POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Strengthening Mental Health Act: Alternatives and Ammendments on the Current Policy of the Republic Act No. 11036 -----Presented to PROF. Gerald Magno In Partial Fulfillment of the Requirements Politics, Governance, and Citizenship GEED 20023 ------Presented by ALCAZAR, MARK DANIEL
MARBELLA, GRACELYN
AUSTRIA, CAILA JANE
OLAD, XYZKY
BELTRAN, JUSTIN
PAREDES, MICAELLA
DOMINGO, RICHELLE
PASCUAL, SHIENA
MACAZO, KATE NICOLE
PERIA, JESSYRENE BSA 1-2
2019 i
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Executive Summary The Philippines had officially passed the Republic Act No. 11036 known as the “Mental Health Act” of the Philippines which was signed by President Rodrigo Roa Duterte on June 20, 2018 where it aims to enhance, promote and protect mental health services, provide better access to mental health care and establish Philippine Mental Health Council in the country. Although the Mental Health Law has already been passed, it is apparent that many Filipinos seemed to neglect this matter due to lack of awareness which leads to disregarding the significance of one’s mental health. Mental illness is also the third most common form of disability in the country as stated by the National Statistics Office where bythis policy, it would be possible to lessen the great numbers of Filipino people with mental health conditions (Vardeleon, 2016). One of the alternatives to the current policy is the implementation of mental health assessment in educational institutions, particularly to high schools and tertiary level education to provide assessments in order to identify youths experiencing mental health conditions and provide them with adequate support and services. This policy could help students get access to mental health services they need when their responses to the examinations reveal new information regarding mental health that could be a way for studying their behavior that are not observed at home. This policy also promotes discussion of mental health which could help them to have stronger relationship with others and enhance their mental health condition. As for the difficulties that the policy may encounter, these include the cost implementation and the lack of adequate mental health service providers.
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES The second proposed alternative policy is the public mental health organization which caters the need of the people, especially for the indigenous people with mental health issues in legal and medical aspect and provides free legal and medical assistance. Intended for an extensive reach, this policy will be having local sections designated for easier access across the whole nation. One of its advantages is giving an easier access to people with mental health illness from the government since the legal representatives, tribunals, and supporters are designated for them to participate in the decision making with the patient’s medical information and its aims include to reach the very remote areas in our country. As for the problems that it may face are the budget allocation and the requirement of huge amount of institutions and professionals to attend the needs of mentally ill people. For the third and last proposed policy is the National Monitoring and Mental Health Action Plan of the Republic Act 11036 or the Mental Health Act since the Philippines faces a huge challenge concerning the medical health system and it is currently having a crisis with the available medical treatment for people with mental illness and an inadequate number of mental health professionals and facilities. Its advantage is that the RA 11036 or Mental Health Act will certainly be enacted and properly implemented where it will provide specific steps and actions that will lead to the achievement of the objectives. Action plan will ensure that the ideals and general concept of the law will not just remain as a mere concept and the law will also lessen the commonly occurring problems in government projects and programs such as corruption as it will be strictly monitored. As for its disadvantages, the creation of the action plan involves a lot of research-based programs in order to efficiently impose the policy where the monitoring processes need to be appropriately funded and there must be a budget appropriated specifically for the purpose of research and the creation of the action plan. iii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Since the Mental Health Law was only promulgated last 2018, it is recommended to execute having a mental health examination among the high school and college students in the country as this is the most possible and necessary foundation towards strengthening its implementation. It is because most of the Filipinos today were not aware of a proper classification whether if someone has a depression or not. Moreover, since the youth sector has the most number of cases regarding their mental health, this national assessment would help to reduce the number of adolescents experiencing issues on their mental health. Furthermore, students must determine first whether they need a professional help from medical practitioners specializing on mental health. A public mental organization includes individuals who has a specialty or full knowledge on mental health which seemed to be