Clinical Psychology is still in its infancy as a profession in Malaysia. However, an increased awareness of therapy (partly due to the pandemic) and the younger generations’ more open approach to getting psychological help means that the profession has plenty of opportunity to grow.
Clinical Psychologists will need to overcome several challenges to help more people in Malaysia. I’ve described some of the opportunities and challenges below. I’ve based my observations on objective data where possible but some of what I’ve written is subjective and based on my experience of working in Malaysia. I’d be interested to hear whether you agree or have different views. Please do add a comment or question in the section at the end of the page!
High level of need
The National Health and Morbidity Survey (NHMS) conducted by the Ministry of Health (MOH) in 2015 revealed that the prevalence of mental health problems among those 16 years and above is 29.2%.
This suggests that 7 million Malaysians are in psychological distress and could benefit from the evidence-based psychological interventions that clinical psychologists can offer.
Lack of Clinical Psychologists
There are currently around 200 Clinical Psychologists in Malaysia who serve a population of 33 million people. This is a very low ratio compared to countries such as the UK where 9,500 clinical psychologists serve a population of 67 million.
It’s even lower when you consider that the UK also has thousands of other practitioner psychologists who work to reduce psychological distress. These other practitioner psychologists include Educational Psychologists, Counselling Psychologists, Health Psychologists, Forensic Psychologists & Assistant Psychologists. Malaysia has only a handful of psychologists in these fields.
The lack of clinical psychologists in Malaysia makes it difficult to train large numbers of new clinical psychologists quickly and effectively. The first training course was the Masters in Clinical Psychology at the National University of Malaysia (Universiti Kembangsaan Malaysia, UKM). The Masters in Clinical Psychology at HELP University has also been established for some time. In the past few years several universities have begun to offer Clinical Psychology training programmes.
One of the difficulties in setting up a training course is that there aren’t enough clinical psychologists available to teach or supervise trainees. Trainee clinical psychologists need to be taught and trained by experienced clinical psychologists for them to develop the necessary clinical skills to help others.
Some trainee clinical psychologists, particularly on the newer courses, have struggled to find training placements which provide enough hours of working directly with clients. This affects their learning and can delay the time in which they are regarded as a qualified clinical psychologist.
If you are considering studying a master’s in clinical psychology, I’d recommend checking with current or recent trainees as to their experience of different courses in this regard.
Recently a new law was enacted, The Allied Health Professions Act (2016), that legally protects the term Clinical Psychologist. Prior to the law anyone could call themselves a Clinical Psychologist (and there are several untrained practitioners that do). The law should prevent people claiming to be a Clinical Psychologist unless they are fully qualified. Unfortunately, it has yet to be enforced as the systems to register people are still being devised.
A professional association for Clinical Psychologists, the Malaysian Society of Clinical Psychology was set up in 2009. It aims to advocate for the profession and provide the public with a means of determining who is properly qualified as a clinical psychologist. A professional association has worked well for Counsellors in Malaysia who have been professionalised for much longer and have more influence over government policy.
Availability of Jobs in Clinical Psychology
A report from 2018 states there are only 15 posts for Clinical Psychologists in the government funded health system. The positions available are relatively lowly paid and we are not aware of any move to significantly increase the number of positions or level of pay.
Universities tend to offer the best paid positions for clinical psychologists in Malaysia. Some charities or NGOs also offer full time roles but understandably these tend not to be as well paid.
Consequently, most clinical psychologists tend to go into private practice. Rather than receiving a salary it is more common for psychologists to split the fee they receive from clients between themselves and the owners of the practice. Their monthly income depends on the number of clients they see in a month. To give themselves the best chance of attracting more clients, clinical psychologists often work at multiple practices.
Once a clinical psychologist is confident that they can attract enough clients they have the option of becoming a practice owner. This would allow them to keep all the fees from clients, but they would need to pay their business overheads which would likely include rent, electricity, cleaning, internet, supervision, administration and marketing costs.
So realistically, if you’re looking for a higher level of pay as a clinical psychologist, you either need to join a private practice which already attracts a lot of clients, or you need to be proactive and entrepreneurial.
