A Promise to Be Fulfilled—the Philippine Mental Health Law of 2018
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(Source: pxfuel)
The WHO says around 800,000 people commit suicide every year. Take the case of a 33-year-old Filipino journalist who has attempted to end his life five times; he was diagnosed with borderline and obsessive-compulsive personality disorder, anxiety and depression. He spoke about his attempt in 2015: “I was not in my right mind… I was feeling pretty abandoned by those I considered important to me in my life. At the time, I was experiencing a psychotic break. I typed a suicide note on Facebook, which a lot of people saw – my boss, my friends, my family – because of my suicide note on Facebook, they went on a manhunt to find me.” Fortunately, his mother and his close friend at a nearby condominium were able to run to his aid.
In another instance, a 16-year-old college freshman studying Behavioral Sciences in the University of the Philippines was found dead at her family residence in Tondo, Manila. This was two days after she was forced by the school administration to stop attending her classes because of unpaid tuition. The eldest of five children of a taxi driver and a housewife, she was classified by the university administration under Bracket D of the Socialized Tuition and Financial Assistance Program. The UP Manila’s no-late-payment policy forces students unable to pay their tuition fees to take a leave from the university. The student was forced to file for a leave of absence and it is believed that financial constraints may have triggered the suicide, according to the UP Manila student publication.
Many more such stories can be found in the conventional and social media, though some remain unreported and are swept under the rug.
Mental illness in the Philippines is wrapped in stigma. Though the adverse attitude is softening and slowly unraveling, many Filipinos are ashamed to talk about their mental health concerns. A growing number of mental health advocates continue to encourage openness and seeking professional help among those who may be struggling with depression and anxiety.
The Department of Health reported that in June 2018 there were 2,550 suicide cases in the country and 20 percent of the calls received in its Suicide Hotline were related to depression. Moreover, 3.3 million Filipinos suffer from depressive disorders. A 2017 WHO report said 8 in every 100,000 Filipinos commit suicide; 6 of the 8 are males and two are females, aged 15-29 years old.
The growing mental health crisis among Filipino youth is worrisome, said Dr. Cornelio Banaag, the foremost child psychiatrist in the country. He has seen cases of depression, anxiety, self-harm, and suicidal thoughts and actions rise among children as young as ten years old.
Congresswoman Rida Robes lamented that suicide among the country’s youth “is becoming as prevalent as the common cold.” Similarly, Archbishop Jose Advincula of the Archdiocese of Capiz cited the need to understand the root cause of wanting to take one’s life. He encouraged individuals to talk to their priests or seek help from someone they trust. He said the church is always ready to provide moral and spiritual guidance to those who are suffering from depression.
“The Department of Health reported that in June 2018 there were 2,550 suicide cases in the country and 20 percent of the calls received in its Suicide Hotline were related to depression.”
Why the spate of suicides? Some blame technology and social media, changing lifestyles and lack of family and community support, including parental absence among children of overseas Filipino workers. Extreme poverty, hunger, loneliness and isolation of the elderly, lack of a sense of purpose in life, disconnectedness, deteriorating relationships and lack of quality time with children are likely explanations. Also, the Philippines is confronted with many mental health risk factors such as disastrous typhoons, volcanic eruptions and the pandemic outbreak. Add to this the homicidal anti-drug campaign by the Duterte administration and chronic civil strife in Mindanao.
In truth, we do not have the hard evidence to pinpoint the culprits in the rising trend of mental disorders. In fact, this is a global research challenge identified at the international workshop spearheaded by the UK Academy of Sciences in 2018 and 2019. The Philippines is part of this global action research. Mental health experts say that one in every five Filipinos suffer from some mental disorder. For now, this fact is generally accepted because getting precise figures is a work in progress.
The good news is that the Philippines is now taking mental health care to heart. Mental health initiatives are now on stream.
