Health and Wellness @ Uni

@ Uni A Module to Enhance Students’ Health and Well-being HEALTH AND WELLNESS

Health and Wellness @ Uni A Module to Enhance Students’ Health and Well-being

© UiTM Press, UiTM 2022 All rights reserved. No part of this publication may be reproduced, copied, stored in any retrieval system or transmitted in any form or by any means; electronic, mechanical, photocopying, recording or otherwise; without prior permission in writing from the Director of UiTM Press, Universiti Teknologi MARA, 40450 Shah Alam, Selangor Darul Ehsan, Malaysia. E-mail: [email protected] UiTM Press is a member of MALAYSIAN SCHOLARLY PUBLISHING COUNCIL Perpustakaan Negara Malaysia Cataloguing-in-Publication Data Associate Professor Dr Salmi Razali Head of Department Department of Psychiatry Faculty of Medicine Universiti Teknologi MARA 47000 Sg Buloh Selangor This book is produced in collaboration between several faculties and centres in Universiti Teknologi MARA (UiTM) including: Office of the Deputy Vice Chancellor (Student Affairs), Uitm, Shah Alam, Selangor Office of the Deputy Vice Chancellor (Academic and International), Uitm, Shah Alam, Selangor Health Centre, UiTM, Shah Alam, Selangor Career and Counselling Centre, UiTM, Shah Alam, Selangor Career and Counselling Unit, UiTM, Puncak Alam, Selangor Career and Counselling Unit, UiTM, Melaka Islamic Affairs, UiTM, Shah Alam, Selangor Faculty of Medicine, Selangor Campus, UiTM Faculty of Health Sciences, Selangor Campus, UiTM Faculty of Dentistry, Selangor Campus, UiTM Faculty of Education, Selangor Campus, UiTM PUBLISHER: UiTM Press Health and Wellness @ Uni A Module to Enhance Studentsʼ Health and Well-being

PREFACE I would like to thank the team from various faculties and centres in UiTM for their hard work and time in creating this module guidebook. I would like to thank Pfizer Malaysia Sdn. Bhd. for providing educational grant for the production process of this module guide. I encourage all students to read and practise the formula, tips, and guides available in this module guidebook as their routines. The content of this module guidebook is also available online in our Massive Open Online Course (MOOC). Practising comprehensive biopsychosocial and spiritual aspects of life is the key to health and wellness. Thank you This module guidebook aims to empower students of Universiti Teknologi MARA with knowledge of how to be healthy. It is a valuable resource and provides guidance on a comprehensive way of managing mental health problems among UiTM's students. It is hoped that students use this module guidebook to ensure they have optimum mental health and to assist them in managing their psychological problems. The guidebook covers the comprehensive concept of health, wellness, and illness and provides guidance, tips, and steps for the holistic management of mental health problems among students. Fundamental divisions of the comprehensive approach include biological (or physical), psychological, social, and spiritual interventions. Examples of scenarios of psychological problems commonly encountered among students and steps by steps ways of how and what students should do are easily discussed. Students also can learn of various facilities and services available in UiTM to assist them. This would provide an easier guide and safer environment for students whilst providing high-quality healthcare to them. Department of Psychiatry Faculty of Medicine Universiti Teknologi MARA Associate Professor Dr Salmi Razali Head of Department FOREWORD Hence, it is heartening to note that this module – Health and Wellness @ Uni has been put together to help students using a holistic approach to ensure optimum mental health and well-being. Using the principle of self-education strategy, guided by specific objectives and learning experiences, the module may help our students to achieve their goals and develop better proficiency according to their levels and speed of self–learning. This initiative is an essential component of a comprehensive strategy by the university to empower students to take control and be responsible so they can achieve their fullest potential. Just as we take care of our physical well-being, so too should we care about mental health as it is part of our overall health. By learning proper self-care and having safe conversations about the challenges we face, we can encourage and inspire others to seek help. I hope the module can produce empowered healthy graduates in our efforts to build a more caring and inclusive society as we strive towards a better tomorrow for all. Thank you. The poor mental health of university students is becoming more prevalent worldwide. Mental illness is potentially made worse from negative stigmatising attitudes directed at mental health problems by endorsing supernatural aetiologies and inaccessible services. The Global Burden of Disease Study in 2019 showed mental disorders in the top ten leading causes of burden worldwide. In Malaysia, the National Health and Morbidity Survey showed a rising trend in reported symptoms of mental illness among those above 16 years old from 10.7% in 1996 to 29.2% in 2015, with approximately one in three Malaysian adults struggling with mental health issues. In the past two years, the COVID-19 pandemic has aggravated the challenges faced by our young students who struggle to stay ahead while balancing academic, personal, and family expectations. Many have reportedly been diagnosed with depression, anxiety, psychosis, and other mental health problems, including suicidal behaviours. As the largest university in Malaysia with approximately 180,000 students per enrolment nationwide, UiTM is serious about addressing issues afflicting students. Statistics on mental health problems among our students acquired from UiTM Health Centre, and UiTM Career and Counselling Centre showed a significant increment of mental health cases in the recent years. Moving forward, we need to have in place a proper holistic management to effectively tackle mental health related problems among our students. We must have a clear understanding of mental health and mental illness. We need to empower students with social and emotional skills, such as empathy, self-awareness, respect for others, and the ability to communicate to ensure they have optimum mental health. By equipping students with the mental strength and emotional stability like perseverance, responsibility, curiosity and agility, our students will be better prepared for challenges of a volatile, uncertain, complex, and ambiguous future environment. Universiti Teknologi MARA Professor Datuk Ts. Dr Hajah Roziah Mohd Janor Vice-Chancellor

FOREWORD Hence, it is heartening to note that this module – Health and Wellness @ Uni has been put together to help students using a holistic approach to ensure optimum mental health and well-being. Using the principle of self-education strategy, guided by specific objectives and learning experiences, the module may help our students to achieve their goals and develop better proficiency according to their levels and speed of self–learning. This initiative is an essential component of a comprehensive strategy by the university to empower students to take control and be responsible so they can achieve their fullest potential. Just as we take care of our physical well-being, so too should we care about mental health as it is part of our overall health. By learning proper self-care and having safe conversations about the challenges we face, we can encourage and inspire others to seek help. I hope the module can produce empowered healthy graduates in our efforts to build a more caring and inclusive society as we strive towards a better tomorrow for all. Thank you. The poor mental health of university students is becoming more prevalent worldwide. Mental illness is potentially made worse from negative stigmatising attitudes directed at mental health problems by endorsing supernatural aetiologies and inaccessible services. The Global Burden of Disease Study in 2019 showed mental disorders in the top ten leading causes of burden worldwide. In Malaysia, the National Health and Morbidity Survey showed a rising trend in reported symptoms of mental illness among those above 16 years old from 10.7% in 1996 to 29.2% in 2015, with approximately one in three Malaysian adults struggling with mental health issues. In the past two years, the COVID-19 pandemic has aggravated the challenges faced by our young students who struggle to stay ahead while balancing academic, personal, and family expectations. Many have reportedly been diagnosed with depression, anxiety, psychosis, and other mental health problems, including suicidal behaviours. As the largest university in Malaysia with approximately 180,000 students per enrolment nationwide, UiTM is serious about addressing issues afflicting students. Statistics on mental health problems among our students acquired from UiTM Health Centre, and UiTM Career and Counselling Centre showed a significant increment of mental health cases in the recent years. Moving forward, we need to have in place a proper holistic management to effectively tackle mental health related problems among our students. We must have a clear understanding of mental health and mental illness. We need to empower students with social and emotional skills, such as empathy, self-awareness, respect for others, and the ability to communicate to ensure they have optimum mental health. By equipping students with the mental strength and emotional stability like perseverance, responsibility, curiosity and agility, our students will be better prepared for challenges of a volatile, uncertain, complex, and ambiguous future environment. Universiti Teknologi MARA Professor Datuk Ts. Dr Hajah Roziah Mohd Janor Vice-Chancellor

