From Centralized to Decentralized Service: Mental Health and Psychiatry in Malaysia

Abstract

This chapter charts the formation and transformation of mental institutions, therapeutic concepts, and psychiatric practices in Malay(si)a from the early nineteenth century throughout the post-independence era. Introduced by colonialists in the early nineteenth century, mental health institutions in Malaya started out as a colonial program that aimed to clean the colony of vagrants, starving migrants, paupers, drug addicts, convicts, and people afflicted with mental illnesses by confining them in gaols. It was not until the mid-nineteenth century that the mental asylum was separated from the gaol. At the turn of the twentieth century, an increase in the number of mentally ill patients coincided with the large influx of migrant workers from China and India. The overrepresentation of male Chinese patients mirrored the demographic structure of the immigrant population. Racialized medical comprehension of mental illness was not uncommon. Therapeutic practices included occupational therapy, shower baths or cold douches, and electroconvulsive treatment (ECT). These practices were an essential part of a broader process of molding the mentally ill into economically productive, morally useful and desirable colonial subjects. As a set of transplanted practices, colonial institutional mental health services did not automatically acquire legitimacy. The availability of traditional healing services, the public preference for traditional therapies, and social stigma and scarce modern psychiatric services jointly contributed to the unpopularity of these mental health institutions. Several changes and debates took place after independence. The government took the initiative to decentralize mental health services by setting up psychiatric units at district and general hospitals from 1958. Local medical education began to offer psychiatric training to overcome the shortage of professionals. The involvement of international bodies like WHO in modernizing the country’s psychiatric services was met with a mixed response. While local psychiatrists welcomed more international assistance and resources, social scientists and medical anthropologists expressed alarm concerning the undesirable results of standardization and called for culture-specific procedures. There was also a movement towards community care, which was initiated by NGOs in the late 1960s and translated into a national community mental health program in the late 1990s. The program was compromised due to shortage of professionals, inadequate budget and stigmatization. Despite the promotion of the modern mental health service as more legitimate, modern–traditional, mixed consultation is not uncommon today.