This article first appeared in The Edge Malaysia Weekly on September 29, 2025 - October 5, 2025

Without legal mandates, voluntary guidelines on mental health risk leaving systemic gaps that employers cannot fill on goodwill alone, as nearly one million Malaysians — 4.6% of the population — live with depression, and two in three employees say they experience burnout.

Unlike physical health and safety, which is governed by explicit legislative mandates, psychosocial well-being in the workplace is a grey area, mostly guided by employers’ voluntary standards and driven by corporate goodwill rather than enforceable obligations.

But as economic and societal pressures rise, mental health challenges are likely to intensify, and without mandates, policies cannot be sustained, making legislative support urgently necessary, say industry stakeholders.

The conversation around workplace mental health has gained visibility in recent years, but it remains mired in ambiguity.

“In Malaysia, workplace mental health challenges are layered and complex. While awareness is growing, stigma remains deeply entrenched in our culture,” says Joan Low, founder and CEO of ThoughtFull World Pte Ltd, a digital mental health company.

According to a National Health and Morbidity Survey (NHMS) in 2023, the number of people with depression has doubled from 2019 to 2023, with nearly half having thoughts of self-harm or suicide. The economic consequences have been equally concerning, as mental health issues were estimated to cost the country RM14.46 billion in lost productivity in 2018, a figure likely to be higher today.

In response to the alarming trend, last year, the Department of Occupational Safety and Health (DOSH) made a step forward by introducing guidelines on psychosocial risk assessment and management.

However, since the guidelines are advisory rather than mandatory, investment in mental health often depends on strategic priorities and budget constraints.

“The 2023 NHMS revealed that around one million adults are living with depression — a figure that has nearly doubled since 2019. At ThoughtFull, our in-app assessments further show that two in three Malaysian employees report experiencing burnout, underscoring that mental health is no longer just a personal issue, but a pressing operational challenge for organisations,” says Low.

DOSH’s 2024 guideline marks a significant milestone in setting out the responsibility of both the public and private sectors to uphold employees’ rights by fostering work environments that prevent excessive stress and mental health risks. However, many organisations are still in the early stages of understanding and implementing these practices, says Low.

Gaps in existing laws, such as the Occupational Safety and Health Act (OSHA) 1994, exacerbate matters. OSHA imposes a general duty of care on employers, yet it does not explicitly address psychosocial risks. The Mental Health Act 2001, meanwhile, governs care and treatment but does not extend rights into the workplace, and anti-discrimination protections are also limited.

“As Malaysia does not have a comprehensive law safeguarding employees with mental health conditions, access to support is left largely at the employers’ discretion, and such support would usually include the ability to equip the workforce with the right knowledge when addressing other concerns such as stigma and discrimination,” says Low.

Through its partnership with AIA, ThoughtFull has expanded access to end-to-end, digital-first mental health support, achieving a 43% utilisation rate and a 67% reduction in stress levels among users, while providing employers with actionable insights to strengthen workplace well-being.

The absence of mandatory protections also worsens stigma, reiterates Dr Chua Sook Ning, founder of Relate Malaysia. Relate offers affordable online and in-person assessments and psychotherapy as a community service.

Stigma, says Chua, is not confined to casual interactions but is embedded in policies and systems. There are three kinds of stigma: structural, social and self.

“Institutional stigma refers to policies, rules and procedures of both private and public entities that restrict the rights and opportunities of certain groups. McKinsey & Co reported that 65% to 85% of employees perceive mental health stigma in the workplace. In addition, only about 25% of people are willing to work closely with someone in recovery from a mental illness,” says Chua.

“Dismantling structural stigma is more than offering access to resources. Companies also need to make mental health a priority, which includes providing mental health training, ensuring fair and non-discriminatory policies that support individuals with mental illnesses, [having] open conversations about mental illness, and continuously assessing if mental health supports are adequate.”

For insurers, the absence of legislation that directly addresses psychosocial risks results in piecemeal coverage.

Zurich Malaysia is among the few insurers to extend mental health coverage, but chief human resource officer Teo Mye Lene is aware of the restrictions.

“Expanding coverage to include serious conditions such as depression and bipolar disorder is an important milestone for the industry, but more needs to be done. The majority of protection plans today remain focused on acute or hospitalisation needs, whereas the greater demand lies in prevention and early intervention through therapy, counselling and continuous support,” says Teo.

“Internally, we have expanded flexible benefits that include therapy claims, introduced hybrid work arrangements and digital health tools, as well as implemented digital platforms such as AskHR to streamline processes.”

Externally, Zurich has extended mental health coverage in selected plans, adds Teo, “and we continue to work with employers to offer preventive strategies that focus on resilience and well-being”.

Chua stresses that limited coverage undermines the very principle of early intervention, reinforcing a culture where mental health issues are only addressed at boiling point.

“Based on publicly available data, there are only a few insurance companies that do provide mental health coverage, and they do so under strict conditions. Often, there is limited coverage — not just in terms of amount covered, but also [relating] to types of mental illnesses and treatment,” says Chua.

“For instance, one company covers only consultation fees by psychiatrists for six conditions up to RM1,500, provided no health claims were made in the previous year. This no-claim bonus is only given up to a total of 10 times per lifetime. Other companies offer a once per lifetime payout for five mental illnesses, and only if they are at an advanced stage. This means that an individual cannot make an insurance claim to cover early treatment costs.”

Moreover, Chua says there are cases where individuals who do declare having a mental illness are either denied coverage or must pay significantly higher premiums.

