Introduction

In the history of psychiatry, asylum used to be the main form of care for patients with severe mental illness.¹ The psychiatric institutions are described as a closed system, being isolated from society. Those patients who live in institutions suffer from isolation and freedom restriction, disowned by family and society, as well as loss of normal social roles [1]. They became apathetic, submissive and lost their individual rights. They are supervised by authoritarian staff to do their day-to-day routine, in a large group [2]. For them, celebration of anniversaries or festivals are often forgotten. It was as if they were forgotten by the outside world. 

In the midst of COVID-19 pandemic, social distancing as one of the safety measures not only keeps everyone physically apart but also affects interpersonal relationships which gives rise to mental health issues [3]. Residents in mental institutions are deeply affected, too. In institutions where visiting was allowed previously, those were put on hold or even prohibited in fear of outbreaks. In the normal population, the negative impact of social distancing can be decreased with the usage of electronic devices and the internet [4]. In accordance with most of the mental institutions’ policies, personal belongings, particularly electronic devices are kept away and most of them do not possess any electronic devices at all! As a result, it has created even more loneliness among the residents. According to Ward et al, social distancing and similar measures in response to the coronavirus disease 2019 pandemic have greatly increased loneliness and social isolation among older adults. Their longitudinal studies have shown that it increases the mortality rate in elderly age people [5].

Malaysia is a multiracial country that has many religions with beautiful cultures and preserved heritage. The festivals are celebrated round the year. Culturally, festive seasons are celebrated by respective races and religions, and being reunited with the family is part of the celebration. This is the time where family and friends gather around and have a reunion. However, since the onset of COVID-19 pandemic, the tradition and celebrations have to be put on hold for observing the new norms. 

In mental institutions, health care professionals practice the concept of Le regard médical (the medical gaze) in which the doctors focus more on illness, medicine and objectifying the patients [5]. Medical professionals tend to focus too much on the clinical issues and often forget or overlook patients’ other needs and wants. Institutionalism further reinforced a patient’s passive attitude and hence their needs became unmet. Some of the suggestions of empowerment among long stay residents include organizing activities and providing more company, so that it can increase happiness or improve the mood status. As a result, they will be more motivated to learn how to perform self-care [6]. However, due to global pandemics, activities as such need some creative modification to suit the new normal.

The organizing committees and organizing bodies

‘X’ Hospital, being one of the mental institutional psychiatric hospitals in Malaysia, was built in 1916. It is considered an asylum to care for patients with severe mental illnesses, either long-stay inpatients or acute psychiatric in-patient. Over the years, successful efforts had been made to deinstitutionalize and return the patients to the community from custodial care. Even though the number of patients has been reduced, the hospital still has over 500 long-stay residents who were either abandoned by the family or are too disabled to return to the society. The longest duration of stay for some patients would be up to more than 70 years! These patients consist of Malay, Chinese, and to the minority of Indian races. Despite the Malay race being the majority race in Malaysia population, there are almost 300 (more than 50 %) Chinese long-stay residents in this mental institution.

It has been a tradition for ‘X’ hospital to celebrate the Chinese New Year (CNY) festival annually on a comparatively large scale with activities such as lion dance performance, Chinese Orchestra music, etc. However, it was put on hold in 2021 due to the COVID-19 pandemic. Hence, in January 2022, the hospital director suggested the Chinese psychiatrists in the hospital to form a committee to organize a CNY celebration.  One of the psychiatrists was elected to be the organizing chairman, and all Chinese doctors and supporting staff in the hospital were recruited to be committee members. It was an event co-organised by the Board of Visitors (BOV) and Psychiatric Welfare Body of the hospital. The aim and objective of this event is for the long-stay residents to celebrate CNY, experience warmth and not feel left out by the society during the special season despite ongoing global pandemic. This celebration was planned to be held out on a moderate scale and simplified ways in accordance with the new norm.  

Background of co-organizing bodies

Under the provision of Malaysia Mental Health Act 2001 and Mental Health Regulation 2010, the Minister of Health appoints a BOV for each psychiatric hospital [7]. It is an external agency whose functions and responsibilities include reviewing patients’ detention, looking into complaints and inspecting facilities. Its members should not be one of the treating doctors or working in that particular psychiatric hospital to grant impartial care and welfare for the patients. BOV of ‘X’ Hospital used to be a co-organizer for most of the festival celebrations in the hospital. 

Psychiatric Welfare Body, which is better known as Badan Kebajikan Psikiatri (BKP) in Malay language, is an organization that was formed within the hospital in 1957 and officially approved by the Registry of Societies Malaysia in 1999. The main objective is to ensure welfare of the mentally ill patients. The function of the society includes finding funds to aid residents' activities, co-organises rehabilitation activities in the hospital, engage patients and their families and educate the public on mental health awareness. In accordance with its function, BKP is invited as one of the co-organizers for this CNY celebration.  

