The Cost Of Inaction When It Comes To Mental Health

The World Health Organisation (WHO) raised an alarm on the seriousness of the hidden pandemic and called for increased investment in preventative measures associated with mental health illness.

Globally, suicide is the second-leading cause of death among youth aged between 15-29 years old. Governments around the world had only spent 2% of their health budget on mental health^[1].

A similar pattern and lackadaisical inaction mirror Malaysia’s stance on the importance of investing in mental health. The recent Malaysia’s Budget 2021 saw spending being slashed on psychiatry and mental health services in the Health Ministry.

Compared to an expenditure of RM344 million in 2020, the current budget is RM313 million, a decrease of 9.1% (RM 31 million). The amount is the lowest since 2017 and the sharpest cut on psychiatry and mental health services over the last decade^[2].

The cut is untimely as the pandemic had only aggravated the hidden killer in our society and 266 cases of suicides and deaths were recorded in 2020^[3]. A total of 465 suicide attempts received treatment in government hospitals between January to June 2020^[4].

What the country needs is an injection of funds for mental health services. There is an increasing and urgent need for focused intervention. The numbers don’t lie.

The ministry’s mental health and psychological support services (MHPSS) recorded that 122,328 people have dialled in for help and 89.4% of callers are experiencing psychological repercussions of various social problems due to the prolonged pandemic situation^[5].

There has been a significant increase in the use of emotional support hotline services. In 2020, 40% of callers between January and July expressed suicidal thoughts, compared to 34% in 2019. – Dr. Chua Sook Ning, Relate founder^[4]

This inaction or slow intervention is not just grievous for those who are supporting family members with mental health issues, it is also costing the nation a lot.

Based on Relate’s 2021 report, if an estimate of 382 young men and 141 young women end their lives through suicide – a loss of RM346.2 million alone will be recorded, more than the money invested in mental healthcare^[6].

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People are a nation’s capital and investing in their growth is a profitable one. If more spending is allocated on tackling mental health issues between now and 2030, there would be at least 60 million fewer cases of anxiety, depression and epilepsy. And 200,000 deaths could have been avoided globally^[1].

The Cost Of Lives Lost Is Detrimental To A Naton’s Growth

Mental illness is a heavy burden on a country’s gross domestic product (GDP). Referring to the life cycle, at the age range of 15-29 years old, it is the time when society expects a return of their investment of rearing a child after the hefty capital placed on educating them. Incidentally, the onset of mental illnesses is also often during this fragile stage in life.

While it may be easy to overlook the invisible mental health aspect of this pandemic, this unseen crisis may not only worsen the Covid-19, but also may be even more catastrophic to our country’s well being and productivity in the long term.– The Pakatan Harapan Health Committee^[7]

Suffering from mental illnesses is dire at the crux of adulthood escalates into loss of workforce participation and a lifetime of lost earnings as the youth will eventually leave education abruptly. The afflicted youth would lose a significant amount of their lives in therapy and rely on medication rather than earning qualifications and a set of skills that would benefit the nation’s future.

The loss of workforce participation should not be taken lightly, as the ageing population growth would surpass the youth when Malaysia is set to become a super-aged nation by 2060^[8] – similar to that of Japan and South Korea where senior citizens make up a majority of the population. With a shrinking youth population, the nation’s economic development may also experience a stagnation – with fewer innovations, lesser spending and more reliance on social protection for senior citizens.

Mental Health Issues Quantified At The Workplace

The transition from dependent childhood to independent adulthood is a stressful event. To one who is recovering from mental health illness, it is a possible trigger.

