STRENGTHENING MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SYSTEMS AND SERVICES. MALAYSIA COUNTRY REPORT 2022

THE DSW also provides protection and rehabilitation services in 39 children’s institutions with a

capacity for 3,955 children as follows:

a. Rehabilitation institutions - 22

b. Protection institutions - 17

On a similar note, the social welfare sector was furthermore recommended to take a lead role in

the establishment of residential rehabilitation services as a medium- to long-term priority action. At

the moment, the majority of such services are provided by NGOs. With many organizations facing

limited funding and other restrictions, it is timely for the social welfare sector to assume a bigger

role in this area.

Responsive care: Justice sector

The justice sector currently plays a minimal role in responsive care, except for children and adolescents

who are engaged in the justice system (for example, victims of family violence). Psychologists

within the justice system provide psychological assessment, screening, management and referral

for children and adolescents who come into contact with the justice system. Although they do not

widely advertise their services to the public, they do encourage the public to utilize the services that

they provide. For example, parents and/or students do visit the psychologists at the police station

after their engagement at schools during MHPSS awareness campaigns.

Table 5. Sectoral roles in implementing MHPSS actions: Prevention of mental health conditions in the

immediate social context

Actions in bold indicate where a sector is recommended to have a leading role or primary responsibility for

implementation

Prevention of mental health conditions in the immediate social context

HEALTH

EDUCATION

SOCIAL WELFARE

JUSTICE

Support to mental

School and

Support to mental

health approaches in

education-based

health approaches in

education, including

programmes and

education

teacher well-being

approaches:

• Whole-of-

education mental

health promotion,

including a focus

on creating safe,

respectful and

inclusive learning

environments,

supporting social

and emotional

learning, and

supporting

positive peer

and peer-teacher

relationships

• Teacher-parent

communication

• Teacher and staff

well-being

Introduction

Prevention of mental health conditions in the immediate social context

HEALTH

EDUCATION

SOCIAL WELFARE

JUSTICE

Establishing youth

and peer support

groups

Digital literacy, online

Digital literacy and

Digital literacy, online

networks for mental

civility education

networks for mental

health

Intensive

Supporting intensive

interventions to

address risk factors

(including substance

Support to schools

School-based

use)

following crisis (e.g.,

interventions

suicide in community)

following crisis in

the community

(e.g., suicide)

Identify and address

Raise awareness

Parenting

mental health needs

about positive

programmes to build

of parents/carers

parenting

skills in nurturing and

responsive care, and

non-violent discipline

Prevention: Education sector

The education sector was recommended to have a major role in the implementation of actions to

prevent poor mental health. This includes a leading role in coordination and implementation of actions

to optimize learning environments, build individual assets and support healthy peer relationships.

Schools in particular were identified as a key platform for delivery of many MHPSS actions. As such,

the education sector should have a greater role in developing and implementing whole-of-school or

education mental health promotion approaches through the development of policies, implementation

guidance and delivery of training for teachers, school counsellors and other education staff in mental

health. This sector also has lead responsibility for developing curricula to support social and emotional

learning; addressing bullying, harassment and substance use; and implementing programmes to

foster healthy peer relationships and build interpersonal skills. Schools were also noted to be an

important source of programmes to support digital literacy and civility and to potentially play a role in

establishing both online and in-person peer groups and networks in relation to mental health. Given

the linkages between schools and parents, the education sector was also recommended to support

implementation of parenting programmes in collaboration with social welfare.

Prevention: Health sector

The health sector was recommended to play a supporting role to the education sector in mental

health preventive approaches. These include the training of educators in mental health and providing

school-based interventions following a crisis in the community (e.g., suicide).

Prevention: Social welfare sector

Most stakeholders agreed that social welfare should play a major role alongside the education sector

in preventive services, particularly in the development and implementation of large-scale parenting

programmes. This sector was also seen to have primary responsibility for targeted interventions

64 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

to address children and adolescents at risk of poor mental health (for example, children who have

experienced violence, abuse or neglect).

Prevention: Justice sector

Although the justice sector was identified as playing a minor role in prevention, the sector is needed

to support intensive interventions to address risk factors. The sector could also be engaged in

programmes to promote anti-violence and bullying in school.

Table 6. Sectoral roles in implementing MHPSS actions: Mental health promotion - Ensuring an enabling

and safe environment

Actions in bold indicate where a sector is recommended to have a leading role or primary responsibility for

implementation

Mental health promotion: Ensuring an enabling and safe environment

HEALTH

EDUCATION

SOCIAL WELFARE

JUSTICE

National,

Integrating

Integrating mental

multisectoral

mental health into

health of children

mental health plans

education policies

early childhood

and adolescents

and strategies,

development, child

into juvenile justice

including suicide

protection/ending

and justice health

prevention

violence, social

policy and plans

welfare and social

protection policies

and plans

Integration of

mental health into

maternal and child

health, adolescent

health, nutrition,

and HIV policies and

strategies

Policy and standards

Identifying barriers

Protections for

for high quality

in access to mental

children and

mental healthcare

health services for

adolescents in

marginalized groups

the mental health

system

Legislation

mandating access to

mental healthcare,

including removing

mandatory parental

consent requirements

Legislation

mandating access to

mental healthcare

for children and

adolescents

deprived of liberty

and in out-of-home

placements

Introduction

Mental health promotion: Ensuring an enabling and safe environment

HEALTH

EDUCATION

SOCIAL WELFARE

JUSTICE

Support to legislation

Legislation and

and policies to

policies to prohibit

protect children and

violence, harm,

adolescents from

discrimination

violence and harm

•

Decriminalize

suicide

•

End all forms of

violence

•

Child marriage

•

Discrimination

•

Control of

substance use

•

Restrict access to

lethal means

•

Child labour

•

Recruitment to

armed forces

•

Minimum age

of criminal

responsibility

Social protection

programmes for

families

Training and

community-based

programmes to

address stigma and

discrimination

Capacity building

in adolescents

in adolescents to

to support

support participation,

participation,

including those with

lived experience

of mental health

needs or risks, in the

planning and design

of MHPSS

66 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Promotion: Justice sector

The justice sector was identified as having a lead role in developing and enforcing legislation to

protect children and adolescents from harm and discrimination. This includes amending legislation

to decriminalize suicide and increase the minimum age of criminal responsibility.

Promotion: Health sector

With respect to policy and legislation, the health sector was identified as having a lead role in

developing mental health policy and technical guidance to support the delivery of responsive care.

This includes a role in advocating for legislation that ensures the rights of children and adolescents to

mental healthcare, removes mandatory requirements for parental consent, and protects children and

adolescents within the mental health system from harm. This sector was also seen as having overall

responsibility for developing national, multisectoral mental health policy and strategies. Additionally,

the heath sector was identified as having a role in supporting efforts to improve mental health literacy

and mental health promotion.

Promotion: Social welfare sector

Because of its existing close linkages with communities, the social welfare sector was identified

as having a key role in developing and implementing programmes to promote mental health and

address the broader social determinants of well-being (such as early childhood development). This

sector was also recommended to have a leading role, along with the justice sector, in supporting the

enforcement of legislation and policies to protect children from harm, including supporting mandatory

reporting of child abuse.

Promotion: Education sector

Strengthening the integration of mental health into education policies and plans was identified as a

key priority for the education sector. This sector was also noted to play an important role in addressing

mental health stigma and discrimination through curriculum-based and other learning programmes

related to mental health.

In addition to sectors having lead responsibility for implementing different MHPSS actions within

each tier, there are several critical areas of convergence where effective implementation of specific

actions requires strong collaboration across sectors. These include actions to:

Improve early identification, screening and referral to multidisciplinary care;

Ensure continuing care and support for children, adolescents and their families experiencing

mental health conditions or at increased risk;

Implement targeted, intensive interventions for children and adolescents at increased risk of

poor mental health (particularly in relation to high-risk exposures such as violence and conflict

with the law);

Implement whole-of-school-based approaches to prevent poor mental health and promote

well-being;

Support positive parenting and provide services and supports to parents and carers of children

with mental health needs, or for their own mental health needs;

Social protection and supports to address broader determinants of mental health and well-being.

Introduction

Non-governmental organizations

Not-for-profit NGOs were seen to play a potentially important role in the implementation of MHPSS.

Many local and international organizations are engaged in areas that relate in some way to mental

health and well-being (such as physical health, sexual and reproductive health, child welfare and child

development), providing a platform to integrate more specific MHPSS actions. In particular, strong

partnerships with communities and understanding of community needs would facilitate delivery

of actions around mental health literacy, addressing stigma, community-based service delivery

(identification, referral and first aid), and programmes to support parents and families. The NGO sector

was also seen to have an important role in supporting mental health advocacy. Within this sector,

youth organizations were also identified as crucial in promoting mental health literacy and participating

in the implementation of preventive and care interventions in community and school settings.

Private sector

The private sector was identified as having a significant role to play in filling the service delivery gaps as

this sector provides a large proportion of health services, including mental health services. In general,

stakeholders recommended that further mapping was required to better understand the current

roles and capacities of the private sector in mental health, with greater coordination and regulation

of the sector. The private sector was also identified as having a potential role in providing financial

support or other resources (such as technology, including digital technology, expertise and training

opportunities) to support MHPSS initiatives through corporate social responsibility programmes.

UNICEF

Through consultation with UNICEF representatives in the region, UNICEF was identified as having

an important role and comparative advantage in:

Advancing the advocacy agenda in relation to children and adolescent mental health prevention

and promotion;

Playing a crucial convening role in facilitating linkages between sectors (such as health, social

welfare, child protection and education) and supporting cross-sectoral dialogue, planning and

resource allocation;

Data synthesis and evidence generation through supporting research to draw attention to key

mental health needs and advocating for evidence-based action;

Supporting, through funding, new initiatives, pilot projects and other innovations to test new

ways of delivering MHPSS for children and adolescents;

Integrating MHPSS into existing UNICEF programmes and platforms (including primary healthcare,

education, parenting programmes and child protection);

Supporting and delivering programmes to address mental health-related stigma and improve

mental health literacy through national-level advocacy and community-based programming; and

Integrating MHPSS in emergency settings.

68 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Legislation, policy and strategy

Malaysia has a strong legislative and policy framework to support MHPSS and ensure the mental

health and well-being of children and adolescents. The National Strategic Plan for Mental Health

2020-2025 lays the foundation for multisectoral action to promote well-being, prevent poor mental

health, provide responsive services and protect the rights of children and adolescents. The Strategic

Plan includes some specific actions to address the unique needs of this age group (such as screening

and early detection, mental health education and responsive care in schools). However, while the

Strategic Plan recognizes the importance of engaging sectors in addition to health, it does not

articulate a clear, multisectoral vision for mental health or describe the mechanisms needed to enable

cross-sectoral collaboration and accountability. This includes a lack of performance indicators or other

mechanisms to monitor collaboration or coordination.

The Mental Health Act 2001 includes some general protections of rights of those within the mental

health system in relation to physical restraint, deprivation of liberty, involuntary treatment, and

appeal. However, there are no specific protections for children and adolescents. Such protections

could include:

Right to least restrictive assessment and treatment possible, including specific consideration

of the use of physical restraint, involuntary seclusion, and deprivation of liberty for those under

the age of 18 years;

Right of children and adolescents to make decisions about mental healthcare and recovery to

the fullest extent possible, with consideration of the best interests of the child or adolescent

(including removal of mandatory requirements for parental consent);

Appointment of a personal representative other than a family member, if necessary

Right to have contact with family or other support persons;

Right to recreational activities, education and other supports that respond to individual needs.

