[OPINION] Mental health not just a personal problem but a challenge to policy makers

Trigger warning: This article makes references to suicide.

In 2020, the World Health Organization reported that nearly 3.6 million Filipinos suffered from at least one type of mental, neurological, or substance abuse (MNS) disorder.

In 2021, close to one in five Filipino youth had considered ending their life. According to the University of the Philippines Population Institute, the share of youth who experienced suicide ideation and attempts more than doubled between 2013 and 2021.

These figures appear all the more grim as we remember that numbers are not just numbers; they are warm bodies, actual people suffering from an endemic problem that has long been consigned to the background of priorities.  

With the worsening mental health crisis, we are bound to know at least one person struggling with mental health. In some cases, this person may be our colleague, our friend, our family; in some, ourselves. 

Despite how it may feel, mental health is not a personal problem. Rather, it is a systemic issue, emblematic of the intricate yet often frayed link between policymaking and health.

In the context of the Philippines, mental health is very much a policy challenge.

Prior to 2018, the Department of Health had provided an operational framework for a Comprehensive National Mental Health Program through administrative orders. However, the absence of a law hindered the prioritization of mental health. 

In response, efforts from a coalition of concerned stakeholders spanning government, civil society, media, and the academe initiated the drafting of the landmark act on mental health, which was eventually signed into law in 2018.

Republic Act 1103, or the Mental Health Act, affirms the basic right of all Filipinos with mental health conditions to protection and access to services. Notable national initiatives after the passage of the law include creating access sites for the procurement of psychotropic medicines, giving primary care practitioners the capability to treat and manage MNS disorders, launching emergency hotlines, and releasing mental health resources. 

Despite these, many gaps evidently persist. These surfaced in the joint study by the Ateneo School of Government and Unilab Foundation, examining the implementation of the Mental Health Act and identifying developments and challenges.

Mere law on paper

There remains no evidence of the effectiveness of current mental health initiatives. In a scathing take by Maravilla and Tan in their 2021 study, the Mental Health Act was dubbed as a mere law on paper that has not advanced necessary health reforms for Filipinos. 

Affirming the reciprocal relationship between the country’s economy and mental health, the authors cite the negligible spending on mental health, amounting only to 5% of total health expenditures. Even during the COVID-19 pandemic, infrastructure was prioritized over health, with significant cuts to essential programs on epidemiology, health facilities, and health information technology.

Despite the establishment of the Special Health Fund, a pool of financial resources intended for financing health programs, there remain no specific benchmarks or set guidelines on how these funds will be accessed and utilized.

Furthermore, there is a weak political will among lawmakers. Hardly any legislators have publicly expressed their commitment to moving the Act forward, only a few local government units (LGUs) have implemented their mental health initiatives, and the budget for mental health remains unallocated towards community-based care. 

Devolving mental health

The passage of the Local Government Code of 1991 devolved the provision of health services from a centralized health system to independent local health systems with the goal of managing and maintaining health services at the LGU level. 

This decentralization is driven by the idea that public services — such as mental health care delivery — are more efficiently managed by localities instead of a central managing authority.

In the Mental Health Act, LGUs are mandated to develop their own mental health programs, following the guidelines of the Philippine Council for Mental Health (PCMH) and in partnership with concerned government agencies and the private sector.

Since then, respective LGUs have implemented mental health initiatives, such as telemental health services, psychological first aid, and counseling services. Ordinances have also been enacted to institutionalize these programs.

However, several obstacles hinder LGUs from acting on this mandate. 

Despite ordinances in place, LGUs do not have sufficient budget to allocate for mental health programs, often relying on mental health advocates within their localities. Even if certain LGUs seek to invest more in mental health programs, they are hindered by statutory limitations that only allow them to allocate no less than 20% of their annual internal revenue allotment.

Fear also exists as an understated yet critical limiting factor. Notwithstanding their mandate, LGUs may remain hesitant to take responsibility for mental health initiatives. This element of fear, the lack of common understanding among national and local actors, insecurity of funding, and mistrust among actors continue to relegate mental health to low prioritization.

Towards patient-perspective care

Patients remain among the most fundamental stakeholders in mental health policymaking. Yet their perspectives are often overlooked, causing policymaking to lose sight of its purpose.

In reality, Filipinos remain reluctant to formally seek help for mental health. The prevalent mental health stigma in the country results in self-stigmatizing attitudes that hinder help-seeking behavior. This is worsened by the absence of readily available care services and facilities. As mental health services remain costly and inaccessible to many, financial constraints restrict Filipinos from seeking the help they need.

Evidently, then, any mental health care initiative must go hand-in-hand with the objective of stigma reduction. Furthermore, there is a need to rethink the role of the patient in mental health.

Rather than prescribing a one-size-fits-all approach, mental health care services must be tailored according to patient’s experiences and perspectives. Furthermore, actively involving the patient in policymaking serves as a progressive step towards overcoming their marginalization.

While mental health is increasingly being normalized in the public discourse, the crisis itself should not be. The mental health crisis must always be approached with urgency and, as a policy challenge, cannot be divorced from demanding accountability. — Rappler.com

The authors are with the health governance program of the Ateneo Policy Center, School of Government, at the Ateneo de Manila University. Melissa Louise M. Prieto is the research assistant and program coordinator, Kenneth Y. Hartigan-Go is the senior research fellow, and Angel Faye G. Castillo is the program manager.

This piece draws from the study titled “Mental Health in the Philippines: A Policy Challenge.” The views expressed herein are those of the authors and do not necessarily reflect the views of Ateneo de Manila University.