FOREWORD In accordance with the vision of the National Mental Health Policy to create a psychologically healthy and balanced society that emphasizes on the promotion of mental health and prevention of psychosocial problems, UiTM has taken the initiative to produce this module with the aim to create awareness on the importance of mental health and empower university students in dealing with mental health issues. The module will be made compulsories for all new students prior to enrolment. The initiative is an essential component of a comprehensive strategy by the university to empower students to take control and responsibility for actions that will lead to the fulfilment of their capacity. It is hoped that the module will help produce empowered, healthy graduates that will provide the nation with individuals infused with strong moral and ethical values, caring, tolerant, progressive, resilient, and able to guarantee the well-being of all levels of society. Thank you. Mental health disorder is a major public health importance throughout the world. It contributes to a substantial proportion of health problems in most countries. The Global Burden of Disease Study in 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide. In Malaysia, the National Health Morbidity Survey demonstrated a rising trend in the prevalence of mental illness in the general population above 16 years old from 10.7% in 1996 to 29.2% in 2015, stating that at present, approximately one in three Malaysian adults are struggling with mental health issues. Universiti Teknologi MARA (UiTM), is the largest university in Malaysia with approximately 160,000 students nationwide, is seriously recognizing the mental health crisis among university students. Statistics on mental health problems among students acquired from UiTM Health Centre and UiTM Career and Counselling Centre showed a significant increment of mental health cases in the past years. Universiti Teknologi MARA Profesor Dr Mohd Sazili Shahibi Deputy Vice-Chancellor (Student Affairs) FOREWORD Some recommendations to improve your happiness, sense of control and ability to handle life's ups and downs are generally you need to manage your stress levels, enjoy yourself, boost your self-esteem, have a healthy lifestyle, talk and share and also build your resilience. All these recommendations are collected and carefully arranged in ten (10) chapters in this module to make it easier for the reader to understand and implement well and organized which are Introduction of Health and Wellness, Stress Management and Self-Empowerment, Mental Illness, Physical Health, Exercise and Mental Health, Socialisation, Social Support, Spiritual Health, Spiritual Disturbances and Case Vignettes. It is hoped that this module will be one that you enjoy, and that it will open yet another door for you into a world of challenge and can be benefit to student, lecturer, close friends, family members, colleagues, people around, university and the community. Thank you What and how makes humans happy has been extensively researched by behavioural scientists. We are aware that happiness can predict health and longevity and that it is possible to gauge societal advancement and the efficacy of public initiatives using happiness ratings. Happiness does not just happen to you. Everyone has the ability to make tiny or small adjustments to their actions, their environment or their interpersonal interactions of mental health and mental health care that can lead to better lives. The purpose of this module is to assist student, lecturer and university community on mental health and establish guidelines for student, lecturer, staff management, client services and for strategic planning. This module intended to bring out systemic change and eliminate obstacles that prevent university community's access to high-quality, culturally competent physical and mental health care and social services. Assoc. Prof. Ts. Dr. Suriyani Ariffin Office of Deputy Vice Chancellor (Academic and International) Universiti Teknologi MARA Director of Academic Development,

FOREWORD Some recommendations to improve your happiness, sense of control and ability to handle life's ups and downs are generally you need to manage your stress levels, enjoy yourself, boost your self-esteem, have a healthy lifestyle, talk and share and also build your resilience. All these recommendations are collected and carefully arranged in ten (10) chapters in this module to make it easier for the reader to understand and implement well and organized which are Introduction of Health and Wellness, Stress Management and Self-Empowerment, Mental Illness, Physical Health, Exercise and Mental Health, Socialisation, Social Support, Spiritual Health, Spiritual Disturbances and Case Vignettes. It is hoped that this module will be one that you enjoy, and that it will open yet another door for you into a world of challenge and can be benefit to student, lecturer, close friends, family members, colleagues, people around, university and the community. Thank you What and how makes humans happy has been extensively researched by behavioural scientists. We are aware that happiness can predict health and longevity and that it is possible to gauge societal advancement and the efficacy of public initiatives using happiness ratings. Happiness does not just happen to you. Everyone has the ability to make tiny or small adjustments to their actions, their environment or their interpersonal interactions of mental health and mental health care that can lead to better lives. The purpose of this module is to assist student, lecturer and university community on mental health and establish guidelines for student, lecturer, staff management, client services and for strategic planning. This module intended to bring out systemic change and eliminate obstacles that prevent university community's access to high-quality, culturally competent physical and mental health care and social services. Assoc. Prof. Ts. Dr. Suriyani Ariffin Office of Deputy Vice Chancellor (Academic and International) Universiti Teknologi MARA Director of Academic Development,

FOREWORD An important initiative taken by the committee in addressing mental health problems among the students is the development of Mental Health and Wellness Empowerment Module for University Students. The module Health and Wellness @ Uni was developed by a qualified and experienced team comprises of both academicians and non-academicians. The module will be delivered through massive Open Online Courses (MOOC) accessible to all students and made compulsory for new students prior to enrolment. The module is the first of its kind in Malaysia and contains information on mental health and guidelines specifically for university students. The module aims to empower the mental health and well-being of university students, to reduce their vulnerability to stressor, able to cope with daily life challenges and increase their resilient in dealing with mental health issues. I am proud to acknowledge that through the excellent, tireless, and dedicated commitment of the team members, we are able to develop a module that provides a comprehensive and integrated information on mental health, available measures and interventions provided by various departments in the university inclusive of biopsycho-social-spiritual components to students with mental health problems. I would like to congratulate the team for the effort. Last but never the least, I would like to express my appreciation to all the panel members, and everyone involved in the development of the module as well as those who had helped to make the publication and the implementation of the module a success. Thank you. The entrance to university marks a period of transition for many young people. During the transition, students face new challenges such as leaving home, making independent decisions about their lives and studies, adjusting to the academic demands, and interacting with a diverse range of new people. These challenges may affect their mental health and well-being making the university students a particularly vulnerable population. Poor mental health of university students is becoming a serious issue in many countries. Malaysia as one of the leading countries in higher learning education is one of them. Despite governments efforts to raise awareness, statistics have shown that university students’ mental health remains challenging. Recognizing that issues related to mental health and mental health care are of crucial importance, UiTM Student Affairs Department led by UiTM Health Centre and UiTM Career and Counselling Centre has been taking initiatives to address mental health issues among university students. Our journey started officially in 2018 by the establishment of the UiTM Mental Health Committee represented by committed staff from multiple departments. Various initiatives and regulations were proposed, amended, and formulated throughout the years to ensure provision of comprehensive range of mental health care and services which include promotive, preventive, treatment, and rehabilitative activities. Shah Alam Dr Zaiton Nasir Universiti Teknologi MARA Director of UiTM Health Centre FOREWORD Assalamualaikum & Salam Sejahtera. The fast pace of life today, makes all human beings move as fast as the world moves. University students like you, are no exception. You are not alone. The university provides almost all of the services you need. The Lecturers, Medical Doctors, Physicians at the Hospital, Religious Advisors, Counsellors, Principals, Hostel Managers as well as the University Auxiliary Police, will keep you healthy and safe. As a counsellor, my advice to all of beloved students, is to make this campus a place where you learn about life with joy. Successful people are those who had gone through difficulties but will overcome those challenges. "FALL SEVEN TIMES, STAND UP EIGHT" And remember, for every challenge you face, there is always an opportunity for growth. If you are having any difficulties, don't keep to your ownself. We are always there for you. All The Best. Thank you. Career & Counseling Centre Universiti Teknologi MARA Mdm Wan Noraini Wan Yusoff Head

FOREWORD Assalamualaikum & Salam Sejahtera. The fast pace of life today, makes all human beings move as fast as the world moves. University students like you, are no exception. You are not alone. The university provides almost all of the services you need. The Lecturers, Medical Doctors, Physicians at the Hospital, Religious Advisors, Counsellors, Principals, Hostel Managers as well as the University Auxiliary Police, will keep you healthy and safe. As a counsellor, my advice to all of beloved students, is to make this campus a place where you learn about life with joy. Successful people are those who had gone through difficulties but will overcome those challenges. "FALL SEVEN TIMES, STAND UP EIGHT" And remember, for every challenge you face, there is always an opportunity for growth. If you are having any difficulties, don't keep to your ownself. We are always there for you. All The Best. Thank you. Career & Counseling Centre Universiti Teknologi MARA Mdm Wan Noraini Wan Yusoff Head

MODULE ADVISORS Professor Dr Hajah Nor Aziah Haji Alias Director Academic Unit, UiTM (2019-2021) Associate Professor Ts. Dr. Suriyani Ariffin Director Academic Development, UiTM (2021-current) Dr Zaiton Nasir Director Health Centre, UiTM Associate Professor Dr Salmi Razali Head Department of Psychiatry, Faculty of Medicine, UiTM Wan Noraini Wan Yusoff Head Career and Counselling Centre, UiTM Dr Nurfazlinda Md. Shah Program Secretary, Health Centre, Shah Alam, UiTM MODULE WRITERS Editor and Head of Module Writer Associate Professor Dr Salmi Razali Department of Psychiatry Faculty of Medicine UiTM Module Writers Dr Nur Jannah Nasution Raduan Faculty of Medicine, UiTM Sakinah Idris Faculty of Medicine, UiTM Fatimah Sham Faculty of Health Sciences, UiTM Razif Dasiman Faculty of Health Sciences, UiTM Mohd Maaruf Abdul Malik Faculty of Dentistry, UiTM Norashikin Salleh Faculty of Dentistry, UiTM Dr Ani Mazlina Dewi Mohamed Faculty of Education, UiTM

MODULE WRITERS Module Writers Dr Zarizi Ab Rahman Faculty of Education, UiTM Wan Noraini Wan Yusoff Career and Counselling Centre, UiTM Salwani Ibrahim Career and Counselling Centre, UiTM Roslinda Mohd Subbian Career and Counselling Centre, UiTM Nurfatihah Aziz Career and Counselling Centre, UiTM Noor Aiennatul Mardhiyah Abdul Wahab Career and Counselling Unit, UiTM Ustaz Puaad Osman Islamic Affairs Unit (Unit Hal Ehwal Islam) (HEI), UiTM Ustazah Norrihah Mohd Nadzir Islamic Affairs Division (Bahagian Hal Ehwal Islam)(BHEI), UiTM Ustaz Muhammad Najih Irsyad Ahmad Puhad Islamic Affairs Unit (Unit Hal Ehwal Islam) (HEI), UiTM MODULE REVIEWERS Eliyas Bin Sulaiman Mohandas Department of English Language and Linguistics, Academy of Language Studies, UiTM Munirah binti Mohd Izam Faculty of Education, UiTM Associate Professor Dr Farnaza @ Farnaz Ariffin Department of Primary Care Faculty of Medicine UiTM

