In conjunction with the World Suicide Prevention Day (10 September), Dr Amarpreet Kaur shares her point of view about how retrenchment and job loss amid the Covid-19 pandemic can lead to mental health issues.
Many experts are predicting a significant rise in mental health problems worldwide due to Covid-19 and its effects on life and work. Do you believe Malaysia will face the same?
Malaysia has not been spared in this pandemic, in any way, shape or form. We are in crisis, from an economic point of view and healthcare, which includes the mental health and wellbeing of our fellow Malaysians. The impact of Covid-19 has managed to trickle down to each and every level of society from every angle imaginable. Just a few months ago, we were dealing with the physical impacts of Covid-19, which was stressful to say the least, but now comes a tsunami of economic implications and disastrous mental health sequelae.
With the Government’s implementation of the Movement Control Order (MCO) in March, numerous non-essential businesses have come to a halt. Many Malaysians have lost their income or have been terminated from their jobs. Losing a job disrupts one’s mental health, bringing in an array of feelings which includes depression and anxiety. With these mental health issues on the rise, we then see an increase in negative coping mechanisms that one might engage in, and this in turn can lead to substance abuse and suicide as the last resort.
Due to this pandemic, job losses in the country has increased by 42% year on year for this first quarter according to SOCSO. Data has shown that 61% of job losses are among workers aged 40 and below. Male workers are more likely to be retrenched than female counterparts at 60%, this may reflect the fact that there are more men than women in the workforce. Out of 7.5 million active employees registered with SOCSO in 2019, 1.458 million worked in tourism-related sector. In addition, the unemployment rate is forecast to hit 4% in 2020, compared to 3.2% the 1997 Asian financial crisis. Unfortunately, Malaysia’s relative success at containing the Covid-19 outbreak has not translated into economic performance.
Fear, worry and anxiety can cause depression and eventually lead to suicidal thoughts, as was the case with a 62-year-old patient who committed suicide in Serdang Hospital, Selangor. In May, a jockey and a hawker took their own lives in Penang due to financial problems caused by the economic hardships. Earlier this month, a Malaysian pilot who had been terminated from Air Asia, had committed suicide possibly due to stress from losing his job. The country’s National Fire and Rescue Department have been busy handling cases of people threatening to take their lives since the partial lockdown. The Health Ministry’s Crisis Preparedness and Response Centre and Mercy Malaysia launched a support hotline for anyone affected by the current crisis on the 24th of March. Not surprisingly, 46.8% of calls received were psychologically related. The losses associated with the MCO, together with the spread of Covid-19 have definitely contributed to the rapid rise and exacerbation of mental health issues. The Covid-19 crisis does not just affect one’s physical health; it kills in many ways.
In terms of retrenchment and job loss, why are some people better able to adapt to these sudden changes in life than others?
Let’s face it: there is a global pandemic of unemployment, and this is a crisis within a crisis. People find themselves laid off, asked to take indefinite leave or are just straight off fired. Besides being in a financial challenge, it also stirs up all kinds of psychological issues. The stress of losing a job can take a heavy toll on someone’s mood, relationships, and overall mental and emotional health.
Adaptability is a requirement because change is constant and inevitable. The hardest changes to understand are the ones that are unexpected and out of our control, such as a global pandemic or a recession. It can be hard to come to terms with, but the experience of this can be made better or worse depending on one’s reaction and attitude.
Losing one’s job is akin to the grief of losing a loved one. It is important to realize that this and allow oneself to have compassion towards themselves. Giving themselves permission to grieve is the first step to getting back on their feet. People who adapt better give themselves time to adjust. They allow themselves to feel what they are feeling, and understand that even the most unpleasant, negative feelings will pass.
They also accept the reality of the situation, rather than dwelling on the unfairness of it all and how much better life would be if it had not happened. The sooner one accepts this, the sooner one can get to the next phase of their lives.
Most successful people have experienced major setbacks in their careers but have turned things around by picking themselves up, learning from the experience and trying again. It is important to remember that this is a temporary setback. People who adapt well are also those that try to look for the silver lining, maybe this is a chance for them to rethink their career priorities. There is always something of value to find if you look hard enough.
