*Population in 2020，GNI and life expectancy in 2019 are updated based on UN's data.

     *Medical information is based on WHO's report of 2017 Mental Health Atlas-country profile.

I.    Overview

　　Malaysia covers an area of 330,345 square kilometers. The country includes 13 states and three federal territories (Kuala Lumpur, the administrative capital Putrajaya, and Labuan). Two of the states, namely Sabah and Sarawak, takes 60% of its territory, and located at northwest of Borneo with an official name East Malaysia. The legal capital Kuala Lumpur, is the most densely populated and prosperous area in Malaysia. The population is more than 31 million, and the main ethnic groups are Malays (56%) and Chinese (23%). The official languages are Malay and English, and there are more than 130 languages spoken due to the diversity of ethnic groups. According to statistics from the World Bank in 2019, the average national income (GNI) is US$11,230, which belongs to middle- and high-income countries in the world.

II.  Mental health policy and system

　　Health care services are provided by public and private departments, and the Ministry of Health is the competent authority. In addition, there are public health services provided by non-governmental organizations and traditional supplementary medical cares. Currently, the national health insurance system is not implemented yet, and the main source of medical expenses is from the government taxation.

　　In 2017, the National Institutes of Health in Malaysia published a technical report on mental health performance assessment, a special attention should be paid to the prevalence of mental health problems among children and adolescents aged 5-15, adults over 16 years, and elderly over 60 years old, which are 12.1%, 29.2%, and 24.0% respectively. In addition, the suicide attempt rate among adults and adolescents is 0.5%, and 6.8%, respectively, and the drug abuse for the people over 13 years old is 111.9 out of 100,000. It's a serious mental health issue.

　　Compared with the Organization for Economic Cooperation and Development (OECD in short) countries, psychiatric care in Malaysia is lower in all aspects, including psychiatric bed density, psychiatric manpower and budget allocation.

　　The National Mental Health Policy was formed in 1998 and revised in 2012, the goal is to provide development involving the planning and implementation of physical and mental health strategies to promote the mental health and well-being of all people. This policy requires that mental health services need to be cared for in primary care. The National Mental Health Plan includes care for children and adolescents, adults, the elderly, and various target groups with special needs, such as mental health promotion and prevention of mental illness, easy access to primary medical services, early detection of primary medical level, management and rehabilitation of patients with severe mental illnesses by secondary and tertiary medical teams.

III.   Human Resources

　　Based on data from 2018, there are 410 registered psychiatrists in Malaysia and the psychiatrist ratio is of 1.27 per 100,000. Only a half of that number is serving for the MOH while the rest are either in the MOE (Ministry of Education) and MOD (Ministry of Defense), or in the private clinical practices. There has the best ratio of 5.24 per 100,000 population in the Metropolitan city of Kuala Lumpur, and the states of Sabah and Kedah have the worst ratio of 0.54 and 0.55 per 100,000 population, respectively . The difference between the two is nearly 10 to 1.

　　The Malaysian Advisory Committee on Mental Health Promotion called for the lack of the manpower of psychiatrists in 2017, and it was believed that supplementary manpower should be one of the basic conditions to meet the mental health needs of the entire society. The appropriate allocation ratio is 1 psychiatrist per 10,000 people, but now is only about 1/10 of the ideal target at some areas. In other categories, there are more than 100 clinical psychologists, which only 12 are working in institutions of the Ministry of Health, and moreover, there are 188 counselors, 146 functional therapists, and 40 social workers. It has currently two ways to increase the manpower, including receiving a master's degree program provided by four universities in Malaysia, or passing the Royal College of Psychiatrists specialist examination.

　　Mental health education training started in 2000, the purpose is to improve the mental health knowledge and skills of medical staff, the training program includes a master's degree in psychiatry, seven sub-specialty training, community mental health in primary medical care, mental health in children and adolescents, Healthy Mind, social and psychological response to disasters, and CPG (clinical practice guideline, including depression, mental disorders, and attention disorders). For the implementation and training of mental health services in medical units, a variety of guidelines and modules have been provided since 2003, which include the aforementioned themes and suicide issues.

　　There are currently more than 30 NGOs providing community mental health services, including professional organizations, volunteers or family groups. For example, the Malaysian Psychiatric Association (MPA) and the Malaysian Mental Health Association (MMHA), and most NGOs are connected to the psychiatric department of psychiatric hospitals and affiliated with the National Mental Health Committee that coordinates mental health activities. There are also independent organizations, regardless of their attributes, they are mainly engaged in promotion activities to increase awareness of mental health problems. Furthermore, there are some training, forums, consultations and psychosocial rehabilitation services, etc., for family members and caregivers.

　　In Malaysia, there is a local four-year psychiatric training program which is an university program and jointly managed by several public universities and the Ministry of Health. The program generates about 5 to 10 new psychiatrists each year, but as more universities join the program, this number has increased in recent years. In 2017 and 2018, there are 40 new psychiatrists being produced in a row by this program.