LIST OF CHAPTERS Chapter 1: Introduction Salmi Razali, Salwani Ibrahim Chapter 2: Stress Management & Empowerment Noor Aiennatul Mardhiyah Abdul Wahab, Sakinah Idris, Salmi Razali Chapter 3: Mental Illness Salmi Razali, Sakinah Idris Chapter 4: Physical Health Ani Mazlina Dewi Mohamed, Zarizi Ab Rahman Chapter 5: Exercise & Mental Health Zarizi Ab Rahman, Ani Mazlina Dewi Mohamed Chapter 6: Socialisation Fatimah Sham, Razif Dasiman Chapter 7: Social Support Mohd Maaruf Abdul Malik, Norashikin Salleh Chapter 8: Spiritual Health Puaad Osman, Nor Jannah Nasution Raduan Chapter 9: Spiritual Disturbance Norrihah Mohd Nadzir, Muhammad Najih Irsyad Ahmad Puhad Chapter 10: Case Vignette Salwani Ibrahim, Nurfatihah Aziz, Roslinda Mohd Subbian, Wan Noraini Wan Yusoff

02 03 04 STRESS MANAGEMENT & SELF-EMPOWERMENT MENTAL ILLNESS PHYSICAL HEALTH 30 30 30 31 44 44 45 56 56 56 56 52 53 59 62 63 35 40 2.1 INTRODUCTION 2.2 CHALLENGES AS A UNIVERSITY STUDENT 2.3 STRESS AND MENTAL HEALTH 2.4 STRESS MANAGEMENT 2.4.1 Time management 2.4.2 Problem solving 2.4.3 Relaxation techniques 3.1 INTRODUCTION 3.2 THE CONCEPT OF MENTAL ILLNESS 3.2.1 Comprehensive approach 3.2.2 Mental Illness 3.3 MANIFESTATION AND TYPE OF MENTAL ILLNESS 3.3.1 Depression 3.3.2 Anxiety 3.3.3 Psychosis 4.1 INTRODUCTION 4.2 DEFINITION OF PHYSICAL HEALTH 4.3 PHYSICAL HEALTH AND MENTAL ILLNESS 4.4 PHYSIOLOGY OF STRESS 4.4.1 Understanding stresss 4.4.2 What happens to the body when experiencing stress? 4.4.3 Body chemicals and stress 3.3.4 Mania 3.3.5 Obsession 3.3.6 Drug Abuse 3.3.7 Suicide 3.4 CAUSES OF MENTAL ILLNESS 3.5 HOLISTIC MANAGEMENT OF MENTAL ILLNESS 3.5.1 Preventive Measures 3.5.2 Treating Mental illness 4.5 IMPACT OF STRESS ON PHYSICAL HEALTH 4.5.1 Obesity 4.5.2 Eating disorder 4.5.3 Insomnia 4.5.4 High blood pressure 4.5.5 Osteoporosis 4.5.6 Heart disease 4.5.7 Diabetes type II 4.6 PHYSICAL SYMPTOMS OF MENTAL ILLNESS 4.7 NUTRITION AND DIET 2.5 SELF-EMPOWERMENT 2.5.1 Assertiveness 2.5.2 Self-efficacy and motivation 2.5.3 Self-resilience 2.6 MENTAL HEALTH CARE DURING CRISIS 2.5.1 Tips to maintain mental health during crisis 05 EXERCISE & MENTAL HEALTH 66 66 67 67 5.1 INTRODUCTION 5.2 HOW EXERCISE AFFECTS MENTAL HEALTH? 5.3 EXERCISE AND PHYSICAL ACTIVITY IMPROVE MENTAL HEALTH 5.4 EXERCISES FOR MENTAL HEALTH 68 71 72 73 5.5 DOSAGE OF OPTIMUM AEROBIC EXERCISE 5.6 SUITABLE SINGLE AEROBIC EXERCISE SESSION 5.7 OTHER BENEFITS OF PHYSICAL ACTIVITY AND SPORT 5.8 SAFETY CONSIDERATIONS CONTENTS 01 INTRODUCTION 16 16 17 19 20 21 1.1 INTRODUCTION 1.2 THE CONCEPT OF HEALTH AND WELLNESS 1.2.1 The comprehensive concept of health 1.2.2 A Healthy student 1.3 NORMAL, STRESS AND MENTAL ILLNESS 1.3.1 Normal 1.3.2 Stress 1.3.3 Symptoms of stress 1.4 MENTAL ILLNESS 1.4.1 Differences between stress and mental illness 1.5 THE CONCEPT OF HOLISTIC HEALTH MANAGEMENT 1.5.1 Prevention 1.6 SERVICES AVAILABLE FOR HOLISTIC HEALTH MANAGEMENT 1.6.1 Seeking help is not wrong 1.6.2 Emergency helplines 1.6.3 Health and counselling services 1.6.4 Spiritual help and services 1.6.5 Other service providers TABLE OF

SOCIALISATION SOCIAL SUPPORT SPIRITUAL HEALTH SPIRITUAL DISTURBANCES CASE VIGNETTES 76 76 77 94 94 95 96 104 104 106 114 115 116 126 126 127 84 85 98 100 106 108 110 121 130 6.1 INTRODUCTION 6.2 SOCIAL AND SOCIALISATION 6.2.1 Features of Socialisation 6.3 SOCIAL SKILLS 6.3.1 Benefit of well-developed social skill 6.3.2 Characteristic of social skills 6.3.3 How to improve social skills? 6.3.4 Improving nonverbal communication 6.3.5 Practising in the real world 7.1 INTRODUCTION 7.2 WHAT IS SOCIAL SUPPORT? 7.2.1 Concept of social support 7.2.2 Types of support 7.3 THE CONCEPT OF SUPPORT SYSTEM 7.3.1 Socio-ecological model 7.4 WHAT ARE THE SOCIAL SUPPORTS AVAILABLE IN THIS UNIVERSITY? 7.4.1 Educational Social Support 8.1 INTRODUCTION 8.2 IDENTIFYING SPIRITUAL RESOURCES 8.2.1 Traditional religious practise 8.2.2 Private spiritual practices 8.2.3 Expressing feelings 8.2.4 Ultimate meaning 8.3 SPIRITUALITY FOR MUSLIMS AND NONMUSLIMS 9.1 INTRODUCTION 9.1.1 The concept of spiritual disturbances 9.1.2 Main cause of spiritual disturbances 9.2 COMMON SPIRITUAL DISTURBANCES 9.3 RARE TYPES OF SPIRITUAL DISTURBANCES 9.3.1 Examples of spiritual disturbances 9.3.2 Seeking help for spiritual disturbances 9.3.3 Symptoms of Spiritual Disturbances 10.1 INTRODUCTION 10.2 REASONS FOR SEEKING HELP 10.2.1 Seeking help steps for mental health problems 10.3 DESCRIBE YOUR ROLES IN HELPING OTHERS 10.2.1 What can I do if someone refused my help? 10.2.2 How can I look after myself? 6.4 SOCIAL PROBLEMS 6.4.1 How to improve social health 6.5 SOCIAL PROBLEMS 6.4.1 Definition 6.4.2 Social problems among university students 6.4.3 Possible contributing factors for social problems 6.4.4 Handling social problems 7.4.2 Family as social support 7.4.3 Other support systems 7.5 HOW CAN YOU IMPROVE YOUR SOCIAL SUPPORT NETWORK? 7.6 METHODS OF IMPROVING SOCIAL SKILLS 8.4 STEPS TO MAINTAINING GOOD SPIRITUAL HEALTH 8.4.1 Spiritual health and daily life 8.4.2 Understanding life as a spiritual journey 8.4.3 Spiritual health and happiness 8.5 THE IMPORTANCE OF SPIRITUAL HEALTH IN MENTAL HEALTH 8.6 SPIRITUAL HEALTH AND HEALTHY LIFE 9.3.4 Doubtfulness 9.3.5 Black Magic Disturbances 9.3.6 Addressing Spiritual Needs 9.4 HOLISTIC PRACTICES TO PREVENT SPIRITUAL DISTURBANCES 9.4.1 Prevention of spiritual disturbances 9.4.2 Suggested verses for practise 9.4 CASE VIGNETTES 10.2.1 Discussion for Scenario 1 10.2.2 Discussion for Scenario 2 10.2.3 Discussion for Scenario 3 10.2.4 Discussion for Scenario 4 10.2.5 Discussion for Scenario 5 10.2.6 Discussion for Scenario 6 10.2.7 Discussion for Scenario 7 10.2.8 Discussion for Scenario 8 06 08 09 10 07

01 INTRODUCTION LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Explain comprehensive concept of health and wellness. ▶ Describe the concept of illness; normal-stress-illness. ▶ Explain the concept of holistic management of illness. ▶ Describe various facilities and services available for holistic management.

