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Sometimes, a life-changing conversation begins with one question: “Are you okay?” This week on It’s About YOUth, we speak to child and adolescent psychiatrist Associate Professor Dr Fairuz Nazri Abd. Rahman from Universiti Kebangsaan Malaysia about recognising suicidal distress, responding safely, and whether Malaysia is doing enough to ensure no young person struggles alone.
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00:06Hello, good evening. I'm Amrul Ayman and you're watching It's About Youth.
00:10Now, suicide is one of the hardest topic for any society to talk about.
00:15But silence does not keep people safe.
00:19Now, as the world marks World Suicide Prevention Day this week,
00:23the 2024-2026 theme is Changing the Narrative on Suicide
00:28that asks us to replace silence and stigma into openness, compassion and action.
00:36Now, to discuss this, we are joined by Associate Professor Dr. Fairus Nazri Abdul Rahman,
00:43a child and adolescent psychiatrist from University Kebangsaan Malaysia.
00:48Doctor, welcome to the show. Thank you for joining us.
00:50Thanks for inviting me.
00:51Okay, Doctor. Let's begin with the theme itself.
00:54Prevention Day theme is Changing the Narrative on Suicide.
00:57Now, beyond encouraging people to speak up,
01:00what needs to change in the way society and our systems respond?
01:05Yeah, I think it used to be a taboo subject.
01:08People didn't really want to talk about it at all.
01:11But I think times have changed for the better.
01:14So people are being more willing to open up more about it,
01:19about having ideas of suicide or having an experience of suicide among close acquaintances
01:27and in services as well.
01:31Professionals are more willing to ask about it and trying to help and do something about it.
01:39So I think that's a good change, actually.
01:42And changing the narrative also means recognizing that prevention cannot sit with one profession.
01:49Suicide prevention is not solely the psychiatrist's responsibility.
01:53Are families, schools, workplaces, healthcare services, and perhaps the government
01:58working together effectively in Malaysia?
02:01Or this effort still fragmented, Doctor?
02:05Yeah, I mean, there are so many levels of work to do.
02:12Because there's so much work in terms of communicating with each other, actually.
02:18I think everyone is willing to help out in their own way.
02:23But if we don't talk to each other, if we don't work together,
02:28then people are going to slip through the cracks.
02:31So there needs to be more of that, actually.
02:36Malaysia is not starting from zero.
02:38We already have policies, programs, and services.
02:42Malaysia has healed 1555 and Mentari, Minda Sehat, MySafe,
02:48and decriminalization and several new laws regarding this.
02:52With so many initiatives in place,
02:54why are people still falling through the cracks?
02:57Like you said, people falling through the cracks.
02:59So where is the weakest link that we are seeing here, Doctor?
03:02Okay.
03:02I mean, traditionally,
03:04I think you have heard of us before working in silos.
03:08So we have our own territory.
03:10And we work really well within our own ministry or something like that.
03:14So our Ministry of Health has their National Council of Excellence on Mental Health.
03:20They have the Thalian Heal.
03:23So JKM has Kaseh.
03:25And MOE also has Minda Sehat.
03:29So everyone's working really well.
03:31It's just that when the jurisdiction crosses,
03:36so let's say there's someone in school that needs help.
03:40So who do the teachers get in touch with?
03:43They don't know which doctor to get in touch with.
03:46They may know there's a nearest hospital.
03:49They can just send the child,
03:51but they don't know how to give a heads up to the hospital.
03:55Or if someone calls the Thalian and says they're suicidal.
04:00So how does the Thalian get first responders to help out with this person?
04:06So that's still all in the works
04:09and it's not going as smoothly as you want to on the ground.
04:14And also to know whether those efforts are working,
04:16however, we need a clear picture of the problem.
04:19DOSEP reported 1,068 deaths by suicide in 2023,
04:24while another PDRM series cited about 1,087.
04:30What could explain this difference in these published figures?
04:35And why is consistent and timely data important for prevention in suicide?
04:40Okay, so there are two different agencies.
04:43Police take their data from the immediate events.
04:47What they see, they will report.
04:48But the Department of Statistics will wait for maybe the coroner's post-mortem autopsies
04:57or the medical death certificates.
