MENTAL HEALTH BULLETIN

MENTAL HEALTH BULLETIN
Persatuan Kesihatan Mental Malaysia
PATRON: TOH PUAN DATO’ SERI HJH. DR. AISHAH ONG
April 2014 (1/2014)
KDN PP/5342/02/2013 (031842)
MMHA MENTAL HEALTH BULLETIN April 2014 1/2014
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CONTENTS
Knock , knock , is there an
‘angel’ in there?
The first quarter of 2014 reports a missing airliner
MH370 in the Southern Indian Ocean. May guiding
angels support all who are undergoing this difficult
emotional time and turmoil. Similarly, we pray that there will be angels, too, in corporations and employers who will help put treated
[and rehabilitated] people with disabilities [PWDs] who have mental
illness, into a meaningful, independent and functional mode in life.
In this issue, Assoc. Prof. Dr. Stephen Jambunathan shares about
managing Obsessive Compulsive Disorders, while Randy Uthe assures fellow-carers that his wife also has OCD and that it is OK!
Not all clients are successfully employed like Joyce, Eve and Ben as
mentioned in Dr. Looi‟s write-up on MHRO Gee‟s experiences. The
levels of functionality may differ between PWDs with mental illnesses.
Tan accompanied a few PWDs with bipolar disorder and schizophrenia for job interviews recently, and was surprised that there were indeed, „angels‟ in some of the interviewers after all! Job coaching, in
this scenario, is about mediating between potential employers and
employees for suitable working hours and tasks allocation as well as
understanding the importance of supportive human environment to
enable these so called „disabled‟ PWDs.
Finally, MMHA is happy to welcome new staff, Naresh and Rachel
into its fold, programs and activities!
Note From The Editor
2
President message
3-4
A Warm Welcome To…
4
Obsessive Compulsive Disorder
5
My Wife Has OCD & It‟s OK
6
Clients... Going Back To Work
7
...‟Angel‟ In You, Ms. Interviewers
8
MMHA Daily Activities
9
MMHA: Increasing Public Awareness
10
MMHA Announcement
11
Sponsorship Form
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EDITORIAL
President / Advisor
Datin Dr. Ang Kim Teng
Editor
Tan Tang Peng
Editorial team
Dr Ng Chong Guan
Dr Anne Yee
Dr. Looi Poh Suan
Dr. Eileen Nadarajah
Catherine Teong
Evelyn Samuel
Alwin Mah
The Editor
Tan Tang Peng
Santa Kumarie
Nurhijjah bt. Mat Zin
Naresh S/o Arumugam
Bawanie Rachel
Note: Letter to the editor can be addressed or emailed to MMHA as stated below.
Publisher:
Malaysian Mental Health Association, MMHA Office: 8 Jalan 4/33, off Jalan Othman, 46050 Petaling Jaya
Telephone: 03 7782 5499, 03-77825499 , Fax: 03-7783 5432 , Email: admin@mmha.org.my Website : http://mmha.org.my/
All rights reserved. Requests for bulletin or permission to reproduce or translate MMHA Mental Health bulletin – whether for sale
or for noncommercial distribution – should be addressed to MMHA as above. Views expressed by the individual authors may not
necessarily reflect that of MMHA. MMHA does not warrant that the information contained in this publication is complete and
correct and shall not be liable for any damages incurred as a result of its use.
MMHA MENTAL HEALTH BULLETIN April 2014 1/2014
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One of the most difficult areas in dealing with people having mental health problems is acceptance and willingness to seek professional help. Due to denial or poor insight, sometimes
help cannot be provided even though effective treatment is available. It would have lessened
unnecessary suffering and helped to restore social functioning and relationships if the condition is corrected.
Due to stigma associated with mental illness, people with mental disorders are often unable
to share their problems openly or are reluctant to seek proper treatment. The disturbed thoughts and emotions remained hidden from others, except for more obvious conditions like schizophrenia.
To assist sufferers share their burdens, MMHA has started an Online Forum and a Share your Story section in our website. This section allows people with mental disorders and the community to share their
thoughts and encourage more open discussion of mental health issues. It could also be a source of support to
those suffering from mental disorders.
Share your story and participate in our forum. Help us to help others !
