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In February this year, Brunei’s Ministry of Health launched the nation’s first emotional support system hotline, dubbed ‘Talian Harapan 145’ or Hope Line 145 in response to the increase in suicide rates in the country, with a marked increase of 62 per cent between 2016 and 2017 alone.

The stigma surrounding mental health is a widespread issue that needs to be urgently addressed, and that’s exactly why, for the first topic of Neue Talks, we’re going to be diving deep into the issue of mental health, with the help of Dr Hilda Ho, Head of Psychiatry Services at the Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital and Visiting Consultant Psychiatrist, Jerudong Park Medical Centre (JPMC). 

While there have been steps taken to raise awareness and improvements in society’s mindset surrounding the topic, there is still a hushed stillness surrounding the words ‘mental health’, almost as if it were taboo to speak of the phrase. Attitudes surrounding mental health may be more accepting than they were 10, even 5 years ago, but there’s still a long way to go before the taboo label is shed and conversations around it can become normalised.

Sensationalised?

While the media has helped to increase awareness about mental health, it is not without its pitfalls.

Shows like 13 Reasons Why are a grave example of the media sensationalising and even at times, borderline romanticising mental illnesses, while overlooking the nuances and the varied factors that may lead to mental health trouble. The media might even encourage the ideation of these issues through dramatic portrayals of the actions of characters who may be suffering from mental health illnesses.

And for most people, their first direct contact with mental health may even be through these shows, which is why accurate information about how to deal with one’s mental health should and must be available to the masses.

Neue had the opportunity to speak to Dr Hilda about mental health in Brunei, along with issues of awareness and acceptance of the conversation surrounding the topic. She has also been a big advocate and contributor to the advancement of mental healthcare in Brunei, especially with regard to the national Mental Health Order 2014.

Mental health issues in Brunei

What’s the most prevalent mental health issue in Brunei?

The most common complaint is ‘stress’, usually related to having difficulty coping with the pressures and demands of life such as work, studies, finances and family responsibilities. Prolonged stress can eventually develop into more serious mental health problems such as depression or anxiety disorders.

What’s the difference between feeling ‘low’ and clinical depression?

Feeling low can be a normal reaction to any situation; for example, when you feel tired, unhappy or frustrated. It’s usually temporary and doesn’t last longer than a few hours, or a few days. There’s usually minimal disruption to your life, or your ability to function, and on the whole you can carry on with your life normally.

On the other hand, clinical depression occurs when your ‘low’ mood happens fairly continuously for more than two weeks. There are symptoms as well such as poor sleep, low energy levels, tearfulness, poor concentration, loss of appetite, loss of interest in activities and loss of pleasure in doing things that you used to enjoy.

There may be a trigger, such as bereavement or loss, but often there is no clear situational reason for the depression to have developed. There’s often a negative effect on the person’s ability to function, and can cause them to be less capable in coping with their responsibilities. For example, their work or school performance may suffer, or their relationships might be affected.

It’s important to note that clinical depression is a medical condition, and requires treatment because if left untreated, it may gradually worsen. When severe, clinical depression can be accompanied by thoughts of suicide or self-harm. Usually treatment consists of a combination of medication and psychological therapy. Clinical depression is often successfully treated and the person is able to function normally as before. 

What are some things that can aggravate mental health troubles?

There are three broad areas that can adversely affect your mental health. The first is personal factors, such as adverse previous experiences, like abuse, loss or bereavement. A genetic predisposition to mental illness can also cause mental health problems, or issues such as personal resilience or vulnerability.

Situational factors can also lead to mental health conditions. Having financial difficulty, relationship problems, being unhappy with one’s work or school environment, having poor social support and even bullying can cause a person to develop issues with their mental health.

And the final factor is societal problems. The stigma and poor understanding of mental illness, as well as lack of mental health education are things that should be addressed in order to combat the issue, especially when there might be a distinct lack of awareness of mental health services or lack of access to mental health support or treatment.

What are the mental health services in Brunei?

Before we delve into the availability of mental health services in the country, it’s worth noting that ‘Talian Harapan’ 145 was established earlier this year as an emotional support system that’s aimed to provide the latest information on mental health services in Brunei. The helpline also provides advice and counselling for personal, social and emotional problems, emergency services and assistance for callers, including giving them a safe space to discuss problems, and in the event it’s needed, advisory services to people with possible suicidal tendencies.

The helpline is manned by mental health professionals on a daily basis, from 8am to 11pm with privacy ensured. However, the helpline will also be monitored from time to time for the possibility of additional hours of service.

Since the ‘Talian Harapan’ 145 was implemented, has there been a marked decrease in the national suicide rate?

Yes, suicide rates have declined significantly in the first half of 2019. 

Could you share what your own experience has been since the helpline was established? Have more people come forward to seek professional help?

Well, more people are open to seek help and talk about their emotions, but there is still some stigma attached to it. Admitting to yourself that you need help is often the crucial first step before making the active decision to seek help. There’s more work to be done to increase public awareness about the importance of looking after their mental health, and the availability of mental health services.

It would also be helpful to ensure the whole community is aware of the availability of our mental health crisis helpline Talian Harapan 145 so that all who need the service are aware of it. 