04:59So that may take a while.
05:01There may be an investigation into the case.
05:04So eventually everyone has different criteria about deciding
05:07whether it was due to suicide or it was due to sudden death or anything else.
05:11So that's why the numbers differ.
05:14We need consistent data because we need to know if there's an acute crisis going on.
05:20If suddenly the numbers are jumping and what are we going to do about it?
05:23We also need to know the numbers because if we do an intervention,
05:27we need to know whether it's really our intervention that's helping the numbers to go down.
05:32And we also need the numbers for, you know, managing resources,
05:38where to put where, how much, things like that.
05:41A baseline data, lots of use for the data actually.
05:46Now that's the big picture.
05:47Now let's move on this conversation to understanding and how to respond to suicidal distress.
05:52And let's also move from national system to what distress can look like in an individual.
05:57How are depression, anxiety and also suicidal distress, how is it different?
06:03And can someone experience suicidal thoughts without appearing depressed
06:07or having, someone say, diagnosed mental health condition?
06:12Okay, so we have to understand the definitions of these terms.
06:17Depression and anxiety are psychiatric disorders.
06:21So we can diagnose them based on certain criteria.
06:24Depression is a mood disorder, anxiety is, well, it can be panic, it can be anything.
06:31But suicidal ideation is actually an acute crisis condition.
06:36So it can happen in anyone.
06:38It can happen in someone with a psychiatric disorder
06:41or it can happen in someone with an undiagnosed psychiatric disorder
06:45that person has not had the time to get diagnosed yet.
06:48Or it can happen in someone without a mental health disorder.
06:55Because things can happen very quickly these days.
06:57You can suddenly get fired or get robbed or get raped, things like that.
07:03Some devastating event can certainly happen and you suddenly find yourself in an acute crisis condition.
07:10So we have to differentiate these things.
07:14And also recognising a possible warning sign is one thing.
07:18But many people still worry about saying the words itself.
07:22Does asking someone directly, are you thinking about suicide really plant the idea in their mind?
07:29Or perhaps how should we ask this question safely?
07:32Okay, so asking about suicide doesn't mean you're planting the idea.
07:37It's probably already there.
07:39So the tragedy is about not asking.
07:44So it's more important to ask and have them answer no instead of not asking when actually they do have
07:52the ideas.
07:53So there are ways about asking about suicidal ideation.
07:57I suppose it's quite awkward to just say like,
07:59Oh, are you suicidal today or something like that.
08:01Again, so we usually go in terms of a general kind of question.
08:06Like, how are you doing today?
08:07How's life going on for you?
08:09And then that person says, life's not so good.
08:12Okay, so what do you think?
08:16If life's not so good, are you thinking about death?
08:21Yeah, maybe.
08:22So do you think if like God took your life, that's passive death thoughts.
08:27If God took your life, would that be okay with you?
08:29Yeah, actually, that would be okay.
08:30It's fine with me.
08:31And then do you actually even think about ending your life?
08:36And then you go for active thoughts of death.
08:39And is there a plan?
08:41What kind of ideas do you have?
08:43Okay.
08:43And then we can offer some help.
08:45And suppose we ask that question and the person says,
08:48Yes, what should a friend or a family member do next?
08:52What should we say?
08:53What should we avoid saying?
08:55And when we must be seek urgent help for this person?
08:59Okay, it's quite a tricky situation for someone who's untrained.
09:02But we can give some tips.
09:05A lot of us like to sweep under the carpet.
09:08Like, don't think about it.
09:10Stop thinking about it.
09:11That's not good for you.
09:13Or think of God and you'll be fine.
09:19That's like bypassing the actual situation.
09:24So we actually need to validate,
09:27Oh, you sound like you're in trouble.
09:29You sound really bad.
09:31Is that how you feel?
09:33I validate that emotion first.
09:37And we don't have to judge.
09:38Like, oh, that's why you shouldn't have done that.
09:41Or things like that.
09:42And don't use positivity.
09:44Like, cheer up.
09:46You'll be fine.
09:47Don't use that.
09:48So attend to that person in a genuine manner.
09:53And offer some help.
09:54Is there something I can do for you?