Planning and Preparation for the celebrations

Once the committee was set up, a few events were outlined to symbolise CNY celebration but at the same time adhering to the new normal standard of procedure which does not require mass gathering. After further discussion, we came to the decision of activities that signified CNY which included Mandarin oranges distribution, Ang-Pow (red packet) distribution and CNY gift to underprivileged Chinese patients under the conjoint care of hospital Medical Social Welfare (MSW) division and Community Mental Health team.  

Our funding mainly came from BOV, BKP, Medivest Sdn Bhd and donation funds as a goodwill among our committee members. Besides, we also obtained sponsored items such as Mandarin oranges, packet drinks and festive biscuits from a private company and anonymous individual sponsors. On top of it, we also received decorative items and red packets from the committee team members.

Mandarin oranges distribution

Mandarin oranges, which is pronounced as ‘Gam’ in Cantonese language, has the same pronunciation as the word ‘gold’ in Mandarin [8]. It is usually given out in pairs as an auspicious gift during CNY house visits as a symbol of prosperity. This event was held with the special arrangement done by the Dietary and Serving division of the hospital. The Mandarin oranges were purchased and given out to all patients on the first day of CNY during lunch hour. All the hospital residents received two oranges each. The reaction and feedback was well received. 

Ang-pow (red packet) distribution

Red packet or named as ‘Ang-Pow’ in Hokkien language, is a red coloured envelope packed with money. Red is considered a symbol of luck, life and happiness. Ang-Pow is given as tokens of good wishes during auspicious occasions such as CNY and weddings [9]. First of all, we get the empty red packet contributed by our committee members. Then, we gather the number and list of Chinese patients in our hospital. Each Ang-Pow worth Malaysian Ringgit (MYR)10, equivalent to USD 2.29 (USD 1= MYR 4.37 in December 2022) to be given to the Chinese residents. Our committee members have distributed the Ang-Pow to the head of nurses in each ward, in mid-February, 2022. No mass distribution was done to minimise the interaction and to adhere to the new normal. Some of the wards selected a few patients to do a simple symbolic receiving ceremony. Generally the mood was cheerful and patients were happy to receive the red-packets. The money was then kept for all patients in credit in the cafeteria for future use.

CNY gift for underprivileged patients and families

Besides those long-stay residents, there are a total of 20 Chinese underprivileged patients who are under the constant care of the hospital MSW Division and Community Psychiatry team. Home-visits were done and they delivered those patients with CNY gifts that consisted of an Ang-Pow for the patient, packet drinks and festive biscuits for the respective families. Feedback from the patients was good and they were joy-filled. It was suggested to continue the tradition of sending “blessings” to them during such a warm, joyous CNY season. 

Conclusion

CNY celebration in the new normal had been carried out in a harmonious and modified way in accordance with the new normal and policy at that moment. In mental health institutions when long stay is unavoidable, we should deinstitutionalise patients from within and empower them by celebrating their own identities. More empathic care and support should be provided and in the era of COVID-19 pandemic, creative and simplified ideas with modification of activities should be encouraged in order to care for the patients in a holistic approach. 

Acknowledgement: 

We would like to thank the Director General of Health Malaysia for his permission to publish this article.

We would like to record our appreciation to the director of HPJB together with deputy directors, other divisions in HPJB such as Dietary and Serving Division, Medical Social Welfare Division and Community Psychiatry team for their immense support to the committee. 

We would like to show our appreciation to those who provide funding to our event, particularly hospital Board of Visitor (BOV), Psychiatric Welfare Body (BKP), Medivest Sdn Bhd, a private company, anonymous staff and person.

We would like to thank the private company and anonymous person for donating CNY gifts.

Finally, a special mention goes to all the committee members who make this simple modified celebration a success in the new normal situation. 

Declaration 

The authors report no actual or potential conflicts of interest.

Funding

This celebration received funding and sponsor items from the hospital Board of Visitor (BOV), Psychiatric Welfare Body (BKP), Medivest Sdn Bhd, a private company, anonymous persons and anonymous staff. 

The authors did not receive financial support or sponsorship for the submitted works. 

Authors’ contributions

Chai YC: concept of writeup, initial draft, critical review. Lau JR: literature search, writing up. Tan CS: data acquisition, literature search. Chua TY: conception, data acquisition, initial draft.  Chong JQ: literature search and critical review. All authors reviewed and edited the manuscript and approved the final version of the manuscript.