Dr David Lim (DL): Thank you, Prof Taj, for making time for this interview. Let’s start with your professional background. Even a cursory glance at your online biography is sufficient to impress upon the reader that your knowledge and experience in academia and counselling psychology are as wide as they are deep. In 30 words or less, how would you sum up your background for the Inspired readership?

Prof Datuk Dr Mohd Tajudin Md Ninggal [PT]: I am a professional trained and licensed Counselling Psychologist in the United States with strong emphasis in Individual and Group Counselling, Family Counselling, School Counselling, Career Counselling, Multicultural Counselling, and Psychological Testing and Assessment.

DL: For the benefit of the layperson, please could you briefly state the disciplinary differences between “counselling”, “counselling psychology”, “psychology”, and “psychiatry”?

PT: Counselling and counselling psychology are a subset of psychology, which is the scientific study of the mind and behaviour. Psychology is a multifaceted discipline and includes many sub-fields of study such as human development, sports, health, clinical, social behaviour and cognitive processes.

Counselling generally refers to short-term consultation while psychotherapy typically refers to longer-term treatment. Counselling typically deals with present issues that are easily resolved on the conscious level, whereas psychotherapy intensively and extensively examines a person’s psychological history. The key difference is that whilst counsellors use evidence based practice, counselling psychologists must adhere to literature and research-based treatments.

By contrast, psychiatrists are at their core medical doctors. They are certified to prescribe neuropharmacological support, that is, medication, to their patients who are experiencing moderate to severe levels of mental disorders.

DL: The National Health and Morbidity Survey [NHMS] conducted by the Ministry of Health [MOH] annually describes mental health issues as encompassing the whole range of psychiatric “disorders of psychological function that have been systematically described among the clients of psychiatrists.” Could we conceive of mental health problems as forming a spectrum, with one end representing the mildest and the other end representing the most severe of cases?

PT: Life can be scary, confusing, or upsetting when you’re experiencing emotional, cognitive, and physical changes. You might even ask yourself, “Do I have mental illness?” It’s a natural question, especially since, according to the 2020 NHMS, one in five Malaysian adults experienced some type of mental disorders. Getting a diagnosis from a professional is essential but learning about mental disorders may be an excellent first step towards improving one’s mental health. According to the Diagnostic Statistical Manual of Mental Disorders [5th Edition], or DSM-V, in short, there are 10 types of personality disorders that range from mild and moderate to severe. The 10 types of disorders are grouped in three different clusters: A (Bizarre, Odd, Eccentric); B (Dramatic, Erratic); and C (Anxious, Fearful).

A personality disorder is a type of mental disorder in which the individual is beset by a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. Unfortunately, there is still a lack of understanding of the disease especially in terms of common mental disorders, the causes and possible consequences, as well as recognising the early signs of major mental problems.

DL: The 2015 NHMS produced some grim findings. The survey found that 1 in 3 Malaysians aged 16 years and above suffered from mental health issues. Individuals in the 16-19 years age bracket and from low income families bore the brunt. This was up from 1 in 10 in a 1996 finding. As for children aged 5 to 15, the 2019 NHMS found that 7.9 percent of those surveyed suffered from mental health problems. Those from the B40 income group were the most at risk.

Given these statistics which some have described as evidence of a hidden epidemic, and given the Covid-19 global pandemic which has truly upended lives, how concerned should Malaysia be? Which particular aspects of the problem should we worry about the most? And how will all this impact learners across all levels of study?

Getting a diagnosis from a professional is essential but learning about mental disorders may be an excellent first step towards improving one’s mental health.

PT: Yes, studies have showed that most university students face difficulties concentrating on their studies and maintaining their mental health. Longterm isolation arising from online learning during the Covid-19 pandemic can strongly affect one’s mental health. The impact of the pandemic on students’ mental health is already extremely concerning. In a study I conducted last year involving new university students, both male and female students reported experiencing moderately high levels of emotional instability. They reported feeling anxious and lacking in self-confidence when doing their online study from home.

