In Part 1 of our mental well-being study published on 28 April, we found that over 50% of the survey respondents reported experiencing negative emotions. Immediate living conditions during the Movement Control Order (MCO) such as the number of occupants in a household and the type of home people lived in affected the mental well-being of Malaysians.

In Part 2, we explore how changes in employment and income during the MCO affect mental well-being as measured using the DASS-21 questionnaire. While we explore mental well-being, our study does not diagnose depression, anxiety and stress as a medical condition. For more details on how the DASS-21 questionnaire was applied and the study’s overall methodology, please refer to Part 1.

Sample

For the analysis in Part 2, we used a sub-sample of 720 respondents from the 1084 responses that we initially collected. The reduction in observations were due to incomplete and irregular household income related data provided by respondents. The elimination of problematic observations allowed us to provide a more accurate picture of the current financial predicaments faced by our respondents.

The demographic breakdown of the sub-sample was similar to the overall sample (which is available in Part 1): 59% of our respondents were living in urban areas, with 70% coming from Selangor and Kuala Lumpur. 63% of the respondents were female, 82% were Malay/Bumiputera and 42% were between the ages of 24-34. Additionally, the average respondent also reported having three financial dependents.

As in Part 1, our responses do not represent a nationally stratified sample. With surveys, under and over reporting can occur, and outliers have been omitted. The results should be viewed with these limitations in mind.

How have household incomes changed during the MCO?

Income reductions all round

We asked respondents to report their household income before and during the MCO period.  Overall, the average reported household income before and during the MCO was RM8,790 and RM7,773 respectively. (This figure is higher than the national average, but is reflective of the concentration of our respondents in Selangor and KL where average household income is higher).

In Part 1 of the study, we examined living conditions and household types. Grouping income by household type (Figure 1a), we observe that levels of average household income differ by housing type, with more affluent households living in bungalows/semi-detached housing or apartments and condominiums, and those with the lowest income levels living in low cost housing. On average the difference between income before and during the MCO was RM1,008.

Figure 1a: Average Household Income Before and During MCO by Housing Type

We also analysed income by different employment types. The difference in average household income before and during the MCO here is more stark (Figure 1b). Part time employees, the self-employed and business owners saw their income reduced by over half. Part-time employees were the most affected, with their average pay reduced by 50%, closely followed by business-owners who reported a 48% reduction in income. Full-time employees were the most stable among all employment types, reporting a 3% income reduction.

Figure 1b: Average Household Income Before and During MCO by Employment Type

A decrease in income, an increase in negative mental well-being

Figures 2a-2c report how changes in income affected mental well-being. Unsurprisingly, 54% of of those who reported a decrease in income also reported experiencing depression and approximately 40% reported experiencing anxiety and stress. Approximately a quarter reported experiencing severe and extremely severe depression and anxiety, with 18% reporting similar levels of stress. 

Conversely, those who reported an income increase experienced normal levels of overall mental well-being, apart from depression, where 43% of respondents reported experiencing mild to moderate signs of depression.

Figure 2a: Changes in income and its effects on depression levels

Figure 2b: Changes in income and its effects on anxiety levels

Figure 2c: Changes in income and its effects on stress levels

Mental Well-Being and Employment

Students and the unemployed experiencing most negative mental well-being

Figures 3a-3c show that students and the unemployed consistently experience the most negative mental well-being across all three dimensions, with part-time employees in third place.

Part-time employees and the unemployed reported experiencing higher levels of severe negative mental well-being. 27% and 38% of part-time employees and the unemployed respectively reported experiencing extremely severe and severe signs of depression – compared to 20% or less in other groups (except students).  A similar trend emerges in the anxiety dimension, with both part-time employees and the unemployed respectively experiencing 34% and 29% of extremely severe and severe anxiety.