Datin Dr. Ang Kim Teng
President,
Malaysian Mental Health Association
Salah satu masalah yang sukar di atasi di dalam menangani isu masalah pesakit mental adalah keengganan
mereka untuk mendapatkan bantuan dan rawatan professional. Mereka yang mengalami masalah mental
selalu menafikan penyakit yang di hidapi ditambah pula dengan sebab penyakit itu sendiri. Oleh itu,
rawatan yang berkesan tidak dapat diberi kepada pesakit mental kerana beranggapan yang mereka adalah
sihat. Rawatan ini seterusnya akan dapat membantu mengurangkan gejala dan penderitaan yang di alami
oleh pesakit mental.
Stigma penyakit mental ini secara tidak langsung menyebabkan pesakit enggan berkongsi masalah secara
terbuka atau keberatan untuk mendapatkan rawatan yang sesuai. Gangguan emosi serta kecelaruan fikiran
selalunya di sembunyikan dari orang lain kecualilah gejala yang ketara seperti schizophrenia.
Bagi membantu dan mengurangkan beban pesakit mental , laman web MMHA telah mewujudkan forum
atas talian dan ruangan perkongsian cerita . Ruangan ini diharap dapat membantu mereka yang mempunyai
masalah kesihatan mental dan orang ramai pada amnya untuk berkongsi pandangan dengan masyarakat. Ini
akan menggalakkan perbincangan yang terbuka berkaitan kesihatan mental. Ia juga merupakan salah satu
strategi bagi menyokong dan membantu mereka yang mengalami masalah kesihatan mental.
Berkongsilah pandangan dan cerita anda, dan menyertailah forum MMHA !
Datin Dr. Ang Kim Teng
Presiden,
Persatuan Kesihatan Mental Malaysia
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有精神健康问题的人对于寻求专业人士帮助的意愿和接受度是我们面对的最大挑战
之一。尽管存在着有效的疗法，有时我们还是因他们的无知和无法接受事实而爱莫
能助。若这种情况得以纠正，那么患者就能避免没有必要的痛苦，且能恢复他们的
社会功能和关系。
基于社会对精神疾病所持有的偏见和误解，精神病患常无法敞开地分享他们的问题
或不愿意寻求正规的治疗。除了如精神分裂比较明显的症状，，很多困扰着病患的负面想法和情
绪往往被隐藏起来。
为了协助病患分享他们的重担，马来西亚精神健康协会在我们的官方网站启动了一个“在线论
坛”和“分享您的故事”平台。精神病患和社会大众能在这个平台分享他们的想法，以更开放的
方式讨论精神健康议题。这个平台也可以为精神病患提供支援。
欢迎您参与我们的论坛和分享您的故事。帮助我们去帮助他人！
马来西亚精神健康协会主席
拿汀洪金定医生
NARESH S/O ARUMUGAM
My name is Naresh s/o Arumugam. I have a degree in Bachelor of Social Work
Management (Hons). I joined MMHA two months ago as an Executive Officer
because of my interest in social service field. I look forwards to contributing
more to increasing public mental health awareness!
BAWANI RACHEL
Hi, my name is Bawanie Rachel. I joined MMHA recently as an MHRO. I
graduated with a Bachelor in Psychology (Hons) from HELP University in
2012. I hope to explore and learn more about mental health issues and psychosocial rehabilitation throughout my time here in MMHA.
MMHA MENTAL HEALTH BULLETIN April 2014 1/2014
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Assoc. Prof. Dr. Stephen Jambunathan
Consultant psychiatrist and psychotherapist
University Malaya Specialist Centre,
The Mind Faculty, Solaris [www.themindfaculty.com ]
Obsessive compulsive disorder means obsessions, compulsions or both, with a life time prevalence of 1-3 %,
no gender, age nor race differences.
Diagnostic criteria for obsessions include recurrent, persistent thoughts, urges or images which can be intrusive and unwanted, causing anxiety or distress. Attempts to ignore or neutralize these obsessions are by thoughts or compulsive actions of repetitive
behaviours like washing [of hands], checking (because of doubts) or rituals. These compulsive behaviours bring relief as they reduce anxiety and perceived as having prevented some dreaded event. However, they can be time consuming resulting in significant
personal, interpersonal or occupational impairment.
