Imagine seeking help at your most vulnerable moment, only to be spoken down to, ignored, restrained or dismissed.

For many Malaysians living with mental illness, this is not a hypothetical scenario; it is a lived reality.

Dignity in mental health care is not a favour, a reward for good behaviour, or a kindness bestowed by mental health professionals.

It is a fundamental human right, rooted in the inherent worth of every person, regardless of diagnosis, behaviour or social standing.

Yet, despite growing awareness and policy commitments, dignity remains one of the most neglected elements of mental health care in practice.

International human rights law is clear.

People with mental health conditions are entitled to the same respect, autonomy and protection as any other citizen.

Mental illness does not cancel one’s humanity.

Unfortunately, systems designed to “care” too often forget this fundamental truth.

Where Malaysia stands

Malaysia’s Federal Constitution does not explicitly mention mental health.

Still, its guarantees of liberty, equality and protection from degrading treatment are deeply relevant.

The problem lies not in the absence of principles, but in the gaps between doctrine and practice, particularly in how laws are designed and implemented.

The Mental Health Act 2001 – the backbone of mental health legislation in Malaysia – focuses heavily on admission, detention and treatment.

While it provides some safeguards against arbitrary decisions, it remains largely medical and custodial in orientation.

It was built around managing illness and risk, not empowering individuals or protecting dignity as envisioned by modern human rights standards.

Similarly, the Persons with Disabilities Act 2008 recognises psychosocial disabilities and symbolically affirms dignity.

Yet, it lacks strong enforcement mechanisms.

Without legal “teeth”, people subjected to coercive, degrading or discriminatory practices have little recourse for justice.

The result?

Dignity often becomes optional and applied inconsistently, depending on the setting, resources or attitudes.

When care becomes harm

People with mental illness continue to experience humiliation, neglect, paternalism and exclusion, sometimes within the very systems meant to help them.

Being spoken to as if one were a child, excluded from decisions about one’s own treatment, restrained without explanation, or confined in undignified conditions, are all violations of dignity, even when done under the banner of care.

Mental health services have historically been shaped by control and risk management rather than respect, empowerment and personhood.

This legacy still lingers today.

A truly dignified system asks a simple, but powerful question: How would we want to be treated if this were us?

A rights-based vision

A rights-based approach to mental health places dignity at its core.

It emphasises autonomy, participation, non-discrimination and accountability.

Under this framework, people with lived experience are not passive recipients of care, but rights-holders whose voices must shape policies and services.

Malaysia has ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) – a landmark treaty that affirms the right to liberty, freedom from degrading treatment, and equal recognition before the law.

Crucially, it challenges coercive practices and promotes supported decision-making, helping individuals make choices, rather than replacing their choices altogether.

Alongside legal rights sits the ethics of care, which reminds us that dignity is also lived in everyday interactions.

It is reflected in how clinicians speak, listen, explain and respond.

A dismissive tone, patronising language or condescension – often justified as “being frank” – can quietly strip a person of dignity just as effectively as physical restraint.

International initiatives such as the World Health Organization (WHO) Comprehensive Mental Health Action Plan and the WHO Quality Rights initiative reinforce this message.

They call for mental health services that are humane, recovery-oriented and grounded in respect for human rights.

Barriers that strip dignity

Despite these commitments, dignity-centred mental health care in Malaysia faces serious obstacles.

Stigma remains deeply entrenched, not only in society, but sometimes within healthcare settings themselves.

Mental illness is still wrongly associated with weakness, danger or moral failure.

This fuels shame, delays help-seeking and erodes dignity long before a person even enters a clinic.

Access is another major concern.

While private mental health services exist, they are often unaffordable.

Insurance coverage remains limited, reinforcing the perception that mental health care is optional rather than essential.

This creates a two-tier system where dignity is often reserved for those who can pay.

Perhaps most troubling are reports of coercive and custodial practices in some private psychiatric nursing homes and long-term care facilities.

Over-sedation, prolonged restraint, confinement and lack of meaningful activity reduce human beings to objects of management.

Weak regulatory oversight allows such practices to persist largely unseen and unchallenged.

Yet, there are glimmers of hope.

Digital mental health platforms, telepsychiatry and community-based psychosocial interventions are expanding access and offering more person-centred options.

Growing interest in de-escalation, peer support and trauma-informed care suggests that change, though slow, is possible.

Dignity is everyone’s responsibility

Upholding dignity in mental health care cannot be the sole responsibility of psychiatrists or hospitals.

It requires coordinated action across society.

Policies must name dignity explicitly – not as an abstract ideal, but as a measurable goal.

Healthcare systems must translate dignity into service standards, staff training and real accountability.

Families, schools, employers, religious institutions and the media must challenge stigma and create environments where seeking help does not invite shame.

Long-term investment is essential.

Under-resourced services inevitably compromise dignity through overcrowding, rushed consultations and exhausted staff.

Legal reform is equally critical.

Mental health laws must be aligned with contemporary human rights standards and supported by independent and empowered oversight mechanisms.

Strong leadership matters.

The establishment of a Mental Health Commission in Malaysia, or at least a designated Mental Health Commissioner within Suhakam, could provide strategic direction, monitor human rights compliance and give mental health a visible voice at the highest policy level.

Such leadership would send a clear message that dignity in mental health is not a marginal issue, but indeed, a national priority.

Shifting how we see people

Ultimately, dignity-centred mental health care demands a fundamental shift in mindset.

We must move away from seeing people through the narrow lens of diagnosis, risk or burden, and toward recognising their inherent worth, agency and humanity.

Mental illness does not erase personhood.

Recovery is not just about symptom reduction.

It is about restoring meaning, identity and belonging.

When dignity is upheld, people are more likely to seek help, engage in care and contribute fully to society.

The question is no longer whether we can afford dignity in mental health care.

The real question is whether we can afford to continue without it.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist and the Malaysian Mental Health Association president. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.