impossible to implement concretely as there are inadequate number of workers specializing on mental health in the country. For the National Monitoring and Mental Health Action Plan of the Republic Act 11036, it is also necessary to be executed properly by the departments holding responsibility on observing the mental health of the Filipinos. It will serve as a way of an overall assessment on the implementation of the mental health law in the Philippines but it also suggests on increasing the number of facilities which will require a large amount of fund from the government. Rather than prioritizing on the national monitoring and a mental health action plan, it is more convenient to execute first the mental health examination on high school and college students as it will serve as the fundamental step on applying the law. When the national assessment of mental health to students have already implemented continuously, the national
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES monitoring and the mental health action plan will include this particular step for them to observe the effects on it to people and to the country. Overview/Background Statement of Purpose Philippines is known by the other foreign countries as one of the happiest nations in the world. The country ranked 69th from the happiest country on earth, according to the United Nations (Cabico, 2019). In this fact holds the reason that we are approaching devastating circumstances in a positive way. Ironically speaking, the archipelago has its status for having the highest number of depressed people in the Southeast Asian region (Reyes, 2019). The issue on mental health becomes more and more prevalent through the years, and adversely bringing an effect to Filipinos. In fact, according to the World Health Organization (WHO), one out of five Filipino adults suffer from mental health disorders making it the third of the most common disabilities in the country, as stated by the National Statistics Office. Recent available data provided that depressive disorders affected 3.3 million Filipinos, with suicide rates in 2.5 males and 1.7 males per 100, 000 (Global Burden of Disease, 2015). Latest numbers from the World Health Organization also stated that over six million Filipinos live with anxiety and depressive disorders. However, the statistics presented and cases reported were only a portion of the actual number because there is a stigma about mental health issues in the Philippines which makes the people suffering from it avoid consultation and treatment (World Health Organization). The fact is, this is a growing issue and still, it is one of the country’s least priorities. The data above shows that the current status of the mental health of the Filipinos are unstable. Issues about Mental Health needs to be addressed. The Philippine status quo shows v
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES that suicide cases and youth mental health issues continues to increase, and according to experts it is primarily due to the new era of social media and technology. According to the study conducted by the Association for Psychological Science (2017), adolescents who spent more time online has a higher probability to be affected by mental health issues. In line with this, Philippines becomes the world leader in terms of social media usage as the internet users in the country reached 67 million Filipinos (Camus, 2018). This is one of the reasons why mental health issues are becoming prevalent at this time which is why emphasizing the need to focus on the Mental Health of every Filipino should be a priority. Indeed, there exists a mental health law in the Philippines, the Republic Act No. 11036 (or RA 11036) or "An Act Establishing a National Mental Health Policy for the Purpose of Enhancing the Delivery of Integrated Mental Health Services, Promoting and Protecting the Rights of Persons Utilizing Psychiatric, Neurologic and Psychosocial Health Services, Appropriating Funds Therefore and for Other Purposes" shortly known as the Mental Health Law, officially declared as a law in June 20, 2018 to answer the mental health problem. However, it is also clear that many Filipinos seemed to disregard this serious matter. Lack of awareness about the existing law is also a problem. Filipinos tend to neglect the importance of an individual’s mental health. Even though the Mental Health Law has already been passed, it is evident that many Filipinos are still suffering from this issue, helpless. That is the reason for the need to modify and strengthen the current policy. It needs to be properly implemented and executed. There should be a solid foundation to determine and assess the people’s mental health state. Reformation and improvements should now be implemented to provide accessible and
