KUALA LUMPUR: Anita Abu Bakar was flying high over a decade ago. Married with a loving husband, two children and a flourishing career as an investment banker and managing director of an investment firm, it seemed like as though she had it all.
Outwardly, it seemed she had ticked all the boxes for success but internally it was a different story.
"I had anxiety and panic attacks and mild depression. I was really unwell," she said.
In 2010, it all came to a head and she had a breakdown. During this time, she could not work or get out of bed and was dependent on her mother and husband. She also had suicidal thoughts.
"There were too many things happening so my body and brain just gave up. I then lost functionality of life and I couldn't take care of anyone," she said.
Anita told Bernama it was difficult to seek help before she had her breakdown. As the boss, she felt she had to hold herself together and present the best face possible. It left her feeling isolated, bereft and at a dead end.
"People at work knew I was not well but they did not know why or what it was. I felt ashamed, of course. Hence why we didn't talk about it," she said.
Thirteen years on and as the world prepares to mark World Mental Health Day on October 10, Anita and other advocates say mental health awareness and support have improved with less stigma attached to mental health issues. However, they cautioned there is still room for improvement, especially for working people.
Cost of Ignoring Mental Health Research has found that Malaysia is one of the most overworked countries in the world, with 45-hour work weeks and two weeks of annual leave. In comparison, Australia has 33-hour weeks and a month's annual leave.
Surveys by the government and private entities found that Malaysians are reporting more mental health conditions and are overworked, not getting enough sleep and feeling stressed.
Researchers acknowledged the higher numbers could also be attributed to increased awareness and willingness to seek help.
According to the 2015 National Health and Morbidity Survey (NHMS), 29 per cent of Malaysian adults had a mental health disorder. In the 2019 NHMS, 2.3 per cent of Malaysian adults had depression.
The surveys do not specify how much of the mental health issues were work-related.
Non-Governmental Organisation (NGO) Relate Mental Health Malaysia (Relate Malaysia) found 29 per cent of workers surveyed in 2018 reported poor mental health conditions.
In 2019, the American Insurance Association found that 51 per cent of workers were suffering from one dimension of work-related stress and 53 per cent reported getting fewer than seven hours of sleep per day.
Such work-related stress can lead to mistakes, less productivity and mental health challenges, according to psychological research.
A report on the economic cost of mental disorders in Malaysia by Dr Chua Sook Ning that was published in Lancet Psychiatry in 2020 found that mental health conditions in the workplace cost the Malaysian economy an estimated RM14.46 billion in 2018.
Legally, Malaysia has provided for workers' mental health as the Occupational Safety and Health Act 1994 (OSHA) requires employers to "take care of the safety, health and welfare of employees, including mental health", said Associate Professor Dr Irniza Rasdi, head of the Occupational Health unit in the Department of Environmental and Occupational Health at University Putra Malaysia (UPM).
But the difficulty in addressing mental health issues at the workplace usually stems from employers who may not have put any mental health provision in place either due to their ignorance and lack of care or their employees not being aware of their rights and how to utilise them.
Despite being one of the top people at her company, Anita's experience at work – of the shame and embarrassment of admitting to co-workers that she was struggling with her mental health – is reminiscent of many workers in
Despite being one of the top people at her company, Anita's experience at work – of the shame and embarrassment of admitting to co-workers that she was struggling with her mental health – is reminiscent of many workers in Malaysia.
KPJ Sentosa Specialist Hospital consultant psychiatrist Dr Mastura Rosly told Bernama while mental health care has improved in some ways, stigma and misinformation are still big issues in Malaysia.
"It's a difficult topic to really research or approach because when you ask somebody if they have stigma, their automatic response is no, they don't. But it's reflected in other data that we do have. For instance in Malaysia, only 20 per cent of individuals with mental health, I mean serious mental health issues actually get professional help," she said.
She said out of this group, 54 per cent had sought help from a traditional healer first. She also called for more work on improving awareness and reducing stigma.
Other mental health experts agree. In the Lancet economic analysis, Dr Chua said "the associated social stigma and the low mental health literacy in Malaysia are major barriers that need to be urgently addressed before effective prevention and intervention programmes can be put in place".
Dr Irniza told Bernama via WhatsApp that stigmatisation and lack of support from employers and co-workers are two of the main reasons people do not seek help until it is too late.
"Other reasons include lack of awareness – employees do not realise they have issues with mental health until it gets really bad. Or they don't know how to seek help or the policy related to mental health is not clear. And it can also be a lack of knowledge. It could be that employers want to help but they're not sure how to handle their employees," she added.
She also said people who have no friends or few friends or have the wrong or negative perception about seeking help for mental issues and with low social support are the least likely to seek help.
Broad Definition Fuels Stigma
Whether right or wrong, there is a persistent trend among employees who are reluctant to report their mental health struggles fearing that it may torpedo their career prospects. An extreme example would be the case of surgeons in the United States who reportedly have a higher suicide death count than the general populace.
If they report feeling depressed or any other psychiatric condition, they may be deemed unfit to practice medicine as American surgeon Dr Carrie Cunningham, an associate professor of surgery at Harvard Medical School, found out when she sought help for her depression after working through the Covid-19 pandemic.
Experts and activists Bernama consulted differed on how to break this trend. Some believe current protections are enough while others support change from the top.
Dr Mastura said there is little need for new legislation on mental health until Malaysia can fulfill people's physiological needs as enshrined in Maslow's hierarchy of needs.
Maslow's hierarchy, which is also presented in the form of a pyramid, lists physiological needs such as earning an income, shelter, food, reproduction and safety as the most basic requirements while self-actualisation is the highest goal.
"I think achieve those basic needs first with your policies. If you can't even achieve the very basics of that pyramid, we may be jumping the gun to try to achieve the most abstract," she said.
As for Dr Irniza, who is also a management board committee member at the Malaysian Society for Occupational Safety and Health, she feels the current legislation is sufficient and added it is good the provision relating to the general duties of employers and self-employed persons to their employees under Section 15 of OSHA 1994 is rather broad.
"The word health includes physical and mental health. The phrase gives autonomy and flexibility to the company or institution on how to manage mental health issues that suit their workplace. The aim is to keep workers mentally healthy," she said.
Nevertheless, some think addressing mental health with policy and
Nevertheless, some think addressing mental health with policy and legislation would help.
AmerBON attorney Michael Cheah, who deals with labour cases, disagreed that the wording in Section 15 was enough, saying it is too vague. His main issue is that until it is clarified, employees may be vulnerable depending on how their employers interpret the phrase.
"The phrase just says to ensure the health and safety of the workers. Health is not defined here. When they mean health, it should also include the mental health of workers as well. It has not been tested in court. We don't know how wide the definition is but I think it should include mental health," he said.
However, all agree that mental health access could be better. In her economic analysis of mental healthcare in Malaysia, Dr Chua said mental health spending in Malaysia is usually about one percent of the health budget. The amount is below the average spending on mental health of upper-middle-income countries, which is the category Malaysia is in.
Dr Irniza agreed it is important to improve mental health support and care.
"Mental health access is not enough but we are getting better and better. It's crucial to increase awareness among the Malaysian population on mental health plus psychosocial hazard, the cause of stress," she said.
She said one way is for employers to have a clear policy on workplace mental health.
If not, there are NGOs like the one Anita founded in 2016 – Mental Illness Awareness and Support Association – to offer others help holistically.
"Once I formed MIASA everything changed of course (and I am now sharing my story)," she said. – Bernama