Other recommendations from stakeholders included merging the Child Act and Mental Health Act

to develop an act that specifically caters to mental health in children; developing a national Mental

Capacity Act to provide greater clarity on the rights of children and adolescents with respect to

consent and assent to mental healthcare (particularly in cases of severe mental disorder) and the

rights and responsibilities of parents; and amending Article 8(2) of the Federal Constitution to include

protection from discrimination on the basis of disability, including children with a developmental

disorder. An additional gap in legislation exists for undocumented migrants and asylum seekers,

including children and adolescents. Due to their lack of legal status, these children may not be eligible

for healthcare services, including for mental health.

Mental health has been integrated to some extent into the sectoral policies and plans of education

and social welfare. The National Education Blueprint recognizes the importance of emotional

development and the school curriculum and environment in supporting resilience, emotional skills

and peer relationships, and there is currently a national programme to support screening in schools.

However, there are gaps in relation to greater inclusion of mental health literacy and social and

emotional learning within the national standard curriculum, a clear, whole-of-education policy to

support mental health, and strategies to reach out-of-school children and adolescents with MHPSS.

Malaysia also has a suite of laws, policies and plans related to child welfare and protection that

address some of the key determinants of mental health (such as violence, trafficking, education and

participation), with inclusion of MHPSS (such as counselling and psychosocial support) and strong

linkages with health services. Stakeholders identified a need for strengthened social protection policy,

with a greater focus on children and families. The justice sector has also included the provision of

psychiatric assessment and care in legislation and policy with respect to management of children

in custody, as well as some protections for child victims and those in conflict with the law to

prevent further psychological harm. Nevertheless, policies that more clearly articulate the roles and

responsibilities of these sectors with respect to MHPSS would strengthen access to and the quality

of MHPSS for those most at risk. The justice sector, in particular, noted that this process takes time

and requires greater ministerial support across sectors.

Challenges and recommendations for strengthening the multisectoral mental health system

“Amending the law will take a long time. You need a supporting ministry. And then you need

the AG (Attorney General) chamber to table a bill in parliament. And usually, it takes political

will. So, you need to have somebody within the cabinet to campaign for mental health and

support services. I think currently the priority is the GDP and economy. I don’t know how

highly they rate mental health support services. So, you need to get people to go and talk to

their members of parliament, so that they can raise this. You need to advocate, you need the

mental health practitioners to raise it with their ministers and their relevant ministries, you

need the MOE (Ministry of Education) to raise it, so that there is joint effort. Because this is

not something that is politically slanted. It’s apolitical. It’s for the benefit of the country

but only if they see it as a priority.” —A justice sector informant

Across sectors, stakeholders noted that in addition to addressing these gaps, there was a need

for implementation strategies, plans and frameworks that more clearly defined the roles and

responsibilities of agencies, particularly at local level units. While supportive policies are in place,

the lack of clear guidance and accountability contributes to limited implementation.

“So far, there are policies like, for example, National Adolescents Guidelines policies where it

says...it looks into the needs...it addresses the needs for adolescents, all in all. But policies

are remaining as policies.” —A health sector informant

“I was saying that something to move the needle is having policy. Then, it makes things

happen. Having a policy, and getting the stakeholder to buy into that policy and implementing and

following up to make things happen. You will see changes” —A social welfare sector informant

“You can come up with all the action plans, we always say you have a strategic plan, action

plan, but where’s the action? So, that part is lacking” —A social welfare sector informant

KEY RECOMMENDATIONS - LEGISLATION AND POLICY:

Ensure ‘mental health in all policies’ with more explicit recognition and actions to address

mental health in non-health sector policies, and as part of the COVID-19 response.

Expand existing national mental health policy, or develop specific child and adolescent

mental health policy, to provide clearer and more comprehensive guidance on actions to

promote, prevent and respond to the mental health needs of this age group.

Strengthen mental health legislation to include specific protections and considerations

for children and adolescents, including clearer rights with respect to consent to mental

healthcare and removal of mandatory requirements for parental consent.

Amend Article 8(2) of the Federal Constitution to include protection from discrimination

on the basis of disability, including protection for children with developmental disorder(s).

Develop multisectoral implementation plans and guidance with clear roles, responsibilities

and accountability at all levels

(including key performance indicators related to

multisectoral coordination).

Review legislative and regulatory barriers to access (e.g., undocumented migrants,

mandatory requirement for parental consent).

Develop policies and strategies to reach out-of-school children and adolescents, and other

marginalized groups.

Improve dissemination of MHPSS-related policies and plans across sectors and to

administrative and implementation agencies.

Develop multisectoral mental health plans at subnational level to support coordination

and implementation.

Strengthen legal protections against all forms of harm and discrimination, including

decriminalization of suicide and prohibition of all forms of corporal punishment.

Strengthen social protection policy, with a focus on children and families.

Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Leadership and governance

While there are examples of programmes and approaches that have engaged multiple sectors, such

as coordination between the social welfare and health sectors in child protection cases, limited

multisectoral collaboration and lack of coordinated leadership across sectors was identified as one

of the major challenges to implementation of MHPSS.

National level

Limited high-level, multisectoral coordination of policy and planning remains a challenge in Malaysia.

Stakeholders across sectors noted that each sector has a different policy focus, planning cycle and

budget priorities and that these are not currently aligned around a common vision or goal for child and

adolescent mental health. Stakeholders recommended that the health sector, specifically the Ministry

of Health, have overall leadership and accountability for MHPSS, including responsibility for mental

health policy, technical guidance, oversight of training, and monitoring and evaluation. However,

key roles were also identified for other sectors in providing leadership for MHPSS - most notably

the social welfare sector (for marginalized children and those at risk) and the education sector (for

developing and implementing school-based actions and MHPSS in learning environments), with roles

also for the justice sector in supporting MHPSS for children and families at high risk. UNICEF, WHO

and NGOs were also identified as having key leadership roles - particularly in relation to supporting

evidence-based policy through technical guidance, and linkages with communities. The private sector

was additionally identified as an important national stakeholder that should be engaged in policy and

planning to improve coverage of services.

Stakeholders across sectors emphasized the need for collaborative, high-level support for mental

health with a clear, multisectoral vision, acknowledging that many of the determinants and necessary

actions for mental health lay outside the traditional scope of the health sector. To facilitate better

collaboration and coordination, it was recommended that a national steering committee be established,

led by the Ministry of Health, with membership of all key sectors (including UN agencies and NGOs)

and the authority and resources to drive action. The National Strategic Plan lays the foundation for

this, by including the establishment of a national coordinating body with representation from health,

education, labour, social welfare and local government units to support greater coordination and

integration of mental health into all policies.

Subnational implementation levels

In addition to greater coordination at a national policy level, there is also a critical need to improve

coordination and governance at subnational implementation levels. In the context of decentralization,

state, district and local government authorities are responsible for planning, prioritization, resource

allocation and implementation. Lack of awareness of MHPSS-related policy and legislation at state

and district levels and a disconnect between national and subnational agencies contribute to limited

implementation and coordination between sectoral units and inconsistent delivery of national programmes

in different administrative areas. Lack of consistent policy goals and objectives in relation to mental health

across sectors was also highlighted, leading to fragmented implementation and gaps in delivery.

To overcome these challenges, stakeholders recommended that greater support be provided to

District Offices to: increase awareness of mental health and relevant policies and plans; support

planning and resource allocation; and establish district-level, multisectoral committees to guide

implementation and collaboration.

“So, I agree we all tend to work in silos. There’s no real platform for sharing and I think

that is also one of the problems that we have is that sometimes, nobody knows” —A social

welfare sector informant

“So, if you ask me, all of them have their role and all of them are doing their best when it

comes to MHPSS. But they’re all not connected to each other.”—A health sector informant

Challenges and recommendations for strengthening the multisectoral mental health system

KEY RECOMMENDATIONS - LEADERSHIP AND GOVERNANCE:

Establish a high-level, multisectoral national steering committee led by the Ministry of

Health, with representation from all key sectors (including UN agencies, NGOs and the

private sector), and with the authority and resources to drive action.

Build the capacity of District Offices in MHPSS to support local planning, coordination and

resource allocation.

Establish local, multisectoral committees to support coordination and implementation of

the priority MHPSS package.

Develop subnational implementation plans for MHPSS that clearly articulate sectoral roles

and responsibilities and are aligned with national goals and strategies for mental health.

Service delivery

Multiple platforms exist to support the delivery of MHPSS actions (see Figure 16). Within responsive

care, health facilities (primary, secondary and tertiary level) remain an important setting to deliver

screening through to specialized care. The National Strategic Plan and Operational Framework

emphasize the need to strengthen primary-level and community-based mental health services and

avoid admission of children into adult institutional care settings. Greater investment is needed in

developing child/adolescent-centred and friendly care models; strengthening entry points for children,

adolescents and their families through maternal and child health services, nutrition programmes,

adolescent health and other physical health services; and establishing child-focused, multidisciplinary

teams. The National Strategic Plan as well as stakeholders also recommended expanding models

of service delivery outside traditional clinical settings, in particular transitioning to community-based

and mobile services to improve access to screening, referral and care, and home-based services to

provide more person-centred care (particularly for subclinical or continuing care) and to reduce the

burden on health facilities.

Figure 16. Platforms for delivery of MHPSS across the three tiers of MPHSS actions

RESPONSIVE

CARE

SCHOOLS

ALT. CARE &

JUSTICE

ONLINE

PREVENTION

COMMUNITY

HEALTH

PROMOTION

74 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

In addition to the delivery of responsive care actions, community-based delivery was also identified

as an important platform for implementing actions to address mental health literacy, shift community

norms and stigma, and deliver preventive actions (including parenting programmes, family violence

programmes and targeted interventions for children, adolescents and families at risk). To address gaps

in service delivery and the workforce, community-based organizations and NGOs were identified as

important partners, with opportunities to work with existing NGOs to integrate MHPSS actions into

their programming. Stakeholders also recommended considering the establishment of community-

based centres providing safe spaces for children and adolescents that include provision of information

and services for mental health. There was also a recommendation for young people to lead MHPSS

programmes designed for children and adolescents, particularly in preventive care. Additionally, to

ensure that MHPSS is more accessible to people with disabilities and marginalized populations,

stakeholders recommended fortifying on-the-ground outreach and peer-to-peer support systems led

by young people and NGOs.

Schools and other learning environments are a critical platform for reaching large numbers of

children and adolescents with MHPSS. All sectors nominated school-based delivery as essential

to the effective implementation of MHPSS, with a focus on improving early identification and

screening, contributing to multidisciplinary and continuing care and, most significantly, actions to

build individual assets, promote positive peer relationships and create safe learning environments.

There have already been important efforts to integrate screening into secondary school settings.

However, much greater attention to the training and supportive supervision needs of teachers and

school counsellors is needed to support these programmes and referral linkages with other sectors

and service providers, as well as consideration of the additional demands on teachers’ time to support

MHPSS. Opportunities to strengthen curriculum-based approaches to support social and emotional

learning and teachers in behavioural management should be further explored. Schools are not only

a platform for delivering interventions. Learning environments in and of themselves have a profound

influence on mental health and well-being from early childhood through to adolescence. Addressing

the school/learning culture, academic pressures, respect and inclusiveness through the development

of whole-of-education approaches to mental health promotion are also important to support mental

health and well-being.

