Mental health services for refugees in Malaysia during the COVID-19 pandemic
Authors: Alvin Kuowei Tay, Susheela Balasundaram
Journal: The Lancet Psychiatry (2021)

Since the declaration of the COVID-19 pandemic in March, 2020, Malaysia has navigated through periods of partial and full lockdowns, with border closures being enforced and interstate travel being restricted. These restrictions have severely impeded the provision of humanitarian assistance to the most vulnerable members of society, including refugees and asylum seekers. In Malaysia, as of Dec 1, 2020, over 178 140 refugees and asylum seekers are registered with the UN High Commission for Refugees (UNHCR).1UNHCRReport on UNHCR's Response to COVID-19. UN High Commission for Refugees, Geneva2020https://reporting.unhcr.org/sites/default/files/COVID-19%20progress%20report%20-%2004.10.20%20-%20FINAL.pdfDate: March - September 2020Date accessed: December 10, 2020Google Scholar We have done surveys of refugees in Malaysia and found that the prevalence of mental disorders was extremely high, with up to 43% meeting criteria for at least one of the common mental disorders including depression, generalised anxiety, post-traumatic stress disorder, and complicated grief.2Tay AK Mohsin M Hau KM et al.Variations in prevalence and risk profiles for common mental disorders amongst Rohingya, Chin and Kachin refugees from Myanmar.Psychol Med. 2020; (published online Sept 11.)https://doi.org/10.1017/S0033291720003104Crossref PubMed Scopus (4) Google Scholar The UNHCR public health response measures1UNHCRReport on UNHCR's Response to COVID-19. UN High Commission for Refugees, Geneva2020https://reporting.unhcr.org/sites/default/files/COVID-19%20progress%20report%20-%2004.10.20%20-%20FINAL.pdfDate: March - September 2020Date accessed: December 10, 2020Google Scholar to COVID-19 in Malaysia have largely focused on the following aspects: food security and money assistance, sexual and gender-based violence and child protection, protection services and documentation, clinical and telehealth services, health services for communicable and non-communicable diseases, and mental health and psychosocial support (MHPSS). The MHPSS framework draws on the multilayered system of services recommended by the Inter-agency Standing Committee:3Inter-Agency Standing CommitteeIASC guidelines on mental health and psychosocial support in emergency settings. Inter-Agency Standing Committee, Geneva2007https://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdfDate accessed: December 10, 2020Google Scholar social consideration in basic services and security, strengthening community and family support, focused psychosocial support, and clinical services. A stepped-care model combining broad-based supportive activities with specialist services and functional referral pathways between different layers of services is needed for scaling up MHPSS for refugees in the context of the COVID-19 pandemic. Accordingly, UNHCR has launched a series of nationwide initiatives aimed at scaling up an evidence-based MHPSS, Integrative Adapt Therapy,4Tay AK Mung HK Miah MAA et al.An Integrative Adapt Therapy for common mental health symptoms and adaptive stress amongst Rohingya, Chin, and Kachin refugees living in Malaysia: a randomized controlled trial.PLoS Med. 2020; 17e1003073Crossref PubMed Google Scholar, 5Miah MAA Mahmuda M Elshazly M Khan S Tay A Ventevogel P Contextual adaptation and piloting of group integrative adapt therapy (IAT-G) amongst Rohingya refugees living in Bangladesh.Intervention (Amstelveen). 2019; 17: 149-159Crossref Scopus (18) Google Scholar for all refugees and asylum seekers across Malaysia during the pandemic. These initiatives include the following: mass training and supervision of a large group of practitioners in Integrative Adapt Therapy across a range of implementation platforms including primary health clinics, schools, community centres, non-government organisations, and both physical and digital safe spaces for people who have experiences sexual and gender-based violence; e-health programmes designed to foster resilience and mental health across culturally diverse communities; and a multilingual e-clinic platform designed to facilitate access to MHPSS by triaging at-risk individuals from a refugee background in a timely and efficient manner. During the COVID-19 pandemic, UNHCR has adopted a nationwide capacity building approach to enable its partners to deliver humanitarian mental health assistance to refugees and asylum seekers across Malaysia. This approach has enabled over 80 humanitarian workers from geographically dispersed areas of Malaysia to be trained in and deliver Integrative Adapt Therapy from 30 centres. As of Nov 18, 2020, 85% of service providers have completed the training programme and are engaged in statewide delivery of Integrative Adapt Therapy across different regions under the supervision of Integrative Adapt Therapy master trainers. Our approach ensures robust and rigorous training, quality assurance, and monitoring of performance, clinical, and implementation outcomes. At the same time, the capacity building initiative allows for rapid deployment of an evidence-based intervention to those in need across the entire country during the extraordinary times of the COVID-19 pandemic. We declare no competing interests.