According to World Health Organization mental health is a subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence and self-actualization of one’s intellectual and emotional potential among others. While psychological disorder or mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Psychological disorders are usually associated with significant distress in social, occupational or other important activities [1].

Another study revealed that major depressive disorder, alcohol dependence, social phobia and simple phobia to be the most common disorders found in the United States. Meanwhile, 14% of the population was found to have a history of three or more comorbid disorders [2].

The global prevalence of major depressive disorder was 4.7%. Person under 18 showed lower prevalence of major depressive disorder while female prevalence was higher than males. Study also showed higher prevalence of major depressive disorder in developing countries except for East and Southeast Asia compared to developed countries [3]. According to World Mental health Center depression will be the 2nd most diagnosed disorder among community mental health center till 2020 [4] .

In Malaysia, the concept of mental health is somewhat different. Malaysian concept of mentally healthy includes rational thinking, interpersonal skill, controlling emotions, positive thinking, open-mindedness and the ability to solve problems. Among all Malaysian, the Chinese identified mental health as interpersonal skills while Malays identified Controlling emotions [5]. Prevalence of common psychological disorders in Malaysia was 5.3% with mixed anxiety and depressive disorder been the most frequently diagnosed. Out of them, 23% were found to have secondary comorbid diagnosis [6]. Factors associated with the presence of common psychological disorders in Malaysian population were difficulties in workplace, experiencing life events such as divorce or marital separation, unsolvable financial problems and serious problems with friends or neighbors [7] stated that the prevalence of depression in Malaysia was 10.3%. The presence of anxiety, serious problems at work, unhappy relationship with children, high perceived stress, domestic violence, unhappy relationship with spouse, low self-esteem, unhappy relationship with family, serious financial constraint and presence of chronic disease are the factors contributing to depression [8].

There was a less than 40% of those with lifetime disorder had ever receive professional treatment. A total of 36% had utilized any of the health services. About 7% of diagnosed patients in Malaysia stated that they had been diagnosed by health professionals. 28% had contact with health professionals, 8% had utilized inpatient services and 25% had taken medications [9].

Research statement

Our research focuses on the investigation of psychological disorder and provided facilities in the mental health community centers of District Perak. The great interest of the study is to find the prevalence of diagnosed psychological disorders in mental health community centers and provided facilities for therapeutic management of psychological disorders to promote advanced facilities and recommendation.

Significance of research

Understanding the prevalence of mental illness and their treatment was central for this research study. Researches on mental health epidemiology showed that mental disorders are common throughout the world. This study was helpful in identifying the estimation of psychological disorders among the community mental health centers. In 2014, there were an estimated 9.8 million adults aged 18 or older in the United States with SMI. This number represented 4.2% of all U.S. adults [4].

As there is growing number of mental health issues so it is important to find out the ratio of psychological disorders to reveal the importance of related provided facilities and recovery in mental illness among community mental health centers.

Research question

1. What is the prevalence of psychological disorders among the community mental health centers?

2. Which one are the most diagnosed psychological disorders among the community mental health centers?

Methodology

This research study used a survey research design.

Permission from ministry of health

To start the research, research was registered in National Medical Research Register (NMRR) for approval. After approval research was conducted to find the data and information from different mental health and general health centers.

This was surveyed research. Seven community mental health centers in the Batang Padang District, Perak were contacted randomly and data regarding the prevalence of psychological disorders and demographic information was obtained from the community mental health center administration. Following community mental health centers were contacted to obtain data related psychological disorders: Tapah Hospital, Tapah Clinic, Bidor Clinic, Trolak Clinic, Slim River Clinic, Slim River Hospital, Tanjung Malim Clinic. During the data collection researcher were able to get the percentage of reported cases of psychological disorders among seven community health centers, no further information was accessed.

The results revealed the significance of findings. There is a high prevalence of psychological disorders (Table 1). Most community health center reported to have the highest cases of Schizophrenia (n=2974) with the majority are from Slim River Hospital (n=1922). Followed by depression (n=988) that was placed second most reported cases in community health center. The third most diagnosed psychological disorders was anxiety (n=599), other psychological disorders were reported: Bipolar Affective Disorders (n=271), Substance abuse disorder (n=239), Obsessive Compulsive disorder (n=247), Sleep disorder (n=150) suicidal (n=51) and others behavioral and emotional issues (n=28). Table 2 showed the number of psychological disorders in community health centers in Batang Padang District Perak.

Table 1: Distribution of patients across community health centers.

Table 2: Distributions of psychological disorders in community mental health centers in Batang Padang district, Perak.

Results show the distribution of patients across Community Mental Health Centers. Data collected from seven health community centers revealed a total of 5545 patients being treated in the past the past two years with the highest number of patients from Slim River Hospital (n=3652) followed by Tapah Hospital (n=1526). Male patients were slightly higher than female patients with 51.07% of patients were males (n=2832) while 50.49% were females (n=2800). Meanwhile, there was no genders record provided by Tapah Clinic. Bidor Clinic; total client (n=52) male (n=25), female (n=27), Trolok Clinic total client; (n=13) Male (n=8), female (n=5), Slim River Clinic; total clients (n=38), male (n=22) female n=16), Tanjung Malim Clinic; total client (n=51), male (n=23) female (n=28). Results are shown in following table among Perak district (Table 3).