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES affordable services for the people with mental health illness who are not capable of to sustain and help themselves. It is time that every individual’s mental health be prioritized. REVIEW THE CURRENT POLICY Currently, the Philippines had officially acknowledged a Mental Health Bill which was signed by President Rodrigo Roa Duterte on June 20, 2018. The Republic Act No. 11036 known as the “Mental Health Act” of the Philippines is an act which aims to enhance, promote and protect mental health services, provide better access to mental health care and establish Philippine Mental Health Council in the country. It gives basic and fundamental rights to the Filipino people who needs mental health services which ensures that people’s mental health are given enough attention by appropriating an accessible, affordable and a high-quality service for mental health care. The Mental Health Act seeks to integrate mental health programs, to improve the mental health facilities and also to promote it to the educational institutions and workplaces. Although it was a major victory for the mental health advocates, the truth is, it was pending in Congress for about 20 years. Also, several bills were already proposed as early as 1980s, but it was not given any focus, thus making the Philippines as one of the few countries in the world without a mental health law. In addition, it was signed into a law during the time wherein suicides rates are drastically high. According to the Republic Act No. 11036, there are main objectives for the implementation of this Mental Health Act which could help solve mental health problems in the country. First, to be able to increase the effectivity of the State to lead and to govern mental health issues by implementing different programs, strategies, national policies and regulations concerning mental health. Also, it has an objective to have a mental health care system that vii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES accordingly protects the rights and freedom of people including psychiatric, neurologic and psychosocial health needs. It aims to increase the knowledge consisting information systems and other researches related to mental health issues. It also has a purpose to provide basic health services that would be able to help enhance mental health care through different plans and strategies including the use of educational institutions, workplace and communities. All of these objectives enable the people to receive the best help and mental health services to all the Filipino people with mental health conditions. With regards to the increasing statistics of people with mental illnesses and with the current situation of the Philippines concerning mental health, this policy is necessary in order to strengthen the psychosocial well-being of the Filipinos. As a matter of fact, according to the National Statistics Office, third most common form of disability in the country is the mental illness. As for the most recent data released by the Department of Health (DOH), there is a percentage of 17 to 20 percent of Filipino adults who have psychiatric disorders, 10 to 15 percent of Filipino children from age five to fifteen which all suffers from mental health problems. It is said that there are 88 cases of mental health problems for every 100,000 Filipinos. With this policy, it aims to achieve its purpose and objective to lessen these great numbers of Filipino people with mental health conditions. (Vardeleon, 2016) Based on the situation of the Philippines right now, the access to mental health facilities is uneven as noted in the report of World Health Organization - Assessment Instrument for Mental Health Systems (WHO-AIMS). Majority of the facilities are located in the National Capital Region which makes it hard for those places who are far from it. The budget allocated to the health department is not sufficient because only 5% of its annual budget is given to the mental health. viii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES In the country, concerning the mental health professionals, there is a very low number of professionals involving the mental health. According to the World Health Organization, although there is only up to 20 percent of the population having mental health disorder, it is inadequate with the numbers of mental health professionals in our country with only 700 psychiatrists and 1,000 nurses and more than that almost all of them work for profit or in private practice which receives low-income and do not have enough access and support. The country has insufficient mental health professionals which simply shows how the Philippines needs to improve a lot when it comes to the problems involving mental health with what we are currently doing in our country (Magtubo, 2016). It is absolutely of no doubt that psychiatric services are expensive and costly which is why this act was pursued to provide an accessible and affordable mental health services. People with mental health disorders are also being driven more into poverty by the high costs and inaccessibility of the treatment (Solitario, 2017). It also has to coordinate with drug rehabilitation centers, and shall have a referral system which public and private health and social welfare service providers are to be involved. It was mid-last year when it was implemented yet there are still no definite reports about its status since the enactment. It is largely seen by many as if it is of no effect. The provisions of the act actually impressed the masses as it was regard to be a huge step that Philippines has taken towards improving mental health. But again, the anticipated outcomes are still of nowhere to be found. Although there have been a number of advocates that are on the move, as the Philippine Star noted, it holds no significance with regards to its national effect.
