Editor's note: The infographic in this article was added on 11 July 2017.
In the Philippines, one in five people suffers from a mental health problem. In a country with a population of 100 million, there are presently only 700 psychiatrists and a thousand psychiatric nurses.
The statistics are worrisome. But more alarming is the fact that a national mental health law has yet to be enacted despite the urgings of various advocates.
Vice President Leni Robredo, during her term as district representative in the 16th Congress, was the last to file such legislation (House Bill 5374), with a counterpart (Senate Bill 2910) authored by Senator Pia Cayetano. Neither one passed muster.
Had it been approved, the mental health law would uplift the country’s current mental health practice, protect the rights of the mentally ill, and create a national mental health council. It would also mandate the study of mental health among medical students.
The absence of a law is not for lack of trying. The earliest version was filed in the late 1980s, with Senator Orlando Mercado as the author. The following year, a similar measure was proposed by another senator, Jose Lina.
Instead of a law, what serves as a guideline is the Philippine Mental Health Policy, signed by then Health Secretary Manuel M. Dayrit in 2001.
Policy statements included leadership in the mental health sector, standards for quality health care, human resource development, and empowerment and participation, among others.
It was last revised in 2005 accordingly to the National Objectives for Health (2010-2015).
Who are affected
Between 17 to 20 percent of Filipino adults experience psychiatric disorders, while 10 to 15 percent of Filipino children, aged 5 to 15, suffer from mental health problems.
According to the National Statistics Office (NSO), mental health illnesses are the third most common forms of morbidity for Filipinos.
Furthermore, a 2010 national census that found 1.4 million people with identified disabilities showed that mental disability accounts for 14 percent of all disabilities.
In the same NSO study, 88 cases of mental health problems were reported for every 100,000 Filipinos.
According to the latest numbers from the new Philippine Health Information System on Mental Health (PHIS-MH), schizophrenia is the top mental health problem in the Philippines, affecting 42 percent of the study cohort. Most of them were male.
Other mental health disorders in the list are depression, anxiety disorder, schizoaffective disorder, acute and transient disorder, and stimulant-related disorder.
This particular survey included 2,562 patients in 14 participating public and private hospitals from May 2014 to May 2016. The PHIS-MH was conducted to collect data on mental health in the Philippines as a tool to put together a mental healthcare database in the country.
Suicide is another creeping problem in the Philippines. In 2012, 2,558 Filipinos committed suicide, and of the number, 2009 were males.
The World Health Organization (WHO), meanwhile, notes the numbers could simply be a fraction of the actual problem since suicide, especially in a Catholic country, tends to be under-reported.
It was recently reported that non-government organizations like the Natasha Goulbourne Foundation, in cooperation with medical experts and activists, are now working with the government to establish anti-suicide measures.
The Natasha Goulbourne Foundation and Department of Health earlier announced a new campaign, Hopeline, a 24-7 suicide counseling hotline. It will kick-off this month.
Health Secretary, Paulyn Ubial gave assurances that “mental health won’t take a backseat in the health agenda of the current administration.” She declared that mental health was included in the department’s priority health concerns.
The funds set aside for mental health is a pittance - just five percent of the health department's total annual budget.
And of that, 95 percent goes to operational costs such as maintenance of institutions and personnel’s salary, according to the World Health Organizations, Assessment Instrument for Mental Health System (WHO-AIMS).
As a public health concern, mental health is not among the priorities as evidenced by its exclusion from health insurance packages.
The state-run insurance firm, Philippine Health Insurance Corporation (Philhealth) recently added mental illness under its coverage but this is only for severe disorders and confinement is for a short duration.
Institutions and professionals
Although there are mental health care facilities - both public and private - in the country, these are scant and poorly linked. The majority, however, are still within the National Capital Region, making accessibility a challenge for those in far-away places.
“Access to mental health facilities is uneven,” the WHO-AIMS notes.
The government presently runs the National Center for Mental Health in Mandaluyong City, Metro Manila, Cavite Center for Mental Health in Trece Martires, Cavite, and the Mariveles Mental Ward in Bataan. All are specialized institutions for mental health care.
The bigger state-run hospitals also have psychiatric wards as well, such as the Philippine General Hospital in Manila.
Private hospitals such as Makati Medical Center, University of Santo Tomas Hospital, University of the East Ramon Magsaysay Memorial Medical Center, and Metro Psychotherapy Facility offer mental health care services, as well as other smaller facilities.
Also, a reflection of how mental health is perceived in the country is the very low number of professionals specialising in this critical field.
Even with just 20 percent of the population experiencing some form of mental health disorder, the number of health professionals (700 psychiatrists and 1,000 nurses) is grossly inadequate.
It is made worse by the fact that more than half of these psychiatrists work for profit, mostly in private practice, depriving many low-income sufferers of medical access and support.
There is currently no available data regarding the exact distribution of the mental health professionals, but it is highly likely that many are concentrated in urban areas.
Mental hospitals have an occupancy rate of 92 percent, based on the 2007 WHO-AIMS report, with a majority of patients diagnosed with schizophrenia.
Community mental health care
The most notable example of the need for mental health care in the community setting was when Typhoon Yolanda (international name Typhoon Haiyan) lashed through parts of the Philippines.
The destruction, loss of lives and tragic experiences hammered the need to support victims in the area of mental health care.
The United Nations estimated that more than 800,000 people suffered various types of mental health conditions such as depression, anxiety disorders, and post-traumatic stress disorders.
About 80,000 needed further medication and support.
WHO Philippine Representative, Julie Hall, told media, that mental health problem trends increase in 6 months to 18 months post-tragedy, and only declines 18 months to 2 years after.
“During that time, obviously people are going to need a lot of support and help,” she said.
As a response, WHO executed a psychological first aid to tackle Yolanda-related mental health problems such as psychological distress and trauma-related conditions as well as depression.
Under the WHO’s Mental health Gap Action Plan (MhGAP), 300 community workers and health professionals were trained to give psychological care to people immediately.
In the WHO-AIMS report, the researchers noted that there was indeed an effort to place mental health services in the community settings headed by the National Mental Health Program in the mid-1990’s.
It was meant to provide training to health professionals to identify psychiatric morbidities and psychosocial problems.
However, the report also noted that those who went through training were no longer in place of their duty and the current healthcare staff have inadequate training in mental health. Interactions with mental health facilities are uncommon, the report noted. MIMS
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