“Sometimes I Think It Was Better That I Died in My Country Than Coming Here:” Assessing Mental Health and Service Needs Among Refugees in Malaysia

Background and Purpose: Over 150,000 refugees or asylum seekers currently reside in Malaysia and have been registered with UNHCR. Most originated from Myanmar, although over 10,000 come from other countries, particularly in the Middle East and Africa. Refugees in Malaysia are not permitted to work, attend school, or receive mainstream services. Those not from Myanmar experience particular challenges as fewer refugee-specific community services are available and physical as well as religious differences coincide with increased police harassment. This study evaluated mental health and service needs of refugees in Malaysia from countries other than Myanmar.

Methods: Using a mixed method design to assess socio-demographic characteristics, mental health, and service needs, we approached potential participants during medical clinic hours at the Malaysian Social Research Institute (MSRI), a non-governmental organization that serves refugees and asylum seekers in Malaysia from countries other than Myanmar. Of 85 people approached, 68 completed the interview. After completing informed consent, we assessed mental distress using the Refugee Health Screening-15 (RHS-15) in either Dari Persian or Arabic, and asked open ended questions regarding needed services, interest in participating in a support group, and barriers to service access. Interviews took an average of 30 minutes.

Results: Nearly all participants (n=67) surveyed were female. The average age was 32.5. Most participants were from Afghanistan (n=47), with a number from Syria (n=6), Palestine (n=5), Yemen (n=4), Sudan (n=3), and Iraq (n=3). Time spent in Malaysia ranged from a few days to 5 years. Most participants (n=58) were married, and most (n=58) had children. On the RHS-15 scale, 98.5% measured positive for distress, with the average score of 30.3 surpassing twice the cut off score (12). Major needs described included improved or faster UNHCR processing, employment, and a stop to police harassment. All but one participant reported an interest in participating in support group activities, highlighting considerations of language and gender as relevant components of service provision. Topics of interest to address in potential mental health services included stress and life challenges, while major barriers to participation included illness, children’s needs, and police harassment during transportation to services.

Conclusions and Implications: Findings regarding high levels of mental distress point to the difficulties facing refugees in Malaysia, suggesting additional supportive services are needed. Indeed, participant’s interest in services suggests many are open to participating in group or other supports, despite the associated challenges. Responses highlight the difficulties facing refugees who reside illegally in Malaysia, and motivate efforts to enhance protections for vulnerable populations while expanding permanent resettlement opportunities.