The potential of online and digital platforms has received increasing recognition, particularly in the

context of COVID-19. Malaysia has several hotlines, helplines and online applications that provide

information, mental health literacy and referral linkages. However, these platforms are currently

underutilized, with potential to make better use of online technology to support counselling, telehealth

for mental healthcare, interactive parenting programmes and integrating mental health into academic

online education for students.

Justice settings are also important for the delivery of screening, referral, targeted interventions to

address risk factors and continuing care for children who are victims or witnesses of crime, as well

as juvenile offenders. Several existing models of collaborative care were noted in Malaysia, with the

justice, health and social sectors collaborating to provide mental health assessment and referral.

However, stakeholders noted that these approaches could be strengthened through clearer policies

and protocols in relation to MHPSS for children in conflict with the law and child victims/witnesses,

and stronger linkages with other sectors and agencies.

All sectors noted significant barriers impacting on equitable access to MHPSS. Rural and remote

communities and migrants and ethnic minorities were recognized as having limited access to

facilities, services and skilled providers, with both government and NGO services concentrated in

more urban settings. Children and adolescents not engaged in formal education were also noted as

a key underserved group, as most national policies and programmes are focused on school-based

delivery. Children and adolescents living with disability were also identified as having high unmet

needs for MHPSS and very poor access to inclusive care - with stakeholders recommending a much

greater focus on ensuring that services are inclusive of those with disabilities. Stakeholders also

recommended further research to understand barriers and service-delivery preferences as well as

improved coordination with community-based organizations to better serve marginalized groups.

Challenges and recommendations for strengthening the multisectoral mental health system

KEY RECOMMENDATIONS - SERVICE DELIVERY:

Develop models and standards of child and adolescent-centred health services for mental

health

Strengthen two-way referral mechanisms between primary and tertiary care.

Transition to integrated community-based services that span the three tiers of MHPSS.

Integrate MHPSS into other health services at community level, including maternal and

child health, nutrition, adolescent health and general medical/physical health.

Establish more community centres that provide safe spaces for children and adolescents

and provide MHPSS information and services.

Build on existing school-based models to strengthen responsive care as well as key

preventive actions.

Strengthen and evaluate online and digital service delivery models that link mental health

promotion, positive peer relationships, parenting programmes and responsive care (self-

referral and counselling).

Strengthen protocols within justice settings to support the delivery of MHPSS and protect

children and adolescents from psychological harm, and strengthen linkages with health and

social welfare agencies.

Identify barriers and service-delivery preferences for marginalized and underserved

communities, particularly strategies needed to reach out-of-school children and adolescents,

and those living with disability.

Standards and oversight

Several recommendations were made to strengthen the quality of MHPSS and improve oversight.

At a national level, the Ministry of Health was identified as having primary responsibility for quality

assurance through setting technical standards and guidance, establishing indicators and monitoring

performance. While this role is more clearly defined with respect to responsive care and clinical health

services, oversight in relation to actions against the other tiers (prevention and promotion) is less clearly

articulated. To support oversight, it was recommended that a harmonized set of indicators for MHPSS be

developed that could be used to monitor performance and quality across multiple sectors. Stakeholders

also recommended establishing an independent monitoring body (or technical advisory committee)

made up of representatives from key sectors, reporting to the Ministry of Health, with responsibility

for monitoring quality and compliance and evaluating MHPSS programmes provided across all sectors.

A high priority is strengthening a national protocol for early identification, screening and referral for

children and adolescents with mental health conditions and those at increased risk. This includes

expanding locally validated and age-appropriate screening tools (including for children) and detailed

protocols for administering these within different settings (health, education, child welfare and justice).

A national, standard protocol and procedures for referral of children and adolescents with mental

health needs are also critical - not only for efficient referral within the health system but to support

inter-agency referral between sectors (for example from schools or child protection settings to health

services). Stakeholders also emphasized that these protocols needed to be two-way in order to

improve communication between specialist services and primary providers (health, education and

social welfare) and strengthen follow-up and continuing care and support.

76 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

To support responsive care, national standards for adolescent-friendly health service delivery should

be expanded to provide more specific service standards in relation to mental health, including trauma-

informed approaches. Similarly, standards of care provided in other settings are also needed - for

example, protocols and service standards for provision of psychological first aid or initial management

of behavioural problems in schools, and provision of MHPSS in social welfare and justice settings. For

the education sector, developing a national standard curriculum to support mental health education

was identified as a high priority. For the justice sector, stakeholders recommended that protocols be

developed to provide greater guidance on the management (health and legal) of children in conflict with

the law who have a mental health condition, and protocols to minimize harmful impacts on the mental

health of juvenile offenders and child victims/witnesses. Standard operating procedures and protocols

that cover multiple agencies are also needed for children and adolescents engaged in the justice or

social welfare sectors. Within child protection, these should include detailed guidance on the roles and

responsibilities of each sector and relevant agencies in screening, referral, management, preparation

for release or discharge, and follow-up to ensure continuity of care and monitoring in the community.

Stakeholders also recommended developing a standardized system for NGOs to engage with the

Government in MHPSS. This included a standardized process for applying for funding, aligned with

MHPSS delivery priorities.

KEY RECOMMENDATIONS - STANDARDS AND OVERSIGHT:

Define clear multisectoral indicators to monitor MHPSS performance.

Establish a national, independent monitoring body (or technical advisory committee) with

cross-sectoral representation, reporting to the Ministry of Health, to monitor quality,

compliance and performance of MHPSS programmes.

Strengthen guidance, protocols and procedures with respect to delivery of child-

and adolescent-friendly mental health services, including parental consent and

trauma-informed approaches.

Develop clear guidance and protocols for early identification, screening and referral (within

sectors and between), with clearly defined roles and accountability of key actors.

Establish standard operating procedures across agencies to support coordinated care of

children and adolescents engaged in child protection or justice settings.

Strengthen justice-related protocols to minimize harm to children and adolescents who

come into contact with the justice sector.

Develop a national, standard referral protocol across health, education, social welfare, justice

and other settings (including for NGOs) that also supports communication back to primary

providers to support follow-up and continuing care.

Develop a national, standard mental health education curriculum for all levels of education.

Standardize a system to support NGO engagement in MHPSS.

Strengthen continuous evaluation of the accreditation of the mental health workforce.

Challenges and recommendations for strengthening the multisectoral mental health system

Multisectoral mental health and

psychosocial support workforce

The multisectoral MHPSS workforce is challenging to define as it is diverse and dynamic. It ranges

from specialist providers whose primary roles relate to mental health to providers and volunteers who

may be required to deliver some aspect of MHPSS but for whom this is not a primary responsibility and

who have fragmented access to training, accreditation and support. The three tiers of MHPSS actions

(responsive care, prevention and promotion) can be coarsely mapped against the corresponding

multisectoral mental health workforce as shown in Figure 17.

Figure 17. Key tiers of the workforce required to ensure MHPSS

RESPONSIVE CARE

Staff

qualified

in clinical

services

Staff with professional

or on-the-job training to

provide early identification,

screening, referral, and case

management: social workers, teachers,

case workers, and other community

members (including first responders)

PREVENTION

Staff with professional or on-the-job training to design

and deliver preventive interventions and programmes:

teachers, social workers, counsellors, case workers, justice

officers, health workers, youth and peer leaders

MENTAL HEALTH

Policy, administrative and technical staff working on policy and

PROMOTION

legislation across health, social welfare, education and justice

Non-government and community-based organizations, youth organizations,

and community leaders engaged in health promotion and advocacy

The current MHPSS workforce

In Malaysia, the MHPSS workforce includes public, private and non-government actors across the

health, education, social welfare/child protection, justice and community sectors (see Figure 18).

All sectors identified workforce shortages as a major challenge impacting on implementation of

MHPSS policies and programmes. Limited numbers of professionals trained to deliver components of

MHPSS (such as health professionals, teachers, school counsellors, social workers and psychologists)

contribute to constraints on service delivery, very high caseloads and over-reliance on tertiary services

leading to referral bottlenecks and delayed access to care. To address inequity in access to MHPSS,

there is also a need to consider the skills mix and distribution of the workforce as well as the need for

collaborative and multidisciplinary teams. In addition to increasing the number of skilled providers in

rural areas, stakeholders also emphasized the need for providers with diverse gender, disability, ethnic

and cultural backgrounds so that communities have access to an appropriate and trusted provider.

78 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

FIGURE 18. MULTISECTORAL MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT WORKFORCE

 Psychiatrists

 Other clinicians (family

medicine specialists,

general practitioners,

HEALTH

paediatricians)

 Psychologists

 Counsellors

 Nurses

 Paramedics

JUSTICE

 Community health

COMMUNITY

volunteers

 Community leaders

 Senior citizens

 Parents

 Psychologists

 Refugees

 Polices

 Community

 Prosecutors

counsellors

 Judicial workers

 NGOs

 Youth

organizations

SOCIAL

WELFAR

 Social workers

 Teacher

EDUCATION

 Counsellors

Recommended roles for the MHPSS workforce

Many priority MHPSS actions are already integrated into existing workforce roles, although providers’

capacity to carry out these roles is hampered by the challenges noted above. Table 7 outlines key

recommended roles by sector.

Within the health sector, specialist clinicians have primary responsibility for delivery of responsive

care (screening, referral and clinical care). Malaysia currently has 1.27 psychiatrists per 100,000

population,²³ compared to the upper-middle-income country average of 2.03.^15,17 The number of

psychologists is 1.03 per 100,000, compared to the upper-middle-income country average of 1.47.

There are only 0.07 child psychiatrists per 100,000 and 6.84 mental health nurses per 100,000 in

Malaysia.¹⁵ Aside from these specialist clinicians, paediatricians, family medicine specialists and

general practitioners also provide MHPSS responsive care to children and adolescents. Furthermore,

nurses and assistant medical officers are also a part of the clinical team providing MHPSS. To address

constraints in specialist provider availability, stakeholders recommended improving training and

support to non-specialist providers (including mental health volunteers) to provide MHPSS, noting

that most children and adolescents do not require highly specialized care, but could be better managed

at primary level by trained providers supported by specialists as needed.

Challenges and recommendations for strengthening the multisectoral mental health system

Within the education sector, teachers and counsellors currently perform screening for common

mental health conditions. Through screening for learning difficulties (the Literation and Numeration

Screening - LINUS programme), teachers can opportunistically detect underlying mental health

conditions. School-based counsellors have also been trained to use age-validated screening tools.

Counsellors provide counselling or refer to psychologists or psychiatrists for more complex clinical

cases. Teachers are also the primary providers of education related to mental health, although the

need for standardized curricula and teaching aids to support this was noted as a key challenge. To

better support teachers and counsellors, stakeholders recommended establishing a collaborative

programme whereby a psychiatrist and/or psychologist is assigned to be in charge of the schools

under a particular district so that the schools have direct access to them for consultation or referral

regarding children with potential mental health conditions. However, to achieve this, the number of

mental health experts dealing with adolescents and children needs to be increased, especially in

the public health sector.

Within the social welfare sector, social workers and psychologists encompass a broad workforce in

Malaysia, providing case management of children and adolescents within the social welfare system.

Social workers are primarily employed by the Ministry of Women, Family and Community Development

(national level) and by the Department of Social Welfare at subnational levels. However, they also work

within health (e.g., hospitals) and justice settings and are employed through NGOs. Accurate data

regarding the total size of the social welfare workforce are lacking. However, in 2018 it was estimated

that there were around 3,352 social workers employed across child protection, justice and anti-trafficking

programmes. An estimated 236 were directly engaged in child protection and 183 in managing children

within the justice system.⁶⁷ Social workers supervise children and adolescents in their daily activities

to promote life skills, independence and resilience. Psychologists are responsible for the screening of

mental health problems and providing initial treatments such as psychological first aid and counselling.

