By: Shemone Anne Jayame Felsinger, Psychology undergraduate at the University of Nottingham Malaysia and research assistant intern at SOLS Health.
Mental health in the past has generally been neglected, but more recently it has increasingly become a topic of great discussion. People have begun to realize how important it is as a part of our health that greatly influences the quality of our lives. A lot of this change can be attributed to mental health advocacy, which the WHO defines as the implementation of a set of actions by individuals and/or organizations, aimed at promoting positive mental health outcomes in the population (WHO, 2003). Promoting the rights of persons with mental disorders and public education to reduce stigma against mental health issues are just some of the examples of actions taken by mental health advocates. With this article I hope to introduce different groups involved in advocacy and how they play different roles in promoting positive mental health outcomes.
Arguably the group most essential to effective mental health advocacy are mental health ‘consumers’. In layman terms, this refers to individuals affected by a mental health condition and who are actively receiving treatment. When it comes to developing and improving mental healthcare services, the perspectives and opinions of consumers play an important role in guiding planners to the ‘gaps’ and shortcomings in the system that might have otherwise gone unnoticed. Being direct service users, their “lived experience” also means that they are in a good position to understand and articulate various issues and needs related to improving mental health awareness and cares ranging from formal mental healthcare services, informal support/care systems, policies/legislation, public education initiatives and so on. In the local context, a powerful illustration of consumer advocacy fueled by experience is Puan Anita Abu Bakar, who used her personal experience of battling an anxiety disorder to set up a mental health advocacy and peer support NGO known as the Mental Illness Awareness And Support Association (Miasa). According to her, although her family had supported her as she worked to recover, she still struggled with the loneliness of not knowing anyone else who shared her experience, and the difficulty of knowing very little about mental illnesses in general (Bakar, n.d.). Her experience inspired her to share her story and establish Miasa to help raise awareness, educate on mental illnesses and support others with mental illnesses (Bakar, n.d.). Her work serves as a reminder that a mental illness cannot take away all hope and that the journey in facing and overcoming challenges can guide us to helping others as well.
Besides consumers, mental health professionals such as psychiatrists, clinical psychologists and mental health nurses are a second group of important stakeholders in advocacy. As treatment providers, they have the advantage of interacting closely and frequently with patients, and thus would be better able to understand their needs. Secondly, mental health professionals are well-positioned to offer insight into “hidden” technical service gaps, such as workforce shortages or access gaps, and to weigh in on mental health policies on behalf of consumers. In Malaysia, the Malaysian Mental Health Association (MMHA) is one example of collective advocacy advanced by health workers. Established as a non-profit organization in 1968, its founders were a group of mental health professionals and community leaders involved in the treatment and recovery of mental health patients who, through their work with mental health patients, recognized a need for supportive services for recovering and recovered psychiatric patients. The MMHA was founded specifically to fulfil that need.
Non-Governmental Organizations (NGOs)
Unlike consumer and health worker-led advocacy efforts, which tend to focus more on issues related to access and needs within the formal mental healthcare system, advocacy done by NGOs tends to be undertaken in tandem with, or in response to, the perceived needs of their beneficiary groups in the wider community.
SOLS Health is an example of an NGO that embeds advocacy into its various programme-led activities and campaigns to support and empower communities. As a non-profit championing accessible mental health services, it provides formal therapy services to clients at its centre, while also reaching out to poor and disadvantaged groups in the community to offer affordable mental health services, and training in psychosocial support skills and psychoeducation.
A good example of this is “Keluarga Akrab Mencapai Impian” (KAMI), a family strengthening programme targeting families in public housing flats, who tend to face additional and multiple challenges such as poverty, single parenthood, cramped housing and unemployment. Aside from this, SOLS Health also supports other vulnerable groups, such as women and child survivors of domestic violence, and at-risk children and youth, through offering trauma-informed counselling and psychotherapy support via its “Building Resilience Acceptance Valiance and Empowerment” (BRAVE) programme. Both the KAMI and BRAVE programmes help support troubled individuals and families overcome their struggles, increase resilience, and build supportive and healthy community ties.
Finally, SOLS Health actively advocates for better public mental health literacy through running online social media campaigns aimed at engaging and educating the public on mental health issues, while also encouraging greater understanding and empathy towards those affected by mental health issues.
