Mental Health in the Philippines: By the numbers

By:Charisa Ane Magtubo September 2,2016

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.

Insufficient budget
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

Source: Magtubo., C.(2016). MIMS TODAY Mental Health in the Philippines: By the numbers. Retrieved
from https://today.mims.com/mental-health-in-the-philippines--by-the-numbers on March 16, 2018

SPECIAL REPORT: Suicide and the Pinoy

youth
Published July 17, 2015 8:38pm
By CARMELA G. LAPEÑA

In countries like the Philippines where mental health is rarely discussed, it usually takes a high profile
case before people begin talking about suicide and depression.

There are only a few studies on suicide, but those that exist all show the need for better data, and more
importantly, a national prevention program.

Suicide is the second leading cause of death globally among people 15 to 29 years of age, according to
the 2014 global report on preventing suicide by the World Health Organization.
In the Philippines, the estimated number of suicides in 2012 was 2,558 (550 female, 2009 male),
according to the same report.

Meanwhile, the age-standardized suicide rate (per 100,000) in 2012 was 2.9 for both sexes – a 13.5
percent increase from 2.6 in 2000. For females, there was a 13 percent decrease from 1.4 in 2000 to 1.2
in 2012. For males, there was a 24.4 increase from 3.9 in 2000 to 4.8 in 2012.

The figures in the Philippines are lower than the annual global age-standardized suicide rate of 11.4 per
100,000 population (15.0 for males and 8.0 for females). The Philippines also has the lowest suicide rate
among ASEAN-member countries.

However, it is important to consider that suicides are likely to be underreported.

Breaking taboos

"Registering a suicide is a complicated procedure involving several different authorities, often including
law enforcement. And in countries without reliable registration of deaths, suicides simply die
uncounted," WHO noted in its report.

The WHO also noted that because of stigma surrounding suicide, it is difficult for many people to seek
help. "Raising community awareness and breaking down taboos are important for countries making
efforts to prevent suicide,” it said.

In some countries, suicide is illegal. This is not the case in the Philippines, but there are other major
barriers to the development of a national suicide prevention program.

Among these barriers, which psychiatrist Dr. Dinah Pacquing-Nadera cites in her paper on suicide in the
country, is "strong Catholic faith which frowns upon suicide, discouraging families from reporting."
Jean Goulbourn, president of the mental health advocacy group Natasha Goulbourn Foundation,
explained that many Filipinos do not understand depression.

"Ang akala nila baliw ang depression. Ang unang-unang kailangan nilang malaman ay... ang depression
ay hindi baliw," she said in a previous interview.

Although there are 4.5 million depressed Filipinos – the highest in Southeast Asia — only one out of
three who suffer from depression will seek the help of a specialist, according to WHO. One third will not
even be aware of their condition.

“In the Philippines, many people still think that depression is not an illness, but something that one
eventually snaps out of, and that’s the reason why so many people who are suffering from depression
feel embarrassed to seek help,” said Senator Grace Poe, who filed a resolution on the increasing
incidence of suicide and depression in the country.

Filed in 2013, the resolution highlighted the importance of a focused suicide prevention program, as
well as improving data quality and better reporting on suicide deaths.

Suicide and the youth

There is little available data on suicide among the youth in particular, but the 2013 Young Adult Fertility
and Sexuality Study (YAFS4) showed a decline in the proportion of youth who ever thought of suicide.

Conducted by UP Population Institute and the Demographic Research and Development Foundation,
YAFS4 found that among 15 to 19 year olds, the rate was 13.4 in 2002, and 8.7 in 2013.
The study also noted a low level of suicide attempts in the same age group, with 3.4 in 2002 and 3.2 in
2013. However, there was an increase in the proportion of suicide attempts among those who had
thought of suicide, with 25 in 2002 and 36.7 in 2013.

Among Filipino students surveyed in the 2003–2004 Global Schoolbased Student Health Survey (GSHS),
42 percent had felt sad or hopeless for two weeks or more in the past year, 17.1 percent had seriously
considered committing suicide in the last year and 16.7 percent had made a plan about how they would
commit suicide.

According to the GSHS, females were more than twice as likely as males to have had suicidal thoughts,
but males were more likely to carry out a suicidal act than females. As with the other studies, it was
likely that youth suicide rates were underreported due to the associated stigma.

Meanwhile, another study titled “Suicide in the Philippines: Time Trend Analysis (1974-2005) and

Literature Review” revealed that "while suicide rates are low, increases in incidence and relatively high
rates in adolescents and young adults point to the importance of focused suicide prevention programs."

Using data from Philippine Health Statistics, as well as published papers, theses, and reports, the study
by Maria Theresa Redaniel, David Gunndell and May Antonnette Lebanan-Dalida found that suicide
rates have been steadily increasing in both sexes from 1984 and 2005.

For males, the rate increased from 0.23 to 3.59 per 100,000 and for females, the rate increased from
0.12 to 1.09 per 100,000. The authors noted that these increases might be explained by improved
reporting and changing social attitudes.

The study also showed that in the mid-90s, rates in all age groups peaked, and was most pronounced in
the 15 to 24 age group. This is unlike patterns in most countries, where rates tend to increase with age,
but the authors noted that "reasons for this excess in young people in the Philippines require further
investigation."

According to the study, family and relationship problems were the most common causes. In its profile of
non-fatal self-harm cases, around 52 to 87 percent of suicide hospital admissions reported having
problems with the spouse, boyfriend or girlfriend, or parents.

The study also highlighted the need to improve data quality and reporting of suicide deaths to inform
and evaluate prevention strategies.

As in other studies, the authors wrote that there is likely to be underreporting because of non
acceptance by the Catholic Church and the associated disgrace and stigma to the family.

This is also something that the Natasha Goulbourn Foundation has tried to address by reaching out to
the Catholic Bishops' Conference of the Philippines so that those who died by suicide can still receive a
Catholic burial.

As there is still no national suicide prevention program, public education is done mostly groups like
Natasha Goulbourn Foundation and the Philippine Psychiatric Association, which is pushing for a Mental
Health Act.

“The important things to remember are that suicide is a worldwide phenomenon, it's a public health
issue hitting the youth and causing economic losses, and that it's preventable,” Nadera said. —
RSJ/KBK/JST, GMA News

Retrieved from http://www.gmanetwork.com/news/lifestyle/healthandwellness/524070/special-

report-suicide-and-the-pinoy-youth/story/ on March 16, 2018