Non-government volunteers also play a crucial role in tele-counselling by operating helplines and they

also participate in community programmes to reach vulnerable populations to deliver MHPSS. One

stakeholder highlighted a challenge noted for social workers at social welfare homes that also applies

to the MHPSS workforce at large. It regards work-life balance and the general well-being of the MHPSS

workforce while caring for the mental health of their clients.

“…we find that our staff working at social welfare homes themselves are experiencing

distress...because they have two shifts, but their shift starts as early as 6.00 a.m., so their

own welfare they cannot manage well”—A social welfare sector informant

Within the justice sector, there are psychologists from Section D11 (Sexual, Women and Children

Investigation) of the Royal Malaysia Police that provide responsive care and prevention for children and

adolescents. Although their main focus is on victims, suspects and witnesses of crimes within the

justice system, their services are also open to the public. They provide screening and counselling, while

referring to clinical psychologists or psychiatrists for more complex cases. They also actively engage

with schools to deliver MHPSS education and information. A challenge identified by stakeholders

is that the public is not aware that they can access MHPSS services at the police station. This is

because of the stigma associated with seeing a psychologist at a police station, with connotations

of criminality. Nonetheless, through their outreach programmes at schools, these psychologists

continue to encourage parents and students to use the MHPSS services that they offer.

80 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Table 7. Overview of key MHPSS roles, by sector

Sector

Provider

Responsive care

Prevention

Promotion

Health

Specialist

Screening,

Targeted

mental health

diagnosis and

interventions to

clinicians

management

address risks (e.g.,

as part of a

harmful substance

multidisciplinary

use)

team

Supporting school-

based approaches

Other clinicians

Screening,

Supporting

diagnosis and

positive parenting

mental health

management as

and targeted

literacy

part of a team,

interventions

and supported

to identify and

by specialists as

support children

needed

and families at risk

Supporting school-

based approaches

Community

Community-based

Supporting

Mental health

Heath

early identification

universal

literacy,

Volunteers

and screening,

prevention actions

addressing

referral, supporting

(e.g., promotion of

stigma and

community-based

positive parenting)

discrimination

care

Education

Teachers

Early identification,

Supporting social

Supporting

screening and

and emotional

mental health

referral

learning, skills

literacy and

and resilience,

anti-stigma

Behaviour

promoting positive

through greater

modification for

peer relationships

engagement

uncomplicated

(curriculum-based

with families

cases

and participation

and school

Supporting

in whole-of-school

communities

continuity of

approaches)

care and ongoing

education

Guidance

Screening and

Supporting

counsellors

referral, provision

school-based

mental health

of counselling and

interventions to

literacy and

initial management

increase mental

anti-stigma

of mental health

health literacy

through greater

conditions

and social and

engagement

emotional skills

with families

and school

communities

Challenges and recommendations for strengthening the multisectoral mental health system

Sector

Provider

Responsive care

Prevention

Promotion

Social welfare

Social workers/

Early identification,

Parenting

Mental health

and child

community

screening and

programmes

literacy and

protection

development

referral of children

(universal) and

programmes

officers

and adolescents at

support to families

to address

increased risk

in need (targeted)

stigma and

discrimination

Management

Other targeted

as part of a

interventions to

Social

multidisciplinary

address risks

protection

team (facility,

programmes

residential and

for children and

community-based)

families

Justice

Police, court

Early identification

Targeted

psychologists

and referral

interventions

and other

for screening,

and follow-

frontline justice

diagnosis and

up of children,

workers

management

adolescents

and families at

risk (including

meaningful skills

training for young

offenders)

Community

Youth leaders,

Early identification

Promoting positive

Mental health

community

and mental health

peer relationships,

literacy and

leaders,

first aid

positive parenting,

programmes

community-

and support to

to address

based

community-based

stigma and

organizations

interventions

discrimination

Competencies, training and support

Stakeholders identified the common competencies required of the multisectoral MHPSS workforce

(see Figure 19). Particular emphasis was placed on improving understanding of child and adolescent

mental health and related behaviours, as well as specific skills in relation to screening, managing

difficult behaviour and dealing with crisis (including psychological first aid).

82 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

FIGURE 19. COMMON CROSS-SECTORAL MHPSS COMPETENCIES

Common MHPSS competencies

Understanding

Skills: early

Understanding

of common

Understanding

identification,

of child and

mental health

of relevant

screening,

adolescent

conditions and

laws, policies

behaviour

development

risks during

and plans (and

management,

and behaviour

childhood and

their role)

psychological

adolescence

first aid

Communication skills (with children, adolescents and families and with implementing partners,

local authorities, officers)

Specialist training programmes for health sector clinicians is relatively well established in Malaysia.

Postgraduate psychiatry training is monitored by the Ministry of Health and a Conjoint Board.⁷¹

Two parallel pathways exist for postgraduate training - a postgraduate Masters programme in

psychiatry and the Member of the Royal College of Psychiatrists (MRCPsych) qualification.⁷¹To be

able to practice, psychiatrists are required to register with the Malaysia Medical Council and National

Specialist Register. Another cadre of the MHPSS workforce in the health sector consists of clinical

psychologists. They are trained in specialized postgraduate courses to obtain a qualification in clinical

psychology⁷² and are regulated by the Allied Health Professions Act (Act 774).

For the education sector, limited teacher training in mental health and well-being has contributed

to low awareness of mental health, lack of recognition of mental health conditions and behavioural

problems, and limited skills in positive behavioural management. Additionally, stakeholders noted

that there are no specific guidelines for school counsellors for continuous professional development.

Stakeholders recommended that all teachers receive training in mental health skills to support children

with developmental disorders, learning difficulties and other needs; and improved skills in early

identification of mental health conditions (including training in the use of screening tools). To facilitate

this, it was recommended that a specific mental health committee be established within the Ministry

of Education with responsibility for training, support and supervision of teachers and counsellors.

Another recommendation was establishing a policy to support the professionalization, quality and

oversight of counsellors within the Malaysian Counselling Board. It was further recommended that

the education sector work in collaboration with the Ministry of Health to support continuous training

for counsellors and teachers.

Training and education of the social service workforce is fragmented, with no national requirement

for a specific education or qualification. Some social workers have degrees in social work (offered by

seven universities) or other social sciences, while others have non-related degrees or qualifications.

Assistant social welfare officers have diploma-level training, which may or may not be in relevant

fields or disciplines. There is currently no systematic programme to integrate child protection or

mental health into training of the social welfare workforce. The Malaysian Association of Social

Work has developed a definition of social work and a code of ethics; however, there is no specific

legislation supporting the professionalization of this workforce. Like the justice sector, psychologists

within social welfare and justice settings primarily receive in-service training, although this is not

standardized. Stakeholders recommended incorporating mental health into the pre- and in-service

training of teachers, social workers, police and other justice sector workers, as well as greater

collaboration with the Ministry of Health to support continuous development and access to mental

health training for those with specific MHPSS roles.

Challenges and recommendations for strengthening the multisectoral mental health system

There were also recommendations to improve support for and supervision of the mental health

workforce. These included establishing cross-sectoral, multidisciplinary teams at implementation

level, particularly to improve support for and supervision of non-specialist providers (such as linking

teachers and social workers to psychologists and psychiatrists), incentives to work in MHPSS (such as

free training); and increasing the salary and remuneration of social workers, psychologists and others

engaged in mental health and child protection to attract skilled and dedicated workers and improve

retention and motivation. Establishing workforce networks, such as school counsellor networks, was

also recommended to encourage the sharing of knowledge, experience and support. Attention to

the mental health needs of providers is also needed, reflecting the often stressful and sometimes

distressing roles required. Stakeholders further recommended providing mental health training to

communities (including community leaders, religious leaders, parents and refugees) to support

implementation of community-based actions, such as improving awareness, addressing stigma and

providing psychological first aid, to improve accessibility.

Overall, greater coordination across sectors to map the mental health workforce, roles and

competencies is needed to support workforce planning - including training, supportive supervision,

distribution and collaboration through multidisciplinary teams at a local level.

KEY RECOMMENDATIONS - MENTAL HEALTH WORKFORCE:

Improve collaboration across sectors at national level to facilitate development, planning

and support of the mental health workforce. This could include establishing committees

within sectors (e.g., Ministry of Education) to oversee mental health workforce training and

support, in collaboration with the Ministry of Health.

Undertake further detailed mapping of the multisectoral mental health workforce and

existing mental health competencies to identify gaps (numbers, skills, distribution).

Integrate and strengthen pre-service mental health training for health, education, social

welfare and justice sector providers - including for non-specialist providers.

Provide updated in-service training for non-specialist health providers, teachers, counsellors,

psychologists, social workers and police aligned with clearly defined MHPSS roles and ensure

that this training in ongoing to support continuous development (including establishing

ongoing training as a requirement for accreditation).

Provide opportunities for mental health training for community members to support mental

health awareness.

Establish steps to support professionalization of the social service workforce (this could

also include school counsellors).

Strengthen job aids, tools and protocols to support key MHPSS roles (screening, referral,

behaviour management and mental health first aid).

More explicitly integrate MHPSS actions into the defined roles and performance indicators

of key cadres (teachers, counsellors, social workers and justice officers).

Improve remuneration and job security/career pathways for social workers, psychologists

and other mental health professionals.

Establish mechanisms for support supervision of the mental health workforce through

multidisciplinary teams, support networks and services and supports to address the mental

health of providers.

84 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Budget and financing

Malaysia’s public health system is financed mainly through general revenue and taxation collected by

the federal Government, while the private sector is funded through private health insurance and out-

of-pocket payments from consumers. Spending on health (at 4.3 per cent of GDP in 2019) remains

below the average for upper-middle-income countries (at 5.85 per cent of GDP in 2019).^73,74 Public

sources of financing account for 52 per cent of total health expenditure. The main sources of total

health expenditure in 2019 were the Ministry of Health (45 per cent), followed by household out-of-

pocket expenditure at 35 per cent.⁷³

The WHO has estimated global average spending on mental health at 2.1 per cent of a country’s national

health budget,⁷⁵ which may be viewed as a sufficient national budget allocation for mental health.

Meanwhile, government expenditure on mental health in Malaysia in 2017 was estimated to be 1.3 per

cent of total health expenditure.⁷⁶ For the 2022 budget, the Malaysian Government has allocated a total

of RM319 million (out of RM32.4 billion, or 0.98 per cent) on estimated operational expenditure which

covers emoluments, services and supplies for mental health services under the Ministry of Health.^77,78

An additional RM70 million was also allocated to address mental health issues by strengthening support,

counselling and psychosocial services, and to increase advocacy programmes and strengthen the role

of NGOs as drivers of mental health programmes.⁷⁷The total budget of RM389 million (1.2 per cent) for

mental health in 2022 is markedly less than the WHO global benchmark.^75,77,78There must also be greater

expenditure on the psychosocial aspects (non-healthcare determinants) of mental health such as mental

health literacy, living and working conditions, adequate income and wages, food security and physical

activity. This can be achieved through investment in public health services and engagement with various

stakeholders such as other ministries and community leaders to form a ‘whole of society’ approach.

