YOUTH mental illness is on the rise in Malaysia, based on trends in recent years. In 2011, a six month pilot screening test for mental health problems among students revealed that out of a sample of randomly selected schools, 17.1% of students had symptoms suggestive of severe anxiety disorders, while 5.2% had severe depression symptoms and 4.8% experienced severe stress.

This test was initiated by the Health Ministry, after concerns were raised over increasing cases of psychosis, depression and suicide cases among students.

In 2014, according to the ministry of health annual health report, a similar health screening exercise performed in health clinics across the country found that adolescents recorded the highest proportion of detected mental health risks.

Less than a year later, young adults aged 16-19 recorded the highest prevalence (34.7%) of mental health problems out of all age groups, in the 2015 National Health and Morbidity Survey.

The situation is a grave one. If the figures are anything to go by, mental illness has been increasing among school-age youth for several years now, raising the question of what our national schools (since most of the data is captured from this segment) are doing to support students with mental wellbeing issues.

Limitations of School Health Services (SHS)

To answer this, we need to examine the health services in national schools (School Health Service, or SHS) provided by the Health Ministry. With over 90% coverage across the country each year, hundreds of thousands of students are examined by government health teams comprising paediatricians and general practitioners working in primary health care.

The main activities of the SHS are to carry out a range of medical examinations, initiate prevention and investigation of communicable diseases, administer routine vaccinations and deliver health education to both primary and secondary school-going children.

However, based on the Health Ministry’s school health service webpage, the orientation of these activities is still very much focused on physical health.

Taking medical examinations as an example, students’ height and weight measurements are taken to determine nutritional status, and they are also screened for visual and hearing problems. There is even a skeletal examination to detect early deformities of the spinal cord.

However, none of these medical tests appear to screen for common mental health problems like depression. The closest type is ‘detection for learning disabilities’ for young school children, but even here, detection relies on referrals from teachers, who have little to no experience in diagnosing mental health problems, rather than trained healthcare professionals.

Likewise, very few health education activities are aimed specifically at promoting mental health. According to the Health Ministry’s SHS website, health education is divided into group and individual health education. The former is carried out through campaigns or health camps in schools, where students acquire knowledge through exhibitions, lectures and demonstrations by health personnel. Quoting the website, “more often, group health education will prioritise public health problems associated with school children such as thalassemia screening, Anti-Smoking Campaign and Health Lifestyle.”

Besides that, students are also individually counselled on personal health matters during medical examinations. However, common issues covered here are related to diet, skin disease and personal hygiene, rather than advice pertaining to mental health and wellbeing, and how to deal effectively with stress and anxiety.

Re-orientate SHS to include mental health

It has been four years since the government’s school health service was evaluated (according to the Health Ministry’s website, the last review was carried out in 27 September 2013).

Meanwhile, there is increasing evidence pointing to a worrying rise in mental health morbidity among teenagers and the youth.

Our Health Minister recently announced that over 100,000 Form Four students were struggling with high levels of stress, anxiety and depression. Meanwhile, official statistics show that the number of Malaysian students with mental health problems has soared, from one in 10 individuals in 2011 to one in five in 2016.

As more and more youth start to slide towards mental illness, the Ministry of Health must act decisively to help safeguard the mental wellbeing of the younger generation.

A clear avenue for intervention already exists, through the school health services. However, the system must be re-orientated towards a more holistic public health approach. This means widening the scope to include mental health, instead of a narrow focus on physical health.

School health teams must be trained to detect school children with mental health problems. Doctors in the team must give talks to educate school teachers on mental health and mental illness. Schools should be equipped with trained counselors to guide and help students manage stress.

There is also a need for better education and awareness on mental health. As long as mental health remains a sensitive issue in our society, it will be difficult to implement effective support systems as students may feel too ashamed to seek help.

To this end, the Ministry of Health should collaborate with NGOs such as the Malaysian Mental Health Association (MMHA) and relevant youth groups to increase mental health literacy among teachers and students. In particular, having younger advocates address the students may help overcome the ‘age distance’ barrier and encourage more openness.

Finally, the Ministry must invest in research to study why mental illness is rising among school children. Strong evidence leads to better insights, which in turn will drive effective intervention measures.

The decline in mental wellbeing among the Malaysian youth must be addressed with a sense of urgency. If their problems are not treated with proper concern, the nation will be faced with a generation suffering from serious mental health problems and ill-equipped to face the ever-increasing competitive global environment.

However, if the government intervenes to strengthen mental health in schools, the outcome will certainly be one of positive change that cascades down to future generations. - November 19, 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.