Unless you’re spectacularly #woke, when you think mental illness or mental health problems, the first word that comes to mind would likely be psycho, gila, or Tanjung Rambutan – followed by a dark, high security mental asylum. You’ve got the flickering lightbulbs, skittering cockroaches, and token straitjacketed fellows muttering to themselves in padded cells… aaand we’ve basically described Arkham Asylum.

But here’s the thing – In 2015, the Ministry of Health reported that roughly 3 out of every 10, or 29.2% of adult Malaysians suffer from mental health problems. 

So here’s the question… if that’s the case, then why aren’t we seeing 3 out of 10 people running around naked, talking to themselves, or screaming obscenities at a tree?

In reality, these actions are actually symptoms of psychotic disorders such as schizophrenia and dissociative identity disorder (what we used to know as “split personality”); which only affects 1% of the population. The majority are actually “invisible” disorders such as anxiety and depression, also called Common Mental Disorders (CMD). 

So to put things in perspective, it would be highly unlikely for someone to be committed to a mental institution for a CMD, so this article will be focused on psychotic disorders, or people who are found to be insane. Common psychotic symptoms include hallucinations and delusions.

But hmm, how do you even decide if a person is “insane” in the first place?

What is “insane”?

This isn’t directly related to the article, but it’s interesting to know that the word (and definition) of “insane” changes depending on whether you’re a doctor, lawyer, or a member of the public. For the most part, we’ve addressed public perception earlier, so let’s focus on the medical and legal views. 

For doctors – in this case mostly Clinical Psychologists and Psychiatrists – the word “insane” can be considered an outdated and inaccurate term. Rather, specific diagnosis of a mental disorder is given. These conditions are documented in books such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). We may joke that reading such lengthy books would drive you insane, but the medical community relies on such texts to help diagnose mental diseases.

However, the word “insane” is still used in law, although the actual term used by Malaysian lawyers is “unsoundness of mind”. The legal definition of “insane” comes from the M’Naughten Rules, a classic case from the UK, and is commonly used as a criminal defence. This is mentioned in Section 84 of the Penal Code:

This basically means that a defense lawyer could argue that their client was insane when they committed the crime, meaning that they didn’t understand what they were doing and/or that they didn’t understand that what they were doing was wrong. Of course, this would need to be backed up by evidence, facts, and even medical reports. You can read more about this here:

[READ MORE: How does an insanity plea work in Malaysia?]

So… how does someone get admitted to a mental hospital?

Malaysian law has changed considerably over time with regards to mental health. Historically, the Lunatic Ordinance of Sabah 1951, Mental Health Ordinance Sarawak 1961, Mental Disorders Ordinance of 1952 used to govern this for Sabah, Sarawak, and Peninsular respectively. These laws have now been unified under the Mental Health Act 2001 which came into power under the Mental Health Regulations 2010, and govern both sides of the country today.

So lets say someone you know becomes off their knocker – do they actually get rounded up and hauled off to be locked up…?

Don’t worry, they won’t.

Section 8 of the Mental Health Act 2001 gives us the various ways a person can be admitted into a psychiatric hospital. Some of them are obvious, such as voluntarily going for it, or being transferred from a different hospital. However, hospitals also have legal power to detain and admit psychiatric patients without their consent, and it is given in Section 10 – Admission of involuntary patient into psychiatric hospital.

The section itself is rather long, but the gist of it is that it can be done in two ways:

1. A relative makes an application (via a form) to the Medical Director asking to admit them for a psychiatric illness; or
2. An application is made by a doctor due to the extent of their disease, or for the health and safety of themselves (or others). 

But that’s not all. A practicing Doctor will also examine the person in question within 5 days of the admission. Some other requirements in Section 10 include:

- Two different medical practitioners must examine the patient

- The two examinations cannot be done by the doctor who recommended the detention

- One of the examinations must be done by a qualified psychiatrist

- The patient must be lawfully discharged if there is no further reason to detain them

So basically, lots of hoops to jump through, lots of boxes to tick. This hopefully means that the people who are admitted involuntarily are not held in a hospital unfairly.

Are there laws protecting mental patients after admission?

So you might have seen how badly mental patients have been treated in movies but, in real life, it’s not easy to get away with patient abuse in hospitals.

First and foremost, our article on the Bolam Test explains the standard of care for medical professionals. Basically, a doctor is expected to act with a general standard of competency that other doctors can meet – and should this not be met, the practitioner can be legally liable. It’s basically the professional version of your mom and dad going: “Why your sister get straight A but you cannot?”.

So what happens when patients ARE mistreated?

Section 86 of the Mental Health Act 2001 –  Ill-treatment of patient

This basically makes it illegal for any care staff to mistreat a mental patient. This is where the Bolam Test comes in, and is used as a standard to determine if the a patient has been mistreated or not. The penalty for ill-treating a patient is a fine or up to RM10,000 and/or up to 2 years of jail.

Don’t be afraid to seek help!

While things have improved in recent years, mental patients back in the day were prone to various forms of mistreatment in the view of “curing” them. Some old-timey treatments included isolation, blood-letting, lobotomy, and drilling holes in the skull. Fortunately, public opinion, medical advancements, and the law itself have evolved to help take care of those in need of mental healthcare (although there’s still much more to be done).

But now, help and proper treatments are readily available so it might make you feel a little safer about sending a loved one who may be suffering from psychotic illness to get treatment. If you ever need to report a case of hospital abuse (whether for mental patients or otherwise), this reporting guide from the Malaysian Medical Council could help you out. 

It’s also worthwhile to mention again that mental health issues like CMDs are becoming increasingly common, and there shouldn’t be a stigma attached to it. If you need more information, help, or just someone to talk to; organizations like Relate Malaysia or Befrienders can help.

Relate – Website | Contact form | Facebook messenger

Befrienders – Website | Hotline : 603-79568145