The insight in OCD can range from good, fair, poor or absent with delusional
beliefs. It can also be tic-related. Having insight means having an awareness or
understanding that one is behaving abnormally himself or herself, as a result
of a psychological problem, and that one needs therapy and medication.
The management for OCD comprises bio-psycho-social aspects. The biological aspect consists of blood investigations, medications to increase serotonin in the brain, antidepressants or augmentation with medication
from other groups.
The psychological treatment such as the Cognitive Behavioural Therapy challenges obsessive thinking and
desensitised compulsive behaviours. In the Exposure and Response Prevention therapy, one challenges the
rigid and irrational obsession by confrontation and resisting the compulsions that reduce the anxiety. This
forced practice will lead to the formation of new beliefs and behaviours.
Another psychological treatment is using Eye Movement Desensitization and Reprocessing therapy in which
one induces repetitive eye movements, monitors bodily sensations, emotions, thoughts and images, making
periodic self assessment, and addressing strength of locked in memories and memory loops for about 3 to 10
times in an hour session. This method induces the formation of new neurological circuits and obliterate dysfunctional OCD circuits.
The social and environmental aspect of treatment encompasses crisis intervention, dealing with stressors,
managing life, lowering the bar of achievement and acknowledging one‟s milestones.
Other OCD related disorders include hoarding disorder, trichotillomania ( hair pulling disorder ), excoriation disorder ( skin picking ), OCB induced by substance abuse, culture bound obsessiveness, tics ADHD,
anorexia, depression, and anxiety disorder. Early detection and intervention for medical problems related to
the brain/mind are important, amidst the many hurdles like the stigma of psychiatry, lack of awareness,
costs, priorities and family dynamics.
OCD is a family disorder that must be addressed together with family for numerous reasons, such as family
conflicts and dynamics causing stress, psychological escape, and complying to rules out fear or love. The
Mind Faculty in Solaris has already begun the OCD clinic where OCD is addressed at home too by a multidisciplinary team. Each patient will have a specifically selected team to address the disorder. This is the first
of this type in Malaysia and in this region.
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I can easily recall the subtle differences between my colleagues as being health care professionals and people with families. As a professional nurse, they focused on the patient‟s needs with a very rational scientific
approach to the patient‟s condition. As a parent or spouse, when their family member was ill, that scientific
approach always switched to very personal and emotional reactions. I now look back at those days with new
eyes after I moved here from the U.S. to marry my wife.
Honestly, I moved here to Malaysia and married my wife with every bit of knowledge about her illness.
What I was lacking when I moved here to Malaysia was a deeper sense of wisdom on what to do about my
wife's illness and how I can best relate to her. My wife has clinical anxiety, depression and OCD. She simply has fears and worries that produce hard times dealing with life. The truth is such fears and anxieties are
inherent in all of us. The only differences are in our ability to deal or cope with such feelings, thoughts and
emotions. As a spousal caregiver, I have to balance my rational and clinical thinking with the support I need
to give, and doing so in Malaysia as an expat added further challenges. The cultural expectations and differences in laws were challenges but deep inside the situation is the same. People with mental health challenges need to know they are loved and cared about. This is true whether the person we are caring for is our
spouse, sibling, child, parent or any other relation. I know when I came here I took my knowledge about the
conditions for granted. Caring for someone with mental illness day in and day out meant that I had to contend with much more than simple cognitive knowledge. I had to additionally deal with my own fears, anxieties, thoughts, emotions and expectations as well as my spouse‟s. Malaysia‟s laws concerning mental illness
and people‟s understanding of it are different than what I was used to. So I had to also deal with those of the
community around me on a more conscious level. I know that my spouse is perfectly capable of doing anything she sets her mind to and chooses. Helping her accomplish goals, when going against the stream of her
own community‟s or personal worldview, has been trying even with the help of my wife‟s doctor and medications. The positive side was that I knew I didn‟t have to do it alone.