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Moreover, research and development must also be founded and are responsible in producing relevant information and data that would be used in making mental health programs that are inclined with the certain customs and practices of different regions and indigenous groups. But, as per Philippine News Agency, Dr. Dinah Palmera P. Nadera, a mental health policy consultant who is part of the task force supervised by Department of Health, explained that they still have to meet and consult with various agencies to consider on how to engage and deal mental health with the differing customs and practices throughout the whole archipelago. To put it all together, a span of time is sure to be taken to produce the expected results of the implementation. The previous years have shown that Philippines has no enough research about Mental Health. In the last three years, mental illnesses and suicide cases have risen drastically. Even though there has already an act regulating about mental health, it seems to have no effect in the overall condition of mental health in the Philippines. This is caused by numerous factors that affect its implementation and effectiveness, such as those which are discussed in this review including the inadequate number of mental health professionals and personnel in the country, and to add, these few professionals are only concentrated in urban areas (Philippine Star, 2018). From the required ratio of one per 50,000 people, Philippines only has one per 250,000 people. Second is the insufficient supplies and equipment which are needed to provide an efficient and appropriate service for the patients, that even the health care facilities itself lack. In addition, there are also inadequate institutions that facilitate mental health services in the Philippines. Research and development is still of low and poor performance because the country has been encountering problems in dealing with the country's varying customs and practices. x
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES These challenges also come due to the financial problems that the government has been encountering for the implementation to be effective. There are no quite enough resources to fund the necessities in compliance with all the provisions under the act. According to the 2007 report by Department of Health and World Health Organization, only five percent of the health care budget is charged towards mental health, which 95% of it is allocated to the operation maintenance and salary of the personnel. Raymond John Naguit, the national chairperson of Youth for Mental Health Coalition, conveyed his concern on the availability of funds for mental health services as the adequacy of mental health professionals depend on it. Although it is still too early to conclude whether the act is a success or a failure, other can say that for the past few months since the act was signed, there has been no relevant changes in the mental health condition of the country. But, for some people thinking that before this policy was passed into law, it is really a big problem for the mental health patients since there are few benefits that they can rely on. But now, although there has been facts which concludes the insufficient mental health facilities, inadequate mental health professionals, huge number of people with mental health conditions and other problems concerning mental health, the public’s perception with this policy is that they accepted and supported this Mental Health Act since it would benefit a lot of people suffering from mental health conditions. It is recognized by the public as a tool in order to improve, to be aware and to have greater access for the mental health facilities, professionals and other things involving mental health issues. For now, we are still in the process of making betterment and improvement concerning mental health which also makes the Filipino people be hopeful in accessing more services, resources and benefits that they could get in this Mental Health Act. This Mental Health Act aims to
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES have a progress and changes in our country which concerns different issues regarding mental health system. STATEMENT ON THE NECESSITY FOR CHANGE Recently there has been a progress in terms of addressing this mental health concern when President Rodrigo Duterte signed the Philippine Mental Health Law, also known as Republic Act 11036 last June 21, 2018. this is the first to pave the way for better aid to mental health problem. The law seeks to integrate mental health services and programs from the down to the regional and local level. It will improve mental health facilities in all regional, provincial and tertiary hospitals and spread the information in schools and even in workplace. Moreover, there is additional psychiatrist for the public. According to Sen. Hontiveros, having this national law will be a big help, for it allocates the needs of mentally ill people to lessen their suffering. Aside from the status of the Filipinos’ mental health stated from the preceding sections, new approach is necessary in order to develop and create a shift in the perspective of the Filipinos regarding the Mental Health. Based on Stanford University School of Medicine -ethno-geriatrics study, Filipinos’ only way of dealing with mental health disorders is by seeking help from family, friends, and by faith in God. It was also common for the adults to consider people with mental health illness a financial burden. There was limited awareness and there is a lacking scientific-based perceptions about mental health. Consequentially, there is a strong necessity for new and effective approach to stop this crisis. The approval and passing of this law reflects that the government is now ready to attend and cater the mental health needs of its