Today I took a group of 16 students to visit the psychiatric hospital in Penang. We talked with Dr. Lau, the psychiatrist in charge of the Department of Psychiatry and Mental Health of Penang General Hospital. He told us about the various departments and services and explained that they were very short of staff; they have four psychiatrists and one clinical psychologist. Last year they saw over 15, 000 patients – maybe 150 patients a day.
Mental disorder is very stigmatized in Malaysia and a person suffering from psychosis is often not taken to the hospital but brought to a spiritual healer. Malays bring their psychotic relative to someone who can take off the evil spell thought to cause the problem. Chinese people might bring the person to a kind of medium since the problem is thought to be caused by a spirit. A psychotic person suffers from his/her disorder for, on average, three years before being brought to the hospital for treatment. The most typical story told by a person suffering from psychosis is that he or she is suffering because someone cast a spell that is causing the problem – this is a Malay explanation for psychosis. Chinese people might regard an ancestral spirit as causing the problem.
Malaysia has a high rate of substance abuse problems. Alcoholism is a far greater problem among those of Indian descent than it is among Moslems (who are prohibited from drinking alcohol). Malaysia also has a real heroin problem and the hospital has methadone programs to deal with this.
Dr. Lau explained that all the various drugs available in the USA are available in Malaysia but the more expensive drugs (such as Risperdal and Seroquel which are used to treat psychosis and sometimes bipolar disorder) are so expensive that they are often not considered "cost effective." The Malaysian health care system provides free medical care and medication but will not pay for the more expensive drugs.
The stigma associated with mental disorder affects social services. Mental health issues are not regarded as a form of handicap that allows welfare support. People disabled by mental illness must depend on their families. Someone who has been working at a job for 16 years can get workers' compensation which has a kind of "no fault" clause regarding reason for not being able to work but most patients at the hospital have not been working that long.
The legal system regarding mental illness is quite different than that in the USA – a person can be held for three months in the mental hospital if a "Form A" is issued by a doctor. If a "Form B" is issued, then the person can be held for observation but not treated. "Form C," submitted by the family also allows a person to be held against his/her will. The doctor determines when the person can get out and the doctor has the power (in most cases) to force the patient to take medications.
The students were allowed to interact with the patients – to a degree. Only a few patients spoke English but there was great excitement among many of them when we were allowed to come into their rooms. I shook the hand of virtually every patient in the men's ward and when we visited the women's ward, one patient sang a song (which probably reflected her disorder but was very entertaining). The students found their experience to be eye opening – and it seemed to me that the patients' living conditions were probably better than they are in my hospital in Virginia. Most patients are allowed to go outside each day and walk around in a very beautiful garden which they tend.