LAST week, a person who was dear to me took her own life. 

Y (not her real name) had been fighting a long battle with depression and other issues, but only opened up to very few about her difficulties. She had shunned professional help, due to an unwillingness to admit her problems and a deep-seated fear of being stigmatised.

In a WhatsApp conversation, just days before she committed suicide, Y had sent me the following message: 

“Just wanted to say X sent me the email address (for a psychologist) you sent him. Thank you for helping even though I do not know how to ask for help or talk about it. I wish I did not stigmatise my condition so much but I still have a hard time coming to terms with it.”

She then went on:

“I think I’m struggling more now because I’ve been battling this for years and I’m still not well. It takes a lot of effort to make a lasting change and this year is the year I feel a lot of hopelessness and pointlessness creeping up on me.”

Stigma prevents the mentally ill from seeking treatment

Y’s sentiments were not new. Other friends who knew about her illness had also urged her to seek professional help, but she had consistently refused.

A big part of this was because she was too ashamed of what others would think and say, if they found out about her condition. 

In Malaysia, poor knowledge and negative attitudes surrounding mental illness is a huge barrier that stops many people in need from seeking care.

Local studies looking at the experiences of people with mental health problems, specifically in relation to public attitudes, have found that stigma is a major factor limiting patients and caregivers from seeking out professional treatment.

For example, among a sample of Malaysian Chinese families, one research team found that families tended to avoid discussing their relatives’ illnesses with extended family and friends. These findings were similar to the results of other studies done on bigger groups, where most families perceived mental illness as shameful and thus avoided disclosure in order to protect the family from ‘losing face’.

Even to this day, the perception of mental illness and health care is one heavily riddled with stigma and moral prejudice. A recent study on Singaporean attitudes found that half of Singaporeans believed that mental illness is “a sign of personal weakness”, while nine in 10 believed that that people so affected “could get better if they wanted to”.

The tendency for society to stigmatise and discriminate is a highly crippling factor for individuals with mental disorders. On top of coping with the distress caused by their illness, they are made to feel humiliated, isolated and that they do not deserve the help that they need.

This is a crying shame, because broadly speaking, access to evidence-based treatment is not wanting in our country. Today, mental health services are provided across the public healthcare system, whether in major government hospitals or, for non-specialist services, in primary health clinics.

Yet despite this availability, care seeking and service participation is heavily undermined by society’s misguided cultural beliefs and erroneous understanding of mental health.

In 2015, 15 mental health professionals were interviewed for their perspectives of stigma faced by their patients. Over half reported that patients had shared with them the difficulties of maintaining relationships with family and friends due to their disclosure of mental illness. As shared by two government psychiatrists:

“There have been cases when a patient was discharged (from the hospital) but no family members came to pick them up. So, we get the ambulance to send them back. But when they (family) see the patient, they lock the doors and windows, pretending like they are not home.”

“Some friends are nice to you but the minute they know you’re mentally unstable, that’s when you notice they won’t answer your calls or don’t hang out with you anymore. It’s devastating for the client (patient).”

Ending stigma could save their lives

In this day and age, it is frustrating that many still think of mental illnesses as self-limiting choices, and that the mentally ill have only themselves to blame for being ‘weak’, when this is far from the truth. Neither poor attitudes nor fleeting feelings cause mental illness. Mental illness is not a result of personal failure.

People living with mental illness already carry a heavy burden of shame. Stigma casts them into a deeper vicious cycle of guilt and isolation, deterring them from seeking the care that they need.

The longer this goes on, the higher the dangers of the illness reaching such a severe stage, that they would be driven to consider suicide as a way out.

While my work involves researching about suicide and writing about the statistics, it is nothing compared to the rawness of losing a loved one.

When I learnt of Y’s passing, it felt for a moment as if all the light had gone out of the world. How did it come to be, that my friend, once bubbly and full of life, was driven to such a dark place that killing herself became the only conceivable way out? What could have been done to persuade her not to take the decision to end her own life? 

The issue cannot be ignored any longer. Government policies that champion mental health care must concentrate on ending stigma. Above all, education is essential. Mental health literacy programs that are culturally relevant, and caregiver engagement campaigns may be especially fruitful for reducing negative perceptions of the mentally ill.

Y knew deep down that things were not right, yet it was hard for her to relay to loved ones that she needed help. Last week, she was alive; now she is no more. What more proof do we need to be convinced that mental illness is real, and must be taken seriously? 

As a society, we must do all in our power to ensure that Y’s suffering, and those who have gone down a similar path, was not in vain. We must stop treating mental illnesses as trivial conditions and start educating ourselves about mental health.

That way, when the time arises, we will know how to intervene and save someone struggling from reaching the stage when death becomes the only option. 

*In loving memory of a dear friend. May her soul rest in peace. – September 17, 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.