09:56Do you want us to go somewhere together and get help?
10:01You know, be there for that person.
10:04And this saying of prevention should begin before a crisis.
10:09And one of the earliest protective relationships is at home, Doctor.
10:15Parental connectedness among school-going adolescents
10:18fell from 32% in 2017 to 24.2% in 2022.
10:25Now, why are we seeing this?
10:27Why might fewer young people feel emotionally understood?
10:30Why does this matter?
10:32And what can parents actually do about it?
10:34There's a lot of factors going on.
10:36I mean, parents are having a hard time as well with the economy and with their jobs,
10:40economic pressures, the weather, things like that.
10:44Okay.
10:44And then the kids are also having a hard time.
10:46There was COVID and the weather.
10:49And then there's academic pressure.
10:50Parents only.
10:51I mean, Asian parents tend to just ask,
10:54how was school today?
10:55What grades did you get?
10:56When actually we need to focus on connection rather than control?
11:02I suppose we worry they will fall into the among the bad hats.
11:08But actually, we forgot to have a connection with our kids.
11:12So we can actually ask, how was your day?
11:16What was the best thing that happened to you?
11:17What was the worst thing that happened to you?
11:20And be there when they want to tell us.
11:23Because a lot of us tend to, even parents, tend to go back to our devices.
11:28So the kids are in their room with their devices and parents are with their devices.
11:32So they end up not talking to each other.
11:34So that's a shame actually.
11:36And actually, it's more important to be connected to each other.
11:39Doctor, but when the tragedy happens, concerns about the family can quickly turn into blame.
11:45When a young person dies by suicide, parents are often blamed.
11:49Is that fair?
11:51And how can we discuss the family's role without turning parents into scapegoats?
11:57Yeah, people can be really cruel, especially online.
12:02We have an intervention called postvention.
12:05So if there's a suicide in the family, the doctors will have a meeting with the family.
12:13Even the doctors will feel guilty.
12:15Even the staff will feel guilty.
12:16So we hear each other out about how everyone's feeling.
12:23And we can do a fact finding.
12:26It's not a fault finding.
12:27We don't blame anyone.
12:29We talk about fact finding.
12:31Maybe someone didn't know about something.
12:33And it's never about malice.
12:36I mean, I don't think any family would do it purposely to their child.
12:42So we assume that the family didn't know or didn't have the skills to manage that.
12:48That maybe they were on their own or didn't know how to get help.
12:51So we need to be kinder to families who have gone through this.
12:55Yeah, because there's a higher risk of suicide.
12:57And after one suicide, actually, that can be copycats.
13:01You know, it can be contagious.
13:04And for many Malaysian families, emotional support is also closely tied to faith.
13:11In Islam, faith can be an important source of strength.
13:15But a struggling person may simply be told, like you said, to pray more.
13:20How can faith support recovery without replacing professional treatment?
13:26So, I get this a lot.
13:31Maybe in the general community, we tend to just use spiritual bypassing.
13:37Think of God.
13:38Say your prayers more.
13:41Because sometimes parents don't know what to do.
13:43And then they go straight with a shortcut to the solution.
13:46They think that's going to help their child.
13:48When actually, we need to acknowledge that emotion.
13:52Emotion is an invisible force that can be very powerful and can be very good for us or can be
13:59very bad for us.
14:00But because it's invisible, we hardly ever talk about it.
14:04So, if possible, parents need to create that dimension in their children's lives that it's okay to talk about.
14:13I'm happy, I'm sad, I'm angry, I'm upset, I'm not great, things like that.
14:19I'm going through a difficult time and validate that.
14:23So that everyone's on the same page and understand that someone is not going through a good patch.
14:34Faith is an anchor.
14:37It's embedded in the culture.
14:39So, once we understand the emotion and we validate and we acknowledge,
14:44then we can ask the child, what do you want to do about it?
14:48We can use the I position.
14:50We can say, mommy usually, if mommy is like that, mommy usually prays.
14:55Mommy talks to God.
14:56So, is that something that you think might be useful for you?
15:00Sometimes they're angry with God for going through that.
15:03So, it's okay to be angry.
15:05But we can work through it together.