Meanwhile, 62% and 58% of students reported experiencing signs of anxiety and depression respectively, with 40% reporting stress. These high percentages correspond with our findings in Part 1 where those between ages 18-24 were more likely to report experiencing negatively emotions compared to other age groups – 90% of the 18-24 year olds in the sample were students. Qualitative data suggests that this may be driven by employment issues: student responses to an open-ended question asking what their main worries post-MCO were largely identified being fresh graduates at a time of economic uncertainty as a major concern. Indeed, the Malaysian Employers Federation warned fresh graduates of a bleak job market post-MCO due to business taking cost-cutting measures.

Retirees experience the least negative mental well-being across the board, typically only reporting moderate or mild signals of negative mental well-being.

Figure 3a: Differences in reported levels of depression by employment type

Figure 3b: Differences in reported levels of anxiety by employment type

Figure 3c: Differences in reported levels of stress by employment type

Change in employment status, many unable to work during MCO

The MCO meant limitations on economic activity and many Malaysians in the workforce prior to the MCO experienced a change in their work status during the MCO. (Since the study was undertaken, Malaysia has now moved to a conditional MCO with certain economic sectors reopening).

Of those in employ before the MCO, business owners and the self-employed experienced the most change, with approximately 60% reporting they were unable to work during the MCO period. Part-time employees experienced the highest levels of retrenchment (7%). Additionally, they also form the highest level of those going on unpaid leave and reduced pay, both at 20%.

Full-time employees appear to be the most stable out of all job types, with 88% of them experiencing no change. 

Figure 4: How employment status has changed during the MCO

Retrenched severely affected, followed by those on unpaid leave

In Figures 5a-5c, at least 30% of respondents across all employment statuses during the MCO reported experiencing some negative emotions.  Those on unpaid leave reported the highest level of depression (68%) while those who were retrenched reported the highest levels of anxiety and stress (62% respectively). 

Among the retrenched, 38% reported extremely severe depression and anxiety, and 25% reported extremely severe feelings of stress. Of those on unpaid leave, 48% reported experiencing severe and extremely severe anxiety and 32% reported experiencing severe and extremely severe depression. Only 5%, however, reported extremely severe levels of stress.

Unsurprisingly, those reporting no change reported experiencing the lowest levels of negative emotions.

Figure 5a: Differences in reported depression by employment status

Figure 5b: Differences in reported anxiety by employment status

Figure 5c: Differences in reported stress by employment status

Long and short-term concerns

Financial situation after MCO uncertain

At the end of Part 1, we reported that many respondents were worried about health and safety of themselves and their loved ones. 47% of respondents indicated that they were worried about their financial situation during the MCO, but 56% were worried about their financial situation after the MCO.

Figure 6: Major concerns during Movement Control Order (MCO)

We asked our respondents to indicate up to three major financial concerns at two points in time: at the point the survey was conducted during the MCO, and their future financial worries after the MCO was lifted. Consistent with their overall financial worries discussed above, respondents identified more financial concerns in the future after the MCO ended compared to during the MCO. 

From Figure 7, the major financial concerns that respondents identified were not being able to afford a medical emergency, not being able to support dependents and not being able to pay bills, loans and rent / mortgages. Consistent with the MCO being related to a public health crisis, more respondents were concerned about not being able to afford a medical emergency during the MCO compared to in the future. The situation was reversed for the other major concerns: while they were worried about these issues during the MCO, more respondents identified this as a worry after the MCO.

More respondents also reported no financial worries during the MCO compared to after the MCO, suggesting that economic uncertainty post-MCO weigh on the minds of many.

Figure 7: Major financial concerns during and after MCO

Current Mental Health Support Landscape

There is an opportunity to improve Malaysia’s current approach to mental health support. Its current issues, to some extent, can be attributed to a lack of mental health-related employment, and consequently, limited resources to meet mental health support needs. On an institutional level, the Ministry of Health’s latest numbers indicate that there are 0.5 psychiatrists to 100,000 persons, while there are 0.21 clinical psychologists to every 100,000 persons. This is below the World Health Organisation’s recommendation of 1 psychiatrist to every 100,000 persons, and the global median of 1.1 psychologists to every 100,000 persons.