HEALTH AND WELLNESS @ UNI 16 1.1 INTRODUCTION Welcome to Health and Wellness @ Uni, a module which aims to empower you with knowledge of how to be healthy. In this chapter, you will be introduced to the comprehensive concept of health, wellness, and illness. Holistic management of illness will also be discussed briefly. At the end of the chapter, you will learn of various facilities and services available in UiTM to assist you, should you have any problems. You should attempt all the self- reflections and activities suggested from all chapters in this module too. 1.2 THE CONCEPT OF HEALTH AND WELLNESS 1.2.1 The comprehensive concept of health Health and wellness have a broader meaning and not merely the absence of a disease. According to the World Health Organization (1999), a person who is truly “healthy” is those who are healthy in all aspects of life; physically, psychologically, socially, and spiritually (Refer to Figure 1.1). A person who is healthy, looks good, feels good and are good to others. The key to true health is to practise a healthy lifestyle. A healthy person maintains a healthy weight, eats healthy food, exercises, does physical activities and monitors his or her physical health regularly. Other elements to add to the list are managing stress well, having good emotional control and maintaining healthy interpersonal relationships with family, friends, colleagues, lecturers, superiors, and others in the surrounding environment. Acting in concert to be a healthy person, one should avoid taking hazardous substances such as cigarettes, alcohol, and illicit substances. In the era of advances technology, WHO (2019) also emphasizes the importance of being healthy in your interaction with the surroundings including in media and technologies. Figure 1.1 Comprehensive Concept of Health

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 17 1.2.2 A Healthy student The comprehensive concept of health also applies to you. To be considered as a healthy student you should strive for the optimum in: i. Physical health: ◆ Your body is physically healthy, and you do not have physical diseases. To maintain physical health, it is important for you to exercise regularly and participate in physical activities such as sports and recreational activities. Maintain a healthy diet and do regular check-ups at the nearest UiTM health clinic. Refer to Chapter 4 and Chapter 5 for more information. ii. Mental (psychological) health: ◆ You are mentally fit, have a healthy well-being, emotionally stable and able to manage your stress effectively. Students with optimum mental health would be able to manage their time properly, better concentrate on studies and well prepared for a better future. Refer to Chapter 2 and Chapter 3 for more information. iii. Social health: ◆ You have a good interpersonal relationship with your family, friends, lecturers, and others surrounding you. You can have social interactions with other people without stress. Refer to Chapter 6 and Chapter 7 for more information. iv. Spiritual health: ◆ You have faith, embrace your religion, and perform the required rituals. You feel better connected to God. You feel your life is meaningful and has purpose. Refer to Chapter 8 and Chapter 9 for more information. 1.3 NORMAL, STRESS AND MENTAL ILLNESS Human behaviour comes in a spectrum. It is important for you to understand between the state of being normal, being stressed and being mentally ill. 1.3.1 Normal A normal person is one who is healthy. By now, you should understand the criteria of a “healthy” person. You should be normal and healthy physically, mentally, socially, and spiritually. REFLECTION What are the criteria of a healthy student?

HEALTH AND WELLNESS @ UNI 18 1.3.2 Stress Stress can be divided into four (4) types: i. Eustress or Good stress: ◆ This type of stress is good because it functions to motivate you to be better. For example, sitting for an exam is a stressful event. If you have good psychological skills, you would be able to manage time properly, you could study well and do regular revision. ii. Distress or Bad stress: ◆ This type of stress is a bad stress which causes undesirable effects. Without good psychological skills, you may have emotional disturbances. If you have good psychological skills such as coping skills, distress is tolerable. For example, the loss of someone you love. iii. Acute stress: ◆ This is an immediate stress which occurs temporarily. It may become eustress or distress depending on how you believe it to be and the pattern of your coping strategy. iv. Chronic stress: ◆ This is a prolonged stress. Daily hassles may be a source of minor stress. However, continuous minor stress may cumulatively become significant chronic stress. For example, you have a roommate who has a behaviour that you dislike. 1.3.3 Symptoms of stress Stress manifests with various symptoms: i. Emotional symptoms: ◆ feeling discomfort, sleep disturbances, easily irritated and easily angry. When severe stress occurs you may have anxiety, panic attack and depression. ii. Physical symptoms: ◆ body ache, headache, and gastritis. iii. Social symptoms: ◆ relationship with your family, friends and others may or may not be affected, social isolation and loneliness. iv. Spiritual symptoms: ◆ feeling empty, no goal in life, feeling burdened to perform required religious rituals. It is important for you to remember that if your stress is mild or less severe, you may able to continue with your routine life. However, in severe stress, you may not be able to perform your daily chores.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 19 REFLECTION If you are stressed out, how would you describe changes that happened to you? 1.4.1 Differences between stress and mental illness Emotional change is a subjective matter. You may find it difficult to differentiate between one and another. Table 1.1 below may help you to differentiate between stress and mental illness. Learn more symptoms of mental illness in Chapter 3. 1.4 MENTAL ILLNESS The definition of mental illness is very subjective. An imbalance of your physical, mental, social, and spiritual aspects may cause you to suffer from mental illness. You are considered to suffer from mental illness when you experience: i. Distress: ◆ You feel discomfort because of your behaviour. ii. Duration: ◆ You have the disturbances for a certain duration of time. iii. Impairment of function: ◆ You are not being able to continue with your normal activities (such as your studies, relationship and interaction with others, fulfilling your responsibilities, and other social activities) anymore. iv. Risk to self or others: ◆ You deal with your stress by using maladaptive coping strategies that can harm yourself (such as not eating well, not looking after self-hygiene, inflicting self-injury) or others (harming people, aggressive behaviour, violent behaviour). v. Atypical behaviour: ◆ Your behaviour is not socially and culturally acceptable (such as inappropriately talking to self, going naked in public, unnecessary paranoia). You will learn more regarding mental illness in Chapter 3. ACTIVITY Check for other symptoms of distress available online. Discuss the symptoms with your friends.

HEALTH AND WELLNESS @ UNI 20 DISTRESS MENTAL ILLNESS FREQUENCY The symptoms of stress come intermittently, not frequent, mostly tolerable and becoming severe when the problem is present The symptoms of stress and other symptoms of illness come frequently, most times of the day in uncontrollable patterns DURATION Short duration and temporary Long duration RISK AND SAFETY You and others are still safe Harming self or others PATTERN OF BEHAVIOUR Maintain acceptable pattern of behaviour Atypical pattern of behaviour FUNCTION May or may not change Disturbed function EXAMPLE • Feeling very anxious before an examination • Feeling very sad after break-up with friend • Having doubt while performing ablution • Feeling very disappointed with self • Sudden panic attack in the absence of stress • Continue to feel sad for more than 2 weeks • Repeating ablution 20 times at one time • Self-harming behaviour, cutting self, suicide Figure 1.2 The Concept of Holistic Health Management 1.5 THE CONCEPT OF HOLISTIC HEALTH MANAGEMENT All aspects of life (physical, mental, or psychological, social, and spiritual) that determine your health should be treated to ensure you are healthy. Table 1.1: Differences between stress and mental illness

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 21 1.5.1 Prevention It is vital to prevent illnesses and ensure that you are maintaining your healthy; “prevention is better than cure”. Prevention does not merely stop you from contracting an illness, but it also prevents further complications. Preventive measures can be divided into three phases: i. Primary prevention: ◆ This refers to the preventive methods you do before an illness. You learn and practise effective psychological skills to manage your stress and prevent mental illness. You do regular check-ups so that any symptoms can be detected early. You maintain a healthy lifestyle. ii. Secondary prevention: ◆ At this stage, you already have the illness. You seek treatment as early as possible so that the illness is controllable. You adhere to the treatment as planned by the therapists and modified your lifestyles to maintain good health. iii. Tertiary prevention : ◆ Prevention of severe complication is part of preventive measures too. You adhere to medications and treatment planned for you to avoid complications. In certain circumstances, you may need to rely on a support system to continue the rehabilitation process. ACTIVITY Discuss with you friends, activities that may help you to prevent any illnesses. You will further learn in Chapter 3 of preventive measures for mental illness. 1.6 SERVICES AVAILABLE FOR HOLISTIC HEALTH MANAGEMENT There are various services and facilities available in UiTM for you to seek help. The university strongly encourages you to get the best treatment so that you can continue to be healthy specifically during your study and generally throughout your life. 1.6.1 Seeking help is not wrong If you experience any difficulty, it is important for you to seek help. It is not wrong to seek help. When you are stressed or experiencing emotional disturbances, you may not be able to make decisions properly. Guilt, fear and feeling afraid of being blamed are parts of symptoms of those experiencing stress or having an illness. These feelings may prevent you from seeking help. Hence, it is