Not long after I moved here to Malaysia I looked up the Malaysian Mental Health Association. The MMHA
caregiver support group proved to be a tremendous help in my transition and resource as I find ways to help
walk alongside my wife. Walking alongside those we care for is the key. I can‟t forget the proper boundaries and techniques that are an important part of caring for my spouse. I also remember to balance those
with the fact that I can‟t and don‟t need to do everything for her. With patience, encouragement, time, and
support I can help my wife do the things for herself she is capable of without over taxing her. It is those moments when I see my wife accomplishing a goal she has set for herself that give me joy of simply being a
part of it. Knowing it is ok that the goal may take a little longer than usual, or may need extra energy and
thought means that I‟m not really missing out on anything. I actually gain more insights than I would have
without such wonderful opportunities.
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When the phone rang, I thought it was another normal call to enquire our services at MMHA. Imagine my
surprise to hear a familiar voice asking, “Hello Gee, how are you?” That was Joyce on the phone, our former
client, so nice to hear from her again!
Joyce, in her late thirties, was with MMHA for two and a half years in 2008. Her family shifted from the
northern state to Petaling Jaya in 2008, just so that she could attend MMHA rehabilitation programme as she
was unable to hold a steady job before that due to her illness with frequent relapses.
In 2011 Joyce left MMHA after getting a part time job at a fast food restaurant. She continues her medication
regularly and has been very happy working since then. She will occasionally call to send her regards to us
and we do bump into her when we pass by the fast food outlet where she works. As one of the crew in the
outlet, Joyce shares the work with the rest of her colleagues, cleaning, helping to
pack, arranging things and completing tasks assigned to her. Her supervisor describes her as an asset because she is very hardworking and reliable. There were
times when her condition was not well controlled and she was unable to work,
however, her employer still prefers to continue hiring her. Joyce is glad she has
an understanding boss. Like Joyce who left MMHA after getting employment, Eve is one of them who gives
us a call every now and then.
Eve, in her early forties, came to MMHA in 2007. She was gainfully employed before her illness. After six
months in MMHA, she got a job as a full time General Clerk in a rehabilitation centre for the physically impaired. Her job involves registering users of the rehabilitative machines, cleaning and checking the machines
and ensuring they are properly switched on or off. She will call to inform us about her progress at work. She
said although her pay is not very high, she is very happy working there because her boss treats her well and
she is able to help others who are less fortunate. Eve is now staying with one of her relatives and she feels a
sense of freedom ever since she has a full time job.
Our most recent client who has been successful in getting a job
is Ben. Ben is a young man who came to MMHA in 2013. He
was never employed before, being rejected after attending
many interviews. He has many family problems where his
mother and all his siblings suffered leading to him suffering
from severe depression. He was also very conscious about his physical appearance, had low self- esteem and
lacked confidence. His doctor advised him to attend wellness programme and rehabilitation at MMHA.
At MMHA he realised that his looks did not matter by the way he was treated. He regained his self-esteem
and self-confidence and gained insight into his family problems and able to appreciate his single mother who
has sacrificed so much for him. He decided to get a job to help his mother and started looking for job advertisements. He asked the MHROs for opinion regarding the types of job suitable for him. When he was called
for interview, the MHROs encouraged him and prepared him for the interview. He succeeded in getting a full
time job working at the computer entering data in an established supermarket. We shared his joy when he
called to inform that he would not be coming to MMHA anymore just before starting work.
Ben was with MMHA for only three months. His success is our greatest fulfilment.
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“Yes, we do employ „OKUs‟* here, but they have to work 9.00am to 6.00pm like everyone else.” “Only selected tasks? We are encouraging multitasking here! And four hours a day work? Sorry, we don‟t make such
flexible rules to accommodate „OKUs‟.” “...what if she cannot survive our office politics and insensitive remarks!” The Malaysian‟s Persons with Disabilities [PWDs or „OKUs‟] Act 2008 explains disability as restrictions in participation and unequal opportunities [such as in employment] through social exclusion and
inequality imposed upon PWDs by our society1! In the context of people with mental illnesses, societal stigmatization and employment unbending rigidity can „disable‟ these PWDs from a meaningful working life.
Manager A told me that she had tried employing a PWD with mental illness, but he „disappeared‟ after a few
months of work. However, her company has another who is an administrative staff for many years now, and
she is very good and reliable in her work. Her company has about six job coaches to supervise employed
PWDs. There were two vacancies in her food outlets. We discussed and agreed that four hours a day would
be an ideal duration for a training start. PWDs Daniel and Lionel, both in their early twenties, were interviewed separately. Although Daniel had been briefed before the interview, he appeared upset and daunted by
the appearance of the two formally dressed managers and the office setting, and wanted to go home.