Table 3: Distribution of patients and psychological disorders across community mental health center in Batang Padang district, Perak.

Results revealed that Tapah hospital reported anxiety (n=139), depression (n=387), Obsessive compulsive disorder (n=42) Suicidal (n=0), Bipolar affective disorder (n=39), schizophrenia (n=813), Substance Abuse (n=79), Sleep Disorder (n=27) and total cases (n=1526).

Tapah Clinic reported anxiety (n=30), depression (n=26), Obsessive compulsive disorder (n=0) Suicidal (n=0), Bipolar affective disorder (n=0), schizophrenia (n=134), Substance Abuse (n=3), Sleep Disorders (n=0), others (n=17) and total cases (n=213).

Slim River reported anxiety (n=425), depression (n= 550), Obsessive compulsive disorder (n=205) Suicidal (n=51), Bipolar affective disorder (n=221), schizophrenia (n=1922), Substance Abuse (n=155), Sleep Disorders (n=123) and total cases (n=3652). Among other clinical cases were reported (n=154), but not significant cases of psychological disorder, from clinics.

Total number of Psychological disorders, reported cases were (n=5545) among all seven community mental health centers. The population of Batang Padang district is more than 191,900 (2015) which indicate the prevalence rate of psychological disorder is more than 2.89% in last 2 years.

All community health centers provided medication, outpatient and follow up services. In-patient services were only provided by the hospital in Tapah and Slim River. Only Slim River Clinic offered psychological evaluation services, other five major community mental health centers are not providing and psychological assessment and psychological management for once a week. Two clinics which are Tapah Clinic and Tanjung Malim Clinic have psychotherapy service and other all clinics are not providing any psychotherapy to deal with psychological disorders for once a week. Rehabilitation services were only provided by Slim River Hospital and Tanjung Malim Clinic only for 3 to four hours in a week. Most of the community health centers provided counseling service, except Bidor Clinic and Trolak Clinic (Table 4).

Table 4: Distribution of psychological facilities among community mental health care centers.

 This section is related to the discussion of results. Study results have highlighted our hypothesis. Present study discussed the Prevalence of Psychological Disorders and availability of facilities in community Mental Health centers: A survey Research Study in District, Perak, Malaysia. Results show that there is the significant increased ratio of major psychological disorders among Community mental health care centers and general community health centers in district Perak.

Prevalence of psychological disorders

The results revealed the significance of findings. Data collected from seven health community centers revealed a total of 5545 patients being treated in the past the past two years with the highest number of patients from Slim River Hospital (n=3652) followed by Tapah Hospital (n=1526). Male patients were slightly higher than female patients with 51.07% of patients were males (n=2832) while 50.49% were females (n=2800). Meanwhile, there was no genders record provided by Tapah Clinic. Results suggested that within the last two years the prevalence is increased and the most increased number of patients admitted and registered were in the hospital Slim River. The Study also suggests that the major mental illness is more common among male than female as registered in different hospitals of district Perak. In many south Asian countries its dilemma the mental illness is most associated with aggression and disturbed behavior, and most females are controlled at home and have no opportunity to get proper treatment as registered in hospitals. Many researches focus on the prevalence of psychological disorders among different communities and countries. The prevalence between 2006 and 2011, however, is higher than the prevalence in Singapore (12.5%) in 2007 [10].

According to mental health statistics in Malaysia, every 3 in 10 adults aged 16 years and above have some sorts of mental health problems (29.2%). The prevalence of mental health problems among adults increased from 10.7% in 1996, to 11.2% in 2006, to 29.2% in 2015.The Health Ministry announced that more than 1,000 people have killed themselves over a 3-year period of 2007-2010 [11].

There was a survey research conduct on 1,000 people of various ages in Baltimore over 25 years, interviewing them four times between 1981 and 2005. Using the information from all of the interviews, they found the rates of six mental disorders to be considerably higher and among these disorders more significantly were depression, schizophrenia and anxiety [12].

Malaysia sits at the heart of South East Asia with a population of 23 million people of diverse ethnicity, cultures and religious backgrounds. In 2000, it was reported that about 10.7 percent of the population had been diagnosed with mental illness [13]. These numbers are quite high and only based on hospital figures. Therefore, the actual number of people living with mental illness nationwide remains unknown. However, the findings of some other studies carried out in both urban and rural areas in Malaysia, have also placed the prevalence of mental illness in the population between 9.6 percent and 35 percent, respectively [12].

Determining how many people have a mental illness can be difficult and prevalence estimates vary. While numerous surveys include questions related to mental illness, few provide prevalence estimates of diagnosable mental illness (e.g. major depressive disorder as opposed to feeling depressed or generalized anxiety disorder as opposed to feeling anxious) and fewer still provide national prevalence estimates of diagnosable mental illness [14]. In Malaysia, national surveys were conducted in community households by trained medical professionals every decade; and these surveys found that mental health problems had increased from 10.7% in 1996 to 11.2% in 20064 [15]. In the National Health Morbidity Survey IV (NHMS IV) 2011 report, the prevalence of lifetime depression was 2.4% and current depression was only 1.8% [16].