This institutional stigma effectively penalises individuals for seeking help, perpetuating silence, she adds.

Mental health needs to be treated as a human rights issue, says Chua, citing the United Nations Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, drafted in 1991, as a benchmark.

“For example, Australia, which adopted this resolution, specifically says that it is unlawful to discriminate against a person because they have a mental health condition. In addition, there is also an independent body that is responsible for dealing with complaints of discrimination under the act.”

But there isn’t a comparable framework locally, points out Chua.

“Mental health stigma is very difficult to tackle, and that stigma is prevalent even among those who have the technical expertise and knowledge. This is a long game and we need significant and long-term commitment to change negative attitudes, implement workplace policies that promote mental health and increase access to mental health resources.”

Another challenge is the lack of understanding of the correlation between physical and mental health, says Azran Osman Rani, co-founder and CEO of wellness, physical health and mental health solutions provider Naluri Pte Ltd.

“[Our approach to healthcare] is very reactive. You wait until someone is really sick — say, stage four cancer — and only then expect them to come to the hospital. The second thing I realised is that as large as hospitals [are], they remain siloed by specialisation. Every specialist looks at only one part of you — the cardiologist at your heart, the oncologist at your cancer cells, the dietician at what you eat. There’s very limited integration between mental and physical health,” says Azran.

“The third issue is that your doctor gets paid irrespective of whether you actually get healthy or not. [Companies] just end up with a big bill, and you realise there’s something structurally wrong. What made me think differently was my airline experience.”

Azran shares that aircraft maintenance providers once profited from engine breakdowns, as they could charge more for repairs and parts.

To realign incentives, airlines introduced “power by the hour” contracts, paying a fixed fee per flying hour. This shifted responsibility to providers, who now bore the cost of breakdowns and were motivated to keep engines running efficiently.

“So the question was: Could we apply the same idea to healthcare? Wouldn’t that make sense? That’s how we started with our first client, focusing on chronic disease management for employees. When employees aren’t fit to work, the disruption to operations is very costly. Our early clients realised that our approach — placing psychologists at the core of a multidisciplinary team — was unique,” says Azran.

“We said it wasn’t about telling employees to exercise more or cut down on unhealthy food. It was about moods, mindsets, motivation and problem-solving skills when they faced challenges. That’s how we began.”

When the Covid-19 pandemic hit, many organisations started reaching out to Naluri, he adds.

“For the first time, mental health was front and centre — employees were depressed, anxious, burnt out, disengaged, and even experiencing suicidal thoughts and attempts.”

In Indonesia, mental health support is mandated across state-owned enterprises, making it Naluri’s fastest growing market. Malaysia, by contrast, has no such mandates, and public health budgets remain stretched, with mental health often sidelined behind chronic diseases and ageing-related costs, says Azran.

Naluri’s data shows that early interventions can reduce long-term claims for chronic conditions, cutting costs for employers and insurers alike, he says.

“People who see a general practitioner will in 10 years [have] claims of less than half [compared to those] who didn’t see a GP. You might be paying RM35 more, but when the GP takes your blood pressure and talks to you about managing your blood pressure, your health awareness increases, and you’re more likely to do something about it. Those who ignore the signs [might] go on to have a heart attack down the road and have to pay RM50,000 instead,” explains Azran.

But by failing to address and recognise the parallels between physical and mental health, organisations have given rise to “presenteeism”, a phenomenon where employees show up to work but are unable to perform productively due to poor well-being.

Being able to tackle presenteeism will be the biggest “high-hanging fruit”, believes Azran.

“Absenteeism is sick leave. Presenteeism is I come to work, but I’m not productive. This is first sign of people [struggling to manage their] mental distress,” says Azran, adding that the value of presenteeism is about three to four times the size of sick leave.

“Typically, for example, sick leave is about 3% to 4% of payroll. So presenteeism, is like 10% to 15% of payroll. So you’re paying the salary [but] they’re not productive,” he says, citing findings from data collected via Naluri’s Employee Assistance Programmes.

Moreover, with rising medical inflation, presenteeism could well be the strongest business case for legislation governing workplace mental health risks, he says.

Zurich’s Teo agrees with Azran, stressing that insurers can play a role by reinforcing the message that mental health deserves equal recognition alongside physical health. “At Zurich Malaysia, this principle is embedded in our ‘Care for What Matters’ ethos,” says Teo.

“Locally, we also see the importance of ecosystem collaboration. The Ministry of Health’s recent workplace bullying guidelines are a timely step towards creating safer workplaces. HR leaders must also advocate for policy reform and foster collaboration across the ecosystem.”

Citing the findings from Z Zurich Foundation’s “Youth mental well-being” white paper released in May, Teo says prevention-focused programmes in Asia-Pacific generate returns of up to 23.6 times for every dollar invested.

“For us, this is clear evidence that mental health investment is not only socially responsible but also economically wise,” she says.

Ultimately, high-hanging fruit such as systemic prevention, early intervention, manager training and embedding mental health into organisational culture will only be realised if mental health is treated as a statutory right rather a discretionary benefit.

“One ambitious but necessary goal is embedding mental health into workplace culture so that seeking therapy or support is considered routine, much like a physical health check-up. Another is strengthening anti-discrimination protections to ensure employees with mental health conditions are safeguarded, not marginalised,” says Teo.

“A third is fostering ecosystem collaboration, where employers, insurers, regulators and civil society come together to shift the narrative from mental health being a cost to being an investment in long-term resilience.”

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