Determining the Attitudes of a Rural Community in Penang, Malaysia towards Mental Illness and Community-Based Psychiatric Care

摘要

Introduction: Historical attitudes toward mental illness have been one of stigmatisation. This has serious implications for patients as it disadvantages them in aspects of daily living and leads to delay in seeking and in defaulting treatment. Aim: The objective of this study was to determine the attitudes of a rural community in Penang, Malaysia towards various aspects of mental illness and towards community-based mental health facilities. Materials and Methods: A Malay version of Community Attitudes toward Mental Illness-Swedish (CAMI-S) questionnaire was used as a tool to achieve the objective of this ethically conducted cross sectional study. The results were analysed descriptively using PASW Statistics 18. Results: Most respondents felt that mental illness was unlike other illness (78.1%) and most did not trust mentally ill patients in remission to become babysitters (92.7%). However, majority of the respondents disagreed in treating the mentally ill as outcasts (78.1%). Most respondents (85.4%) also agreed that mental health treatment should be provided through community-based facilities where possible. Conclusion: While most respondents displayed a mixed feeling of distrust and fear but they also exhibited tolerance towards preventing stigmatisation and accepting community-based care for the mentally ill. Introduction Attitudes toward mental illness have historically been that of stigmatisation and unfavourable responses (1). However, it was noted in a review article by Ng that attitudes among Asian populations have several distinctions as compared to those in the West. These differences arise because most psychiatric definitions originate in the West, which possess different cultural settings when compared with Asia (2). Several prominent themes that exist among studies conducted in Asia about mental illness have a tendency to display somatisation as a way of dealing with an illness and a greater inclination to attribute mental illness to supernatural or religious phenomena. Conditions that are chronic, relapsing and irreversible are likely to carry a stigma and are judged to be stemming from supernatural or sorcery punishments, social transgressions or constitutional deficits (2). In most Asian societies, family members who are inflicted with mental illness are cared for by the family. While this may lead to a greater sense of shame and stigma, it may also offer potential support and care, which are valuable in the management of psychiatric illnesses. Stigma also has implications for the patient himself, leading to increased psychiatric symptoms and stress, as well as reduced self-esteem. It also reduces the chances of a patient seeking treatment and leads to delays in recovery. Indeed, the stigma of mental illness may even be subjectively worse for the patient than the actual disease (3). Negative attitudes associated with mental illness go beyond mere stigmatisation, in a review by Romer in 2008, studies have shown that the mentally ill are frequently disadvantaged when it comes to matters such as access to housing, employment and health care (3).A review of attitudes toward mental illness in various Asian cultures, conducted by Ng in 1997 also found that differences exist between different Asian ethnicities. In Malaysia, the Malay community was found to be more supportive and less rejecting towards the mentally ill. In more heavily urbanised Singapore, which is predominantly populated by ethnic Chinese, there was a prevailing unsympathetic attitude towards the mentally ill, resulting in many cases of suicide amongst sufferers. The Chinese attitude appears to be consistent with other East Asian cultures, such as the Japanese, who regard a mentally ill relative as a shame to the family (2). There is a dearth of studies performed in Malaysia about attitudes toward the provision of mental healthcare through community facilities. Elsewhere in the world, a study conducted in London in 1995 showed that attitudes toward me