citizens. This calls for the need to propose policies xii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES necessary to effectively implement the law. The signing of the Mental Health Law is a major change that lead the people to rationalize and think critically of what the newly signed law should be. DISCUSSION ALTERNATIVE POLICY OPTIONS POLICY 1. Mental Health Examinations in Education Institutions According to the World Health Organization (WHO, 2018), adolescence is a crucial period for the development of a person. One in six people are 10-19 years old and mental health conditions form 16% of the world’s problem of disease and injury in people this age. Most cases of mental health conditions are not treated and detected, and half of these conditions start at 14 years of age. In addition, emotional disorders usually occur during the adolescence. Aside from depression and anxiety, adolescents may also experience anger, frustration, or irritability. Globally, the eighth and ninth leading cause of illness and disability among all adolescents are anxiety and depression. In the Philippines, 3.3% of the total population suffer from depressive disorders, 3.1% suffer from anxiety disorders, and 2,558 reported suicide cases. Among high school students, 17% with ages 13-15 years old have attempted suicide at least once, 12% seriously considered attempting suicide, and 11% have made plans on how they would commit suicide (Reyes and Gonzales, 2017). There are several determinants of mental health such as: social factors like violence and socio economic pressures, psychological factors related to social change and human rights violations, and biological factors which include genetic factors. A research by (Lee et.al, 2013) in their study entitled “Factors Associated with Depressive Symptoms among Filipino University Students” discovered a set of social and xiii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES demographic factors related with higher levels of depressive symptoms among Filipino students. The study used the University Students Depression Inventory with measures on lethargy, cognition-emotion, and academic motivation, and was performed among 2,436 students. The study that the frequency of smoking, frequency of drinking, not living with biological parents, level of satisfaction with one’s financial condition, and levels of closeness with parents and peers were the factors associated with higher levels of depressive symptoms. The researchers emphasized that depression can be prevented if its symptoms are addressed early and effectively. Prevention of depression among university students is rare in the country, but is urgent because of the rising rates of suicide among the group. The symptoms of mental health disorders are mostly unnoticed and their causes develop as early as 12 years old and below (developmental stage) with majority of clinical symptoms existing before the age of 14. Gary Aguedo Faustino, director of guidance and counseling at Ateneo’s Loyola Schools stated that the struggle is in basic education or the formative years of 12 years and below, and it is contained in home. When a person is entering college or is 18 years old and above, they are fighting mental health problems already. The formative years are important in shaping the mental health of an individual, but issues rise because of the combination of stressors such as life-changing decisions, influx of hormones, peer and familial pressure, strain of first relationships, academic and societal expectations, and flow of information through technology which frequently appear when an individual enters university. Furthermore, Ronald Del Castillo, a clinical psychologist and an associate professor of health policy and administration, psychology, and behavioral sciences at the College of Public Health of the University of the Philippines asserted that admission to college increase risk for developing mental health problems (Bueno, 2018). xiv
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES One of the alternatives to the current policy is the implementation of mental health assessment in educational institutions, particularly to high schools and tertiary level education. The country needs to provide assessments in order to identify youths experiencing mental health conditions and provide them with adequate support and services. The government, through the Implementing Rules and Regulations (IRR) of Republic Act no. 11036 otherwise known as Mental Health Act provided the education and promotion of mental health in educational institutions. This option is in accordance with the IRR as it can help students have access to mental health care services they need. Educational institutions include schools, colleges, universities, and technical schools. Schools are an important part of the lives of children. They are an ideal place to provide mental health services for children and youth (NASP, 2016). Accordingly, (Carothers, 2015) believes that school-based mental health screenings help reduce barriers to learning and allow youths to have services for mental health care. Moreover, it would likely provide researchers and clinicians with information about mental health symptoms which could help in developing clinical practice, research, and policy. Mental health screenings in schools are an essential step to prevent mental illnesses. Mental examination is as important as physical examination. In this proposed alternative, mental health examinations shall be mandatory. This is to help protect the mental well-being of the students. The examinations shall be conducted by competent mental health professionals and service providers. They shall identify the necessary questions, the useful assessment tools, and carefully analyze the data they collect. Mental health assessments shall also be implemented routinely and need to have second opinion before any results is conveyed to the parents, family members, carers, or legal representatives of the service user. xv
