also beneficial. “Some people may think about tomorrow, the day after tomorrow or look too far into the future – you are only creating more worries for yourself. To achieve your goal, yes, you should have a plan and work within the time frame – for example, if you want to have RM1 mil but you only have RM10,000 now, look at what resources you have, your qualifications and current situation.
“It’s not like you don’t think or do anything about it. About 60-70% of your thinking will shape your present, and your present affects your future. If you want to know your future one year from now, taking the right actions within the next 12 months will keep things in order,” he says, adding that nurturing a good relationship with one’s family and friends is also imperative to one’s mental wellbeing.
It also works wonders for your mental health to engage in hobbies. “The keyword is to do more of what gives you pleasure. Some people go for music therapy as they like to relieve their stress through karaoke.
“Some go for pet therapy – where they learn to calm down by playing with their pets. Many of us are too busy – we are only doing what’s required of us to survive, we are not taking care of our emotional state. We focus on what we need to do, not what we like to do. We should have a balance,” says Dr Muhammad Muhsin.
Maintaining good ties with family and friends is crucial to one’s mental health – 123RF
Mental health and you
What are the signs that say a person needs the help of a mental health professional? After all, it is only human nature to feel unhappy, anxious or depressed sometimes.
Dr Khairi says common signs and symptoms, like heightened irrational behaviour, require the help of a mental health professional
Dr Khairi Rahman, a psychologist at Pantai Hospital Kuala Lumpur, acknowledges this but points out much of those experiences should be temporary in nature, and are often associated with certain causal or definitive factors.
“Once those causal factors have been identified and addressed appropriately, this temporary negative mental state of health would fade away,” he says.
This, however, may not be the case with prolonged unhappiness or being in a depressed state where there are no apparent reasons or external factors causing one to be in such a state of mind, he observes.
Dr Khairi points out some common signs and symptoms that require the help of a mental health professional. They include heightened irrational behaviour, such as increased drinking, smoking or sleeping a lot more than usual, inability to focus well at work or even carrying out simple tasks, crying for no apparent reason, prolonged loss of appetite, shying away from friends and others, and not enjoying the activities they used to love.
HELP University psychology lecturer Dr Ng Siew Li says based on her experience, people seek mental health services for various reasons – stress or time management issues, anger or relationship issues, depression, anxiety and beyond.
“Sometimes, people who seek the services may not necessarily present with obvious signs. For instance, you may not see obvious signs if someone has a depressed mood because he may appear to function as usual.
“In general, prolonged changes in one’s mood or behaviour, such as being unusually aggressive or isolated, that result in significant distress or dysfunction like missing work or frequent arguments with others may be possible signs,” Dr Ng says. She adds it also depends on the duration, frequency, and intensity of those changes in mood or behaviour as well.
Who to ask for help
Mental health professionals come in various forms. Assuming you have established the need to seek help, should you choose a counsellor, therapist, psychologist or psychiatrist?
Dr Ng points out that people in different helping professions have slightly different functions, and the way they treat patients is also different. “For example, although counsellors and clinical psychologists both provide psychotherapy, clinical psychologists are also trained to do assessments and testing. For example, we (clinical psychologists) do testing to assess for attention deficit hyperactivity disorder (ADHD), learning difficulties and giftedness, among others.”
Dr Khairi adds that this would depend on the background of a patient’s case. According to him, the majority of other mental health cases may benefit from the help of psychologists, therapists, counsellors or even experienced pastors, and they are fairly dependent on the nature and background of the cases.
Meanwhile, most cases that fall under the scope of mental illness benefit from psychiatric intervention, he says.
Dr Ng adds that psychiatrists are medical doctors who have specialised training in treating people with mental health concerns. “In Malaysia, psychiatrists typically prescribe medication when treating patients. Counsellors or clinical psychologists cannot prescribe medication; they typically provide psychotherapy,” she says.