Apart from government sources, funding is also provided through NGOs (financed by international or

local donors), private foundations, corporate social responsibility programmes and through user out-of-

pocket fees. Additionally, NGOs may be financed through state government funding. There are limited

data on other sectors’ spending on MHPSS-related services and programmes. However, stakeholders

across sectors emphasized that current budgets were insufficient to support implementation, particularly

with increasing demand for MHPSS as a result of COVID-19. Furthermore, stakeholders noted that

budget processes are complex and cross-sectoral coordination limited, leading to a lack of cross-sectoral

planning and budgeting, although some stakeholders indicated that there is some flexibility within

sectors to reallocate non-MHPSS funding to support MHPSS programmes. In the absence of a detailed,

costed, multisectoral mental health plan that clearly defines the roles and responsibilities of each sector,

accurately apportioning the human and other resources required to implement MHPSS is a challenge.

This is particularly so for programmes, services and supports provided outside the health sector.

Challenges and recommendations for strengthening the multisectoral mental health system

KEY RECOMMENDATIONS - BUDGET AND FINANCIAL RESOURCES:

Aim for MHPSS budget allocation of 2.1 per cent of the national health budget.

Include mental health services

(including outpatient services) within national

insurance schemes.

Include a national mental health goal in social and economic plans and/or as a primary

programme within the Ministry of Health.

Define a detailed minimum-services package for child and adolescent mental health (based

on the tiered framework of actions) addressing responsive care, prevention and promotion

that can be costed, with budget responsibility across key sectors clearly defined.

Establish a national, cross-sectoral planning body and cross-sectoral budgeting committees

for MHPSS to support efficient and coordinated budget requests and processes.

Increase support for subnational and local government units to improve resource allocation

for implementation of MHPSS.

Consider establishing a public fund to provide additional funding for prevention, promotion,

research and innovation with respect to mental health.

Participation

Mental health-related stigma, discrimination and lack of mental health literacy are major barriers to

seeking support and services. Stigma and misconceptions were described as contributing to a lack of

care-seeking by parents, who preferred to keep mental health conditions to themselves and address

them privately. Misunderstandings and misconceptions about mental health and behaviour are also

common, with teachers and parents dismissing signs of poor mental health as attention-seeking or

misbehaviour. Limited mental health literacy among children, adolescents and their parents/carers

also contributes to delays in care-seeking and the underutilization of available supports and services.

Engaging communities and strengthening the participation of children, adolescents and families

is central to ensuring that policies, programmes and services respond to their needs and address

barriers. According to stakeholders, further research and consultation are needed with children,

adolescents and families (including marginalized and underserved groups) to understand the specific

barriers and needs in relation to MHPSS to directly inform policies, programmes and services.

Stakeholders particularly emphasized the need to improve mechanisms to engage migrants, refugees,

out-of-school children and adolescents and those with disabilities, in policy and programme design.

Youth participation (including young people with lived experience) was also seen as essential to

developing policies and programmes that effectively respond to needs.

To support greater participation and engagement, stakeholders made a number of recommendations.

At a national level, it was suggested that young people should have a formal role in the recently

established NCMW. The NCMW came into being “to provide sustainable solutions to the possible

long term mental health impact of COVID-19”.79 The coalition was initiated by Rotary Malaysia and its

members include organizations such as the Malaysia Mental Health Association, Malaysian Psychiatric

Association, Ministry of Health, WHO and UNICEF, among others. In addition to supporting planning,

monitoring, evaluation and feedback on a national plan of action for mental health, the NCMW also

provides a platform to discuss mental health issues beyond COVID-19. It was also recommended

that key sectors more proactively seek the input and feedback of communities and young people by

holding community meetings or ‘roadshows’ to explore mental health and MHPSS priorities.

86 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

At local level, stakeholders also recommended establishing community-based centres for children and

adolescents that offer a safe space, opportunities to provide MHPSS information and services, and

capacity building for young people (including in social and emotional skills), and are places where youth

leadership could be supported and engaged in programme design. In addition to parenting programmes

to improve parent/caregiver skills and mental health literacy, it was also recommended that parents be

engaged in the design and delivery of MHPSS programmes. Parent-teacher associations were identified

by multiple sectors as an underutilized platform for supporting parent engagement - to obtain input

and feedback, support delivery of MHPSS programmes (such as mental health awareness) and build

more effective linkages between communities, families and schools for MHPSS.

Strengthening mechanisms for community feedback and monitoring both at service-delivery level

(e.g., health facilities) through to subnational and national government bodies responsible for mental

health is also important. An accessible and responsive system to support feedback and complaints

in relation to mental health services is needed. There is a national independent body to assess mental

health facilities with respect to compliance with mental health legislation. Currently, a Public Complaint

Management System exists to receive feedback regarding the healthcare services provided by the

Ministry of Health. However, there is no such mechanism to cover the entire country (to include both

public and private health systems) and that is specific to MHPSS.

KEY RECOMMENDATIONS - PARTICIPATION:

Build capacity and increase opportunities for young people and youth organizations to

participate in MHPSS policy and planning, including those with lived experience and

marginalized young people.

Establish formal roles for youth and parent representatives on national mental health

committees or similar bodies, such as the National Coalition for Mental Well-being.

Strengthen engagement between government agencies, communities and youth groups to

ensure that MHPSS approaches meet local needs and support implementation, including

more formally defined roles for young people in the planning and delivery of MHPSS.

Include youth and parent representatives in subnational committees and/or establish child

and adolescent task forces to support planning.

Establish or strengthen mechanisms for feedback and complaints, including for feedback

in non-health settings and in child and adolescent-friendly formats.

Data, health information and research

All stakeholders identified an urgent need to improve data and information systems related to MHPSS

among children and adolescents. At a national level, timely and reliable statistics (disaggregated

by location, age and sex) related to the prevalence of common mental health conditions and risks

is needed to inform policies and support prioritization and implementation plans, and budgeting.

These include estimates of common mental disorders (depression, anxiety, developmental disorders,

psychosis), suicide rates, psychological distress and behavioural problems, key risk factors (substance

use, bullying, violence, adolescent pregnancy), and population and service delivery data (such as

the number of families requiring social welfare). Ensuring that data include marginalized populations

was also identified as a key need, with capacity to identify those with the greatest needs or most

underserved, and to monitor equity. Additionally, data on the impacts of COVID-19 were identified

as a key short-term priority. Some data are collected through existing household surveys (such as

the NHMS) and it was noted that mental health indicators also need to be integrated into routine

information systems - for example, by re-establishing a national suicide surveillance system.

Challenges and recommendations for strengthening the multisectoral mental health system

Stakeholders also highlighted the need to include mental health indicators in the routine data collection

of sectors outside health and to improve the sharing of data within and between sectors to support

planning and implementation. For example, enabling the timely sharing of data collected through

the education, social welfare and justice sectors with multidisciplinary teams, for instance through

data linkage, would improve the identification, planning and follow-up of children and families at risk.

Currently, there are no mechanisms to collate, manage or share data efficiently between sectors.

Establishing a multisectoral mental health information system that includes relevant government, private

sector and NGO providers was a high priority, as was building a user-friendly platform to enable access

to timely and relevant data. Stakeholders recommended the development of a common system that

could function as a one-stop centre for data collection and sharing as well as for case management.

The information provided should also be in a simplified version so that it can be easily understood by all

key agencies, with a standardized approach to data collection (indicators, format, disaggregation) across

agencies. Many stakeholders also recommended that additional and dedicated resources (financial

and human resources) be provided to support information systems, rather than relying on frontline

providers (such as doctors, nurses, teachers and social workers) to maintain systems and enter data.

Improved access to data describing the multisectoral system was also a noted priority, including

up-to-date information about the multisectoral workforce; MHPSS service availability and distribution;

coverage and use of services such as hotlines; and data about non-government actors in MHPSS. To

support this, stakeholders recommended development of a minimum set of harmonized indicators

that all sectors and relevant units would report or contribute to. It was further recommended that

NGOs and the private sector also collect and report routine mental health data into a central system

to enable greater transparency and oversight.

Research priorities include: further studies to understand the needs, barriers and service-delivery

preferences of children and adolescents; studies to determine the effectiveness of specific MHPSS

interventions; and implementation research to understand effective models of service delivery.

Building local research capacity was identified as key to supporting impactful research.

KEY RECOMMENDATIONS - DATA, INFORMATION AND RESEARCH:

Establish a national suicide and self-harm surveillance system.

Establish a child protection information management system that is accessible within and

across sectors.

Include mental health indicators in routine health information systems and provide age and

sex-disaggregated data.

Integrate child and adolescent mental health indicators into the routine information systems

of the education, social welfare and justice sectors.

Improve mechanisms for timely analysis, reporting and sharing of data within and across

sectors to support implementation of MHPSS and continuity of care for those at risk.

Establish a user-friendly platform ‘one-stop shop’ across sectors, to enable harmonized

collection, use and sharing of data.

Invest in further research and support local research capacity to understand demand-side

needs, barriers and service-delivery preferences and build the evidence for specific actions

and effective implementation models

88 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Children and adolescents aged 0-18 years in Malaysia experience a high burden of poor mental

health. Around 1 in 8 adolescents aged 10-19 and 1 in 20 children aged 5-9 are estimated to have

a mental disorder (including developmental disorder). Suicide is the second leading cause of death

for adolescents aged 15-19. Risk factors for poor mental health, including exposure to violence,

peer victimization and bullying, loneliness and social isolation, particularly in the context of COVID-

19, are also prevalent.

In response to these needs, Malaysia has made important progress to address child and adolescent

mental health. National policy and legislative frameworks are broadly supportive, recognizing, at least

in part, the specific needs and considerations for this age group and the importance of a national,

multisectoral approach to mental healthcare, prevention and promotion. While a large focus of the

current response has been on the clinical management of mental health conditions through the health

sector, there are also important national approaches to improve and respond to mental health in

schools, including through programmes to support early identification, screening and counselling. The

social welfare and justice sectors also deliver multidisciplinary programmes to identify and support

children and families at increased risk, including those who have been exposed to violence, abuse

or neglect, and children in conflict with the law.

Despite this progress, this analysis has identified some important gaps in the current MHPSS response.

These include the accessibility and availability of child- and adolescent-friendly and multidisciplinary

care for mental health conditions (particularly outside specialized tertiary and institutional settings),

comprehensive and coordinated whole-of-education approaches to mental health promotion (including

a national curriculum to support social and emotional learning), a national (and targeted) approach to

support nurturing and responsive care provided by parents and carers, and coordinated programmes

to support healthy peer relationships and address peer victimization. There are also important gaps in

relation to programmes reaching marginalized, out-of-school and migrant children and adolescents.

There are also some important cross-cutting challenges impacting on implementation of MHPSS.

While mental health and well-being is integrated to some degree in the sectoral plans of education,

social welfare and justice, these generally focus narrowly on specific actions (such as mental health

screening or provision of counselling) rather than encompassing a more holistic vision for mental

health and well-being and clear articulation of the sector’s role and response. At a subnational

level, the lack of clear plans, guidance and structures to support implementation and multisectoral

collaboration have contributed to limited coordination across sectors. Across all sectors, insufficient

numbers and inappropriate distribution of skilled personnel were noted as a major barrier to

implementation, contributing to heavy workloads, long delays in access to care and inconsistent

delivery of interventions. Limited availability of services responsive to the needs of children and

adolescents, particularly at community level, and over-reliance on tertiary and institutional-based

care also contribute to high unmet needs and delays in access to services through the health

and social welfare sectors, and time-consuming referral from other sectors. Lack of standardized,

national referral protocols, particularly for referrals arising outside the health sector, also contribute

to delays in access to services and supports, as do the lack of standardized protocols and operating

procedures across agencies for supporting children at high risk. Insufficient budgets for MHPSS-

related programmes, and budgeting processes that do not currently support agenda-based and

cross-sectoral budget planning are also key challenges.

