Improving children’s access to mental health services
(October 6): The World Health Organization (WHO) celebrates World Mental Health Day every year with a global campaign on October 10. Each year, the main message is clear: raise awareness about mental health and mobilize efforts to support people living with mental health difficulties.
This is absolutely necessary because awareness is needed to encourage help-seeking behaviors and therefore increase the likelihood that people will seek mental health services. However, alongside increased awareness, there must be a parallel increase in accessibility to services that cater to all segments of society. Unfortunately, some populations face challenges in receiving such services, with children and adolescents in particular being among the most neglected age groups globally.
Data obtained before the Covid-19 pandemic estimated the prevalence of mental health problems among adolescents at 13%. This translates to more than 165 million adolescents between the ages of 10 and 19. Suicide is the third leading cause of death among adolescents aged 15-19 in the East Asia and Pacific region. More than US$387.2 billion is lost in human capital each year as a result of mental health issues worldwide.
Locally, the 2019 National Health and Morbidity Survey paints an equally grim picture. More than 424,000 children lived with mental health problems; this represents 5.9% of children aged 5 to 9 and 9.5% of those aged 10 to 15. Although we do not yet have access to data regarding the mental health of children and adolescents following the Covid-19 pandemic, we expect the numbers to increase, given the multiple challenges children have faced in the past three years, including social isolation, domestic violence and child abuse, and socio-economic challenges.
The Ministry of Health has made significant progress in improving mental health care services in recent years. However, much of this progress has been geared towards benefiting adults rather than children and adolescents. The needs of children and young people are very different due to their constantly changing stages of development and therefore require special attention. Therefore, the lack of appropriate mental health and psychosocial support services for children and adolescents can have profound and lifelong consequences on their health, development and future opportunities. To improve mental health and psychosocial well-being, interventions must involve multiple sectors beyond health alone, including education, labour, justice, transport, environment, housing and development. welfare.
Here we suggest some steps that can be taken to improve the mental health of our children and adolescents.
First, to significantly improve access to care. A strong mental health workforce is a key component of mental health and psychosocial support systems, especially for children and adolescents. This includes a multidisciplinary team of professionals that includes child and adolescent psychiatrists, psychologists, therapists, teachers, counselors, social workers and others. However, there are three main flaws in our current workforce: scarcity, inequality and inefficiency.
In 2016, Malaysia had a total of 319 medical social workers, while in October 2022 there were only 25 child and adolescent psychiatrists registered in the national specialist register. These figures are insufficient. Without enough mental health professionals, we will not have enough human resources to meet the mental health treatment needs of our population. We can aspire to achieve levels of access and availability of mental health care like those in Canada, which has 145 social workers working in the mental health sector per 100,000 population.
To achieve this, strategies for strengthening the mental health workforce will require, at a minimum, allocating adequate budgets to mental health and psychosocial well-being, investing in the recruitment and training of mental health personnel to eliminate mental disorders.
In addition to responsive health care workers, promotion and prevention efforts should not be neglected. Malaysia has a plethora of non-governmental organizations working together to form the National Coalition for Mental Wellbeing (NCOMW). This coalition focuses on addressing mental health stigma and discrimination, preventing suicide, and providing free online counseling services at the community level. Adequate support should be provided to those organizations providing complementary care to the public health system, thereby reducing the burden on the taxpayer-funded public health system. These measures will help identify children in need of assistance and provide early interventions, leading to better outcomes later in life.
Second, strengthen legal frameworks to protect the rights of children with mental disorders. Currently, the Mental Health Act provides the framework for the care, treatment, protection and rehabilitation of people living with mental health problems. It includes the protection of rights regarding physical restraint, deprivation of liberty and involuntary treatment.
This is due to the current lack of specific protection for children and adolescents, in particular on the right to make decisions about mental health care and recovery to the greatest extent possible taking into account the best interests superior of the child or young person, the prohibition of corporal punishment and the appointment of a personal representative other than a family member.
In addition, there are legislative barriers to accessing mental health services and psychosocial support, as parental consent is required. According to the Mental Health Act 2002, a guardian must give consent to admission of a minor to a psychiatric hospital (section 9) and must give consent to surgery of a minor (section 77) . Article 2 defines a “guardian” as a person having legal custody of the minor (a person under the age of 18).
Thus, to enable children to access such assistance, key stakeholders need to remove this barrier to facilitate accessibility.
Third, establish a strong implementation body and an independent oversight body. In reality, our current system of mental health and psychosocial support services is fragmented. There is a lack of coordination between the different sectors involved, each working in isolation. Therefore, the establishment of a multisectoral national steering committee for child and adolescent mental health is crucial.
This committee could strengthen nationally standardized protocols for early identification and screening tools and strengthen referral mechanisms within and across sectors to ensure continuity of case management. Stakeholders involved in this committee must be transparent and inclusive. The involvement of youth representatives is essential in the committee to ensure that their voices and needs are conveyed to policy makers and the implementing body. This will enable a coordinated and impactful effort to improve the mental health of children and adolescents in Malaysia.
An independent review body will assess the quality, compliance and accountability of the benchmark. This expanded inter-agency collaboration will help monitor and evaluate the implementation, outcomes and impact of mental health programs, including improving data and information sharing.
The theme for World Mental Health Day this year is to make mental health and well-being for all a truly global priority. For this, our children must not be forgotten in our initiatives. This, however, is not a task that can be accomplished overnight; all stakeholders involved must work together to ensure that our children can grow up and have a fair chance at life. As the saying goes, it takes a whole village to raise a child. This cannot be done without the leadership and commitment of all parties.