According to a report by RELATE, the cost of mental health issues in the workplace to the economy is estimated to be RM14.46 billion or 1% of GDP in 2018. This cost is derived from three aspects in the workplace:

Absenteeism due to mental health issues (RM3.28 billion, 0.23%)
Presenteeism when staff are at work despite their mental health issues (RM9.84 billion, 0.68%)
Staff turnover because of mental health issues (RM1.34 billion, 0.09%)^[9]

“The health and safety of all workers needs to be at the forefront for all employers and there is a duty of care to ensure their workforce receives the necessary support. This is even more important when large parts of the workforce have been working remotely and may not have been in such close contact with colleagues or managers.” Sandra Henke, Group Head of People & Culture at Hays^[10]

Not only is productivity reduced due to the lower headcount, but it can also be lost due to presenteeism. In Malaysia, it was found that the number of days or productivity lost is 7 to 8.5 times higher as compared to absenteeism^[11]. What this translates to in terms of digits is an estimated loss of RM 9.84 billion in 2018. Having employees present at work despite suffering their mental health episodes did not improve productivity.

Workers’ desire to leave their jobs isn’t just because of the unsatisfactory wages. 51% had attributed poor workplace culture, 9% had a conflict with their supervisors and at least 25% do not feel valued at the current workplace^[12]. The cited reasons for departing from the current job are causally linked to poor mental health^[13].

Many employers out there are still ruled by the prevalent stigma that mental health is an opportunity for employees to fake illness. The lack of mental health illiteracy persists in the offices and the data is a strong indicator that something’s got to change.

Despite hundreds of millions of people around the world living with mental disorders, mental health has remained in the shadows. This is not just a public health issue — it’s a development issue. We need to act now because the lost productivity is something the global economy simply cannot afford. – Jim Yong Kim, President of the World Bank Group^[14]

The Need For Mental Health Intervention Is Now

There is a disconnect between the increasing awareness amongst the public and at the systemic level. Our grassroots advocacy has been brilliant in starting the conversation on mental health care which brought about the rising awareness amongst the public nationwide.

But is the same sentiment shared by the senior level in the nation?

Despite the rising alertness on mental health issues and the push for many who suffer to seek help, mental health literacy in Malaysia remains low amongst our B40 youth.

Secondary and university students from B40 households recorded an average score of 24% on a depression literacy test indicating that psycho-education efforts thus far require strengthening. A more informed society would improve help-seeking attitudes when it comes to mental health issues^[15].

Not just that, the accessibility to mental health services requires further improvement, in particular to underprivileged families in remote areas.

The community and relevant bodies should work together to increase mental health awareness and improve access to mental health services through free workshops with the B40 group and establishing more affordable mental health services. – Lum Khay Xian, Relate Malaysia clinical psychologist^[16]

At the same time, enterprises should look into fortifying their employees’ mental health as it has a relationship to employees’ productivity. Mental health is an invisible illness that is non-communicable yet just as deadly.

Perhaps, it hasn’t been taken seriously by many as we adopt a “seeing is believing” mindset and health is often something that could be observed through physical markers in workplaces. Many in society are hesitant to seek treatment or further intervention due to the stigma it carries, and a workplace must foster an environment that is aware and supportive of those with a history of mental health illness especially with remote working circumstances.
The solution to this problem at the systemic level is simple, to address the grave situation – we need to invest smarter in people as they are the movers of the country’s economy. It is slowly shifting with the call to decriminalise suicide is in motion which would enhance help-seeking behaviour.

Section 309 of the Penal Code, which makes attempted suicide a crime must be repealed as well as charges against those who have survived suicide attempts be dropped. This is important to make sure survivors are given the necessary treatment and support rather than be treated as criminals. They will then be more willing to come forward for treatment and the stigma associated with mental illness will be addressed more holistically. – The Pakatan Harapan Health Committee^[7]

However, change also comes from each one of us and each individual in society needs to play a part by fortifying our mental health literacy through a few notable organisations out there:

Professional mental health services are available and at a more affordable rate these days. We have also compiled a list of free and affordable mental health services in Malaysia if you or your loved ones should need it.

This article was first published on Wiki Impact. To read more environment/impact related articles and/or inspirational stories of changemakers, real life stories, please visit Wiki Impact.

This article is also available in Chinese and Malay.