The state of Philippine mental health

“The Philippines [has] a National Mental Health Policy (Administrative Order # 8 s.2001) signed by then Secretary of Health Manuel M. Dayrit. There is no mental health legislation and the laws that govern the provision of mental health services are contained in various parts of promulgated laws such as Penal Code, Magna Carta for Disabled Person, Family Code, and the Dangerous Drug Act, etc. The country spends about 5% of the total health budget on mental health and substantial portions of it are spent on the operation and maintenance of mental hospitals. The new social insurance scheme covers mental disorders but is limited to acute inpatient care. Psychotropic medications are available in the mental health facilities. A Commission on Human Right of the Philippines exists, however, human rights were reviewed only in some facilities and only a small percentage of mental health workers received training related to human rights. These measures need to be extended to all facilities.

The National Program Management Committee of the Department of Health (DOH) acts as the mental health authority. Forty-six outpatient facilities treat 124.3 users per 100,000 populations. The rate of users per 100,000 general population for day treatment facilities and community based psychiatric inpatient units are 4.42 and 9.98, respectively. There are fifteen community residential (custodial home-care) facilities that treat 1.09 users per 100,000 general population. Mental hospitals treat 8.97 patients per 100,000 general population and the occupancy rate is 92%. The majority of patients admitted have a diagnosis of schizophrenia. There has been no increase in the number of mental hospital beds in the last five years. All forensic beds (400) are at the National Center for Mental Health. Involuntary admissions and the use of restraints or seclusion are common.

There was an effort by the National Mental Health Program in the mid 1990’s to integrate mental health services in community settings through trainings of municipal health doctors and nurses on the identification and management of specific psychiatric morbidities and psychosocial problems. However, at present it appears that the majority of the trained community-based health workers are no longer in their place of duty, and the current primary health care staff seem to have inadequate training in mental health and interaction with mental health facilities is uncommon.

There are 3.47 human resources working in mental health for 100,000 general population. Rates are particularly low for social workers and occupational therapists. More than fifty percent of psychiatrists work in for-profit mental health facilities and private practice. The distribution of human resources for mental health seems to favor that of mental health facilities in the main city. There is a consumer association involved in planning and implementing policies and plans. Family associations are present in the country but are not involved in implementing policies and plans, and few interact with mental health facilities. Public education and advocacy campaigns are overseen by the DOH and coordinated in the regional offices. Private sector organizations do their share in increasing awareness on the importance of mental health, but they utilize different structures. There are mental health links with other relevant sectors, but there is no legislative or financial support for people with mental disorders.

Non-standardized data are collected and compiled by facilities to a variable extent. Mental health facilities transmitted data to the government health department. There have been several studies done on mental health but not all were published in indexed journals. Some studies on non- epidemiological clinical /questionnaires assessments of mental disorders and services have been conducted.

In the Philippines, the mental health system has different types of mental health facilities, and some need to be strengthened and developed. At present, mental hospitals are working within their capacity (in terms of number of beds/patient), even though there has been no increase in number of beds in the last 5 years. Some facilities are devoted to children and adolescents. Access to mental health facilities is uneven across the country, favoring those living in or near the National Capital Region. There are informal links between the mental health sector and other sectors, and many of the critical links are weak and need to be developed (i.e., links with the welfare, housing, judicial, work provision, education sectors). The mental health information system does not cover all relevant information in all facilities.

In the last few years, the numbers of outpatient facilities have slightly grown throughout the country from 38 to 46. Moreover, efforts have been made to improve the quality of life and treatment of patients in mental hospitals. Some aspects of life in hospitals have improved, but the number of patients has grown steadily. Unfortunately, the low priority on mental health is a significant barrier to progress in the treatment of patients in the community.

In order to put the information contained above into context, comparisons with regional norms are made. The Philippines, like most countries of the Western Pacific region, have a national mental health policy. However, in comparison to other countries, it was put into operation relatively recently. Community care for patients is present, but as seen in many low and lower middle income countries, it is limited. Unlike the majority of countries in the world and the region, the Philippines have no mental health law. The poor involvement of primary health care services in mental health is also a feature shared with many low and lower middle resource countries. The number of psychiatrists per 100,000 general population is similar to the majority of countries in the Western Pacific region and about average for lower middle resource countries in the world (Mental Health Atlas WHO, 2005). ”



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