IV.    Mental health system and promotion

　　There have four large psychiatric hospitals in Malaysia to provide the mental health services, one is Padang Hospital Bahagia Ulu Kinta in the north, the second one is Hospital Permai Johor Bahru in the south, and two more in East Malaysia, namely Sentosa Hospital in Sarawak (Hospital Sentosa) and Hospital Mesra Bukit Padang in Sabah. According to the law of the state, each hospital caters to a certain population area. With the opening of psychiatric services in general hospitals, the number of admissions in mental hospitals was initially decreased, but it became stable for the past 10 years.

　　In the past, transfers of patients from general hospitals were common, but after the expansion of psychiatric services (especially community psychiatric services) in general hospitals, the number of transfers dropped sharply. Now the operation of the mental hospital is more like a general hospital. Those psychiatric hospitals only accommodate long-term inpatients who are unable to live in the community due to disability, and some of them are regional centers for high- and intermediate-level safe hospitalization and also the regional center for the forensic services. However, only 2 of those 4 hospitals have permanent forensic psychiatrists.

　　The majority of psychiatric beds are in the specialist hospitals, and there are 5,367 dedicated inpatient beds in the country, while 4,240 beds (79.0%) are in the four mental hospitals. Only the rest of 1,127 (21.0%) beds are allocated at the general hospitals. The number of psychiatric beds to population ratio is 2.7 per 10,000, which is relatively low as compared to that of in the other countries .

　　A national prevalence survey is conducted every four years. The data on mental illnesses are collected through the medical system of the Ministry of Health based on ICD10 (International Classification of Disease, 10th edition) and self-injury data in hospitals. Primary medical care collects data on new cases and establishes schizophrenia and suicide registration system.

　　In 2002, 704 (82%) primary health centers (PHC) provided mental health services. These services include mental health promotion, early detection and treatment of common mental disorders. Among them, 23 clinics were selected to carry out pilot projects to provide these services for severely ill patients, including follow-up of stable patients, outreach care for dropout patients, family intervention, and primary psychosocial rehabilitation care settings. Daytime facilities for rehabilitation activities have been built at these locations.

　　So far, the pilot projects have survived in several primary health care centers, where there are psychiatrists from nearby hospitals, and a good working relationship has been established with residents of family medical services.

　　Over the years, primary health care institutions have paid more attention to the mental health screening of school adolescents and participants in primary health care institutions. The plan is packaged with employees at different levels by interventions, including referrals to psychiatrists when needed.

　　At the public primary health care (PHC) level, there were 256 resident family medicine specialists in 2016. Those specialists received a short training in psychiatry during their specialist cultivation period. Some of them have interest in mental health and are actively participating in mental health programs ever since.

　　Before 2000, most of them were small-scale activities run by the psychiatric department of general hospitals, mainly focusing on the awareness of mental health and mental illness. After 2000, national activities were organized through healthy lifestyles and World Mental Health Day, and in 2001, family mental health promotion was carried out through healthy family activities. By the year 2003, effective treatment of stress was included in the promotion of healthy lifestyle with the contents such as health education, interpersonal communication, inter-ministerial cooperation, training at the central and local levels, etc. The increase of public awareness for mental health, especially reducing the stigma of mental illness is the focus of mental health promotion.

V.  Major issues, challenge, and opportunities

　　Mental health issues have risen dramatically in Malaysia over the years. According to the 2015 National Health and Morbidity Survey (NHMS), a staggering 29.2% of adult Malaysians (16-65 years old) are estimated to be affected with mental health problems.

　　This means 3 in every 10 adult Malaysians (about 9.6 million) may have mental health troubles and at least 2 million adults with serious mental illnesses. The young age group (16-18 years old) has been found to be most affected with mental health difficulties. The 2012 NHMS captured 6.8% of attempted suicides among school-age adolescents.

　　The earlier NHMS in 2011 reported that prevalence of widespread anxiety disorders is 1.7%, morbidity rate of lifetime and current major depressive disorders 2.4%, suicidal ideations 1.7%, suicidal plans 0.9%, and suicidal attempts 0.5% among the population of 16-year-old and above.

　　Data on prevalence of other specific diagnoses or nationwide mental health service utilization of people with mental illnesses are fragmented and limited. The World Health Organization (WHO) estimates that neuropsychiatric disorders in Malaysia contribute to 16.8% of the global burden of diseases.

VI.    Potential exchange issues

　　In the future, it can be aimed at suicide prevention, the exchange of children and adolescents mental problems and addiction treatment issues. It can adopt academic interflows, substitute training, seminars and other modes for interactive exchanges, and can assist in the upgrade of multiple mental medical manpower training in the online website. At the same time, it is possible to arrange the mutual visits between bilateral agencies for the support in the promotion of the community mental rehabilitation model.