Introduction

Recently, there has a been a lot of focus on mental health. As our country progresses from a developing to developed status, mental health disorders is becoming more rampant and the number is increasing by year. The past decade had shown a significant increase in the numbers of suicide and mental disorder which arises from poor mental health condition. Thus, it is important for Malaysians to be aware of mental health disorders, the importance of preserving good mental health and recognize the symptoms of mental health that may warrant intervention and treatment.

Facts:

The definition of health as a whole, does not only confine to physical health but also include mental health. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

In order to understand mental health problems, we need to understand first the concept of mental health. There is a huge difference between mental health and mental disorder. Therefore, we should not use it interchangeably. A normal individual may not have a good mental health all the time but is still able to perform his normal daily function unlike people with mental disorder. In general, mental health describes a level of cognitive or emotional well-being.

Definition of Mental Health:

There is no official or single definition of mental health. Cultural differences, subjective assessments, and professional theories all affect how “mental health” is defined. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In short, mental health is the foundation for individual well-being and the effective functioning of a community. Mental health is an expression of our emotions and signifies a successful adaptation to a range of demands and stressors. There is no clear line to divide the mentally healthy from the unhealthy. There are many degrees of mental health. There is no single criteria which can be taken as evidence of good mental health. There is no individual who has all the traits of good mental health all the time. This would largely depend on the individual factors, social and physical environment. Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. Poor mental health has been associated with poor socioeconomic status, rapid social change, stressful work condition and physical ill-health.

Mental disorder on the other hand, is a condition whereby one’s mental condition had cause impairment in his normal social and occupational functioning. Mental disorder is an illness.

Epidemiology:

The 3rd National Health Morbidity Survey (NMHS), which was carried out in 2006, provided some information on the state of mental health of adult population in Malaysia (aged 16 and above).This is based on a 28 item General Health Questionnaire which is universally used to screen the state of psychological wellbeing of a person.

Findings from the study were:

• Overall prevalence – 11.2% of adult population in Malaysia has some form of psychiatric morbidity, with the Chinese population experiencing the highest prevalence at 31.1%.
• Gender – more females than males have psychiatric problems, with 55% of them females and 45% males.
• Residence – psychiatric morbidity is higher among urban population than rural, 12.6% for urban population versus 8.5% for rural population.
• Education level – it is higher among those with no education or primary education, 15-16% versus 10% for those with tertiary education.
• Marital status – it is higher among the divorcees (13.6%); followed by singles (13.1%) widow/ widower (12.2%) and lastly those who are married (10.5%)
• Suicidal ideation – overall prevalence of acute suicidal ideas of 6.4% with the highest among teenagers and young adults, aged 16-24 at about 11%.
• Insomnia (inability to sleep) – overall acute insomnia of 14% with those aged 70-74 having the highest prevalence of slightly over 20%.

The findings above, is an indication on state of mental health of adult population in Malaysia at the time of survey. It also does not pinpoint to any specific mental disorder.

(Psychiatric Morbidity, a Report of the Third National Health and Morbidity Survey, 2006. Institute of Public Health, Ministry of Health Malaysia, 2008)

Sign and symptoms

The sign and symptoms of poor mental health may arise from physical, social and environmental stressor .It developed when one has difficulty to adapt or cope with stressor.It may effect physical helath and it is beyond control.This will eventually effect both physical and emotion of an individual. The three main domain affected are:

• Physiological :It may predispose or exacerbate physical illness such as cardiovascular disease and hypertension, causing headache and muscle ache.
• Behavioural: Work performance may be decline, prone to accidents, absenteeism from work, aggression and irritability, poor decisions and problem solving capabilities.
• Psychological : Dissatisfaction, moodiness, depression, emotional fatigue.The most common symptoms of poor mental health in general are irritability, difficulty to sleep, loss of appetite ,loss of weight, anxious, frequent palpitations and feeling demotivated.

Complications

If an individual is exposed to continous stressors or negative life events and has difficulty to cope, they might eventually develop mental disorder. The relationship between life events and mental disorder has been well documented. The risk is higher in those with predisposing factors such as family history of mental disorder, certain psychological and personality disorder, chemical imbalances in the brain and brain abnormalities.The individual may develop mental disorder such as Major Depressive disorder, Bipolar disorder and Schizophrenia.

Treatment

No treatment is required for poor mental health as it is not a disorder. However prevention steps are necessary to avoid the condition developing into mental disorder.

Preventions

For individual, among the steps in prevention are to improve coping strategies, strengthened social support and practising healthy life style.

On a bigger scale, the emphasize should be on Mental health promotion. Mental health promotion requires multi-sectoral action, involving a number of government sectors ,non-governmental and community-based organizations. The focus should be on promoting mental health throughout the lifespan to ensure a healthy start in life for children and to prevent mental disorders in adulthood and old age. The following programmes/activities may be beneficial:

• Early childhood interventions (e.g. home visits for pregnant women, nutritional and financial help for disadvantaged populations);
• Support to children and adolescent (e.g. child and youth development programmes);
• Socio-economic empowerment of women (e.g. improving access to education and microcredit schemes such as Industri Kecil and Sederhana (IKS), Amanah Ikhtiar Malaysia);
• Social support for elderly populations (e.g. community and day centres for the aged);
• Psycho-social programmes targeted at vulnerable groups, for example: people affected by conflicts and disasters( e.g : tsunami,floods)
• Mental health promotional activities in schools (e.g. coping skill and crisis intervention programmes);
• Mental health interventions at work (e.g. stress prevention programmes);
• Community development and support group programmes

Support Groups

• All Health clinic (Klinik Kesihatan) throughout Malaysia provide services to screen for mental health and mental disorders using specific questionnaire. Any individual who would like to seek assessment may do so. Early detection is essential.
• Malaysian Mental Health Association(MMHA)
• Malaysian Psychiatric Association (MPA)