In addition to specific recommendations to strengthen the multisectoral mental health system, there

are a number of overarching recommendations to improve the implementation of MHPSS for children

and adolescents in Malaysia:

1. At national level, the Mental Health Act should be strengthened to more clearly articulate the

specific considerations and protections for children and adolescents, including those within the

mental health system. Consideration should also be given to developing a specific multisectoral

child and adolescent mental health strategy that more clearly articulates the MHPSS actions

across the three tiers of responsive care, prevention and promotion, and details a multisectoral

plan (and coordination structure) for implementation, including cross-sectoral performance

indicators and the clear roles, responsibilities and accountabilities of key sectors.

Key recommendations and conclusions

The Government should strengthen legislative protections for children and adolescents (including

prohibiting corporal punishment, decriminalizing suicide, addressing discrimination, increasing

protections within justice and institutional settings), and address legislative barriers to accessing

MHPSS (such as mandatory parental consent and barriers for undocumented migrants).

Under the leadership of the Ministry of Health, a national, multisectoral steering committee for

child and adolescent mental health should be established, with responsibility for coordinating

policy, implementation and accountability.

Under the Ministry of Health, a cross-sectoral, independent monitoring body should be established

to assess quality, compliance and performance of MHPSS programmes and services.

At district level, the state government should support district offices to develop local, multisectoral

implementation plans, resource allocation and coordination for MHPSS. To support this, consider

establishing district-level multisectoral subcommittees for mental health and provide capacity

building for district-level decision-makers in mental health.

The Ministry of Health, in consultation with other sectors and technical partners, should strengthen

national, standardized protocols for child and adolescent health across agencies, including:

a. Early identification protocols and validated screening tools for this age group and detailed

guidance on their use in different settings (including consideration of the potential harms

of screening);

b. Referral procedures across sectors;

c. Non-specialist management;

d. Case management of children and adolescents engaged in the child protection and

justice sectors;

e. Greater protections for children in conflict with the law and child victims within the justice

system; and

f. National quality service standards for child and adolescent mental health services

across sectors.

The Government should include mental health services (including outpatient services) within the

national health insurance programme and increase public resource allocation for mental health

across the tiers of care, prevention and promotion. To support this, consideration should be given

to including mental health as a primary programme, and a minimum-services package (based on

the regional framework) should be defined and costed, with budget allocation and responsibility

clearly defined across key sectors. The Government could also consider establishing a national,

cross-sectoral body or budget committee on MHPSS to support coordinated and comprehensive

budget requests that align with national MHPSS goals.

The Government, with support from professional associations, training institutions and

development partners, should strengthen the multisectoral MHPSS workforce through:

a. Further in-depth mapping to identify key roles across sectors against the MHPSS priority

actions and the required competencies and inter-sectoral training needs to support these roles;

b. Development of job descriptions for identified roles and/or integration of MHPSS roles into

the defined scope of practice and performance indicators for key providers across sectors;

c. Integration of child and adolescent development and mental health into the pre-service

training of health professionals, the social service workforce, justice sector workers, teachers

and other school-based staff, in alignment with the roles and responsibilities with respect

to MHPSS;

d. Strengthened in-service training in mental health (including continuous education) for health

providers (including non-specialists and community-based workers), social service workers,

justice sector workers, teachers and education staff that is competency-based and aligned

with expected MHPSS roles;

92 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

e. Training provided to relevant ministry-level staff from the health, education, social welfare

and justice sectors to support planning and development of the workforce as well as broader

MHPSS programmes;

f. Expansion of the number of posts at national and subnational levels; and

g. Improved supervision and support for MHPSS providers across sectors, including establishing

provider support networks and multidisciplinary teams, improved remuneration, job security

and career pathways, and attention to the mental health needs of providers themselves

The Ministry of Health, in consultation with other key sectors and academic and development

partners, should improve the collection, use and accessibility of data at national and subnational

levels - including data to identify mental health needs, support planning and implementation,

and track progress. This should include the development of a minimum set of MHPSS-related

indicators harmonized across sectors, including performance indicators related to multisectoral

collaboration and development of user-friendly platforms (such as a data dashboard) to improve

the access of service providers and communities to mental health data.

10. The Government, development partners and NGOs should increase opportunities for children and

adolescents to participate in MHPSS policy and programming, including establishing more formal

roles for young people (such as representation on the National Coalition for Mental Well-being, or

national steering committee). The Ministry of Health should also improve child- and adolescent-

friendly mechanisms for providing feedback on MHPSS programmes and mental health services.

11.

The Government, development partners and NGOs should expedite the process of systematic

decentralization of mental healthcare to community-based MHPSS by expanding national and

community-based programmes to address mental health- related stigma and discrimination and

improve mental health literacy (particularly aimed at children, adolescents and parents/caregivers).

12. The Government, development partners and NGOs should focus on expanding inter-agency

collaboration as well as the monitoring and evaluation of implementation, outcomes and the

impact of mental health programmes, including improved data and information sharing through

digital platforms.

Key recommendations and conclusions

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98 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Appendix A:

Workshop agenda, prioritization tool

and interview guide

COUNTRY-LEVEL CONSULTATION WORKSHOP ON THE MENTAL HEALTH AND

PSYCHOSOCIAL SUPPORT SERVICES IN EAST ASIA AND THE PACIFIC REGION

Programme outline

Day one

Time

Activity

Facilitator

Session A: Introduction

9:00 - 9:15

Welcome remarks and introductions

UNICEF/Country TAG

chair

9:15 - 9:30

Overview and objectives of the project and

Burnet

workshop

Session B: Overview of the conceptual framework for MHPSS

9:30 - 10:15

The conceptual framework for MHPSS

Burnet to provide

overview

Presentation of the framework

Country partner/

Questions and discussion

UNICEF to help

facilitate discussion

Session C: Prioritizing actions and sectoral roles

10:15 - 10:30

Introduction to the proposed actions of the

Burnet to provide

conceptual framework

overview

Presentation of the actions against each tier

Introduction to potential sectoral roles

10:30 - 10:45

Overview of the prioritization tool and tasks

Burnet to provide

overview

Introduction to the online tool and tasks to be

completed before the next meeting

10:45 - 11:00

Questions and next steps

UNICEF/Country TAG

Participants to complete the online tool in preparation for the second workshop

Appendix A:

Day two

Time

Activity

Facilitator

Session A: Introduction and recap

9:00 - 9:15

Welcome and recap

UNICEF/Country TAG

chair

Session B: Defining a minimum-services package for MHPSS

9:15 - 9:30

Presentation of the key findings from the online

Burnet

tool

Outline of the actions prioritized for the

minimum-services package

9:30 - 10:30

Discussion and agreement on the minimum-

Country partner/

services package

UNICEF/Country TAG

chair

Break out rooms by sector to discuss:

• Agreement on actions included

• Any actions missing or need modification

• Agreement on timeframe

• Each group feedback

10:30-10:45

Break

Session C: Identifying sectoral roles

10:45 - 11:00

Presentation of the key findings from the online

Burnet

tool

Recommendations for sectoral roles for key

actions

11:00 - 12:00

Discussion and agreement on sectoral roles

Country partner/

UNICEF/Country TAG

Break-out rooms by sector to discuss:

chair

• Agreement on lead sector

• Recommended roles for other supporting

sectors

Each group’s feedback

12:00 - 12:15

Questions and next steps

UNICEF/Country TAG

100 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Translational workshopimplementing mental health and psychosocial support

services (mhpss) for children and adolescents in east asia and the pacific region

14 december 2021

Programme outline

objectives:

1. To present key findings of the MHPSS project

2. Co-develop final recommendations for implementation of MHPSS

Proposed participants:

Country TAG members

UNICEF

Youth representatives

Additional government and non-government stakeholders from sectors under-represented in

the country TAG

Time

Activity

Facilitator

Notes

Session A: Introduction

8.55-9.00 a.m.

Hotel safety briefing

Dorsett Hotel

staff

9:00 - 9:15 a.m.

Welcome remarks and

UNICEF /

introductions

Country TAG

co-chairs

9.15-9.25 a.m.

Welcome remarks from the

Dr.

Director of ICR

Kalaiarasu M.

Peariasamy

9:25 - 9:40 a.m.

Overview of the project (aims,

Burnet

Recap the project

approach) and objectives of this

aims, methods,

workshop

and purpose of

the workshop -

emphasizing that

this is a participatory

workshop to

develop and refine

recommendations

Session B: Matching actions to needs

9:40 - 10:30 a.m.

Presentation of key findings:

Country

20-minute

research lead

presentation of key

• Research chronology

findings, followed

• Mental health needs

by 20 minutes for

• Current response

general questions/

• Overview of priority actions:

feedback (noting

there will be time

- Accessible and responsive

to explore areas in

services for mental health

more detail during

problems

the rest of the

- Prevention of mental

workshop)

health problems

– Mental health promotion

Workshop agenda, prioritization tool and interview guide

103

Time

Activity

Facilitator

Notes

• Overview of key findings on

challenges and considerations

for systems strengthening

Questions and reflections

10.30 - 10.45 a.m. BREAK

Session C: Deep dive on priority actions and implementation

10:45 a.m. - 12.30 Group activity:

p.m.

1. Group A: Accessible and

Country

responsive services for

research

mental health problems:

team/

screening, referral pathways,

Stakeholders

multidisciplinary care AND

systems strengthening

2. Group B: Prevention of mental

health problems: building

skills (early childhood, schools,

online), addressing risk factors

AND system strengthening

3. Group C: Mental health

promotion: community

engagement and participation;

and policy and legislation AND

system strengthening

12.30 - 1.00 p.m.

Sharing of experience (NGOs, youth, justice)

1.00 - 2.30 p.m.

LUNCH BREAK

SESSION D: Group presentation

2:30 - 3:15 p.m.

Group A presentation

Country

research

team/

Stakeholders

3:15 - 4:00 p.m.

Group B presentation

Country

research

team/

Stakeholders

4.00 - 4.15 p.m.

Tea Break

4.15 - 5.00 p.m.

Group C presentation

Country

research

team/

Stakeholders

Session E: Wrap up and next steps

5:00 - 5:15 p.m.

Questions, reflections, feedback

Country

research lead

Next steps

5:15 - 5:30 p.m.

Close workshop

UNICEF/TAG

co-chairs

104 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Implementing the mental health and psychosocial support services in East Asia

and the Pacific

Key informant interview

*Note that sector-specific question guides were also developed and are available on request

Interviewer ID:

Date (dd/mm/yy):

Start time:

End time:

Participant ID:

Sector / organization:

Current designation /

role of participant:

How is this role related

to MHPSS?

Has the participant had

a previous role related to

MHPSS? Please describe

Age of participant

Gender of participant:

Consent obtained?

YES / NO

Thank you very much for agreeing to participate in this interview.

Today we will be asking for your views and opinions about how to improve mental health and

psychosocial support (MHPSS) services for children and adolescents. This includes your thoughts

about the mental health needs of children and adolescents, what role your sector currently plays in

delivery of support services, and the challenges and opportunities to improve the delivery of mental

health and psychosocial support services.

The session today will take approximately 60 to 90 minutes.

Participating in this project is voluntary. You do not have to answer any question that I ask you, and

we can stop the interview at any time. If you don’t want to answer a question or would like to stop

the interview you do not have to give a reason. If you wish to withdraw from the project after our

discussion, please contact the study team and the information that you shared will be destroyed.

