ON August 7, Health Minister Dr. S. Subramaniam stated that his ministry actively encourages psychologists to further their studies in order to increase their numbers in the profession, in response to a question posed in the Dewan Rakyat on Malaysia’s low numbers of clinical psychologists.

Out of all mental health specialists, psychiatrists and psychologists are perhaps the most commonly recognised treatment providers. These days, psychiatrists tend to be the central focus of attention whenever mention is made of the mental health workforce in the media. While their significance cannot be denied, it would be unwise to downplay clinical psychologists, who play an equally important role in treating mental disorders. 

Clinical psychologists are classified as allied healthcare professionals, treating patients who have significant mental health disturbances such a psychosis or other serious mental illness, using a range of therapeutic techniques. In that sense, they differ from counselling psychologists, who have a stronger focus on healthy individuals with fewer pathological mental problems.

Dearth of clinical psychologists in government hospitals

Earlier this year, another question was raised in the Dewan Rakyat pertaining to the numbers of clinical psychologists serving in Malaysia, in both the public and private sectors. To this, health minister Dr S. Subramaniam responded by stating that 14 out of 15 available clinical psychologist posts had been filled in Ministry of Health facilities (no information was given on the private sector).

Fourteen clinical psychologists, serving a population of over 30 million, points to a critical shortage of these professionals in our public healthcare service, and a dire problem, given that government hospitals are the main access point for treatment for a majority of citizens.

The critical undersupply clinical psychologists in public service is not a new issue. In fact, it has been an ongoing problem in mental health service for many years. In 2011, for example, there were only 82 clinical psychologists in the whole of the country, of which just three were serving in a government hospital.

According to the ASEAN Mental Health Systems Report in 2016, clinical psychologists numbered at only 12, compared to 163 psychiatrists, 314 medical officers, 188, counsellors and 146 occupational therapists. This means that for every one clinical psychologist, there were as many as 13.6 psychiatrists and 15.7 counsellors working in Ministry of Health facilities.

Limited availability of posts in government hospitals

What are the reasons for the dearth of clinical psychologists in public healthcare? By and large, it would seem that the need for the services of clinical psychologists has not been well acknowledged by the government.

Ironically, although their professional responsibilities and services are duly covered in the Malaysian Mental Health Operational Policy manual, the extremely limited number of available posts (15) in public healthcare does not seem to reflect this stand.

In reality, there are very few position openings for clinical psychologists to be employed in public service- in most psychiatry departments of public hospitals, you would find only one clinical psychologist serving in the entire unit, if any at all.

In 2008, an article published by the founding Vice President of the Malaysian Society of Clinical Psychology, had already highlighted this issue. Significantly, it argued that a principal reason for the undersupply of posts in public healthcare had to do with a misguided view that the role of clinical psychologists overlapped with that of counselling psychologists.

 The confusion between both roles had created some problems in government hospitals where, “instead of creating positions for Clinical Psychologists, positions of Counsellors were increased.”

Indeed, data from 2016 appears support this statement, with a ratio of 15.7 counsellors to every one clinical psychologist working in Ministry of Health facilities.

The low supply of clinical psychologists in public hospitals is a serious issue that affects universal access to mental healthcare. With low job opportunities in the public sector, more and more qualified clinical psychologists are likely to enter into private practice, where consultation fees are steep and unaffordable for the poorer groups in society.

The government must begin to recognize clinical psychologists as important assets to the mental health workforce. A good starting point would be to introduce proper licensing and regulation for the profession. Currently, psychology and other allied healthcare professions are not licensed and regulated by any official body, despite the passing of the Allied Health Professions Act (AHPA) in 2016.

Secondly, in the run up to Budget 2017, the Health Ministry should also seize the opportunity to scrutinize the numbers of clinical psychologists in the mental health workforce and plan to distribute its resources accordingly to increase the number of posts for this group of mental health workers in public service.

Finally, taking the long term view, it is important to ensure a sustainable supply of clinical psychologists in mental healthcare. For that, the government should aim to beef up the number of Masters and PhD courses in Clinical Psychology in public universities, where study costs are more affordable.

So far, only two public institutions, namely the Department of Psychology at the International Islamic University (IIUM) and the Faculty of Health Sciences at University Kebangsaan Malaysia (UKM), run postgraduate courses in clinical psychology. To encourage greater uptake, students with good CGPA scores could be offered scholarships to further their studies in the field.

These measures will help to cultivate proper regard for clinical psychologists and the work that they do, as well as meaningfully address the problem of shortage in the discipline. – August 13, 2017.

* Lim Su Lin is a Policy Analyst with Penang Institute in Kuala Lumpur. She graduated in 2013 with a degree in History from Cambridge University. Her research interests lie primarily in psychosocial health and wellbeing. She explores these in the context of making recommendations to improve social and development policies. The long-term goals of her work are to advocate for more equitable outcomes and reduced inequalities in society.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.