I recently published a policy paper on the challenges LGBT people face in accessing quality mental health services in Malaysia.
One case study stood out and pains me: it was about how a mother was blamed for being a bad parent because her son was gay. The man told me that while his mother accepted him the way he is, the feeling of guilt for her, as a result of her psychiatrist’s words, never went away.
These stories of pain are more a norm than an exception when it comes to LGBT people’s interaction with Malaysia’s mental health services.
The reality is that our local mental health services are unsafe and poorly equipped to deal with the needs of LGBT people.
This is especially true for public mental health services. In 2016, JAKIM launched a 5-year action plan titled Pelan Tindakan Menangani Gejala Sosial Perlakuan LGBT 2017-2021 (Action Plan to address the Social Ills of LGBT Behavior 2017-2021) to supposedly ‘curb’ LGBT behaviour. This plan was drafted and implemented with 22 strategic partners, including the Ministry of Health.
The Ministry of Health produced a booklet titled Garispanduan Pengendalian Masalah Kesihatan Gender di Klinik Kesihatan (Guidelines on Dealing with “Gender Health Problems” in Public Clinics”). The content within these guidelines were alarming as it operates on the premise of “correcting” LGBT people as opposed to acceptance and affirmation.
This notion of pathologising LGBT people as stated in those guidelines and action plan are outdated when compared to international standards.
Gender identity disorder (GID) was actually removed from the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Statistical Classification of Diseases and Related Health Problems (ICD-11) due to improved understanding on variations in gender and sexualities. These are two main references used in mental health.
Bodies that govern these manuals have also issued statements declaring that non-normative sexualities, gender and expressions are not illnesses that do not need to be change or corrected.
Robust studies have also concluded that the wellbeing, quality of life and health of LGBT persons are at their best upon receiving affirmative therapy, as well as being in an environment that affirms and validates their gender and sexualities.
Despite international progress on LGBT mental healthcare, Malaysia’s healthcare system stubbornly persists with correctional approaches towards LGBT people.
Pathologising LGBT people has an impact on their mental health, often bringing out adverse feelings of self-hatred, low self-esteem, guilt and hopelessness. These feelings could result in the desire to “change” one’s own sexuality and gender, leaving them susceptible to the harms of conversion therapy.
Furthermore, majority of mental health and allied health professionals in public and private sectors do not have basic understanding of sexual orientation, gender identity, expression and sexual characteristics (SOGIESC).
With the lack of SOGIESC knowledge, health professionals lack the ability and skills to comprehend and address the unique mental needs of SOGIESC minorities, including addressing internalised transphobia and homophobia.
Ignorance also results in many LGBT clients subjected to invasive and unprofessional questioning about their private parts, sexual practices or SOGIESC. Clients are often left with the burden of answering, deflecting or educating these health professionals, which deteriorates their confidence in health services.
An affirmative mental health services extends to an LGBT person’s interaction throughout the entire clinical setting. Receptionists and staff members with poor knowledge about SOGIESC or discriminatory attitudes could result in an LGBT person feeling unwelcomed.
Having clinical records and forms that are inclusive of LGBT people’s needs (e.g. having a preferred name section) are also important validations of their needs and humanity.
With non-affirming mental health services, discriminatory operational guidelines and health professionals with poor knowledge of SOGIESC, it is not an exaggeration to say that public mental health services are unsafe for LGBT people.
Moving forward, mental health and allied health professionals must also be trained to address the needs of LGBT people. Incorporating SOGIESC and human rights knowledge across all health training curriculums could be a first step.
All agencies, including the Ministry of Health, must review their mental health guidelines and policies to ensure they depathologise LGBT people and adhere to international standards.
Programmes such as conversion therapies, must be banned and even criminalised.
On a broader scale, efforts to decriminalise LGBT people and establish constitutional, legislative and judicial protections must also be made to create a safe and accepting environment for LGBT people. All of the above must be done in collaboration and consultation with local LGBT activists and community representatives.
Health is a universal human right, and it is the right of the LGBT community to access the best possible mental healthcare they can.
But until our collective society and politicians could set a good example in ensuring inclusivity and acceptance of diversity, the stories of pain and suffering among the LGBT community and those whom they love will never cease.
Mahatma Ghandi once said that a nation’s greatness is measured by how it treats its weakest members.
Looking at how we treat our most marginalised of communities, I feel great sadness in saying that our country has a long way to go.