A study for the World Health Organisation has provided evidence of how the gap between the rich and the poor affects individual and collective mental health. It shows how the gap causes psychological and physiological changes that affect the mental health of individuals. The report also argues that the mental health component is important in analysing broader health and social issues.

(The study should be seen in conjunction with another study “The Spirit Level”, which revealed that a wider income gap leads to a higher incidence of social ills. Think of the rising crime rate, etc in Malaysia.)

Malaysia has one of the widest income inequalities in the region – and so it’s not surprising that a Bernama report shows that mental health cases are on the rise in the country. Maybe that is why we see so many Malaysians displaying all manner of strange behaviour, whether on the roads or even in Parliament or the Perak State Assembly!

Mental Illnesses Among Malaysians On The Rise

KUALA LUMPUR, June 19 (Bernama) — Mental illnesses has been on the rise in the country, with more individuals seeking treatment for problems ranging from mild anxiety disorders to severe schizophrenia.

According to health ministry statistics, last year saw 379,010 individuals treated as psychiatric outpatients in government hospitals, as compared to 324,344 in 2007.

The number of psychiatric inpatients last year was recorded at 21,217 cases as compared to 21,852 cases, the previous year, said the ministry’s Director of Medical Development, Datuk Dr Azmi Shapie.

He said, more teenagers were also suffering from mental health problems, according to the 3rd National Health and Morbidity Survey in 2006.

“The survey also showed that 19.5 per cent of the older age group (70 to 74 years) and 14.4 per cent of the youngest (between 16 and 19 years old) were also more prone to having mental health problems, than the rest of the age group,” he said at the 14th Malaysian Conference on Psychological Medicine here Friday.

Dr Azmi was delivering a speech by Health Minister Datuk Seri Liow Tiong Lai.

He said that mental illnesses were also more prevalent amongst females at 12.1 per cent, as compared to male (10.4 per cent).

He said mental illness was also a cause which led to suicide, which its rate was also on the rise, where its mortality rate is 16 per 100,000 or one death in every 40 seconds.

“In Malaysia, the suicide rate has increased to between nine and 12 persons per 100,000 population, as compared to eight in the 1980s.

“The rate has been found to be the highest among ethnic Indians,” added Dr Azmi.

Here are some paragraphs I would like to highlight from the ‘Mental health, resilience and inequalities’ report prepared for the WHO (emphasis mine):

Mental health is also the key to understanding the impact of inequalities on health and other outcomes. It is abundantly clear that the chronic stress of struggling with material disadvantage is intensified to a very considerable degree by doing so in more unequal societies. An extensive body of research confirms the relationship between inequality and poorer outcomes, a relationship which is evident at every position on the social hierarchy and is not confined to developed nations. The emotional and cognitive effects of high levels of social status differentiation are profound and far reaching: greater inequality heightens status competition and status insecurity across all income groups and among both adults and children. It is the distribution of economic and social resources that explains health and other outcomes in the vast majority of studies. The importance of the social and psychological dimensions of material deprivation is gaining greater recognition in the international literature on poverty and informs current efforts to develop indicators that capture the missing dimensions of poverty.

For this reason, levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological wellbeing. While psycho-social stress is not the only route through which disadvantage affects outcomes, it does appear to be pivotal. Firstly, psychobiological studies provide growing evidence of how chronic low level stress ‘gets under the skin’ through the neuro-endocrine, cardiovascular and immune systems, influencing hormone release e.g. cortisol, cholesterol levels, blood pressure and inflammation e.g. C-reactive proteins. Secondly, both health-damaging behaviours and violence, for example, may be survival strategies in the face of multiple problems, anger and despair related to occupational insecurity, poverty, debt, poor housing, exclusion and other indicators of low status. These problems impact on intimate relationships, the care of children and care of the self. In the United Kingdom, the 20% – 25% of people who are obese or continue to smoke are concentrated among the 26% of the population living in poverty, measured in terms of low income and multiple deprivation of necessities. This is also the population with the highest prevalence of anxiety and depression….

While there is much that can be done to improve mental health, doing so will depend less on specific
interventions, valuable as these may be, and more on a policy sea change, in which policy makers across all sectors think in terms of ‘mental health impact’. It is already evident that the relentless pursuit of economic growth is not environmentally sustainable. What is now becoming clear is that current economic and fiscal strategies for growth may also be undermining family and community relationships: economic growth at the cost of social recession. This means that at the heart of questions concerning ‘mental health impact’ is the need to protect or recreate opportunities for communities to remain or become connected.

A focus on social justice may provide an important corrective to what has been seen as a growing over-emphasis on individual pathology. Mental health is produced socially: the presence or absence of mental health is above all a social indicator and therefore requires social, as well as individual solutions. A focus on collective efficacy, as well as personal efficacy is required. A preoccupation with individual symptoms may lead to a ‘disembodied psychology’ which separates what goes on inside people’s heads from social structure and context. The key therapeutic intervention then becomes to ‘change the way you think’ rather than to refer people to sources of help for key catalysts for psychological problems: debt, poor housing, violence, crime. There is a need to think more critically about the relative contribution to mental wellbeing of individual psychological skills and attributes (e.g. autonomy, positive affect and self efficacy) and the circumstances of people’s lives: housing, employment, income and status. This also involves recognizing that ‘happiness’, ‘positive thinking’
and ‘trust’ are not always adaptive responses.

Does that make sense? Sounds perfectly logical to me. And yet, the medical profession largely sees mental health in terms of the individual and not as a response to socio-economic injustices and relative poverty and deprivation.

The path to development is by addressing inequalities, and whether a piece fits or not in our pursuit of development should be assessed on its contribution to equality or inequality. Clearly, to address inequalities, we also need to look at the environment, since the impact of damage to the environment is often disproportionately felt by the poor and lower income group. The rich, on the other hand, can buy their way into better and more conducive environments (think gated communities and country homes).

Against such a framework, the NEP, at its best, addresses just one part of the framework: inter-ethnic inequalities. But it has also contributed to worsening overall inequality. A comprehensive framework is needed to tackle not only inter-ethnic inequalities, but also overall inequalities.

For there to be any meaningful meritocracy – and here I don’t mean meritocracy to justify the existing unjust distribution of  income, wealth and well-being – it must also tackle inequalities. Otherwise, there will never be a level playing field for all (e.g a rich kid with access to all kinds of workbooks, computers, tuition compared with a rural pupil going to a school with no regular electricity and water).

There need not be a contradiction between meritocracy and a well-crafted affirmative action programme that can tackle inequalities. A careful balance between the two could lead to a more equal society in which meritocracy can play a part  – but in a way that is fair and just to all.