Home Health Mental health: Neglected public health concern

Mental health: Neglected public health concern


Text by Henrylito D. Tacio

Photos from PMG News and iStock

Michael was one of the most gregarious persons you’ll ever meet; his friends could attest to that. But it all changed when his beloved mother died of a heart attack. He became aloof and loved to be alone.

It became worse when, two months before their wedding day, his bride-to-be died in an accident. He couldn’t accept that the apple of his eyes would soon leave him. “He was completely devastated,” said his father, Jonathan.

In order for him to forget what happened to him, he accepted the offer to work in the United States. While there, he communicated with his family in the Philippines by talking with them over the phone.

In some of their talks, Jonathan sensed there was something wrong with his son. “He may be tired from his work,” he surmised.

But two years after working in the United States, Michael decided to go back to the Philippines for good. His family was completely surprised by his decision. But they accepted it anyway.

It was at the height of coronavirus disease 2019 (COVID-19) when he returned. Arriving in his hometown, he was required to do the mandatory 14-day quarantine. He was alone in his room – even his roommates at the facility wouldn’t talk with him as he came from another country. 

On the ninth day of his isolation, he was found hanging in a room – dead. He committed suicide. He left a note with these words: “I could no longer take the pain.” 

Only then did his family know that he was suffering from depression. The loneliness he experienced during the quarantine may have contributed to drive him to commit suicide. He never revealed to his family the struggles he was fighting. 

The total isolation was the culmination of it all.

Even before the pandemic, suicide was already a health concern. A report from the World Health Organization (WHO) showed the Philippines has suicide rates (per 100,000) of 2.5 for men and 1.7 for women.

The Manila Journal reported that the National Center for Mental Health’s crisis hotline has been receiving an “alarming” surge of calls with a daily average of 32 to 37 and a monthly average of 907 from March to October last year.

Dr. Frances Prescilla Cueva, head of the National Mental Health Program of the Department of Health (DOH), said in a press briefing that among the monthly calls, 53 are suicide-related.

Suicide is a mental health issue – and the DOH said that at least 3.6 million Filipinos are suffering from mental, neurological, and substance use disorders (MNS). The health agency admitted, however, that the figure could be higher as it only covered these three “selected conditions.”

Mental health, as defined by WHO, is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

According to the United Nations health agency, relatively few people around the world have access to quality mental health services. In low- and middle-income countries, more than 75% of people with mental, neurological, and substance use disorders receive no treatment for their condition at all.

“Mental health is one aspect in the society that is not given utmost attention,” deplored senatorial candidate Loren Legarda. “With various societal issues that we are facing, we sometimes neglect to prioritize the mental health of every citizen of this nation without us knowing its effects on people’s day-to-day performance on education, employment, physical health and even relationships.”

Counselling (PMG-News)

Legarda continues to push for the utilization of the Mental Health Act, which she co-authored. Under Republic Act No. 11036, the law seeks to provide affordable and accessible mental health services for Filipinos suffering from mental disabilities.

Mental illness ranks third among the types of disabilities in the country. The health department reported that one in 5 Filipino adults has some form of mental illness, topped by schizophrenia, depression, and anxiety.

A few years back, the United Nations health agency considered the Philippines as having “the highest incidence of depression in Southeast Asia.” Only one-third of those suffering from depression seek professional help, according to the health department.

More often than not, depression is hard to detect among Filipinos. “People confuse depression for normal sadness,” Dr. Randy Dellosa, a psychiatrist, was quoted as saying by national media.

“Depression is a devastating illness that affects the total being – physically, emotionally, and spiritually,” wrote Frank B. Minirth and Paul D. Meier in their book, Happiness Is a Choice. “The emotional pain of depression is more severe than the physical pain of a broken leg.”

Many people think depression is not an illness but something that one eventually snaps out of. “That’s the reason why so many people who are suffering from depression feel embarrassed to seek help,” said then-Senator Grace Poe.

“Approximately 10% of patients seeking consultation in a family practice clinic are already showing signs of depression, some maybe in early stages of depression, and some in a chronic stage,” writes Dr. Edward C. Tordesillas, clinical associate professor of the Department of Family and Community Medicine at the Philippine General Hospital.

According to Dr. Tordesillas, some patients have gone on what he calls “doctor shopping,” since they were unrelieved of their symptoms. 

“Let us not judge those who have mental health issues,” DOH Undersecretary Eric Domingo was quoted as saying by the state-owned Philippine News Agency. “Let us think that it is like hypertension and diabetes when we see someone with symptoms of depression.”

But a report on the assessment of the mental health system in the Philippines using the WHO Assessment Instrument for Mental Health Systems (AIMS) showed that only 5% of health care expenditures by the government health department are directed towards mental health.

“Of all the expenditures on mental health, 95% are spent on the operation, maintenance and salary of personnel of mental hospitals,” the report stated. “The percentage of the population that has free access (at least 80%) to essential psychotropic medicines is unknown.”

The Philippine Health Insurance Corporation (PHIC) recently covered mental illness but was limited only to patients with severe mental disorders confined for a short duration.

According to the report, there are 46 outpatient mental health facilities available in the country, of which 28% allocate units that are for children and adolescents only. “These facilities treat 124.3 users per 100,000 general population,” it said. “Of all users treated in mental health outpatient facilities 43% are female and 8% of all contacts were children or adolescents.”

The leading diagnoses of users treated in outpatient facilities are mainly schizophrenia and related disorders (57%) and mood disorders (19%). Information on diagnosis is based on the number of users treated. The average number of contacts per user is 1.87.

Twenty-four percent of outpatient facilities provide follow-up care in the community, while 11% have mental health mobile teams, the report stated. In terms of available treatments, a majority (51-80%) of the patients received psychosocial treatments.

One good this is that all mental health outpatient facilities have at least one psychotropic medicine of each therapeutic class (antipsychotic, antidepressant, mood stabilizer, anxiolytic, and antiepileptic medicines) available in the facility or a nearby pharmacy all year round.

Last year, Senator Christopher Lawrence “Bong” Go presided over a Senate Health Committee hearing to discuss Senate Bill 1471, which seeks to amend Republic Act 11036 or the Mental Health Act. Filed by Senator Juan Edgardo Angara and supported by Go himself, the bill will enhance Section 5 of the Act or the Rights of Service Users.

The new section will provide Filipinos with mental health conditions immediate access to the “compensation benefits and/or any special financial assistance that he or she is entitled to under existing laws should the service user sustain temporary or permanent mental disability while in performance of duty or by reason of his or her office or position.” 

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