Keynote Speech by
Dato’ Prof Dr Andrew Mohanraj Chandrasekaran
Good afternoon Ladies and Gentlemen .
It gives me great pleasure to deliver the key note address in this International Conference in Clinical Communications and Hypnotherapy organised by the London College of Clinical Hypnosis Asia.
This two day conference covers a wide range of topics in the context of discussing the role of hypnotherapy in revolutionising health care .
‘Revolution’ in health care is the buzz word now . We can anticipate a drastic change in the way things are done – from diagnosis and monitoring health conditions through digital means, delivery of care in a virtual platform, storage of data and records, delivery of medications all leading to greater empowerment of the end-user and narrowing the treatment gap.
Undoubtedly the COVID-19 pandemic played an important part, out of necessity, in many of these ‘out of the box’ solutions .
What does this mean for the provision of mental health services? What sort of revolution are we going to see in the mental health care delivery system? Before we discuss this, it is imperative for us to quickly run through some of the salient features of the mental health consequence of the pandemic .
We saw an increase in cases of Depression, Anxiety and Stress. We have the figures to prove this, internationally as well as in Malaysia. There was also an increase in recorded cases of PTSD, relapse in cases of chronic mental health conditions like Schizophrenia, Major Depression , OCD and Substance-related disorders including nicotine dependence We do not need figures to tell us this. It is given that the isolation and movement restriction and increased demand in services would and did naturally lead to this sorry state . Tragically we also saw higher numbers in suicidal thoughts and completed suicide. Not only in Malaysia and in the region but internationally too.
In Malaysia as well as in other parts of the world, including our neighbours in the region we struggled to provide mental health services to those in need. It was a double whammy in Malaysia, with unprecedented floods hitting several parts of the country right in the middle of the pandemic. The focus was to provide acute mental health services to those affected, particularly to the internally displaced people. In this process , we learned that many with chronic mental health conditions were left out and cases of relapse rose, some with fatal consequences.
While the often-repeated statement that we do not have adequate mental health resources in the country was again used to explain why not all those in need of help could be covered, little attention was paid to the reality that human resources were at times poorly deployed. For example, there are more than 20,000 counsellors attached to the education institutions in the country but the task of reaching out to those in need was given to the mental health staff of the Ministry of education. There was no clear task shifting to download the responsibilities of psychiatrists to general practitioners and other health professionals like nurses and social workers and practitioners of hypnotherapy.
However these are lessons learned and we are now forced to have a re-look at health and mental health services and find ways to optimize services so as to narrow the treatment gap.
Now, how does hypnotherapy fit into this proposed paradigm shift in the provision of mental health care? Can hypnotherapy be a stakeholder in this revolution that we are going to discuss in this two day conference?
Can Hypnotherapy be a bridge between many therapies offered, ultimately empowering patients to take control of their own physical and mental well being?
Additionally, how does hypnotherapy contribute towards meeting the mental health demands of society in the field of education, business and artistic pursuits? These are some of the broader areas of discussion that I am sure this timely conference plans to discuss .
The role of hypnosis has been recognised for hundreds of years resulting in understanding that altered states of consciousness can promote healing. Indeed the close connection between mindfulness and spirituality has also contributed to the acceptance of hypnosis as part of therapy .
Today the usefulness of hypnotherapy is well established in habit control , pain reduction , stress management, smoking cessation and depresssion, not to mention in eating disorders, skin conditions like eczema and psoriasis and even bed wetting in children .
Hypnosis has been used in surgery without anaesthesia, or to compliment and enhance conscious sedation.
Studies show activation of analgesia and hypnosis is superior to just only using pharmacological anaesthesia. Studies done on pain pathways show credible results in evidence of hypnotherapy as a modality of treatment .
Our very own Tan Sri Dr Mahadevan , one of the earliest psychiatrists in our country and fine son of Malaysia helped conduct surgery on an RTA victim when there was no access to anaesthesia but only using hypnosis , in Dublin about 40 years ago .
In my own area of interest, that is Disaster Psychiatry and in the mental health of refugees and asylum seekers with not only depression and anxiety but in those with PTSD, hypnotherapy has been used with remarkable success.
I note that this conference will highlight the successful use of this modality of treatment to complement many medical and surgical interventions.
I would like to caution the practitioners and students of hypnotherapy that the fact that hypnotherapy has proven to be effective only means that there are also dangers in applying hypnosis indiscriminately without regard to the dynamics or of the patient’s emotional problems or overlooking the patient’s psychiatric diagnosis of severe mental disorders.
There are also some indicators of personality traits linked to greater acceptability of this modality of treatment. The neurotransmitter, gamma-aminobutyric acid (GABA), has also been linked to hypnotisability. Researchers found that highly hypnotisable people had higher levels of GABA in a part of the brain thought to be closely involved in hypnosis. This brain region, the anterior cingulate cortex, is involved in cognitive control and volition and this further establishes the usefulness of hypnotherapy .
I note with great interest that the all-important question , “ What next “ is also covered in the second of this conference .
So how do we position hypnotherapy as a modality of treatment in the structure of mental health care and services?
Mental health professionals need to take a holistic approach to interventions and recognise the complementary role played by various modalities of treatment including hypnotherapy.
The mental health practitioners of purely biological interventions need to recognise the fact that hypnotherapy can also enhance biological interventions.
For this to happen, adequate training or at the least some exposure for speciality training by including principles of hypnotherapy in the training programme of General Psychiatry , Clinical Psychology, Surgery and Anesthesiology should be mandated.
Other challenges like insurance coverage for hypnotherapy treatment need to be looked into and appropriate legislation may need to be considered to give worthy recognition to the field of hypnotherapy.
Well-structured courses producing practitioners to complete the mental health landscape in the country must eventually result in accountability to a professional body just like other mental health professionals. These are some of the challenges I see ahead and I hope this conference will throw up some suggestions as to how we can take the agenda forward.
In this regard, LCCH Asia must be congratulated for the provision of advanced certification and Diploma in clinical hypnotherapy
Personally, I would want to see practitioners of hypnotherapy working hand in hand with other mental health professionals to be active stakeholders in reducing the treatment gap in the provision of mental health services. This holds good not only for Malaysia but for many parts of the world.
Finally, I would like to congratulate my good friend Sheila Menon and her team for putting together this very timely conference. My only disappointment is that I have been deprived of the opportunity to participate in a physical conference were face to face interaction would have been possible. The pandemic has certainly changed the way we do things.
All the very best and Thank you. Terima kasih.