15:09So, for mental health disorders, we go to the professionals to get treatment.
15:16But when we go home, we go back to our cultures and our faiths as an anchor in terms of
15:24who we are and our identity.
15:25And, Dr, beyond home, schools and universities, where young people spend much of their lives,
15:33schools and universities are often where bullying, academic pressure and emotional distress first become visible.
15:42Now, are these institutions that I mentioned just now, are they doing enough?
15:45And perhaps where are the biggest gaps that exist right now?
15:50So, where are the biggest gaps?
15:52Gaps, yeah.
15:53Gaps.
15:53Oh, I see.
15:54Okay.
15:55So, as I said earlier, it's a lot more about communication and coming together for that person.
16:00Okay.
16:01So, maybe in schools, they are doing this screening with psychometrics and they find out there are these kids who
16:10are in trouble.
16:12But if you screen, you need to have a system that's backing you up, so you need to be able
16:17to know where you're going to send the kids to in university as well.
16:21So, they have student counsellors and maybe health services, but they don't always get referred at the right time or
16:32fast enough or early enough.
16:33And then, they might have to go to emergency services or to our clinic, our psychiatric clinics.
16:42But the public services are actually overstretched, really, really overstretched and we don't have enough people working around the clock.
16:51So, those are the things that sometimes we don't get there that make us not be able to get there
16:58in time, things like that.
17:00Yeah, but we do want to help as much as possible.
17:03It's just that we get so many referrals every week.
17:08Yeah, we don't know where to put them in our calendar, actually.
17:11Okay, and then also, Dr. Bullying also raised a deeper issue, whether students trust the system enough to report it.
17:22Now, we have the Anti-Bullying Act, it's now enforced, but legislation alone cannot create that kind of trust between
17:29students and schools.
17:30So, what must schools do so students feel safe in reporting this kind of incidents or bullying, perhaps, without fearing
17:38retaliation or being dismissed?
17:40Yeah, I'm still grasping the Anti-Bullying Act because we've had the Child Act 2001 all this while.
17:46So, I'm not sure how different it's going to be.
17:50A lot of it, besides the legal issues, a lot of it depends on the school culture.
17:55How open are they to accepting that, you know, you can't do something unless you acknowledge that it's there.
18:03So, if they don't acknowledge there's bullying happening.
18:06Or teachers are willing to do something about it, because teachers are also very, very stretched and hard-pressed for
18:15time, they focus a lot on academic success.
18:20But they have to search for time for dealing with this issue.
18:25Sometimes they don't even have time to call the parents to come to the school to discuss with each other,
18:29to decide the punishment or to understand what's really going on.
18:35Sometimes there are kids who are doing well in anything, in sports or anything, and they don't really want to
18:44penalise that kid for bullying or the kid has really good connections.
18:48So, they don't really want to penalise that kid.
18:52So, the victim gets ignored.
18:54So, it really comes back to the school culture, school atmosphere.
18:59How willing are they to do something about it?
19:03Because some schools just say, like, there's nothing wrong with my school.
19:08We have had teachers who are, I mean, principals or headmasters, headmistresses who are saying, there's nothing wrong in my
19:16school.
19:17Everything is under control.
19:20But we know there are problems in the school.
19:24Okay.
19:25And another major part of young people's life now unfolds online.
19:31Social media is often blamed for youth mental health problems, leading to calls for bans and age restrictions.
19:38And we have seen that in other countries as well.
19:40They are doing it now, including Malaysia.
19:42So, are restrictions enough?
19:45Or should, or what else must platforms, you know, parents or young adults do?
19:51Oh, it begins very much earlier in the childhood.
19:58Okay.
19:59So, I used to give my kids their gadgets at age 12.
20:02But these days, parents, I go to restaurants and see the whole family around the table.
20:09They all have their own devices, even the baby.
20:12So, that's not a really good idea, actually.
20:16What are the conditions that you tell the child before you give them the gadget?
20:20What did they deserve to get?
20:23What did they do to deserve the gadget?
20:25Are there rules you must, you will say that you cannot watch horror, pornography, and violence?
20:33Or you have a certain hours that you can watch and then you have to give it back?
20:38Who's filtering all that?
