Psychiatric & Mental Health

Services, Malaysia
Prof Dr Mohd Raili Suhaili
MED47212

Faculty of Medicine, Sibu Clinical Campus,SEGi University. All rights reserved.

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 Historical aspects
• The first ‘lunatic asylum’ in small scale at the Penang
Hospital in the north of Peninsular Malaysia in the late
1890s
• 1910, there were records of a psychiatric hospital in the
Taiping Hospital
• Federal Lunatic Asylum near Tanjong Rambutan, Perak
was established in 1911 with 280 beds.
• In 1935, the Permai Hospital in Johor was built to cater
for the needs of the people in the south of the country
• Sabah and Sarawak, two such hospitals were
established in the 1920s

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 Prevalence of mental illness in
Malaysia
1. Adult (16 years and above)
– 0.7% (0.3 million) have Generalised Anxiety Disorders
– 1.8% (0.3 million) have current depression
– 1.7% (0.3 million) have suicidal ideation
– 1.1% (0.2 million) reported to have attempted suicide in the past
2. Children (5 - <16 years)
– 20.0% (1.0 million) have mental health problems such as
developmental disability, emotional and behavioural disorders.
(NHMS 2011)
3. 5% prevalence of Common Mental Disorders in the
Malaysian population (Saroja Krishnaswamy et al,2011)

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 Definitions of Mental Health
1. World Health Organisation (WHO) (2001:
5) defines mental health as “a state of
well-being in which the individual realises
his or her own abilities, can cope with the
normal stresses of life, can work
productively and fruitfully, and is able to
make a contribution to his or her
community”.

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 Definitions of Mental Health
• MOH Malaysia defined mental health as
“the capacity of the individual, the group
and environment to interact with one
another to promote subjective well-being
and optimal functioning, and the use of
cognitive, affective and relational abilities,
towards the achievement of individual and
collective goals consistent with justice”. .
(National Mental Health Policy 2001)
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 Vision for Mental Health Malaysia

• The vision for mental health services in

Malaysia is to create a psychologically
healthy and balanced society which
emphasizes on promotion of mental health
and prevention of psychological problems

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 National Mental Health Policy (NMHP
1988)
1. Provides policy guidelines in mental
health issues
2. Areas covered by the policy are
accessibility and equity in services,
comprehensiveness, continuity and
integration, multi-sector collaboration,
community participation, human resource
and training, standards and monitoring,
research, legislation,and reviews.
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 Objectives of
1. To provide a basis in developing strategies and
direction to those involved in any planning and
implementation towards improving mental health
and well being of entire population.
2. To improve mental health services for population
at risks of developing psychosocial problems.
3. To improve the psychiatric services for the
mentally disordered in the provision of care and
protection by the family, community and relevant
agencies.
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 Objectives of MHS
1. Comprehensive, effective and efficient services,
including outpatient, inpatients, community outreach
services, special services looking into child and
adolescents, elderly, co-morbidity with substance use,
etc.
2. Integrated psychiatric services in mainstream general
health care and continuous services from health clinics
to a hospital and vice versa.
3. Promotion of Mental Health Services for the general
population and specific target groups.

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 Objectives of MHS
4. Multi-sectoral collaboration & opportunity for community
participation.
5. Training for all levels of human resources.
6. Monitoring of standards by key performance indicators,
NIA, credentialing and privileging special procedures e.g.
electroconvulsive therapy.
7. Research (service-oriented, clinical trials, quality
assurance) and evidence based medicine (Clinical
Practice Guidelines, etc.).
8. Services which comply with legislation (Mental Health Act
2001), respecting human rights of people with mental
illness.
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Three models of Malaysian mental health services

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 Scope of Services
1. Primary care
– Promotion of mental health
– Early detection and prompt treatment
– Follow-up of stable cases and defaulter tracing
– Psychosocial rehabilitation (PSR)

2. Hospital with no resident psychiatrist

– Promotion of mental health
– Early detection and prompt treatment
– Follow-up of psychiatric patients and defaulter tracing
– Inpatient care (Optional)