HEALTH AND WELLNESS @ UNI 22 important for other people such as friends, family, and lecturers to help you. Disclosure of an illness to others is not a sign of weakness. Do feel assured that friends, lecturers, counsellors, and the university are with you to ensure that you are always well and safe. 1.6.2 Emergency helplines Please do not hesitate to call 03-55442999 (UiTM Health Centre) or 03- 55443999 (UiTM Auxiliary Police) for any emergency. You will be directed to other services if necessary. ACTIVITY Your friend has a strong intention to harm him/herself. You do not know what to do. Whom should you call? Share with other students the hotline numbers. 1.6.3 Health and counselling services There are several services and facilities available to assist you if you experience any problem, stress, or illness. Klinik Minda Sihat is available at several premises in UiTM including the health, counselling, and spiritual centres.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 23 ii. Psychology and Psychiatry Clinic: ◆ Health Clinic and Counselling services are also available for students at the Psychology and Psychiatry Clinic in Hospital Al-Sultan Abdullah, UiTM, Puncak Alam. You may set an appointment to see a doctor, psychologist, or consultant psychiatrist. If you are from UiTM branches, most government hospitals do provide similar services. The contact number for UiTM related hospitals are available below. iii. Primary Care Clinic, UiTM: ◆ Services for mental health problems are also available for students at the Primary Care Clinic, UiTM at Sungai Buloh Campus. There, you will be seen by doctors and family physicians who are trained as specialists to treat patients with mental health problems. i. UiTM Health Centres: ◆ The main Klinik Minda Sihat is available at UiTM Health Centre, Shah Alam. It is also available in other UiTM campuses throughout Malaysia. You can seek help from UiTM Health Centres even though you are on breaks or having your internship. If you are a UiTM student or staff, just proceed to the nearest UiTM Health Centre available on campus for consultation. Figure 1.3 shows the contact numbers of all UiTM Health Centres throughout Malaysia. REFLECTION If you are feeling very sad, hopeless, and useless, what would you do? Seeking help is not a sign of weakness. Share your feelings with doctors and nurses. Where is the nearest Klinik Minda Sihat to you? Figure 1.3: Contact number for UiTM Health Centres Throughout Malaysia

HEALTH AND WELLNESS @ UNI 24 REFLECTION If you experience repeated severe anxiety attacks, hindering focus and concentration in study, what would you do? Which number should you call to seek help from a psychologist? Hospital Al-Sultan Abdullah Puncak Alam, Selangor (+603-33963000) UiTM Sungai Buloh Medical Centre (+603-6126 5000/7000) Figure 1.4 UiTM Hospital and Medical Centres iv. Career and counselling centre: ◆ Information on matters related to your career and counselling are available from the Career and Counselling Centre: https:// careercounselling4u.uitm.edu.my. v. Psychology and counselling service: ◆ The Career and Counselling Centres provide Psychology and Counselling Services and are available at every UiTM campus. Counsellors may assist you by providing various counselling techniques such as supportive counselling, art therapy, stress management and many others. Counsellors can also help you to identify issues through psychological testings or screening such as the Depression Anxiety Stress Scale Inventory, Stress and Burnout Inventory, Beck Depression Inventory and Anger Management Inventory. Figure 1.5 below are ways in how you access to counselling services from the centre:

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 25 Figure 1.5: Ways to access UiTM Counselling Services REFLECTION If you feel very stressed out for whatever reasons, what would you do? Seeking help is not a sign of weakness. What are the various ways for you to seek help from a counsellor? vi. Peer counsellor support group: ◆ You can also seek for help from Rakan Members available at your Residential College and faculty. Rakan is a group of students who are trained with basic counselling skills and ethics in helping skills. If you feel sad, stressed, or depressed and have no one to talk to, feel free to seek help from them. You may also want to help others. You can be a part of the RAKAN team. Register at the Career and Counselling Centre nearest to you.

HEALTH AND WELLNESS @ UNI 26 1.6.4 Spiritual help and services Spiritual help and services are available from Islamic Affairs Division (Bahagian Hal Ehwal Islam)(BHEI) which is based at Masjid Al-Wathiqu Billah Tuanku Zainal Abidin, UiTM. BHEI is also available on every UiTM campus throughout Malaysia. At BHEI you may enhance your knowledge of Islam and its required religious rituals. At the same time, you can develop healthy social interactions with learned ustaz and ustazah. The ultimate goal for spiritual counselling is for you to have a meaningful life and to be close to the Almighty God. Should you want to attend spiritual counselling, you may visit this link https://masjiduitm.uitm.edu.my/index.php/direktori-staff . You may also follow UiTM Masjid Facebook to view religious lectures at: https://www.facebook.com/pg/MasjidUiTMShahAlam/posts/ Refer to Chapter 8 and Chapter 9 in this guidebook suggestions to enhance your spiritual health. Figure 1.6: Masjid Al-Wathiqu Billah Tuanku Zainal Abidin, UiTM (03-55442350) 1.6.5 Students and academic affairs i. Student Affairs Division [Bahagian Hal Ehwal Pelajar (HEP)]: ◆ The hotline for HEP is 03-55442044. You may also visit https:// hep.uitm.edu.my/main/ for more information regarding matters related to students. ACTIVITY Your friend has a hysteria attack. You do not know what to do. Whom should you call? You may also call the helpline number to seek for help. What is UiTM helpline number?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 27 HEP helps UiTM students in matters of welfare, comfort, and security and to coordinate financial assistance and scholarships available to students. It also provides special funds, such as the Student Welfare Fund, Student Emergency Fund and Student Curriculum Fund. HEP also provides accommodation to the students who live in university colleges and coordinates student activities and movements within the university and with other educational institutions and external associations, so as to ensure that students fulfil both spiritual and worldly needs and are exposed to the reality of the working environment. Unit Pengurusan & Kebajikan Pelajar is a specific unit to assist students in financial and welfare matters. Please call (+603) 5544 3542 and visit their website at https://hep.uitm.edu.my/main/ index.php/pejabat/pejabat- timbalan-naib-canselor-hep/bahagianpentadbiran. ii. Academic Affairs Division [Bahagian Hal Ehwal Akademik (HEA)]: ◆ The hotline number for HEA is 03-5544 3509/3300/3176. You may also visit https://hea.uitm.edu.my/v4/ for more information regarding your academic matters. This division is essential to assist you with any problems related to your academic matters. HEA is responsible to ensure the quality of academic achievement and excellence of UiTM. You may want to enhance your learning activities by joining various learning programmes through several modalities such as the massive open online learning (MOOC), blended learning, ufuture and many others. For more information, you may visit the Institute of Continuing Education & Professional Studies at https://iceps. uitm.edu.my/. 1.6.6 Other service providers There are students who prefer for more privacy and believe that seeking help or assistance from professionals outside UiTM is better. It is acceptable for you to seek help from any services nearest to you. Your health and wellbeing is the priority. Preferably, please inform respective UiTM authorities so that continuous follow up can be done and your well-being are assured while studying in UiTM. Please refer to Table 1.2 for further information. REFLECTION If you have problems with your studies, which UiTM division should you call? If you have problems related to your college, which UiTM division should you call?

HEALTH AND WELLNESS @ UNI 28 SERVICES DIRECTORY PUSAT KAUNSELING SELANGOR TALIAN SAHABAT OPENING HOURS: Tuesday - Thursday (12.00 pm - 4.00 pm) Saturday and Sunday (9.00 am - 5.00pm) Kompleks PKNS Shah Alam, Lot G60, Tingkat Bawah, Persiaran Tasik, Seksyen 14, 40000 Shah Alam, Selangor Tel: 03-5519 0500 / 03-5521 2363 https://sites.google.com/site/pusatkaunseli ngselangor/ HOSPITALS Ministry of Health: https://klinikminda.com/senarai-hospital-psikiatri-di-malaysia/ https://www.infosihat.gov.my/images/media_sihat/infografik/ images/Talian%20Mentari.jpeg Private Hospital: https://new.medicine.com.my/private/hospit als/ Private Mental Health Specialist: https://www.psychiatry- malaysia.org/listcat.php?cid=28&all=Y NON-GOVERNMENTAL ORGANISATION Mental Illness Awareness and Support Association (MIASA) Malaysia; https://miasa.org.my/ Tel: 03-7732 2414 / 013-878 1322 / 014-223 6938/ 019-236 2423 BEFRIENDERS MALAYSIA https://www.befrienders.org.my/ Tel: 603-79568145 Emotional support 24 hours, every day for people who are lonely, in distress, in despair or having suicidal thoughts. Free and confidential. BIBLIOGRAPHY ▶ Career and Counselling Centre https://careercounselling4u.uitm.edu.my ▶ Career and Counselling Centre https://counselling2u.uitm.edu.my ▶ https://masjiduitm.uitm.edu.my/index.php/direktori-staff ▶ Student Affairs Division https://hep.uitm.edu.my/main/ ▶ Academic and International Division https://hea.uitm.edu.my/v4/ ▶ Pusat Kaunseling Talian Sahabat Selangor. https://sites.google.com/site/ pusatkaunselingselangor/ ▶ Ministry Of Health. http://www.moh.gov.my/index.php/database_stores/ store_view/3?mid=95 ▶ Private Hospital. https://new.medicine.com.my/private/hospitals/ ▶ Private Mental Health Specialist. https://www.psychiatry- malaysia.org/listcat. php?cid=28&all=Y ▶ Mental Illness Awareness and Support Association (MIASA) Malaysia; https:// miasa.org.my/ ▶ Befrienders Malaysia. https://www.befrienders.org.my/ ▶ Institute of Continuing Education & Professional Studies. https://iceps.uitm. edu.my/ Table 1.2 Other Consultation Services

STRESS MANAGEMENT & 02 SELF-EMPOWERMENT LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Describe the challenges being a university student. ▶ Explain the relationship between stress and mental health. ▶ Explain various psychological skills in managing stress. ▶ Describe relevant psychological skills for selfempowerment.