With your permission I will be taking notes and recording today’s interview using the video recording

function, or an audio-recorder, to make sure we gather all your ideas. Everything you say will remain

confidential. Your responses will not be shared with your manager or employer, and they will not

affect your role or employment.

What we learn from this interview will be compiled with the responses from other interviews. A

summary of the key findings will be shared with government representatives, and UN agencies in this

country, and in East Asia and the Pacific region. They will also be used to develop recommendations

to improve the delivery of mental health support services in your country and the region. No

personal information identifying you or your organization or employer will be included in any reports

or other documents.

Workshop agenda, prioritization tool and interview guide

105

Please confirm the participant’s consent to continue the interview, and consent to

have the interview recorded.

Question guide:

Theme

Questions

Mental health

I would like to start by asking what you think the main mental

needs of children

health needs or problems are of children and adolescents in [YOUR

and adolescents

COUNTRY]?

• Children (<10 years)

• Adolescents (10-18 years)

• Are there particular groups of children or adolescents who have worse

mental health than others, or are at increased risk? Why?

What do you think are the main factors that contribute to poor

mental health or well-being of children and adolescents?

• Individual level

• Family level

• Peer

• Community

• Society

What factors promote good mental health and well-being?

What impact do you think COVID-19 has had on the mental health

and well-being of children and adolescents?

MHPSS policies

I would like to ask you about what is currently being done by your

and national plans

sector/organization to address the mental health and well-being of

children and adolescents.

Are you aware of any government policies, plans or initiatives that

relate to the mental health of children and adolescents?

• Can you briefly describe these - what sectors do they relate to, what

plans or actions do they include for child or adolescent mental health?

• To what extent do you think these sectoral plans or policies are being

implemented?

What national standards, guidelines, or other tools currently exist to

support the delivery of mental health services or programmes?

If the participant identifies specific policies, please ask them if they

would be happy to be contacted by the research team at a later date to

help us access these documents for the desk review

106 Strengthening Mental Health and Psychosocial Support systems and services for

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Theme

Questions

Current role in

I would like to ask you about the different mental health and

providing MHPSS

psychosocial support services that are provided by your sector /

organization. I will refer to this as ‘MHPSS’ - which broadly includes

services, supports and programmes to respond to children and

adolescents with mental health problems, to prevent mental health

problems (addressing risk factors), and to promote good mental

health.

Could you talk me through what specific MHPSS for children and

adolescents your sector/organization currently provides? We are

interested in understanding what services or programmes are

provided, who they are for, and how they are delivered

Which groups of children and adolescents are these MHPSS for? Are

any programmes targeted and, if so, to who?

To what extent are these initiated or led by the government?

• Which ministries?

• By non-government organizations?

• By the private sector?

• Where they are led by non-government or private sector agencies,

what role has the government had?

Were there any MHPSS that had been implemented by your sector/

organization previously but are no longer provided? Why?

Are there any new MHPSS that are being planned or developed?

Additional prompts:

Services

• What MHPSS does your sector/organization provide for children or

adolescents who have mental health problems (responsive care)?

• What MHPSS does your sector/organization provide that address

specific risk factors to prevent mental health problems (prevention)

• What MHPSS does your sector/organization provide to promote good

mental health and well-being (enabling environment)

- For example, programmes to address harmful norms or attitudes

towards mental health, stigma or discrimination related to mental

health, to protect children and adolescents from harm (violence,

exploitation, abuse, neglect etc)

Delivery

• Through what mechanisms, systems or platforms are these MHPSS

provided:

- community-based

- facility-based (health, education, residential care, other)

- Online or digital

[explore what services are provided through which platforms]

Workshop agenda, prioritization tool and interview guide

107

Theme

Questions

• Who provides MHPSS within your sector/organization and what role(s)

do they have in supporting MHPSS?

- Who (professional, paraprofessional, volunteer) and what role or

tasks do they have in delivering MHPSS?

- What training and other supports do they receive with respect to

mental health of children and adolescents?

» pre-service or in-service

» accredited (diploma, degree, etc) or informal

» who provides this training

- Who is responsible for supervision of these MHPSS roles?

- Are these MHPSS workers supported by a professional

association?

- How are these roles licenced, accredited or regulated? Is there

specific regulation with respect to MHPSS roles?

Linkages

• Is there any current engagement between your sector/organization

and communities to address norms and attitudes related to mental

health, stigma, care-seeking behaviour, or other factors that influence

mental health?

• What linkages are there with other supports provided in other sectors

(health, social welfare, education, justice)?

- What linkages exist with NGOs? The private sector?

- How are these linkages coordinated?

- For children and adolescents who are identified as having mental

health problems, how are referrals coordinated to

» health services

» social welfare

» or other community-based supports

» Are there regulations, guidelines to support these referral

systems?

• To what extent have adolescents, children and parents/carers been

involved in designing, delivering or evaluating mental health supports

or services in your sector/organization? Is there a process for children,

adolescents and parents/carers to provide feedback?

Barriers and

I would like to ask now about what has been working well, and

enablers to

what some of the challenges have been in delivering MHPSS for

providing current

children and adolescents

MHPSS

• What do you think is currently being done well to address the mental

health of children and adolescents by your sector/organization?

• What could be improved or strengthened?

• What are the gaps (what specific areas of mental health and well-

being aren’t being addressed)?

108 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Theme

Questions

• What are the main challenges currently impacting on the delivery of

MHPSS through your sector/organization? For example:

- Lack of understanding or prioritization of mental health

- Community/parent attitudes and norms/social taboos

- Funding and other resources for MHPSS

- Existence of nationally mandated programmes that include

MHPSS

- Mental health worker training and education

- Linkages and coordination with other sectors (social welfare,

education, health services, NGOs, etc)

- Information sharing within your sector/organization and across

sectors/organizations

What role should

I would like to ask you now about what roles and responsibilities

the social welfare

your sector/organization should have in MHPSS for children and

sector have in

adolescents

implementing

• Broadly speaking, what do you think the role of your sector/

MHPSS and

organization should be in implementing MHPSS? How is this different

minimum-services

to the current roles we have already discussed?

package

• Reflecting on the different ‘tiers’ of MHPSS, what role should your

sector/organization have in:

- Responsive care for children and adolescents with mental health

problems

- Prevention of mental health problems

- Creating an enabling environment to promote good mental health

You can refer to figure A1 and table A1 in the conceptual framework

I would like to ask you now about the specific MHPSS actions or

services that your sector/organization should have responsibility for.

This minimum-services package for MHPSS has been proposed by

stakeholders across different sectors in [YOUR COUNTRY]

• Are there any actions that you think are missing?

• What actions do you think your sector/organization should have

primary responsibility for, and why?

• Which of these would be feasible for your sector/organization to

deliver, and why?

• How could they be delivered?

- What mechanisms currently exist to support implementation of

these MHPSS actions? (what existing programmes or services

could MHPSS be integrated with, what existing workforce could

deliver MHPSS actions)

- Do new delivery mechanisms or systems need to be developed?

• What actions do you think your sector/organization could contribute

to (if not primary responsibility), and how (linkages with other sectors

etc)?

Workshop agenda, prioritization tool and interview guide

109

Theme

Questions

Challenges and

I would like to ask you about how the MHPSS actions proposed in

considerations for

the minimum-services package could be effectively implemented.

implementation

In particular I would like to ask about what frameworks, structures,

of a minimum-

resources or supports your sector/organization would need to

services package

strengthen implementation

and strengthening

Legislation and policy

a multisectoral

mental health

• What additional policies are needed to support the delivery of

system

MHPSS?

• What legislation or regulation changes are needed?

•

[consider: sector-specific policies to enable delivery of MHPSS,

multisectoral mental health policies that clearly define sectoral roles]

Governance and leadership

• What government or non-government agency(ies) should have primary

responsibility for implementation of MHPSS?

- Planning

- Implementation

- Monitoring

• What role in leadership or governance do you think your sector/

organization should have, and why?

• How could coordination be improved within your sector/organization

(planning, implementation, monitoring)?

• How could coordination with other sectors (health, education, justice,

social welfare) and with NGOs and the private sector be improved?

• What role should other sectors have in implementation of MHPSS?

• What role should UNICEF have in supporting MHPSS?

• What role should the private sector have in supporting or delivering

MHPSS?

• What role should NGOs have in supporting or delivering MHPSS?

Services

• How could MHPSS be integrated with existing services or

programmes for children and adolescents?

• What new services or programmes might be needed?

• Are there systems or structure changes needed within this sector/

organization to take on these roles and implementation of MHPSS?

• What tools, resources or supports would be needed?

• Is there an opportunity for online or digital delivery of MHPSS?

• What actions are needed to ensure that children, adolescents and

parents/carers have access to these services/supports? What actions

are needed to reach the most underserved children and adolescents?

110 Strengthening Mental Health and Psychosocial Support systems and services for

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Theme

Questions

Standards and oversight

• What national standards, guidelines or other tools currently exist to

support the delivery of MHPSS? How could these be improved? What

additional guidance is needed? [Consider: new procedures, SOPs,

programmes, referral mechanisms, etc]

• What further actions are needed with respect to accreditation or

certification of workers who are engaged in delivering MHPSS?

• How should the quality of MHPSS be monitored and assessed? By

who?

Resources

Financial

• How are current (or planned) MHPSS delivered by your sector/

organization currently funded?

- If government organization:

» Are national policies or programmes that relate to MHPSS

costed?

» What is the source of the budget (through a specific

programme, specific budget line, etc)?

» To what extent does the budget include contributions from

user fees, sponsor contributions, in-kind contributions, private

sector/local business support?

» Are MHPSS funded through national or district/local

government?

» How are the staff who deliver MHPSS funded?

» How is infrastructure for MHPSS funded?

- If non-gov/private/UN

» Are MHPSS plans or programmes costed?

» What is the source of budget for these?

» To what extent does it include user fees, private sector

support, government funding, other?

• What additional financial resources would be required to support

MHPSS? Where should these come from?

Workforce

• What additional human resources are required for MHPSS?

• What ‘types’ of MHPSS providers are needed in your sector/

organization? With what competencies?

• Can MHPSS be integrated into existing roles and/or are new roles

needed?

• What additional training is needed? For who? Who should provide this?

• What supportive supervision is needed?

• What job aids or other resources are needed?

• What requirement or role might there be for professional associations

for MHPSS workers in your sector/organization?

• How could linkages with other MHPSS providers (health workers,

teachers, social workers) be improved to support delivery of MHPSS?

Workshop agenda, prioritization tool and interview guide

111

Theme

Questions

Participation

• What role should children, adolescents and parents/carers have in

designing or developing MHPSS policy, programmes and services?

• What role should they and the community have in monitoring

and evaluating MHPSS? What mechanisms are needed to enable

feedback?

• What mechanisms are there or could be developed to support the

participation and engagement of young people?

Data and information

• What data or information do you think is needed to support the

implementation of MHPSS?

- For design and delivery of services/support programmes

- For monitoring and quality assurance

- For evaluating outcomes and impact

- For financing MHPSS

• Are there existing systems (routine data collection, population or

household surveys, etc) that do, or could, include mental health? How?

• What systems are needed (or could be strengthened) to improve

reporting, use and communication of mental health data? How is

or could this information be shared (within your sector/organization,

across different sectors, with NGOs and the private sector)?

• What do you think are some important knowledge and evidence gaps

with respect to child and adolescent mental health? I.e. what further

research would help support MHPSS?