DL: Would it be reasonable to extrapolate from the 2015 NHMS that at least 1 in 3 adult learners in institutions of higher learning, and 1 in 3 of our coworkers are potentially in the same mental health boat?

PT: According to a recent global survey by recruiting experts Hays, about 37 percent of workers reported that their mental health and wellbeing had been negatively impacted by the pandemic. 42 percent of those affected said their employers did not provide them with support. These figures are highly concerning.

The health and safety of all workers need to be at the forefront of concern for all employers. There is a duty of care to ensure their workforce receives the necessary support. This is even more important when large parts of the workforce have been working remotely and may not have been in such close contact with their colleagues or managers.

In Malaysia, the 2019 NHMS noted that the national prevalence of depression among Malaysian adults was at 2.3 percent. That accounts for roughly half a million individuals. Incidences of depression have undoubtedly been exacerbated by the pandemic, with the government psychosocial hotline receiving close to 12,000 calls and counting since the outbreak. On World Mental Health Day this year, Malaysia’s health director-general Dr Noor Hisham Abdullah called for more education to help identify and destigmatise mental health issues in the country.

Across the globe, many people have had to deal with very different challenges during the pandemic. Struggling to juggle commitments outside of work, coping with isolation, and dealing with the death of a loved one – these are just some of the challenges. Each person’s experience of the crisis is unique and when the visibility of workers isn’t as great as it once was, it can be difficult for employers to identify who needs help. However, there are steps that organisations can take to ensure they are doing their utmost to protect the mental health and wellbeing of their employees. This is no longer just a matter of duty of care; it’s also about ensuring that businesses truly support their staff financially and psychologically during a difficult time for everyone.

DL: The official finding that 1 in 3 Malaysians aged 16 years and above suffer from mental health issues may just be the tip of the iceberg. Some would argue from lived experience and anecdotal evidence that the real figure is likely higher. How would you respond to this as a practising counselling psychologist?

A majority of my university students reported such issues as anxiety and those revolving around time management, low self-confidence, lack of selfdirection and career planning.

PT: The coronavirus pandemic is taking a toll on the country’s mental health, sadly, with the number of suicide and suicidal cases rising in tandem. Some of these cases have been reported in the media. As a practising counselling psychologist, I have come across many people who are finding it hard to cope with the isolation and economic hardship arising from the pandemic. Being in isolation increases the fear and helplessness that one experiences, and this can lead to anxiety and depression. When someone is isolated in crowded families or spaces, the environment can get toxic. Having to adjust to sudden changes related to the movement restrictions, and to uncertainties in finances, employment, education, and even obtaining daily provisions or food supplies – all that can be very stressful, especially in more remote areas, and may worsen loneliness and increase the risk of domestic violence. While social movement curbs are aimed at protecting Malaysians from a contagious and potentially fatal virus, they inadvertently put people at risk of deteriorating mental health.

DL: A study estimates that Malaysia has a national average of 1.27 psychiatrists per 100,000 population, while the World Health Organization recommends a ratio of 1 psychiatrist per 10,000 population. Is the country facing the same shortage of counselling psychologists?

PT: There is no doubt that mental health issues are on the rise in Malaysia. Currently, based on the records from the Malaysian Board of Counsellors, there are more than 10,000 registered counsellors in Malaysia serving a population of 32 million people. A majority of these registered counsellors are working in the school systems and some are working in such government sectors as ministries and hospitals. Only a small percentage of these registered counsellors are in private practice. Yes, it seems that the country is facing shortages of counselling psychologists or counsellors to address the rising cases of mental health issues among the general public especially during the pandemic.

I personally believe that the country’s mental health professionals are doing their very best to provide quality treatment while also promoting a holistic awareness of these issues among the urban and rural populations. Malaysia needs more top-tier mental health care professionals, such as clinical psychologists, counselling psychologists, and counsellors. They are much needed to help people affected by mental health conditions to alter unhelpful thought patterns and behaviours and learn new coping methods. In addition, we need more psychiatrists, who are physicians that specialise in mental health care and who can prescribe medication to those who are diagnosed with severe mental health problems.