Another aspect of adapting to job loss would be developing new relationships and expanding one’s social network. This can be crucial in both helping one to cope with the stress of losing a job as well as finding a new job. The vast majority of job openings are never advertised; they are filled by networking.
Being unemployed does not have to define who we are as a person, it is up to oneself to define themselves, not the state of the economy. Adapting well to job loss includes pursuing activities that bring purpose and joy to one’s life, spending time in nature and volunteering. These may seem trivial things in the context of the bigger crisis of financial strain, but they make all the difference. Keeping a regular daily routine, creating a job search plan, listing out ones positive skills, accomplishments and success and focusing on what one can control such as learning new skills, writing a great resume and setting up meetings with networking contacts will all help with adaptation to job loss in a positive way.
Why are men more likely than women to consider suicide or other drastic measures in situations like these?
Suicide claims almost 800,000 lives every year globally and is the leading cause of death among young people aged 15-29 years of age. Evidence shows that for each adult who dies of suicide, there are more than 20 others attempting suicide.
Suicide is often thought of as a gender-neutral issue, but in reality, it is a problem that affects men far more than women. Women are actually more likely to try to kill themselves, but men are more likely to die from it. This is mainly due to two things: one is that men use more lethal means to attempt suicide and the secondly, that they do not seek mental health services as much.
A man in USA who feared that he and his girlfriend contracted the coronavirus fatally shot his girlfriend and then killed himself. A 36-year-old man in Bangladesh killed himself because he and the people in his village thought he was infected with Covid-19 because he had a fever and cold symptoms.
There is evidence that men who adhere more strongly to masculine ideals see getting psychological help more negatively. This can result in their feelings building up without an escape valve and can escalate to a crisis point. Studies have shown that in the year before they killed themselves, only 35% of men saw a mental health practitioner, compared to 58% of women. Men tend to equate a sense of predictability, purpose and meaning with their jobs, and when that ends it is like the carpet being pulled from under their feet.
Almost everyone that dies from suicide has an underlying mental health problem, and thus having mental health issues is a major predictor of suicide. The majority of those people are suffering from depression. Unfortunately, when it comes to mental health such as depression and anxiety, symptoms and signs are not as visible as the other diseases such as the coronavirus.
In situations like this, it is comparable to the Spanish Flu epidemic where there was an increased rate of suicide. There was also a significant increase in suicide deaths among people aged 65 and older during the 2003 SARS outbreak in Hong Kong.
Economic uncertainty is associated with stress-related disorders and suicide. It has been shown that uncertainly is a more stressful state to be in than really knowing something bad will happen. Historically, economic downturns were associated with mental health disorders and suicides. Increase in the unemployment rate were associated with higher prevalence of depression, alcohol and other substance use disorders and suicide deaths. Mental health consequences of the Covid-19 crisis including suicidal behavior are likely to be present for a long time and peak later than the actual pandemic.
How can individuals and families face these current challenges that are affecting mental health and leading to increased stress? What steps can they take?
Humans are a species that seems to create and suffer a great deal of mental anguish. More than any other species, we kill, maim and harm ourselves and others. 1in 4 of us will have a mental health issue in any given year and 1 in 2 of us will have suicidal thoughts in our lifetime.
If we then add a global pandemic, in which people have to live with constant uncertainty, disrupted routines, isolation from friends and family as well as health anxieties, we can anticipate this pattern being amplified. While anxiety is a normal and healthy function that alerts us to threats and helps us take measures to protect ourselves, recognizing when to seek help can be tricky.
Self-care strategies are important for mental and physical health and can help take charge of one’s life. Getting enough sleep, participating in regular physical activity, eating healthily, and avoiding tobacco, alcohol and drugs are all good strategies for coping during a stressful time.
Allow yourself time to notice and express what you are feeling. It is normal to feel overwhelmed, stressed and upset in the current situation.
Keeping a regular routine makes one feel more in control. Limiting exposure to news and social media and staying busy can distract you from the cycle of negative thoughts that feed anxiety and depression. Doing something positive to manage anxiety is a healthy coping strategy. Focusing on positive thoughts and setting priorities with reasonable goals gives you purpose.