20:40What can you use it for?
20:44So, a lot of the time, they get free range, especially during the COVID.
20:51So, that's really not good for the children.
20:53They're growing up too fast, seeing things that are just not suitable for them.
20:59So, when they are smaller, there's a lot of external control.
21:02Like, give me back the phone, you only have five minutes left.
21:06You only have one hour a day, or things like that.
21:08Only at the weekends.
21:09But when they're teenagers, you can't do that with them anymore.
21:15But you should have, by then, instilled internal control in them.
21:19You know, these are things not right, right?
21:24What are you doing with your phone?
21:26Are you staying up with the phone at night?
21:30Do you want me to take back your phone to help you so that you don't spend too much time
21:35on it?
21:36So, it's a lot of conversation.
21:39And after education, comes another difficult transition, which is entering into the workforce.
21:45In June 2026, unemployment among labor force participants, age 15 to 24, stood at 10.2%, compared with 3%
21:54overall.
21:55Now, this does not establish a causation, but it reflects a difficult transition into adulthood.
22:01So, this begs another question.
22:04Are employers equipped to recognize or to support young workers experiencing this serious distress?
22:13Okay.
22:14Yeah, my kids are all blaming AI for taking the entry-level jobs.
22:18So, yeah, I think the youth are really quite worried about that, actually.
22:23So, it comes back to the employers, because it comes back to whether mental health is going to be covered
22:32by insurance or not.
22:34Insurance is covering a lot of physical health problems, but they're not willing to cover mental health problems.
22:42And employers really don't know whether they want to cover mental health or not.
22:50It's more on them.
22:51They're going to have to spend a lot more.
22:54And then the young people are not willing to say they have mental health problems, because it's going to go
22:58on their record.
22:59And it's going to be a negative view from the employers.
23:04So, everyone's trying to keep it a secret, but they're not getting the help that they need.
23:10And the media, for us as well, shapes how the public understands suicide and how families experience tragedy.
23:20And now, how can the media report suicide without sensationalizing it or oversimplifying its causes or causing further harm?
23:29Now, what should journalists stop doing and what should we do better?
23:33Oh, okay.
23:35So, in June 2025, Content Forum, which is an organization in affiliation with Ministry of Communication, put together a panel
23:47of experts and people with lived experience of suicide.
23:51They put together as guidelines on ethical suicide reporting.
23:59So, they put a few things in there about don't describe the method, don't sensationalize it, think about the family,
24:08ensure confidentiality.
24:10There's a lot of things there.
24:11But there's still a lot more to add on to it if it's to be revised.
24:17So, we see the big medias are abiding by it.
24:21But there may be some sensationalist outlets who are not abiding by it.
24:28It's not binding everyone because not everyone signed on to it.
24:33So, that's still a work in progress.
24:37We do need the help of the media to come together and understand.
24:41It should be in all languages as well.
24:44Because maybe in the main languages are quite okay about it.
24:48But some other languages might slip out in a negative manner.
24:54Surely, that's something we have to look into it.
24:57And, Doctor, before we end, if a young person watching is experiencing suicidal thoughts or someone is worried about their
25:06friend, what should they do today?
25:09And where can they turn for help?
25:11Yeah.
25:13I mean, have that conversation.
25:16If they're willing, they can try and call Befrienders or Talent Heal or Kaseh.
25:21And if they're not getting the response that they want, don't leave your friend alone.
25:30Try to get them to see someone.
25:32If it's really, really bad, bring them to emergency services because they're open 24 hours.
25:38And we're there on call as well.
25:41Doctor, thank you so much for joining us today.
25:43That was Dr. Fairuz from UKM.
25:45And today's conversation reminds us that suicidal distress is not a moral failure.
25:51And prevention is not one person's job.
25:54It begins with talking distress seriously, asking directly and listening without judgment and connecting people to help.
26:03That has been It's About You for tonight.
26:04I'm Amir Laiman.
26:06Good night.
26:08Good night.
26:09Good night.
26:11Good night.
26:15Good night.
26:16Good night.
26:17Good night.
26:18Good night.
26:18Good night.
26:19Good night.
26:20Good night.
26:20Good night.
26:21You
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