Counselling Can Curtail Mental Disorders

By Nur-ul Afida Kamaludin & Sakini Mohd Said

The prevalence of mental health issues in this country is certainly a cause for concern and in some instances, it has even led to death. It is most unfortunate that a matter as serious as this is being treated lightly and this state of affairs can be attributed to a lack of awareness and knowledge among the public.

This third of four articles examines how counselling can help nip mental health problems in the bud.

KUALA LUMPUR (Bernama) -- Malaysians cannot afford to view the issue of mental disorders as a taboo subject or treat it as something that should be swept under the carpet. This is because its impact goes far beyond the torment and anguish experienced by the sufferer and his or her family.

The findings of a 2017 survey on mental health carried out by the Health Ministry are a cause for concern, indeed – it was found that at least 40 percent of Malaysians were expected to experience mental health issues during their lifetime.

According to the survey conducted on 273,203 individuals, 18,336 suffered from various stages of depression. Out of that number, 11,811 had mild depression, 3,680 moderate and 1,682 severe.

These figures are not a pretty sight. If left untreated, the effects of mental disorders can be devastating, even pushing the victim to suicide.

Mental health problems can strike anyone, regardless of their age, sex or profession. Fortunately, it can be prevented and if one already has a mental issue, it can be treated.

This is why it is so important for Malaysians to be aware of mental disorders and safeguard their own mental well-being, as well as learn to recognise the symptoms of mental illness so that intervention and treatment can be sought from the outset.

Besides prescribing psychotropic drugs to keep the patient calm and enable him to carry out his daily activities, supportive approaches such as counselling, psychotherapy, cognitive therapy, group therapy, family therapy, psychoeducation, occupational therapy and psychosocial rehabilitation are also equally important.

IMPACT OF COUNSELLING

Is counselling an effective tool to help people facing mental health issues?

Counselling refers to the provision of professional assistance and guidance in resolving personal or psychological problems. According to the Governing Council of the American Counselling Association, the practice of professional counselling is related to the application of mental health, psychological or human development principles through cognitive, behavioural or systematic intervention strategies that address wellness, personal growth or career development, and also pathology.

Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail has also acknowledged the important role played by counsellors and counselling services, more so now as society comes under more pressure and stress.

At the launch of the National Counselling Month in Putrajaya on Oct 1, Dr Wan Azizah, who is also Women, Family and Community Development Minister, had said that the federal government intends to have 11,000 professional counsellors by 2020 to meet the demand for such professionals and to address the increasingly complex social issues troubling our society.

The 11,000-counsellor target by 2020 will bring about a ratio of one counsellor to 2,945 people, compared with the current 1: 4,030.

As of Aug 31 this year, a total of 8,039 counsellors were registered with the Board of Counsellors.

Universiti Kebangsaan Malaysia senior lecturer in guidance and counselling/psychology Dr Abu Yazid Abu Bakar, however, said increasing the number of counsellors would have little effect if the community, including adolescents, were reluctant to share their problems with the counsellor.

This, he said, was due to the negative perception that only “insane” people sought the services of a counsellor.

“Anyone can seek the services of a counsellor and it doesn’t mean that one must have some kind of a problem in order to see one,” he said.

CONFIDENTIALITY

He said the community must get a clear understanding of the role of a counsellor because of the misperception that these professionals were not different from psychiatrists.

There are four categories of professionals involved in improving the mental well-being of the community –counsellors, psychologists, psychiatrists and social workers. All four are involved in different disciplines in terms of the orientation of their intervention and the activities carried out.

“The functions of a counsellor cannot be same as that of a psychiatrist. The counsellor helps his client to get an insight into his problem so that he can resolve it himself. The psychiatrist, on the other hand, is a trained medical specialist,” said Abu Yazid.

Prof Datuk Dr Mohamed Fadzil Che Din, an expert in counselling psychology from Universiti Pertahanan Nasional Malaysia (UPNM), said all professional counsellors adopt a strict confidentiality policy and, as such, the secrecy of their conversations with their clients is guaranteed.

The requirement for confidentiality is provided for in the Counsellors Act 1998 and the Code of Ethics for the Board of Counsellors Malaysia.

“Legal action can be taken against any counsellor who flouts the law. Get a professional counsellor if you need the services of one as they always adhere to the ethics,” said Mohamed Fadzil, who is also UPNM deputy vice-chancellor (Student Affairs and Alumni).    

THE COUNSELLING APPROACH

The Health Ministry's Allied Health Sciences Division senior principal assistant director Ruhana Mahmod, meanwhile, said the ministry’s counselling services were extended to clients referred by various parties, especially doctors from the psychiatric departments of government hospitals.

Referrals are also made by medical workers in other disciplines like medicine, oncology, obstetrics and gynaecology and surgery, as well as government clinics and hospitals that have no psychologists.

She said their counsellors have different approaches to handling their patients with mental problems.

“What is most important (for counselling) is for the client to be able to cooperate and communicate. If he is unable to respond properly to questions and appears to be in a state of delirium or psychosis, then he will have to be treated by a psychiatrist or clinical psychologist first,” she explained.

According to Ruhana, counselling entailed a basic psychological analysis of the client.