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 Scope of Services
3. Hospital with resident psychiatrist
– Promotion of mental health
– Early detection and prompt treatment
– Specialist outpatient care
– Inpatient care
– Hospital-based community psychiatry
– Psychosocial interventions
– Liaison consultation services
– Subspecialised services e.g. child and adolescent
psychiatry,geriatric psychiatry, etc. (optional)
– Research
– Training
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 Scope of Services
5. Mental institution
– Promotion of mental health
– Early detection and prompt treatment
– Specialist outpatient care
– Inpatient care
– Hospital-based community psychiatry
– Psychosocial interventions
– Forensic psychiatry
– Residential care for hard to place patients and long
stay patients
– Research
– Training
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 Components of Psychiatric Services.
MOH Malaysia
1. Outpatient services
2. Inpatient services
3. Child and adolescent psychiatry
4. Hospital-based community psychiatry
5. Addiction psychiatry
6. Geriatric psychiatry
7. Forensic psychiatry
8. Neuropsychiatry
9. Psychiatric hospitals
10.Psychiatric nursing homes
11.Community mental health centres
12.Clinical psychology
13.Rehabilitation and recovery-oriented services
14.Training and research
15.Promotion of mental health

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 Outpatients services
1. Objectives
i. To provide easily accessible psychiatric outpatient
service.
ii. To improve with early detection and early treatment.
iii. To ensure that all new cases are appropriately assessed
by specialist to determine underlying illness and initiate
biopsychosocial treatment.
iv. To provide continuing treatment for those who require
longer term follow up.
v. To provide psychosocial interventions including
counseling, psychotherapies, patient and family education

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 Outpatients services
2. Functions
i. Triage for all referrals as per agreed format: urgent cases seen immediately and
non urgent cases will be given appointment.
ii. All new cases must be consulted with specialists at least once.
iii. Follow up: Medical officers can review patients and continue medication.
Change of medication should preferably be discussed with specialist in charge.
iv. Depot clinics: For stable patients who require continued medication especially
those on regular depot injections.
v. Defaulter tracing: Every patient who has missed one follow-up will be contacted
as early as possible to arrange for earliest possible outpatient visit.
vi. Initiating early and prompt outpatient treatment: Accurate diagnosis early
ensures correct treatment.
vii. Counseling and psychotherapies when needed: Most psychiatric treatment must
also include elements of counseling or psychotherapy.
viii. Audit of case notes by specialists on patients managed by

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 Inpatients
Types
1. High dependency Care
2. Acute care
3. Convalescent care
4. Rehabilitation

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 Common reasons for inpatient
treatment:
1. severe depression
2. serious suicidal risk
3. severe psychotic states
4. severe anorexia nervosa

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 Mental Institutions, Malaysia
1. Hospital Bahagia, Tanjung Rambutan,
2. Hospital Permai, Tampoi, Johor
3. Hospital Mesra Bukit Padang, Kota
Kinabalu, Sabah
4. Hospital Sentosa, Kuching

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 Hospital Based Community Psychiatry
Services
• Defaulter tracing- some patients default
• Home visits - to ensure medication adherence
• Assertive community treatment (ACT): some
patients have multiple relapses and each
relapse can be rather troublesome with
aggressive behavior and disruptions in lifestyle.
• Acute home care: some patients can be sent
home early after a brief period of hospitalization
if they have a good family support

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 Addiction Services
• Drug and alcohol related problem is a
common
• People living with mental illness are more
at risk for addiction to substances and
many substance abusers are at risk of
developing mental illness.

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 Addiction Services
Components:
1. Outpatient services.
2. Inpatient services.
3. Ward referrals (consultation-liaison).
4. Public program – MMT, NSEP etc.
5. Collaboration with primary care clinics,
community based addiction treatment or
rehabilitation services.
6. Training, research and quality improvement
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 Forensic psychiatry
• Patients/criminal admitted under Chapter
XIII of the Criminal Procedure Code i.e.
admissions under section 342, 344 or 348
• Only in approved Psychiatric hospitals
• A medical report will be given to the courts
as requested in the order (consent of the
patient is not necessary).

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 Psychiatric hospitals
• Refers to institution or the inpatient unit /
ward of a department of psychiatry in a
general hospital.
• The purpose of the hospital is for
admission, detention, lodging, care,
treatment, rehabilitation, control and
protection of persons who are mentally
disordered.

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THANK YOU

[email protected]

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