ASMPH'S Health Webinar | PAGHUBOG: Shaping the Public Mental Health System

On 26 October 2022, the Ateneo School of Medicine and Public Health (ASMPH) Center for Research and Innovation (ACRI) hosted the first of its series of webinars on the topic of public mental health system.  This was in observance of Proclamation 452 series of 1994 that declares the second week of October of each year as National Mental Health Week.

Entitled, PAGHUBOG: Shaping the Public Mental Health System, the webinar featured the following guest speakers:

1. Dr. Jan Llevado, Division Chief of the Specialty Care Division for Mental Health and Cancer Control, Department of Health;
2. Dr. Jasmine Vergara, National Professional officer for Mental Health and Substance Abuse, World Health Organization Philippines;
3. Dr. Manuel Dayrit, former Secretary of the Department of Health and former Dean of ASMPH; adjunct faculty of ASMPH and Lead of the Health Governance Flagship of ASMPH Center for Research and Innovation

Dr. Dinah Nadera of ASMPH, moderator, opened the webinar with the question on how the Mental Health Act (RA 11036 of 2018) and the Universal Health Care Act (RA 11223 of 2018) can preserve the wellness of people when more than 3 million Filipinos are suffering from depression at this time of the pandemic.

ASMPH Dean, Dr. Cenon Alfonso, in his opening remarks, said that the twin promulgation of RA 11036 and RA 11223 is “a light at the end of the tunnel; however, do these laws really provide enough legal, financial, and social support to those who suffer mental health issues?  10-15% of the young are affected by mental health problems.  If left unattended, this situation can become a public health issue that may contribute to an erosion of the country’s economy in the future.” 

The Mental Health Act.  Dr. Jan Llevado gave an overview of RA 11036 which is in      its 4th year of implementation.  She discussed the four pillars on which the strategic framework of the MH Act is anchored, namely: (1) Prevention and Promotion, (2) Governance and Leadership, (3) Services, and (4) Information and Research, and the six main objectives of the MH Act, and how these objectives are met through specific milestones.  These objectives are: (1) Strengthen effective leadership and governance for mental health; (2) Develop and establish a comprehensive, integrated, effective and efficient national mental health care system; (3) Protect the rights and freedoms of persons with psychiatric, neurologic, and psychosocial health needs; (4) Strengthen information systems, research and evidence for mental health; (5) Integrate mental health care in basic health services, and (6) Integrate strategies promoting mental health in educational institutions, the workplace, and in communities.  Through these objectives, the Mental Health Division of the DOH was created, the Philippine Council of Mental Health and its supporting structures were established, and the Mental Health Strategic Plan of 2019-2023 was crafted, which is currently undergoing localization for community-based mental health support.  The Department of Labor and Employment (DOLE) issued Department Order 208-20 on the Guidelines for the Implementation of Mental Health Workplace Policies and Programs for the Private Sector.  All these and other milestones were aimed at preserving health and wellness in communities and workplaces.  With 8% of Filipinos suffering from suicidal thoughts or ideations, DOH developed the National Suicide Prevention Strategy and identified Mental Health as a priority area for health promotion by local government units.  The LGUs will act as champions of community-based mental health care.  DOH also crafted the Health Promotion Framework Strategy for 2030 to protect and enable Filipinos to care for the self and for their communities, where the focus is on primary and intermediate care rather than on specialized care.

Dr. Llevado also discussed the expansion of the Philhealth benefit package that will be piloted in November this year.  On top of its existing benefits, the expanded package will include a primary care package of up to P9,000 that provides for 12 primary care consultations and diagnostic follow-ups, and an outpatient specialist care package of up to P16,000 that provides for 12 specialist care consultations and diagnostics.   The expansion of the Philhealth benefit is a move towards providing an integrated, comprehensive, effective, and efficient national mental health care system for Filipinos.

The Universal Health Care Act.  “Mental health is critically important for everyone, everywhere”, per Dr. Jasmine Vergara.  “It is relevant to many sectors and stakeholders.”  Thus, RA 11223 “ensures that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk.”  However, because of the Covid-19 pandemic and its wide effects on mental health, certain reforms need to be made on the UHC Act in order to improve mental health care systems and to institutionalize support mechanisms, such as health technology assessment and health promotion.  All over the world, the pandemic has led to new mental health stressors with potential health impacts and public health and social measures.  There was a 28% rise in major depressive disorders, 26% rise in anxiety disorders, and 44% of countries reported disruptions to mental health care in early 2022.  In the Philippines, 69% of LGUs have trained health providers in WHO’s mental health Gap Action Programme (mhGAP), that “aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.  mhGAP asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy”, and other clinical conditions. 14% of LGUs have trained staff on mental health and psychosocial support disaster preparedness.  “The academe, alongside the government, and private sector have contributed to the progress in promoting, developing, and implementing mental health mechanisms” that are key elements of the UHC Act. 

One of the reasons for investing in mental health is the social and economic development it yields.  “When people are mentally well, they can work productively and realize their potential”, Dr. Vergara said, and thus “contribute to economic benefits for individuals, businesses, and the economy.”  The UHC Act also promotes respect for human rights; “a sound mental health program and system prevents human rights violations.”  Raising knowledge, commitment, and competencies create a community of diverse health care providers who by their task-sharing can improve health and social outcomes, such as preventing suicide, enhancing social and emotional environments for children and adolescents, and transforming workspaces that reduce mental health risks. 

“By giving mental health the same value and importance as general health, through policies and budget provision, we are able to reshape our environments and prevent abuses, protect rights, avoid violence and discrimination, and build community-based networks and services”, Dr. Vergara concluded.

Integrating the Mental Health Law into the Philippine Health System.  “Mental health issues are not defined as mental disorders”, explained Dr. Manual Dayrit in accordance with WHO’s World Mental Health Report of 2022, that defines mental health as, “not a binary state: we are not either mentally healthy or mentally ill.  Rather, mental health exists on a complex continuum with experiences ranging from an optimal state of well-being to debilitating states of suffering and emotional pain.  So mental health is not defined by the presence of or the absence of a mental disorder.”  The report also states that mental health is associated with poverty, and because of this, 95% of mental health problems which are to a large extent psycho-social, are being taken care of by individuals. 

In the Philippines, Dr. Dayrit said that the MH Act is comprehensive in its objectives and provisions, but it needs “provinces to manage a special health fund for individual-based and population-based health services.”  This is because most mental health facilities that provide a substantial percentage of hospital-based care are private.  Thus, there is a need for a mental health reform towards “a community-based health care system that can promote mental health care for all and provide mental health care services for the community.”  A community-based health care system is defined by WHO WMHR 2022 as “comprising of a network of interconnected services such as, (1) mental health services integrated in general health care; (2) community mental health services, (3) and services that deliver mental health care in non-health settings and support access to key social services.”

“Even if you have a mental health disorder, you can live a normal mental life –- this is the core of the mental health services program”, Dr. Dayrit states.  “We need to change the current mindset on mental health – it’s all about doing things well with the resources we have.  Understanding the fundamentals of mental health issues will enable one to appreciate and deal with mental health issues.”

Dr. Dinah Nadera concluded the forum with this insight: “Investment in mental health is an investment in national development”.