From the information shared by the client, a treatment model will be designed based on the client’s goals and it will be executed via theoretical and counselling techniques like 'person-centred therapy’ (PCT), 'cognitive behavioural therapy' (CBT), psychoanalysis or family therapy.

“The client will also be taught relaxation techniques to reduce his stress level,” she added.

 DIFFERENT METHODS

Although there are various types of counselling techniques, the CBT approach is usually used for clients referred to the ministry by hospitals as it produced results faster. It was also easier for the patients to grasp the workings of the special techniques involved in CBT, thus enabling them to practice them at home or in other places.

Ruhana said adults and children require different counselling approaches due to factors such as age, maturity and cognitive processing skills.

The counselling approach for children and adolescents is the same as that of adults’ but, in the case of the former, their counselling also includes the use of psychological testing tools, and helping them to establish a good rapport and improving their language style.

She said since most children find it difficult to express their problems verbally, the therapist would make use of art and play therapy to explore and comprehend their issues better.   

“One of the techniques we use in art therapy is ‘House Tree Person’, which is helpful when exploring (the client’s problems) and when drawing up the treatment plan,” Ruhana said, adding that the parents are also taught parenting skills and how to handle their children at home.

For adolescents, she said a lot depended on the extent to which the client was willing to share his problems with his therapist.  

“Teens are usually reluctant to share their problems with adults and are more willing to talk to their peers. To put them at ease and get them to open up, the counsellor would act and talk to them as a friend,” she explained.

Based on the cases she has handled, Ruhana said among the reasons adolescents became depressed were family problems (conflicts, parents always at each other’s throats, under pressure to meet expectations of family), issues with peers (feeling left out and ignored, treated with contempt by friends, intimate relationship issues), and problems related to finance and education.    

Family or marriage counselling is considered if family issues are found to be the cause of the client’s problem. The family members are also exposed to psychoeducation to educate them on psychological issues so that they are able to cope better with their family member’s illness.   

As for adults, the usual cause of their depression is family and relationship problems or financial or health issues.

“Most adults are anxious about their health and tend to get worried when they get symptoms related to heart disease or hypertension. They also keep thinking about death (that is, what will happen after they have passed away),” said Ruhana.

EXPAND COUNSELLING

Ruhana said the implementation of counselling services should be expanded and made accessible to the people living in rural areas.

Currently, such services are only available in the main towns and cities, hence making it difficult for rural people to not only gain access to counselling but also get educated on mental health.

“Apart from that, counselling services should also be extended to other sub-fields like family and marriage counselling, and addiction counselling. Currently, individual and group counselling are available,” she said.

She said it was also heartening that public awareness on mental health in Malaysia was now improving as more people were seeking treatment early and were being referred to counsellors or psychiatrists.

This could be due to the fact that more people knew how to ascertain the mental health of an individual using the Depression, Anxiety, Stress Scale (DASS), she said.

“DASS screening tests can tell if a person has specific symptoms like stress, anxiety and also depression," she said.    

In view of the importance of mental health, Universiti Pendidikan Sultan Idris (UPSI) recently announced that it would introduce a Master of Science programme in Clinical Mental Health Counselling next year.

Set to be the first such programme to be offered by a tertiary institution in this country and aimed at improving the skills and competence of counsellors, it will be placed under UPSI’s Department of Psychology and Counselling.

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SIDEBAR

The Health Ministry’s counselling psychology services are available at government hospitals in the various states and districts, as well as at several health clinics, district health offices and training institutions run by the ministry.

The same services are also offered by government agencies such as the Social Welfare Department and National Population and Family Development Board, as well as institutions of higher learning and non-governmental organisations.

In the Klang Valley, counselling services are available at:

UPM’s Community Counselling Clinic at the Department of Counsellor Education and Counselling Psychology, Faculty of Educational Studies, Universiti Putra Malaysia, 43400 Serdang, Selangor. Contact: 603-8946 8118 

Counselling Psychology Unit at Federal Territory of Putrajaya and Kuala Lumpur Health Department, Jalan Cenderasari,  50590 Kuala Lumpur. Contact: 603-22687333 

Counselling Psychology Unit, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur. Contact: 603-2615 6254. Note: Referral letter from a doctor is required.

National Population and Family Development Board(LPPKN)

Bangunan LPPKN, Counselling Unit, Family Development Division, 12B, Jalan Raja Laut, 50350 Kuala Lumpur. Contact: 603-2693 7555 | penduduk@lppkn.gov.my

Psychiatric Department, Hospital Tengku AmpuanRahimah, Klang

Psychiatric Clinic, Level 1, Ambulatory Care Centre (ACC) HTAR, Jalan Langat 41200 Klang, Selangor. Contact: 603-3375 7000 (ext 6273) 

Universiti Malaya Medical Centre (UMMC/PPUM), Lembah Pantai, 59100 Kuala Lumpur.  Contact: 603-7949 2988/ 603-7949 3991/ 603-7949 3598

Psychiatry Department Hospital UKM, Jalan Tenteram, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur.  Contact: 603-9173 3333

All Women’s Action Society Malaysia (AWAM) Contact: 03-78774221 or www.awam.org.my

Women’s Aid Organisation

Contact: 03-7956 3488 or http://www.wao.org.my/

Malaysian Care Contact: 603-90582102 or http://www.malaysiancare.org/

Translated by Rema Nambiar

-- BERNAMA