Limited Demand for Clinical Psychologists’ Services
The business minded amongst you might be thinking that with approximately 7 million Malaysians in psychological distress and only 200 clinical psychologists there’s easy money to be made. Unfortunately, it’s not quite that simple.
To assist the entrepreneurs amongst you I’m going to list why I think demand for clinical psychologists’ services are lower than would be expected:
Stigma and discrimination
People generally avoid accessing mental health services of any kind because they expect that others would treat them badly if they knew they were having mental health difficulties.
Unfortunately, there is plenty of evidence to suggest that this fear is justified.
Common stigmatising stereotypes such as ‘people with mental illness are dangerous, incompetent, unpredictable and to blame for their disorder’ often leads to discrimination towards people with a history of mental health issues. For example, employers may not hire them, romantic partners may reject them, landlords may not rent to them, insurers may refuse to cover them, and the health care system may offer a lower standard of care.
People with a history of mental health issues may also hold these beliefs and can discriminate against themselves. For example, they may not apply for certain jobs because they expect rejection or they may withdraw and isolate themselves from others.
A significant proportion of Malaysians believe that mental health problems are a result of spirit possession or social punishment. This belief can result in even higher levels of stigma and discrimination.
Given the potential costs of being in contact with mental health services it is not a surprise that many people avoid mental health services.
Underfunded Mental Health Services & Medication
If people do access mental health services, they are more likely to meet with a medical doctor or psychiatrist than a clinical psychologist. This will usually result in them being given a diagnosis and medication. For some people medication can be helpful. However, many find that medication does not help or causes them side effects that adds to their problems. For this reason, many countries recommend that people with common mental health disorders be offered talking therapies before medication.
It’s rare that Malaysian government mental health services will recommend talking therapies such as that provided by Clinical Psychologists. This isn’t the fault of the doctors. They generally only have 10 minutes with each patient, so they generally focus on diagnosing and prescribing medication. The lack of clinical psychologists in government hospitals means they may also be unable to refer to a clinical psychologist.
The reliance on medication rather than talking therapies is likely a result of underfunding in mental health care. The WHO Mental Health Atlas 2017 reported that upper-middle-income countries were found to spend a median of 2.4% of their health budget on mental health whereas Malaysia only allocated 1.3% of the total health budget for mental health.
Competition from Traditional Interventions
Many Malaysians prefer to access spiritual or traditional healers when they are experiencing psychological distress.
Depending on their cultural backgrounds Malaysians may rely on a Ustad, Bomoh Sinseh, Vaidya or other traditional healers.
Clinical psychologists should take an open and accepting approach to people having traditional beliefs and methods. However, it is common for traditional healers to actively discourage people from accessing mental health services or speaking with clinical psychologists.
Competition from Self-Help Gurus & Motivational Speakers
I’ve noticed that self-help gurus and motivational speakers are surprisingly popular in Malaysia and some people may turn towards them rather than clinical psychologists. I suspect that is because they make big promises and offer quick solutions that appeal to people. They also package up their offerings with a level of marketing ability that few psychologists can match.
The problem is that the methods they use rarely have any evidence of long-term benefit. If they did, then mainstream medicine and psychology would have studied their methods and started to use them.
So how do we explain the case studies they offer of people who believe the self-help gurus really helped? Well one explanation would be that if you make big promises to someone it is likely to lead to a placebo effect where people see a positive effect because they expect a positive effect (you can read more about the placebo effect here).
Using the placebo effect to help people wouldn’t be so bad if it was offered free but self-help gurus and motivational speakers generally demand high prices for their services. Another issue is that self-help gurus often imply that if a technique isn’t making you feel better then it’s the fault of the individual for not trying hard enough. This can be damaging to people who are already feeling bad.
The challenge for clinical psychologists is that it’s difficult to compete against the promises made by self-help gurus (e.g total self-confidence or instant motivation) and remain ethical ourselves.
Lack of knowledge about how Clinical Psychologists help
There is a lot of misunderstanding about what a clinical psychologist can do to help people in psychological distress.
It’s common for people to confuse clinical psychologists and psychiatrists (we have an article explaining the difference here).
Even amongst medical doctors there is confusion about what clinical psychologists do. Talking therapies, when done properly, are structured evidence-based interventions that teach people new skills or new ways of approaching life. Unfortunately, people often view the intervention as ‘just talking’ and think it’s something that is unskilled and anybody could do.