What are the statistics of the population receiving help for their mental health?

The psychiatry clinic in Kiarong sees approximately 300 new adult cases annually, and we saw more than 100 new child and adolescent (under 18 years old) cases last year. In addition, we also receive around 200 in-patient psychiatry admissions into hospital per year.

As for the helpline, it has received over 800 calls since we started in February, with around 200 calls from callers requiring mental health assistance. We’ve noticed that a lot of callers ring up for information, or to find out more about the service, and perhaps it’s so that they can call back when they’re ready to talk further.

Aside from the helpline, how can we reach mental health professionals?

There are psychology clinics, including walk-in services in RIPAS Hospital and in Ong Sum Ping. If you think you need to see a doctor for a medical assessment, we recommend attending a health clinic first to discuss the issue with a general practice doctor, who can refer you to a specialist in psychiatry if necessary.

We run specialist psychiatry clinics in all 4 hospitals, and in many health clinics. There’s also a selection of private psychiatry and psychology services available. It all depends on what service the person needs, and where they feel most comfortable.

However, in an emergency situation where you are in need of urgent help, we recommend that you should attend the Emergency Department of your nearest hospital as there are on-call psychiatry services available for such emergencies.

We’ve been working to expand the availability and variety of services provided, but below is a list of contact details if you’d like to get in touch with a medical professional regarding any mental health issue you may be concerned with.

The stigma and discrimination against mental health

How are the people receiving help for mental health issues perceived in Brunei? If they are viewed negatively, what can we do as a society to dispel this?

It can be very difficult to change the stigma and cultural beliefs of a society. Often enough, mental health problems are wrongly assumed to be due to a spiritual attack, or some sort of personal ‘weakness’. People are also often blamed for their mental health problem, and made to feel that it’s their own fault they’re unwell.

People who decide to seek mental health assistance usually deal with the double burden of facing their own mental health problem, as well as the guilt, negativity or discouragement from the people that should be their support, like family, friends and society.

At the same time, people with mental disorders can be difficult to manage, and family members may become frustrated or discouraged when they are trying to help. Family members may face the double burden of dealing with the affected person and coping with negative judgement from society who do not understand the complexity of their situation.

In fact, our society’s negative and poorly informed view of mental illness actually leads to prejudice and discrimination. This can make people fear seeking help and delay getting the treatment they need, until the problem becomes worse. It’s clear that attitudes such as these aren’t helping anybody.

People often fear what they don’t fully understand, and perhaps the people in our society fear mental health problems within themselves. If you’re negative and critical of people with mental health issues, you’re probably going to be very afraid when it happens to you.

The most effective tool against stigma is ensuring that people are educated about mental illness, the cause and treatment available, and increasing their exposure to the issues. Having more discussions about mental health and its importance in our community will eventually help to make it more acceptable to seek help.

What can we do to normalise getting help for our mental health?

We can start with ourselves.

We can start with our own behaviour, and making sure that we’re looking after our own mental wellbeing. We can start asking the people around us if they’re okay, and talking about the importance of looking after our own mental well-being.

We can organise activities with friends and colleagues to focus on mental well-being, such as a staff activity day, or simply having a chat over a cup of coffee, and ask if everyone’s okay. We should encourage people to talk and seek help if they need it. We need to talk and listen responsibly and respectfully.

Looking after our own mental health should be a priority, because being mentally unwell affects all aspects of life. Taking care of our mental health should be a normal and routine part of our lives — just like eating or brushing our teeth, we do these things every day to make sure we stay healthy. In the same way, we should monitor our mental well-being and build in activities that protect our mental health into our daily lives.

We need to educate people that mental illness is an illness, just like any other illness. You’re not going to be well 100% of the time. It’s okay to get sick. Everybody gets sick, and usually, we don’t get to choose what sickness we get. If mental health problems aren’t properly dealt with, they can become chronic and lead to more severe mental illness. It’s best to seek help and get treatment early.

Treatment is easily available in Brunei … if you’re willing to accept it.

Will there be more initiatives to increase mental health awareness, in the line of the social media campaign ‘Mind Your Mind’?

Mental health has become an important priority for the Ministry of Health (MoH), and it’s been included in the ministry’s strategic planning and initiatives. Mental health is everyone’s business because there is no health without mental health, and it requires ‘The Whole Nation Approach’ to tackle this issue effectively.

We’re constantly working on mental health promotion and training in the community and amongst health professionals. This year’s World Mental Health Day theme is ‘Suicide Prevention’. This is a timely subject for Brunei as we’ve had to respond to the spike in suicide rates last year, and we’ll be continuing the work we’ve done, as well as planning further mental health awareness activities in the community. 

Moving forward as a society

Putting all that Dr Hilda has said into perspective, mental health is just as important as your physical or spiritual health. One cannot thrive without the other, and we need to understand that it’s not our fault if and when we get mentally ill — the good news is, we have relatively easy access to medical advisory services and treatment in the event that we do need it.

Now that we’ve taken a closer look at the issues surrounding mental health in Brunei, what are your thoughts? How can we be more inclusive and normalise the conversation about mental health? Feel free to let us know in the comments or via any of Neue’s social media platforms – Facebook or Instagram.