DL: Mental health literacy in Malaysia is relatively low, according to the 2020 report on Workplace Mental Health conducted by Relate Mental Health Malaysia, a mental health organisation. The report finds that the “majority of Malaysians are unable to identify signs of poor mental health or the causes and treatment of mental health conditions.” Have you as a practitioner found this to be generally the case?

PT: When we talk about anosognosia in mental illness, we mean that people are unaware of their own mental health condition or that they can’t perceive their condition accurately. Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it. Anosognosia is a word of Greek origin that roughly translates to “without knowledge of disease.” You may also hear it called “lack of insight.” Major mental illnesses such as schizophrenia or bipolar disorder rarely appear out of the blue. Most often family, friends, teachers, or the affected individuals themselves begin to recognise small changes or a feeling that “something is not quite right” about their thinking, feelings or behaviour before an illness appears. Therefore, we need to have more awareness programmes on mental health issues and ways of managing them in the community. Schools, colleges, universities, and other sectors of the community could organise talks and programmes to raise awareness.

DL: You have counselled clients from wideranging backgrounds for several decades, including university students and working adults. What are the problems typically encountered by these two groups of clients?

PT: I have seen thousands of clients during my 30 years of experience in the private mental health practice and in the university setting. Those clients range from adolescents, university students, working adults, single parents, and expatriates to the elderly from different ethnic backgrounds. Their common psychological issues range from multiple physical and emotional abuse, domestic violence, sexual abuse, bullying, relational and marriage problems, work-related stress, depression, anxiety, and suicidal ideation. A majority of my university students reported such issues as anxiety and those revolving around time management, low self-confidence, lack of selfdirection and career planning. By contrast, a majority of working adults reported experiencing work-related stress, depression, anxiety, relational issues, and marital problems.

Do not keep your issues or problems to yourself for too long as it would affect your psychological health in the long run. You need to talk about your feelings to someone whom you are comfortable with and trust.

DL: Of all the cases you have handled over the years, which categories would you consider to be the most common?

PT: Depression and Anxiety Disorders that can include Obsessive Compulsive Disorder [OCD], panic attacks, and phobias which impact adults aged 18 and older – these are the common categories of mental health disorders that I have come across throughout my private practice.

DL: As a last question, what advice would you offer learners and educators who may be experiencing mental health issues?

PT: It is essential for your wellbeing that you take care of yourself and get the most from life. Do not keep your issues or problems to yourself for too long as it would affect your psychological health in the long run. You need to talk about your feelings to someone whom you are comfortable with and trust. That person could be your best friend, a family member, or a professional mental health expert like a counsellor and psychologist. Talking and sharing your feelings with them can help you maintain your mental health and deal with times when you feel troubled. You will feel a bit of relief when there is someone who is willing to lend a sympathetic ear to your personal issues or problems.

It is equally important to keep in touch with your own feelings and mental state since there are some warning signs of mental illness that you need to be aware of. For instance, you might be experiencing changes in sleeping pattern, appetite, behaviour, and mood; or rapid or dramatic shifts in emotions or depressed feelings. You might also be experiencing social withdrawal and loss of interest in activities previously enjoyed. Sometimes these behavioural and emotional changes could be noticeable by your family members, friends or colleagues.

If you happen to experience any of these signs and symptoms, it would be helpful for you to talk openly about your issues with a mental health professional, counselling psychologist, or counsellor. While waiting to see a professional, you need to keep yourself active, eat well, educate yourself about your mental health issues, and take a break if needed. You are the best person to know about what is going on within yourself. In addition, we can also detect people around us acting differently or strangely, or who are no longer their normal selves, especially during this Covid-19 pandemic. Try to assist and support them whenever you have the chance. Encourage them to seek psychological treatment. They could be our family members, friends or colleagues.

DL: T hank you again, Prof, for your time and views.

PT: My sincere pleasure.