One of its more successful online campaigns, the ‘MCO: How do I Cope’ series, was released in March 2020, when Malaysia experienced its first phase of outbreak of the coronavirus and went into lockdown. The series was developed to reach out and support those experiencing psychological disturbances due to lockdown restrictions and turbulent economic conditions. Further down the line, SOLS Health also published various written and visual materials online to raise awareness on topics such as maternal mental health, post traumatic stress disorder (PTSD) and more recently, a story-sharing initiative based on retelling lived experiences of mental health challenges.
In a country where mental health remains taboo and a largely avoided topic, NGOs like SOLS Health, and others can contribute significantly to raise public consciousness on the importance of mental health, while promoting psychosocial well-being and paving the way for better mental health outcomes in the community.
Governments, Policy-makers & Planners
Governments differ from other groups on a very important point: they have the authority to make changes to the country’s mental health systems. They are able to regulate the system, amend laws, and enforce laws. Thailand’s legislature, for instance, includes a tax incentive for employers to hire a percentage of employees that are disabled (WHO & Ministry of Public Health Thailand, 2006). However, there is no enforcement of this law and this highlights another important point: governments need to exercise their authority to resolve mental health issues such as stigma, discrimination, human rights violations etc. In Thailand there is no law against discrimination in housing for people with severe mental disorder (WHO & Ministry of Public Health Thailand, 2006) and this is exactly the sort of problem a government can and should solve. In Malaysia, one way the government should use its authority is to decriminalize suicide as the law penalizing suicide shows no evidence in reducing the rate of suicide and rather makes it more difficult for people with suicidal tendencies to reach out and receive help (Landau, 2020).
Besides authority, governments often have access to greater resources compared to other groups. They are therefore in a position to support mental health advocacy directly through their own initiatives or by providing support to the consumers, health workers or organizations advocating for mental health. Governments can also more easily reach the general public and bring together relevant stakeholders (consumers, mental health professionals, etc.) to achieve positive mental health outcomes. An example is Mongolia’s Ministry of Health which began a program to increase community awareness and reduce stigma around mental disorders. After finding that there was substantial stigma and discrimination by conducting interviews, they brought together psychiatrists, volunteers and other NGO representatives to create an NGO that aimed to educate and campaign around mental health with funding from the ministry (WHO, 2003). With regards to policy specifically, policy-makers and planners can uniquely advocate for mental health by developing policies that support mental health consumers and changing those that oppresses or stigmatizes them e.g. decriminalizing suicude, creating more opportunities for there to be trained mental health professionals and developing insurance policies that cover mental health treatment.
In conclusion, these different groups have roles that often overlap, yet each of them also offer unique contributions to mental health advocacy. There are many ways to advocate, but consumer involvement as well as government action is especially important in advocacy.
A question worth reflecting on is ‘How can I contribute to the mental health advocacy movement?’. It could be as simple as sharing a post to spread mental health knowledge, educating yourself on mental health or becoming involved in research that could shape policy. Regardless of how little or how much one decides to do, acting on our answers will bring the positive change we need in our society.
Bakar, A. A. (n.d.). Message from the President of MIASA. Retrieved September 29, 2020, from http://www.miasa.org.my/message-from-the-president.html
Landau, E. (2020). 'Time to decriminalise attempted suicide'. New Straits Times. Retrieved from https://www.nst.com.my/news/nation/2020/07/611732/time-decriminalise-attempted-suicide
Malaysian Mental Health Association. (n.d.). ‘Who We Are’. Retrieved September 24, 2020, from https://mmha.org.my/about-us/who-are-we/
Nor Ain Mohamed Radhi & Qistina Atikah. (2018). [Exclusive] Help is just a phone call away: New Straits Times. Retrieved September 30, 2020, from https://www.nst.com.my/news/exclusive/2018/01/327565/exclusive-help-just-phone-call-away
World Health Organization (2003).’Advocacy for mental health’. Retrieved from https://www.who.int/mental_health/policy/services/1_advocacy_WEB_07.pdf?ua=1
World Health Organization & Ministry of Public Health Thailand. (2006). ‘WHO-AIMS Report on Mental Health System in Thailand’. Retrieved from https://www.who.int/mental_health/thailand_who_aims_report.pdf?ua=1