HEALTH AND WELLNESS @ UNI 30 2.1 INTRODUCTION In this chapter you will be introduced to psychological skills to better empower you to manage your stress. At the beginning, you will be introduced to the challenges of being a university student. Then, the discussion continues with a subtopic on the relationship between stress and mental health. You will also be given a few tips on how to manage stress. At the end of the chapter, you will learn relevant psychological skills for self-empowerment. You should attempt all the selfreflections and activities suggested across all chapters of this module too. 2.2 THE CONCEPT OF HEALTH AND WELLNESS As a university student, you face various challenges to improve your quality of achievements and capabilities. Join us to discover a few tips in this module. You will be exposed with various skills to overcome stress and improve your quality of life including practising social inclusion by having various social and sport activities, improving your level of spirituality, enhancing your psychological skills, and seeking help when necessary. It is normal for a university student to experience many challenges and obstacles to attain the best academic achievement. You diligently put in efforts, but sometimes stressful situations keep hindering you from attaining the desired results. There are many possible stressful situations that you faced such as poor time management, lack of sleep, financial difficulties, self-criticism, poor self-efficacy, and/or lack of motivation. These stressful situations may become a threat to your academic performance. 2.3 STRESS AND MENTAL HEALTH Stress is a reaction of human biological and physical body responses when it senses danger. We all experience stress; good stress is a source of motivation and helps you to become a better person. But when stress is present for too long, it may affect your daily functioning, and if it is not well managed, it can lead to mental health issues such as anxiety, depression, and/or self-harm (Refer to Chapter 3 for more information on mental health issues). You can refer to Figure 2.1 for a few key points on stress. Figure 2.1 Key Points on Stress

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 31 2.4 STRESS MANAGEMENT As a student, too many challenges and problems may stem from different directions and angles; friends, family, teachers, lecturers and of course academic problems. These problems and challenges if not handled properly will cause stress. Good stress is called eustress and could motivate you to work harder. On the other hand, bad stress is called distress which causes you to have psychological disturbances. Come on! Learn the techniques of managing stress in an effective manner. Let us change stress to eustress, not distress! 2.4.1 Time management Time management is very important in our daily life. There is a strong link between lack of time management and stress levels. Effective time management will bring you the best change in your daily life. Every human being is given the same amount of time each day; 24 hours or 1440 minutes or 86400 seconds. Hence, proper time management is crucial to ensure the time allocated to our daily life is not wasted. As a student, you should know how to manage your time properly. You may use these 10 practical ways to improve your time management skills, refer to Figure 2.2 for tips in good time management. REFLECTION Do you agree that stress stimulates your motivation and empowers you? REFLECTION Which of the 10 tips have you have already applied in your daily life?

HEALTH AND WELLNESS @ UNI 32 2.4.2 Problem solving If you do not properly address your problems, it will increase the risk for mental issues. Problems that occupy your mind will cause stress. Stress that piles up in your mind will overwhelm you. This will affect your learning and academic performance. At the extreme level, excessive stress will cause you to act recklessly outside of your daily routine and affect your relationships with others - lecturers, family, friends, and fellow students. Hence, let us learn together the STEP in how to do problem solving each time we encounter problems by referring to Figure 2.3 for the summary of STEP. Figure 2.2: Tips for Good Time Management Figure 2.3: Problem Solving Steps

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 33 i. Step 1: Say the problem ◆ To find solutions for your problem, you must first admit that you do have a problem. Thus, you must say the problem without blaming anyone. ii. Step 2: Think of solutions ◆ It is challenging to find solutions when you are under great stress. Hence, take out a piece of paper and start listing options available to you. Ensure that the options that you listed are safe and respectful. iii. Step 3: Explore consequences ◆ Once done with listing, explore the consequences for each of the option of solutions to assess what could happen if you choose that option. iv. Step 4: Pick the best solution ◆ Finally, pick the best option and properly analyse the pros and cons of your chosen option. 2.4.3 Relaxation techniques This technique is used to aid in the treatment of emotional tension. Research shows that students who received training in either the deep breathing technique or the progressive muscle relaxation (PMR) technique demonstrated significantly lower state of anxiety scores than those who had not received such training. Follow the steps below for a step-by-step guide on how to practise the deep breathing technique and the PMR technique (Refer to Figure 2.4).

HEALTH AND WELLNESS @ UNI 34 ii. Progressive muscle relaxation (PMR) technique ◆ The Progressive muscle relaxation technique is a form of relaxation training that can teach you how to achieve deep physical relaxation. In PMR, you need to tense groups of muscle (such as hand, shoulder, arm, face, chest, back, leg), hold the tension and then release the tension. Pay close attention to the feeling of relaxation. Relaxation should be enjoyable, so if you find some part is difficult, you may skip it and move to the rest. Be careful not to stress the part of your body with injuries. Refer to Figure 2.5 below for the steps in the PMR technique. i. Deep breathing technique Figure 2.4: Steps for Deep Breathing Technique Figure 2.5: Simple Steps of PMR PUT THE PRESSURE ON YOUR DESIRED MUSCLE MAKE SURE TO HOLD FOR 10 SECOND REST & REPEAT

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 35 Figure 2.6 displays the recommended sequence of the PMR technique: 1. Right lower leg and foot (point you toes and gently tense the calf muscle) 2. Left lower leg and foot 3. Both thighs (press your knees and thighs tightly together) 4. Buttocks (squeeze your buttocks and hold) 5. Both palms and lower arms (clench your fist and tense the lower arm) 6. Abdomen (pull your abdominal muscles in tightly) 7. Right and left upper arms (bring your hand to your shoulder and tense your biceps) 8. Chest (take a deep breath and hold it in) 9. Jaw (tense your jaw and hold it in) 10. Forehead (squeeze the muscles in your forehead and hold) Figure 2.6: Recommended Sequence of PMR ACTIVITY Together with a friend, practise the deep breathing technique and the progressive muscle relaxation technique. 2.5 SELF-EMPOWERMENT Self-empowerment is taking control of your own life, setting goals, and making positive choices. In other words, you must understand your strengths and weaknesses, and possess the ability to believe in yourself. Below are some important skills you can empower yourself with to create a balance in your life; psychologically, physically, socially, and spiritually. 2.5.1 Assertiveness Assertiveness is a communication style. It is the ability to express your feelings, thoughts, beliefs, and opinions openly if they do not violate the rights of others. Poor communication styles include being “aggressive” (a style that violates the rights of others) and being “passive” (violate your own rights). Both styles are non-productive ways of communicating with others. You can refer to Table 2.1 to learn of the differences between being passive, assertive, and aggressive. PASSIVE AGGRESSIVE ASSERTIVE

HEALTH AND WELLNESS @ UNI 36 If you are assertive, you can share your ideas with others, voice your opinions, and be able to say “No” without being rude. An assertive person appears confident and always takes on responsibility professionally as well as in accordance with religious values. Below are tips on how to be assertive (Refer to Figure 2.7 for the summary). » When you are angry because of any inconvenient matter such as another person is taking advantage of you, or you are being criticised, do not respond immediately. » Calm yourself by taking a deep breath. Step back for a while, observe and listen properly. PASSIVE ASSERTIVE AGGRESSIVE Thinking that your needs does not at all matter Recognising that your needs matter as much as anyone else Thinking that only your needs matter Allowing yourself to be bullied Standing up for yourself Bullying others Not saying what you think, or not saying anything Express your point clearly and confidently Can lead to shouting, aggression, or violence Give in to others Good relationship with others Make enemies Figure 2.5: Simple Steps of PMR REFLECTION How do you develop self-empowerment?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 37 » Think wisely about the most appropriate response. You may disclose your feelings by beginning with “I…….” This is the method to avoid pointing fingers or blaming others. » You have the right to tell others of what you want without violating others’ right. ACTIVITY Practise the assertive skills in responding to criticism with your friends. Don't respond immediately Self disclosure S.T.O.P.P Figure 2.6: Recommended Sequence of PMR 2.5.2 Self-efficacy and motivation Self-efficacy is important for you to succeed in this life; obtaining success in academics and to be successful for yourself, family and the future. The motivation must be maintained from the moment you enter the university, face the challenges, and move on to success. Below are tips on how to increase your motivation. Refer to Figure 2.8 for the tips for SUCCESS). » You should set a long-term goal and short-term goals in your life. As a student, what is your goal for this week? » Do not let your emotions control you. You should control your emotions. The way to control emotions is by understanding your thoughts. Think positive! » Do not compare yourself to others. But, compare you with yourself. You should be better than yourself yesterday. Do not give up!