Lionel, however, had worked full time before. He was so tired after the long working hours that he forgot to
take his medication at times. As a result, he suffered a relapse after a year work. During the interview, both
friendly managers tried to break the ice initially. Then, Manager B asked, “so, Lionel, would you like to work
as a waiter in our café at the lobby?” With his mother besides him, Lionel smiled softly and politely, “No, I
don‟t think so.” Our eyes widened slightly as we tried to remain calm. Manager C was quick to remember
what we had discussed earlier about the words to use, “er, Lionel, you see. We are very busy here and we
need more people to help fold napkins and clear tables. Can you help us, Lionel? [she ended softly]” “OK,
can,” was his reply with a nod, much to our simultaneous sigh of relief! His mother told me, “working four
hours a day enables him to have sufficient rest. It is therapeutic for him to have something to do everyday.
Lionel goes to work by LRT himself. I monitor that he takes his medication daily so that he does not get a
relapse.” Lionel had completed his form six education.
Thirty something PWD David called to say that he would like to work again after a ten-year break. Manager
D from a chain of restaurants observed from the counter on how he talked to me and his father. She like this
well-mannered David immediately, “This is a part-time position. He can come to work four hours a day, as
suggested by you and his father here, and more hours if he wants to. I will tell my staff that at anytime, if he
does not feel well, he can ask to go home. Anyway he will be paid by the hours. My boss has this soft spot
about helping PWDs.” David is an economic degree graduate and he is willing to do any job while waiting
for administrative job opportunities.
These interviewers above were such angels! We hope more employers would adopt corporate social responsibility to employ rehabilitated PWDs with mental illness; reduce the rigidity in their employment rules by allowing selective tasks allocation and flexible working hours; and, enjoy a twenty-four months salary tax rebate for each PWD employed.
MMHA would be very happy to share with employees on mental health awareness to help co-workers and
managers or interviewers-to-be, understand and support employment of PWDs in their organization!
1. [Eds] Kenji Kuno, Yeo,S.L., Ogawa, H., Sakai, D. (2012). JOB COACH HANDBOOK– A Practical Guide to Job Coaching. MPH Publishing: Petaling Jaya.
Note: The names of the PWDs have been changed and „OKUs‟* stands for „Orang Kurang Upaya‟ or PWDs.
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Baking class for the clients
„Yummy, yummy!‟
Drawing class conducted by
our volunteer, Mr Sim.
Gardening with volunteers, interns and clients.
„Is this a worm?‟ … also clearing aedes breeding ground?
Sewing class conducted by
our volunteers.
10/3/2014 MMHA clients demonstrated solidarity with those affected by MH370 by making
folded paper planes.
24/3/2014 Visitors from Japan at MMHA for educational and idea exchange purposes.
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PERSATUAN KESIHATAN MENTAL MALAYSIA
MALAYSIAN MENTAL HEALTH ASSOCIATION
8, Jalan 4/33, off Jalan Othman, 46050 Petaling Jaya
Tel: 03-77825499 Fax: 03-77835432 e-mail: admin@mmha.org.my
Website: http://www.mmha.org.my
TO:
PRINTED MATTER
PLEASE SUPPORT US
The Malaysian Mental Health Association provides psychiatric rehabilitation service at our centre; conducts seminars and awareness programmes for the public and targeted population groups, as well as programmes for support group for clients and their families. For these, we depend on financial support from well wishers to ensure that our programmes can reach out to, and benefit, as
many people as possible.
What can you do to help make a difference?
We need financial contribution to help us maintain our rehabilitation, advocacy and public education activities. As such, we appeal
to you to support us by donating to the Malaysian Mental Health Association to help make a difference.
PAYMENT DETAILS (Tax exemption permit No. 8278)

I wish to make a one-time contribution of the following amount: RM_________________

Enclosed herewith cheque/Money Order No: ____________________________________

Pay direct to Malaysian Mental Health Association through our CIMB account No 1248-0012069057
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