If you’re not sure what clinical psychologists do, we have an article here. If you’d like to know more about the most well-known talking therapy, Cognitive Behavioural Therapy, then you can read our article on it here.
Cultural appropriateness of Clinical Psychology
Most of the interventions used by clinical psychologists come from North America, Europe or Australia.
Clinical Psychologists in Malaysia need to find ways to better meet the needs of the diverse population.
Any intervention needs to be available in multiple languages because people in Malaysia can prefer to speak in Malay, English, Mandarin, Cantonese, Hokkien, Tamil, Hindu etc.
The way the intervention is presented may also need to be adapted to the different cultural and religious groups that are present in Malaysia.
High fees to see Clinical Psychologists
Clinical Psychologists commonly charge rates that are too high for most of the population. Although we’ve left this to the end of our list it’s likely to be an important factor that restricts demand for clinical psychologists’ services.
Increasing Demand for Clinical Psychologists’ Services; Share Resolve’s Approach
We’re fortunate enough to have developed a strong demand for our services at Share Resolve. However, our clients tend to have higher levels of income and are generally more open to the idea of psychology interventions. So, we haven’t necessarily had to get round many of the above issues to reach clients. Our mission is to reach more people in Malaysia so from August 2022 we’ll be launching new services.
Stigma and discrimination
One approach to reduce stigma and discrimination is to advocate for mental health and try to change people’s opinions about diagnosis or accessing mental health services.
This is a commendable approach but as a small organisation I doubt we have sufficient influence to make a change to opinions in Malaysia.
Instead, we’ve chosen to avoid using terms and labels that could lead to stigma and discrimination.
This article is one of the few where I’ve used the term ‘mental health’. I feel that the term is so linked with negative meanings in Malaysia that it is better to use other words.
We also avoid using diagnostic terms unless there is a specific need to do so (such as insurance claims). You can read more about diagnosis and why we rarely use it here.
One of the reasons our organisation is named ‘Share Resolve’ is so that our clients can receive calls, invoices and receipts or go into our office without it being immediately apparent that they are in contact with psychological services.
We also make it very clear to our clients that maintaining confidentiality is extremely important to us. So, nobody need know that they have ever been in contact with us. Our offices are in locations which can be discreetly accessed, and we make sure that whatever is said inside the office cannot be heard outside.
Underfunded Mental Health Services & Medication
Some of the clinical psychologists at Share Resolve work at the University of Malaya Medical Centre (University Hospital) on Thursdays. Our intention was to offer psychological interventions to more people via the hospital whilst sharing with the psychiatrists how a psychological approach could be helpful.
The Manage Emotions Live Life Program
In October 2022 we launched our Manage Emotions Live Life Program. Its aim is to offer evidence-based effective psychological intervention at a more affordable rate. The program is intended to get round some of the issues I’ve described.
The advantage of offering a program is that we don’t need to describe it as ‘therapy’ which can put people off. Instead, we can explain that is it is a program to teach skills that help you live a more fulfilling life. Although we won’t make the same promises as the self-help gurus or motivational speakers, we may be able to learn something from their approach to marketing their ideas.
Although I (Dr. Dan Seal) have written the course and I’ve modified the concepts to reflect my experience of working in Malaysia for the past 10 years, I’ll never know as much about Malaysian culture as a Malaysian. So, I will be asking for feedback from people who attend the program and for local Malaysian clinical psychologists to help modify the program so that it is more appropriate. In time I hope we’ll be able to translate it into different languages and modify it for each cultural group in Malaysia.
The program is based on Acceptance & Commitment Therapy (ACT) which is a ‘transdiagnostic’ approach. This means that everyone can benefit from it. You can benefit from it whether you are finding it difficult to manage emotions such as sadness or anxiety or if you’re finding it difficult to stop behaviours such as overeating or overusing social media. It’s also useful if you don’t have any particular problems but you want to learn how to make life even more fulfilling. The more people join the program the more acceptable it will become to the general population.
If you would like to join the program yourself you can find out more about it on our webpage here.
If you have any questions or comments about Clinical Psychology please let me know in the comments box below.