This is the time for everyone to make virtual connections and enjoy virtual socializing. Strengthen relationships and build support. Do something for others and find purpose in helping those around you.
Focus on the actions that are in your control. Action is the antidote to anxiety, and there is a lot that individuals can do to protect themselves and their families including excellent hygiene, wearing a mask and social distancing practices.
Mindfulness and meditation exercises can help us stay grounded during an emotional storm. Mindfulness practice can help us to notice the patterns of thoughts and emotions that can hook us away from our values and goals. Focus on what you value and what you are grateful for instead of the negative things around you.
Do employers also have a role to play in ensuring mental health of their employees is well balanced, especially during this pandemic. What steps should employers implement?
This is not business-as-usual.
Before coronavirus entered the picture, companies were just starting to see the importance of employees’ emotional wellbeing and providing them with resources. But now – as many more employees struggle with a slew of problems and look for mental health support from their employers – it is become an era that cannot be ignored.
As an employer, they have the ability and responsibility to manage the employees benefit providers and health insurance plans to ensure the employees have the help and support they need.
Employers need to reinforce what their benefit providers are saying, support the importance of getting help when needed. Employees may have a lot on their mind and may be experiencing high levels of stress- they may be more distracted. They may need to be told repeatedly in a variety of ways how to access mental health services.
Some of the resources that are normally provided by benefit providers include: telehealth and crisis counselling by phone, Zoom, FaceTime or text, online and local behavioral health support group information, connections and support for people with mental health or substance use disorders, resources for financial counselling and accessing financial aid, resources for food, childcare and nursing care.
Supervisors will likely see the impacts of stress on employee wellbeing and mental health firsthand. The supervisor must ensure that actions are taken by Human Resources to provide support to employees.
Supervisors can also give explicit permission to take mental health breaks, take walks and engage in other acts of self-care. They can offer support through a variety of programs such as virtual happy hours, allowing for vacation time, encouraging work-life balance, and supporting virtual social events.
There should also be the need to understand and accommodate the need for flexible scheduling and acknowledge the challenges with shared space at home to complete school and work.
Communication and check-ins need to be increased. Employers and supervisors need to practice good listening skills with the employees when they are stressed or in distress. Job related stressors need to be identified and eliminated.
Being there for workers and making sure their wellbeing is of the utmost importance will help all to get through this together. If employers are to weather the economic storm ahead, it is vital that they invest in ensuring their workforce is as resilient as possible because if the workforce is resilient, the business itself will be resilient too.
Do many Malaysians still lack access to mental health services or are they reluctant to seek help?
In Malaysia, the National Health and Morbidity Survey indicates that prevalence of mental health problems among people aged 16 years and above was nearly 30%. From this figure, it shows that one in three Malaysians has experienced mental health issues. And mind you, these are figures pre-Covid 19.
Unfortunately, there is a critical shortage of clinical psychologists in Malaysia and very few are with the government mental health services. There are also limited availability of Metal Health Specialists in government hospitals. The number is worrying low with a ratio of 1 Psychiatrist per 100,000, and only 15 Clinical Psychologists were employed in the public health service sector in 2018. Rural areas suffer the most.
The issue of mental health has been highlighted time and time again, as the number of those suffering psychologically keep rising year by year. Lack of awareness, albeit getting better each year, is still a pertinent factor for delayed or not seeking treatment. In addition to this, the stigma of mental illness has been identified as a significant barrier to help-seeking and care.
Most insurance companies do not recognize mental illness as part of critical illness that needs to be managed by providing proper and timely treatment. Standard health insurance policies do not cover for the pre-existing conditions including mental illness. This situation discourages people from seeking treatment. The inclusion of mental health insurance coverage would mean better mental health for everyone and reduced morbidity and mortality, which would only benefit the society in the long term, especially from an economic and productivity point of view. Let us not forget that according to the WHO, mental health disorders cost the global economy 1 trillion US dollars from the loss of productivity per year.
Mental health problems are more common than you think, you are definitely not alone.
Dr Amarpreet Kaur
Consultant Psychiatrist and Clinical Hypnotherapist University Malaya Specialist Centre
Senior Lecturer University Malaya Medical Centre