Guest Editorial

Transcultural Mental Health Nursing in Malaysia: Perspectives and Strategies

Kam Hock Chang
Department of Nursing, Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Malaysia

PP: 134 - 135

Abstract

The 2007 World Mental Health Day Campaign urged all world leaders to give more attention to transcultural mental health services and treatment (WHO 2007). This is due to the fact that out of the approximately 6.5 billion people living on planet Earth, one in every 35 people is an international migrant. They leaved their country of origin to settle permanently in another country for a variety of reasons that includes reunion with family, pursuing better education or economic opportunities, fleeing persecution, and seeking political or religious freedom (WHO 2007). Migration has become a universal phenomenon today and as a result of this it is hardly possible to find a single race, culture, or religion in a single country.

Article Text

The 2007 World Mental Health Day Campaign urged all world leaders to give more attention to transcultural mental health services and treatment (WHO 2007). This is due to the fact that out of the approximately 6.5 billion people living on planet Earth, one in every 35 people is an international migrant. They leaved their country of origin to settle permanently in another country for a variety of reasons that includes reunion with family, pursuing better education or economic opportunities, fleeing persecution, and seeking political or religious freedom (WHO 2007). Migration has become a universal phenomenon today and as a result of this it is hardly possible to find a single race, culture, or religion in a single country.

Malaysia with a population of about 25 million people today also has 2.1 million migrants whose country of origin is mostly in Southeast Asia like Indonesia, Philippines, Bangladesh, Myanmar, or India. These migrants are contributing 25% to 30% of the country current workforce and they work primarily in construction, palm oil plantations and domestic services (SUARAM 2009). Historically, the population of Malaysia comprises of major ethnic groups like Malays, Chinese, Indian, Iban, and Kadazan-Dusun, and dozens of other smaller ethnic groups. The race, cultures and languages of the migrants have made the population of Malaysia even more ethnically, culturally and linguistically diverse.  The ancestors of the Chinese and Indian are also migrants themselves and they have come to work in the tin mines and rubber plantations before Malaysia achieved its independence in 1957. Malaysia is therefore a highly multiethnic, multicultural, and multilinguistic country and this has important implications for mental health nurses and other mental health care professionals who provide transcultural mental health services to the migrants living there.

Migrants are constantly faced with the challenges of acculturating themselves to the mainstream cultures, values, and language of the country that they have migrated while preserving their own ones. They also frequently encountered a variety of problems when accessing the health care system for the diagnosis and treatment of their illness because of linguistic and cultural barriers and the marginalizing health and social policies implemented in the country. In addition, the migrants are often being stereotyped, prejudiced, and discriminated by health care professionals who are also being equally challenged not only to understand their cultures and illness perceptions and experiences but also to understand their spoken languages or dialects. This has been an impetus for the United Nations to proclaim the Universal Declaration of Human Rights which advocates for "equal treatment and opportunity for all, regardless of cultures, ethnicity or social-economic status, and including refugees, mentally ill persons and women" (Brody 2007, p. 1).

In Malaysia, the number of mental health nurses and other mental health professionals who work with migrants whose ethnicity, cultures and religion are different from their own has increased exponentially. The migrants also speak in languages that may be different from the mainstream languages such as Bahasa Melayu, Mandarin, and Tamil and a large variety of Chinese dialects such as Cantonese, Hokkien, Hakka, Teochew, Hainan and Foochow and a couple of indigenous languages like Iban and Kadazan. The National Alliance for Mental Illness maintained that

Culture Counts - One's racial or ethnic background bears upon whether people even seek help in the first place, what types of help they seek, what coping styles and social supports they have, and how much stigma they attach to mental illness.

(National Alliance for Mental Illness)

Ethnicity, culture and religion, therefore, have an immense influence on migrants' perceptions, interpretations and responses to health and illness, particularly so for mental health and mental ill health. Hence, it is of utmost important that mental health nurses and other mental health professionals in Malaysia to continuously strive to increase and update their knowledge and awareness of the mental health issues associated with migration and the impact of acculturation and ethnic identity on migrants. They should also strive to cross the boundaries of Western medical framework that typically underpin their day-to-day professional practices when working with culturally and linguistically diverse migrants and their families. This can help to enhance their understandings of the construction self and that of the migrants and their families, and the expression of emotions across cultures and how it impacts on the nurse-client therapeutic relationships. Mental health nurses and other mental health care professionals in Malaysia should work towards being bilingual or multilingual themselves as this can help to overcome the language barriers between them and the migrants and their families when carrying mental health assessment and treatment. However, if they are unable to communicate in the preferred language of the migrants or their families, the services of properly trained interpreters or translators should be made easily accessible to them. In order to achieve this, more interpreters or translators need to be properly trained to increase the scarce number of qualified interpreters or translators available in Malaysia currently.

Mental health nurses and other mental health professionals in Malaysia need to work towards being a good cultural broker to enhance the bridging, linking or mediating between them and the migrants and their families so as to reduce any conflicts and bring about a positive change in the mental health of the migrants and their families.  Mental health nurses and other mental health professionals also should aim to have a thorough understanding of the cultures and lifestyles of the migrants and their families that they are working with and be sensitive and adopt appropriate aspects of it into the assessment and treatment of the migrants and their families. The number of transcultural mental health units in Malaysia is scarce and as such it is important that more units are set up urgently in the near future to plan and organize transcultural mental health nursing for the migrants and their families living there. Transcultural mental health nursing and cultural brokering are the pinnacles of providing effective and culturally congruent and sensitive mental health services for the ethnically, culturally and linguistically diverse migrants and the general population of Malaysia.

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