HEALTH AND WELLNESS @ UNI 38 » Evaluate your own weaknesses. Improve yourself by enhancing your skills. » Stop debilitating habits such as procrastination, having negative thoughts, non-assertive and easily irritable. » Reward yourself when you achieve your goal. Motivation can affect your performance. If you are intrinsically motivated, you love or enjoy what you do even if there is no reward or incentive. While if you are extrinsically motivated you do not enjoy what you do but motivated to get the rewards. Motivation uplifts your enthusiasm. If you are motivated to achieve something, you will give your full effort, time, and energy. You become determined or persistent in accomplishing tasks even if these are not of your interest. 2.5.3 Self-resilience Problems and stress are unavoidable facts of a student life. Additionally, there will always be unexpected events such as the death of a loved one, disaster, or illness – which can happen without warning. There are ways which you can learn to deal with stress. One of the skills is self-resilience. Resilience is your ability to bounce back when things do not go as planned and positively adapt with stressful situations. A person with high resilience is always on track to reach his/her goals, calm when dealing with difficult situations, learn from mistakes, has positive thinking and positive attitude. Figure 2.8: Tips for SUCCESS REFLECTION What is resilience? How do you bounce back from problems?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 39 The American Psychological Association (APA, 2014) suggests “10 Ways to Build Resilience”. Refer to Figure 2.9 for the summary. The tips are, YOU: » try to get support from close family members, friends, and others to strengthen your resilience. » avoid seeing crises or stressful events as unmanageable problems. » accept situations that cannot be changed. » develop realistic goals and move towards them. » take definitive actions in adverse situations. » look for opportunities of self-discovery after a struggle with loss. » develop self-confidence. » keep a long-term perspective and consider the stressful event in a broader context. » maintain a hopeful outlook, expecting good things and visualizing what is wished. » take care of your mind and body, exercising regularly, paying attention to your own needs and feelings. Figure 2.9: Tips to Be Resilient

HEALTH AND WELLNESS @ UNI 40 2.6 MENTAL HEALTH CARE DURING CRISIS Everyone experiences crisis in life. A few examples of crisis include academic problem, loss of someone you love, accident, having illness and experiencing disaster. During crisis such as COVID-19 pandemic, because of fear of having COVID-19 infection, stress due to lockdown, grieving for the loss of family members and friends due to COVID-19 infection, financial difficulties, challenges in distance online learning and various other pressures, you may have difficulties to maintain optimum mental health. You may experience acute stress continuously leading to mental illness. 2.6.1 Tips to maintain mental health during crisis Refer to Figure 2.10 for a few tips for you to maintain optimum mental health during crisis. You may use the formula SMART as a guide: i. Support system ◆ You need support to go through difficulties in life, in particular while facing crisis. It is alright to seek for help. Friends, parents, siblings, and families are proximal persons that you may ask for help. Counsellors, psychologist, preachers, ustaz, supervisors, teachers, lecturers, and mentors can also help you. Do read further this book and join our MOOC for more information. ii. Managing stress ◆ Practise breathing exercise and progressive muscular relaxation regularly. When you fill stressed out, calm yourself first before you try to solve your problem. Make an appointment to see your counsellor and learn proper problem-solving skill. iii. The 5As skills ◆ Anticipate, Adaptable, Agile, Assurance and Action are the 5As of crucial skills when you are facing severe crisis such as the pandemic of COVID-19. You should have the ability to anticipate that changes happen very fast. For example, attendance to class can immediately changed from face-to-face to virtual learning in case when your class is contaminated with infection. Furthermore, when coping with crisis you should be ready to adapt with new situations. Agility to move quickly, assured with your ability and act wisely according to the fast-changing conditions are vitals when facing a crisis. ACTIVITY Imagine that you have been working on a report for several weeks. When you submit, you lecturer asks you to rewrite your report. How do you handle this situation?

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 41 iv. Resilience ◆ Read further earlier information on resilience 2.5.3 v. Teamwork ◆ When you are facing with crisis, collaborative work leads to better outcomes. Get help from others so that your problems and work burden can be shared. Moreover, working in a team encourages sharing problems, personal growth, increases job satisfaction, and reduces stress. 1 SUPPORT SYSTEM 2 MANAGING STRESS ANTICIPATE, ADAPTABLE 3 AGILE, ASSURANCE AND ACTION 4 RESILIENCE 5 TEAMWORK 2 5 SUMMARY ▶ Being a university student, you experience various challenges in life such as academic difficulties, financial problems, interpersonal relationship problems with friends, lecturers, and administrative staff as well as family-related issues. ▶ Psychological skills are crucial to empower you to manage your stress. Examples of important psychological skills are stress management, time management, problem solving skill, breathing and relaxation, assertiveness skill, self-efficacy, and self-resilience. ▶ Acute and prolonged stress can lead to mental health problems. Without proper stress management, you may suffer from mental illness. ▶ Social Support (S), Managing stress (M), Anticipate, Adaptable, Agile, Assurance and Action (As), Resilience (R) and Teamwork (T) or SMART is the formula for managing crisis. Use the formula for optimum mental health during crisis. Figure 2.10 SMART ways to handle crisis

HEALTH AND WELLNESS @ UNI 42 BIBLIOGRAPHY ▶ Mohamad, M. H., Mohamad, M. S., Subhi, N., Baidi, N., & Asshidin, N. H. (2016). The relationship between stress and university student’s mental health. International Symposium & Exhibition on Business and Accounting (ISEBA 2016), p.p 1-6. ISBN: 978-983-42982-8-9. ▶ National Health & Morbidity Survey (NHMS) 2018: Key Findings from the Aolescents Health and Nutrition Surveys. Kuala Lumpur: Institute for Public Health, National Institute of Health, Ministry of Health Malaysia. ISBN 978- 983-2387-76-3. ▶ Appleby., D., Herting., L., & Schullo., S. (2017). Time Management Activity Teaching Resources for High School Psychology Teachers on Skills. American Psychological Association. ▶ American Psychological Association. Relaxation Therapy. Retrieved from http://dictionary.apa.org/relaxation-therapy ▶ Rasid, Z. M., & Parish, T. S., (1998). The effects of two types of relaxation training on students’ levels of anxiety. Adolescence, 33: 129, p. 99. Gale OneFile: Health and Medicine. ▶ Duckworth, M. P. (2009). Assertiveness skills and the management of related factors in O’Donohue, W. T., Fisher, J. E., & Hayes, S. C. (Eds.). (2004). Cognitive behaviour therapy: Applying empirically supported techniques in your practice. John Wiley & Sons. ▶ Saulsman, L., Nathan, P., Lim. L., Correia, H., Anderson, R., & Campbell, B. (2015). What? Me Worry!?! Mastering Your Worries. Perth, Western Australia: Centre for Clinical Interventions. ▶ American Psychological Association. (2014). The Road to Resilience. Retrieved from https://www.apa.org/helpcenter/road-resilience on November 18th, 2019.

03 LEARNING OUTCOMES BY THE END OF THIS CHAPTER, YOU SHOULD BE ABLE TO: ▶ Describe the concept of mental illness. ▶ Explain various manifestations and types of mental illness. ▶ Describe possible causes of mental illness. ▶ EXplain holistic management of mental illness. MENTAL ILLNESS

HEALTH AND WELLNESS @ UNI 44 3.1 INTRODUCTION In this chapter you will be introduced to the concept of mental illness. Common manifestations of mental illness and various types of mental illness will be briefly discussed. At the end of the chapter, you will be guided through the holistic management of mental illness. 3.2 THE CONCEPT OF MENTAL ILLNESS 3.2.1 Comprehensive approach Kindly refer to chapter 1 for better understanding of the definition of health. All aspects of life; your physical, psychological, social, and spiritual components should function well for you to be truly healthy. These aspects interact with each other to ensure that you are healthy. Disturbance in any of these aspects may trigger changes in your physical, psychological, social, and spiritual function. When this occurs, you are considered “unhealthy” or having an illness or sick. 3.2.2 Mental Illness The definition of mental illness is very subjective. An imbalance between your physical, psychological, social, and spiritual aspects, may cause you to suffer from mental illness. You are considered to suffer from mental illness when you have: i. Distress: ◆ You feel discomfort because of your behaviour. ii. Duration: ◆ You have the disturbances for a certain duration of time. iii. Impairment of functions: ◆ You are not able to continue with your normal activities (such as your studies, relationship, and interaction with others, fulfilling your responsibilities, and other social activities anymore). iv. Risk to self or others: ◆ You deal with your stress by using maladaptive coping strategies that can harm yourself (such as not eating well, not looking after self-hygiene, inflicting self-injury) or others (harming people, aggressive, violent behaviour). v. Atypical behaviour: ◆ You manifest behaviour which is not socially and culturally acceptable (such as inappropriately talking to self, being naked in public, unnecessary paranoia).