On top of the lack of expertise, there is the existing stigma regarding mental health and illness. Although efforts are headway in increasing awareness of mental health, there still exists a lack of understanding towards mental health issues. This can lead to discrimination faced on both personal and professional fronts, and potential reluctance in seeking help. That said, there was an uptake in engagement with mental health support offered by the Ministry of Health and various NGOs via hotlines and messaging platforms during the MCO. This may indicate increasing awareness among Malaysians in seeking out and receiving mental health support.

Seeking help, though, can be costly. The lack of a comprehensive public-sector infrastructure for mental health may lead to those seeking help via the private sector where average prices for mental health support or therapy can cost up to RM250 per session. There is also a lack of comprehensive insurance for mental health coverage in Malaysia, with very few insurance companies offering coverage, and among those who do, only for very severe mental illness and without pre-existing conditions.

Policy Recommendations

Mercy Malaysia expects psychological-related calls to mental health support hotlines to increase beyond the MCO. Considering the projected increased unemployment and economic uncertainty, it is likely that we will see more Malaysians experiencing negative mental well-being as they struggle with the economical fallout of COVID-19. Although the government’s Prihatin stimulus packages are intended to soften the financial blow, efforts also need to focus on supporting the mental well-being of Malaysians.

What might be feasible ways forward towards improving our mental health infrastructure ? First, there is a need to address the issue of the low number of mental health experts and professionals – employment opportunities and training for mental health-related employment need to be bolstered above current levels. This includes opening up mental health related opportunities as well as making mental health support more accessible – like the Healthy Minds Programme in schools.

Second, our findings have shown that those who reside in low-cost housing are more likely to be susceptible to negative mental well-being, as well as those in precarious financial conditions. While the move to increase employment and training for mental health-related opportunities is institutional – we argue that a more community-based approach may help alleviate and overcome the gap of mental health awareness and support in these vulnerable communities. Trusted members of the community can work together with mental health professionals to increase mental health literacy in their communities and recommend appropriate support systems to promote health-seeking behaviours.

Third, based on our findings, those with precarious employment situations experience more negative emotions, and are likely to suffer most from the economic fallout. Increased mental health support or financial assistance towards accessing this may help them weather the expected economic downturn better. Following the more accessible mental health approach mentioned above, we see an opportunity for holistic support to be extended to, and complement, areas such as debt counselling.

There is also an opportunity here to rethink and expand insurance coverage for mental well-being beyond critical mental illnesses. While we appreciate that mental health difficulties are difficult to quantify (there is also a similar problem in the United States), more incentive needs to be given for insurance providers to adopt a more holistic view of mental health. This can be done in tandem with increasing awareness and incentivising employers to give more mental well-being support to their employees during this difficult time.

Conclusion

The study has revealed that business owners and the self-employed have suffered significant loss of income during the MCO, and part-time employees and the unemployed report experiencing the highest level of severe negative mental well-being. Those who were retrenched and on unpaid leave also experienced the highest level of negative mental well-being. Unsurprisingly, these are the groups most vulnerable in a time of economic uncertainty.

Despite its importance, discussion about mental health has only seen prominence in recent years. COVID-19 and the MCO, while having worsened mental well-being, has shed light on the seriousness of this issue. In March, over 610,000 Malaysians were retrenched as companies suffered financial losses over the MCO. This number is expected to rise in the coming months, as we deal with the global economic fallout.

The current situation has amplified an urgency for an improvement of mental health support in Malaysia. While financial social protection for affected groups are in place and have been announced by the government, we see the amplified mental health effects of MCO going beyond the resolution of this public health crisis. The way forward, beyond awareness, is to make a systematic change with how we talk about, deal with, and implement mental well-being into policy.