The Department of Health (DOH) is trying to straighten its mental health information system in collaboration with the UP College of Medicine. With a total budget of PhP 49.3 million, the National Survey and Mental Health Well-being (NSMHW) was approved in February 2019 and will cover nine out of 17 regions in the country during its phase 1 and the balance in phase 2. The data will be collected from 7,395 households and 22,185 individuals nationwide from March to June 2019 for Phase 1 and from August to November 2019 for Phase 2. The survey is a collaboration between the DOH, the Philippine Council for Health Research and Development, and the University of the Philippines – Manila. A team of UP psychiatrists, with technical support from the Harvard University, is conducting the survey.
The results of the NSMWH will be used to estimate the national and regional lifetime and 12-month prevalence of selected mental, neurological and substance use (MNS) disorders among Filipinos. It will also determine the impacts of these conditions as well as the health services utilization among those with MNS disorders.
Pre-COVID-19, the media reported increasing incidence of suicides, especially among the youth. Hotlines and tele-counseling--some run by private groups like the Natasha Golbourn Foundation or by the DOH and the National Center for Mental Health—have become “hot” during the pandemic, especially because of government mandated social distancing and lockdowns.
(Photo by Gabrielle Henderson)
A New Law
In June 2018, the Philippine Mental Health Law was passed after 17 years of lobbying by advocates by the Philippine Council for Mental Health (PCMH), an inter-agency body chaired by the DOH and includes professional organizations, the academe and civil society).
The law promotes the respect for the rights of patients/clients, the integration of mental health care in primary health services and the setting up of community-based health services to reach those in need in barangays and remote villages. Currently, mental health care is mostly provided in hospital settings and community mental health services are underdeveloped. A major bottleneck is the lack of trained human resources. In December 2019, the PCMH drafted a strategic plan to implement the law and achieve the strategic goal of improving mental health information, service delivery and leadership and governance.
The law seeks to have more community-based mental health care, which is long overdue. More developed societies closed mental hospitals back in the ‘60s and ‘70s and began delivering it on the community level. The Philippines attempted to do the same but did not quite succeed. By virtue of the Local Development Code of 1991, health care was decentralized to the local governments, i.e. municipalities and villages. Community-based mental health services did not substantially materialize.
Rep. Robes said, “(T)he Department (of Health) must … be prompted to implement community-based mental health programs with the same vigor and determination it shows in championing anti-AIDS, anti-dengue and anti-Japanese encephalitis campaigns.” She also urged religious institutions, civil society organizations and private corporations to contribute their share in addressing these emergent problems through counseling, stress debriefing, establishment of helplines for young people. She also suggested putting a national anti-suicide prevention program in place, restoring the study of values education as a stand-alone subject in basic and higher educational curricula; legislating responsible social media usage among young people and relaxing steep licensing requirements for guidance counselors to allow public schools to hire the required number of guidance counselors to help students cope with mental health issues.
The Mental Health Strategic Plan requires significant funding. In the past, its budget was embarrassingly meager -- only 3–5 percent of the total health budget is spent on mental health, and 70 percent of this is spent on hospital care (WHO & Department of Health, 2006). Funding for the Plan will be drawn from the DOH annual budget, but COVID 19 has interrupted the momentum for reform in mental health care.
In 2020, anxiety over COVID-19 has overtaken suicide awareness. Spikes in the incidence of depression and anxiety have been reported not only in the Philippines, but also in China and the United Kingdom. This has led to a global call to invest more in mental health and warnings that mental disorders might be the next crisis after COVID-19 which could leave a footprint of constant anxiety among people until an effective vaccine is found.
For now, private and non-government groups are filling the gaps in mental health care in the Philippines. For example, alumni of one secondary school have financed the engagement of psychiatrists to give psychosocial counseling to students with mental health issues. Also, a coalition of NGOs is advocating for mental health, especially under the “new normal” arising from the COVID-19 pandemic.
All told, the Mental Health Law is a promise yet to be fulfilled in the Philippines.
Lucita S. Lazo
Lucita S. Lazo, President of World Association for Psychosocial Rehabilitation, UP High 1966 and former Faculty of the UP Department of Psychology (Diliman), 1970-1979.