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 45 3.3 MANIFESTATION AND TYPE OF MENTAL ILLNESS There are various manifestations of mental illness. Here, you will be introduced to common manifestations of mental illness including depression, suicide, psychosis, anxiety, mania, and obsession. 3.3.1 Depression “Feeling sad” or sadness is a normal emotion. It is normal to be sad. However, prolonged sadness is considered as depression. It is one of the important symptoms of mental illness. When someone is depressed, the sadness continues every day. It may be worse at a particular time of the day. For example, in severe melancholic depression, you may feel very sad early at dawn or early hours in the morning. You may have difficulty to admit that you feel sad or depressed. Other feelings which are considered as depression are loss of pleasure, lack of interest, feeling empty, bored, feeling demoralised and lack of motivation. Depression comes with physical symptoms too. These include sleep disturbances (difficulty to sleep, intermittent awakening at night, early morning awakening), body ache, reduced appetite, reduced weight, lack of energy and lack of sexual interest. If you are depressed, your brain may not function well. (Refer to Chapter 4 to know more on stress physiology). Hence, you may have difficulty paying attention at school, lack of concentration, memory problem, feeling guilty, feeling hopeless and useless and feeling that you are burdening others. Refer to Anne’s story above as an example of those who have depression. Anne seeks help immediately. She takes an appointment to see doctors at Klinik Minda sihat by calling 03-55442999 (UiTM Health Centre). If you have similar experience, please seek help. Read Chapter 1 for further information. Call 0355442999/3999 for any emergency. In severe depression, you may have anxiety, psychosis, and suicidal behaviour. Common mental illnesses manifest with depression include major depression, bipolar disorder, schizoaffective disorder, substance abuse.

HEALTH AND WELLNESS @ UNI 46 3.3.2 Anxiety “Feeling anxious” or having “fear” of something is a normal emotion. It is normal to have these feelings. However, if these feelings are prolonged and disturbed your function, you are considered to have anxiety. It is one of the important symptoms of mental illness. Feeling anxious and having fear is a normal response to a threat or danger (also called the fight and flight response). Examples of normal feelings include when you feel anxious during exam and when you have a fear that a dog may harm you. These symptoms of anxiety are normal. Figure 3.1 illustrates the changes you feel when you are anxious. Figure 3.1 Manifestations of Anxiety https://stephensoncoaching.com/public-speaking-and-the-fight-or-flight-response/

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 47 These anxious feelings may come suddenly; it is called anxiety or panic attack. When normal anxious feelings continue and disturb your function, you may have an anxiety disorder; a mental illness. In severe anxiety, you may have depression. Fearful and anxious towards specific things, coupled with avoidance behaviour is called a phobia. For example, if you are afraid of communicating with others and having a fear of giving a presentation, you might have, or experience social phobia. Refer to Ali’s story above as an example of those who have anxiety. Ali seeks help immediately. He takes an appointment to see counsellor at Career and Counselling Centre at https://careercounseling4u.uitm.edu.my. If you have similar experience, please seek help. Read Chapter 1 for further information. Common mental illnesses manifest with anxiety include generalised anxiety disorder, panic disorder, post traumatic disorder, specific phobia, social phobia, agoraphobia, depressive disorder, and drug abuse. Physical illness may also manifest with anxiety. Examples include hyperthyroidism, heart disease, adrenal tumour, and many others. 3.3.3 Psychosis Psychosis is abnormal. When you have psychosis, you are considered to have mental illness. A few important experiences that you may have if you have psychosis including hallucination, delusion, disorganised behaviour, disorganised thoughts, and disorganised speech. Hallucination is a false sensation. Your brain perceives something without the presence of true sensation. It can be divided into many types including auditory, visual, tactile, gustatory, and somatic hallucination. Table 3.1 shows the experience of hallucinations. Delusion is a false and fixed belief which is not in keeping with your social, educational, spiritual, and cultural belief. There are many types of delusions. Table 3.2 shows a few examples of delusion

HEALTH AND WELLNESS @ UNI 48 TYPE OF HALLUCINATION EXAMPLES AUDITORY (HEARING) HALLUCINATION » I can hear my late mother talk to me, but others cannot hear it. » The voice said to me “You should die. You are a useless student.”. The voice whispered to me. VISUAL (SEEING) HALLUCINATION » I can see the angel flying. » I can see the man was holding a knife. But others cannot see it. TACTILE (TOUCHING) HALLUCINATION » I can feel bugs crawling under my skin. » Something is moving at my back. But nothing was there. OLFACTORY (SMELLING) HALLUCINATION At night, my room smell like the angel have showered my room with roses. GUSTATORY (TASTING) HALLUCINATION I can taste something even though, it is nothing inside my mouth. SOMATIC (DEEP SENSATION) HALLUCINATION I can feel the baby moving inside my tummy. TYPE OF DELUSION EXAMPLES PARANOID DELUSION » I believe that my friends wanted to kill me. » I am sure that they wanted to harm me. DELUSION OF REFERENCE » I believe that everyone is talking about me. » The TV is talking about my life story. GRANDIOSE DELUSION » I have millions of money in my bank. » I am the chosen one, the last caliph in this world. DELUSION OF CONTROL » I believe that my brain is controlled by the alien. » There is something goes inside my body and control my movement. NIHILISTIC DELUSION » My heart is not pumping anymore. » No blood inside my body. BIZARRE DELUSION » I believe that the alien is coming to the earth tomorrow and they will bring me to the heaven Disorganised behaviour occurs when you have weird behaviour which most people agree that the behaviour is inappropriate such as laughing to yourself, not having shower for days, not eating for days, lying down without moving for days, dancing inappropriately in front of public etc. Disorganised thoughts are when others cannot understand your thinking properly. It often manifests with disorganised speech. You are basically talking nonsense, irrelevant and incoherent. Table 3.1 Examples of Hallucination Table 3.2 Examples of Delusion Common mental illnesses manifest with psychosis include schizophrenia, schizoaffective disorder, major depression, bipolar disorder, and drug abuse.

A MODULE TO ENHANCE STUDENTS’ HEALTH AND WELL-BEING 49 Physical illness may also manifest with psychosis. Examples include infection of the brain (meningitis, encephalitis), tumour of brain, problems with electrolyte, metabolites, or hormones (hyperthyroidism, kidney dysfunction) and many others. If you or your friends have any of the above symptoms, please seek help from: ◆ Career and Counselling Centre at https://careercounseling4u.uitm.edu. my. ◆ Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see the doctors or called 03-55442999 for more information. ◆ Or make an appointment at UiTM Hospital and its branches at Selayang or Sungai Buloh Campus to see psychiatrist. Refer to Chapter 1 for further information. REFLECTION Your friend has psychosis. Could you give examples of his/her behaviour? Who should you call to bring her/him for treatment? 3.3.4 Mania Mania is a group of symptoms occurs in bipolar disorder; a type of mental illness. The manifestation of mania is opposite to depression. If you have mania you feel extremely happy, elated and euphoric. Unlike normal condition, during mania, you feel energetic and can do your routine work very fast with good concentration and attention. You talk very fast and people realise that you become talkative. You feel energetic and do not feel that you need to sleep. Hence, you may not sleep at all, or you feel sleeping only for 1 to 2 hours is enough for you. Those with mania also easily feel irritable, hence easily getting angry and instigates aggression and violent behaviour. Sexual interest of those with mania may increase which precipitates flirtatious behaviour and sexual assault. In severe cases, mania can present with delusion. The commonest delusion for those with mania is grandiose delusion. Refer to Abu’s story as an example of those with mania.

HEALTH AND WELLNESS @ UNI 50 Refer to Mala’s story above as an example of those who have OCD. Mala seeks help immediately. She makes an appointment to see doctors at Klinik Minda Sihat by calling 03-55442999 (UiTM Health Centre). If you have similar experience, please seek help. Refer to Chapter 1 for further information. Common mental illnesses manifest with mania include schizoaffective disorder, bipolar disorder, and drug abuse especially amphetamine and methamphetamine (such as ecstasy pills) and cannabis. Physical illness may also manifest with mania. Examples include tumour of brain. If you or your friends have any of the above symptoms, please seek help from: ◆ Career and Counselling Centre at https://careercounseling4u.uitm.edu. my. ◆ Or call Klinik Minda Sihat at any UiTM Health Clinics nearest to you to see the doctors or called 03-55442999 for more information. ◆ Or make an appointment at UiTM Hospital and its branches at Selayang or Sungai Buloh Campus to see psychiatrist. 3.3.5 Obsession You are having obsession when you have thoughts, ideas, images, or impulses which are recurrent and persistent which cause you to feel discomfort and distress. These thoughts are not simply excessive worries about real life problems. You recognise that the thoughts, ideas, images or impulses come from your own thought and you try hard to stop or resist them, but it is difficult. Because of feeling distress with your obsession, you try to reduce it by having compulsion. You have compulsion when you have repetitive behaviour (such as hand washing, arranging, checking) or mental act (such as doubt, praying, counting). The repetitive behaviour or mental act is clearly excessive Common mental illnesses manifest with obsession include obsessive compulsive disorder (OCD) and Tourette’s disorder.