By Dr Kalaashini Ramachandran / Professor Dr Noran Naqiah Hairi / Professor Dr Moy Foong Ming

"No more a child, not yet an adult". Adolescence; a unique stage of life. We have always considered them a 'healthy group' and may not gauge this period important especially in their mental health development. With the COVID-19 pandemic affecting everyone globally, we have yet to defeat the long-standing mental health crisis.

The prevalence of mental health disorders among adolescence is 15% globally¹ and 50% of this disorder begins as early as 14 years old².

What's worse, 72% of mental health services to children and adolescents have been disrupted due to COVID-19. It is sad to acknowledge that in Malaysia, 424, 000 children suffer from this hidden epidemic.

Malaysia's 2019 National Health and Morbidity Survey reported that one in five adolescents suffered from depression (highly treatable but often diagnosed and untreated), two in five adolescences were anxious and about 1 in 10 of them were stressed³.

If left untreated, the consequences can have huge impact on their academic, performance and physical health. 

Negative belief and stigma towards mental health services and professionals are the main obstacle stated by most adolescents in seeking help⁴.

This factor persists to be prevalent making mental health illness among the adolescents continue to exist in oblivion. In addition, the government clinic setting does not provide a conducive environment for adolescents to talk about their problems due to the limited space in the consultation room. Shyness and fear are the other two barriers preventing our adolescent to seek help.

How can we help them overcome these barriers? Could tele-health be a good option? Research has shown that tele-healthcare has promising potential to fill the gaps between current and future needs⁵.

Tele-health that is being practiced till date guided by Malaysia's Tele-medicine Act 1997 is mainly to trace results or to arrange for home delivery of medicine. As tele-health is gaining ground internationally, perhaps this is the right time for our government to revise this act to cover the scope of 'true' tele-medicine which should involve consultation and drug prescription.

New regulations and policies are needed to guide our healthcare providers to address the ethical, legal issues, consents and consultation when planning tele-counseling for our adolescents.

Getting the Ministry of Health and Ministry of Education to be actively involved, we can introduce tele-counseling and tele-health services to every school.

Every government clinic has a designated school health team, and a link can be created between the school health team and the counselors/teachers.

Teachers can recognize students that might need help through their classroom participation, schoolwork or disciplinary records.

Selecting a leader among students to advocate this service will make it more acceptable as peers have more influence.

Students who wish to seek help but are fearful or embarrassed of visiting the clinic can utilize the tele-counseling service at the comfort of their respective environments and get help. This may also encourage a higher rate of compliance for further appointments. Adolescents who are IT savvy maybe more engaged with tele-counseling.

Tele-counseling platform holds a great potential to address mental health among adolescents. A physically and mentally healthy adolescent brings hope to the nation. Mental health care is a right, not a privilege.

Reference:

¹ Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of child psychology and psychiatry, and allied disciplines, 56(3), 345–365. https://doi.org/10.1111/jcpp.12381

² Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593

³ Institute for Public Health 2020. National Health and Morbidity Survey (NHMS) 2019: Non-communicable diseases, healthcare demand, and health literacy—Key Findings

⁴ Aguirre Velasco, A., Cruz, I. S. S., Billings, J., Jimenez, M., & Rowe, S. (2020). What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review. BMC Psychiatry, 20(1), 293. doi:10.1186/s12888-020-02659-0

⁵ Langarizadeh, M., Tabatabaei, M. S., Tavakol, K., Naghipour, M., Rostami, A., & Moghbeli, F. (2017). Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review. Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH, 25(4), 240–246.

(Dr Kalaashini Ramachandran, Professor Dr Noran Naqiah Hairi and Professor Dr Moy Foong Ming, Center of Epidemiology & Evidence Based Practice, Department of Social & Preventive Medicine, Faculty of Medicine, Universiti Malaya.)