Any other issues?

Any other comments or suggestions you would like to raise that we have

not yet covered today?

I will go over a summary of what we have discussed, if you would like to

add or change anything you have said please let me know.

112 Strengthening Mental Health and Psychosocial Support systems and services for

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Appendix B:

Development of the conceptual framework

The approach to development of the project conceptual framework was consultative and iterative,

as explained below.

Synthesis of the available evidence

An important foundation to this work was the framing of mental health and well-being in UNICEF’s

The State of the World’s Children 2021 report.² One of the core messages in the report is to consider

the ‘spheres of influence’ that shape mental health and well-being from an early age. The key spheres

are ‘the world of the child’ (focusing on home and caregiving settings), ‘the world around the child’

(involving healthy attachments in schools and communities) and ‘the world at large’ (including large-

scale social determinants such as poverty and conflict). In a related commentary co-authored by

UNICEF, opportunities to intervene were broadly mapped against these spheres of influence:¹⁰ mental

health promotion is largely aimed at the social determinants of health which impact on the world of

the child, with preventive and treatment services more targeted towards the world of and around the

child. The following additional documents and resources were reviewed in drafting the conceptual

framework: UNICEF reports focusing on MHPSS; ^11-14 WHO guidelines related to mental health;^15-19

the Lancet Commissions on Global Mental Health and Sustainable Development, and on Adolescent

Health and Well-being;^20,21 UN guidance on social and emotional learning;^22,23 and available country-

level operational guidance on implementation of MHPSS from both high-income settings^24-26 and

available guidance from focal countries for this project (Thailand and the Philippines).^27-31 The draft

framework considered the context of the region and in particular the experience and capacity of key

sectors to implement MHPSS.

Review by the Regional Technical Advisory Group

The Regional Technical Advisory Group (TAG) was assembled specifically for this project by UNICEF

with membership including experts in child and adolescent mental health and well-being, UNICEF

regional focal points related to child and adolescent mental health, as well as UNICEF representatives

from each of the four countries where focal research was being undertaken. The conceptual

framework was first presented during a virtual meeting, with the framework then circulated for

written feedback in April 2021. All members of the TAG provided feedback and subsequently endorsed

the conceptual framework.

Additional review by content experts

Further to input from the TAG, written input was sought from content experts in: social and emotional

learning; interventions to address the social determinants of mental health; and the roles and

responsibilities of the social welfare sector in mental health. Input was also sought from programming

and implementing partners in each focal country, as well as the technical lead for MHPSS at UNICEF

headquarters with consideration of the forthcoming Minimum Services Package for MHPSS (in

development) in refining the conceptual framework and actions.

Finally, extensive feedback was sought from country-level stakeholders during an

online, two-day workshop in each focal country.

Each online workshop (in Thailand, the Philippines, Papua New Guinea and Malaysia) was held with

key stakeholders and implementation partners across health, education, social welfare and youth

advocacy representing government, non-government, private sector and UN agencies. Feedback

was gathered through facilitated discussion and an online prioritization tool completed by individuals.

The feedback from across all countries was collated to inform a cross-cutting regional framework, in

addition to identifying specific priorities within each country.

Appendix B:

113

Appendix C:

National-level data on mental health outcomes

and risks

Mental health outcomes

Data

Indicator

Sex

Age group

Residence

Estimate

Upper CI

Lower CI

source

Year

Prevalence

Female

5 to 9

0.11

GBD

2019

of depressive

Male

5 to 9

0.06

2019

disorders

Both

5 to 9

0.08

2019

Female

10 to 14

2.60

2019

Male

10 to 14

1.77

2019

Both

10 to 14

2.19

2019

Female

15 to 19

5.20

2019

Male

15 to 19

4.02

2019

Both

15 to 19

4.61

2019

Prevalence of

Female

10 to 14

0.10

GBD

2019

bipolar disorder

Male

10 to 14

0.11

2019

Both

10 to 14

0.10

2019

Female

15 to 19

0.36

2019

Male

15 to 19

0.36

2019

Both

15 to 19

0.36

2019

Prevalence

Female

13 to 17

7.70

8.76

6.85

NHMS -

2017

of inability to

Adolescent

Male

13 to 17

6.40

7.21

5.75

2017

sleep due to

Health

worry so much

Both

13 to 17

7.10

7.73

6.52

2017

most of the

time or always

in the past 12

months

Prevalence

Female

1 to 4

0.19

GBD

2019

of anxiety

Male

1 to 4

0.12

2019

disorders

Both

1 to 4

0.15

2019

Female

5 to 9

2.27

2019

Male

5 to 9

1.39

2019

Both

5 to 9

1.83

2019

Female

10 to 14

5.45

2019

114 Strengthening Mental Health and Psychosocial Support systems and services for

children and adolescents in the East Asia and Pacific region: Malaysia Country report 2022

Data

Indicator

Sex

Age group

Residence

Estimate

Upper CI

Lower CI

source

Year

Male

10 to 14

3.45

2019

Both

10 to 14

4.46

2019

Female

15 to 19

6.70

2019

Male

15 to 19

4.10

2019

Both

15 to 19

5.41

2019

Prevalence

Female

5 to 15

14.90

17.49

12.67

NHMS

2019

of conduct

Male

5 to 15

16.90

19.72

14.43

2019

problems

Both

5 to 9

15.20

18.03

12.79

2019

Both

5 to 15

15.90

17.87

14.14

2019

Both

5 to 15

Urban

15.70

18.14

13.57

2019

Both

5 to 15

Rural

16.50

19.76

13.61

2019

Both

10 to 15

16.50

19.23

14.06

2019

Prevalence

Female

1 to 4

0.69

GBD

2019

of idiopathic

Male

1 to 4

0.40

2019

developmental

intellectual

Both

1 to 4

0.54

2019

disability

Female

5 to 9

0.81

2019

Male

5 to 9

0.51

2019

Both

5 to 9

0.66

2019

Female

10 to 14

0.74

2019

Male

10 to 14

0.48

2019

Both

10 to 14

0.61

2019

Female

15 to 19

0.66

2019

Male

15 to 19

0.43

2019

Both

15 to 19

0.55

2019

Prevalence of

Female

10 to 14

0.01

GBD

2019

schizophrenia

Male

10 to 14

0.01

2019

Both

10 to 14

0.01

2019

Female

15 to 19

0.08

2019

Male

15 to 19

0.10

2019

Both

15 to 19

0.09

2019

Prevalence

Female

1 to 4

0.20

GBD

2019

of autism

Male

1 to 4

0.69

2019

spectrum

disorders

Both

1 to 4

0.45

2019

Female

5 to 9

0.20

2019

Male

5 to 9

0.68

2019

National-level data on mental health outcomes and risks

115

Data

Indicator

Sex

Age group

Residence

Estimate

Upper CI

Lower CI

source

Year

Both

5 to 9

0.44

2019

Female

10 to 14

0.18

2019

Male

10 to 14

0.65

2019

Both

10 to 14

0.41

2019

Female

15 to 19

0.17

2019

Male

15 to 19

0.58

2019

Both

15 to 19

0.38

2019

Prevalence of

Female

5 to 15

1.70

2.65

1.10

NHMS

2019

hyperactivity

Male

5 to 15

2.90

4.33

1.92

2019

problems

Both

5 to 9

2.10

3.07

1.43

2019

Both

5 to 15

2.30

3.12

1.69

2019

Both

5 to 15

Urban

2.20

3.21

1.44

2019

Both

5 to 15

Rural

2.70

4.12

1.77

2019

Both

10 to 15

2.50

3.79

1.60

2019

Prevalence

Female

5 to 15

9.10

11.15

7.46

NHMS

2019

of emotional

Male

5 to 15

7.50

9.64

5.78

2019

health

problems

Both

5 to 9

6.40

8.08

5.02

2019

Both

5 to 15

8.30

9.78

7.04

2019

Both

5 to 15

Urban

7.90

9.72

6.36

2019

Both

5 to 15

Rural

9.50

12.00

7.46

2019

Both

10 to 15

9.90

12.19

7.99

2019

Prevalence

Female

13 to 17

6.90

7.66

6.18

NHMS -

2017

of suicidal

Adolescent

Male

13 to 17

7.00

8.04

6.08

2017

attempt one

Health

or more times

Both

13 to 17

6.90

7.71

6.24

2017

in the past 12

months

Mortality rate

Female

15 to 19

1.18

1.92

0.66

GBD

2019

due to self-

Male

10 to 14

0.23

0.61

0.10

2019

harm (deaths

per 100,000

Male

15 to 19

4.98

10.38

2.71

2019

population)

Both

15 to 19

3.13

5.91

1.89

2019

Female

10 to 14

0.08

0.14

0.04

2019

Both

10 to 14

0.16

0.35

0.08

2019

116 Strengthening Mental Health and Psychosocial Support systems and services for

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Mental health risks

Data

Indicator

Sex

Age group

Estimate

Upper CI

Lower CI

source

Year

Prevalence of lifetime

Female

13 to 17

1.10

1.61

0.81

NHMS -

2017

marijuana use

Adolescent

Male

13 to 17

4.40

5.33

3.67

Health

Both

13 to 17

2.80

3.40

2.30

Prevalence of lifetime

Female

13 to 17

1.30

1.72

0.98

NHMS -

2017

amphetamines or

Adolescent

Male

13 to 17

3.60

4.45

2.93

methamphetamines

Health

use

Both

13 to 17

2.40

3.02

1.98

Prevalence of lifetime

Female

13 to 17

2.00

2.63

1.57

NHMS -

2017

drugs use

Adolescent

Male

13 to 17

6.60

7.80

5.60

Health

Both

13 to 17

4.30

5.08

3.64

Prevalence of having

Female

13 to 17

13.70

14.81

12.70

NHMS -

2017

been bullied on at

Adolescent

Male

13 to 17

18.70

19.99

17.48

least one day in the

Health

past month

Both

13 to 17

16.20

17.14

15.28

Prevalence of

Female

13 to 17

11.00

12.23

9.91

NHMS -

2017

physical abuse at

Adolescent

Male

13 to 17

12.70

14.07

11.37

home at least once in

Health

the past month

Both

13 to 17

11.80

12.83

10.90

Prevalence of verbal

Female

13 to 17

49.20

51.11

47.29

NHMS -

2017

abuse at home at

Adolescent

Male

13 to 17

37.20

38.53

35.79

least once in the past

Health

month

Both

13 to 17

43.20

44.60

41.85

Prevalence of being

Female

13 to 17

19.30

21.00

17.78

NHMS -

2017

physically attacked

Adolescent

Male

13 to 17

31.40

32.78

30.01

one or more times in

Health

the past 12 months

Both

13 to 17

25.30

26.50

24.10

Prevalence of

Female

13 to 17

10.80

11.57

10.04

NHMS -

2017

loneliness most of

Adolescent

Male

13 to 17

7.80

8.58

7.12

the time or always in

Health

the past 12 months

Both

13 to 17

9.30

9.91

8.75

Prevalence of suicidal

Female

13 to 17

10.80

12.00

9.76

NHMS -

2017

ideation in the past

Adolescent

Male

13 to 17

9.10

10.07

8.27

12 months

Health

Both

13 to 17

10.00

10.79

9.24

Prevalence of suicidal

Female

13 to 17

7.80

8.68

7.06

NHMS -

2017

plan in the past 12

Adolescent

Male

13 to 17

6.80

7.87

5.90

months

Health

Both

13 to 17

7.30

8.05

6.67

National-level data on mental health outcomes and risks

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