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Confidentiality regarding the result shall be strictly observed pursuant to the right of service users. The proposed policy is in agreement with Republic Act no. 11036 or Mental Health Act which acknowledges the rights right of the Filipinos to mental health and the fundamental rights of people who need mental health services. Through mental health examinations, students, their families, and other concerned personnel will be able to have awareness of their mental health conditions and conduct measures to develop their mental health well-being. The policy would need an adequate funding for its proper implementation. The budget for the policy will be taken from the amount allocated for mental health in the Department of Health budget and in the budget of other agencies with specific mandates provided in the Act, which is based on the strategic plan formulated by the Council, in coordination with other stakeholders. Proper implementation of the policy should be observed. Examinations shall be supervised by competent personnel and results shall be interpreted and analyze by competent mental health service providers. The policy shall take place with strict observance of the rights of the service users, their family members, carers, or legal representatives, and mental health professionals. All the information gathered shall be treated with utmost confidentiality. One of the advantages of this policy is that it could help students get access to mental health services they need. The collaboration of educational institutions with the Department of Health and other mental health service providers increases the possibility of helping the students. The policy can provide researchers with information about mental health which could help develop clinical practice, research, and policy. The students’ responses to the examinations and its subsequent interpretation and analysis by competent mental health providers could help reveal new information regarding mental health. It can also make way xvi
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES for studying the behavior of students that are not observed at home. The policy promotes discussion of mental health which can help students feel safe to communicate with their family, teachers, or counselors. A more open communication concerning mental health could help students have stronger relationship with others and enhance their mental health condition. Routine mental health examinations decrease the possibility of delayed treatment and can help erase the stigma of mental health conditions. The lack of knowledge about mental health results to discrimination or stigma against people suffering from mental health problems. Information gathered could help advance awareness and sensitivity associated with mental health. In addition, mental health examinations serve as an initial step for detection, treatment, and promotion of a person’s mental well-being. The symptoms of mental health problems are usually undetected and could get worse. Examinations could help raise awareness of one’s mental health condition, and help prevent mental health problems from getting worse. The policy likewise supports the governments’ campaign for the integration of mental health into educational institutions. Chapter 5 Section 25 of the Metal Health Act’s IRR calls for the awareness on mental health issues, identify and provide support and services for individuals at risk, and facilitate access to treatment and support. It also agrees with the state’s aim to affirm the basic right of the Filipinos to mental health and the fundamental rights of people who need mental health services. On the other hand, there will also be difficulties in this alternative policy. The most evident complication that this policy may encounter is the cost of implementation. Some of the costs needed for the implementation include payments for mental health providers, examinations, and subsequent mental health services. A sufficient fund is a requisite for ensuring proper implementation. Another is the lack of adequate mental health service xvii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES providers. There is still a need to increase and train mental health service providers to ensure quality mental health services. Failure to provide for the necessary services after mental health examination could also negatively affect service users. If educational institutions commit to mental health examinations, they should ensure access for mental health services. The country, nevertheless, already conducted simple actions concerning Mental Health. Last October 23-24, 2018, the Department of Education (DepEd) conducted the first National School Mental Health Forum to discuss concerns related to mental health. Present in the event were health personnel, guidance counselors, teachers, non-teaching personnel from Central, Regional, and Division Offices, public schools, and external partners to present programs and research studies related to school mental health. According to DepEd Assistant Secretary for Public Affairs Service and Alternative Learning System G.H. Ambat, the department has made important actions in promoting the well-being of the personnel and learners. Some of these were trainings on mental health and psychosocial support, and issuance of policies like child protection and dealing with bullying, as well as unloading children of homework during weekends. In addition to these, concepts regarding mental health have been integrated in health and values education subjects. The department called for more guidance counselors. Secretary Leonor Briones initiated the improvement of the qualifications for guidance counselors and their increase in salary in order to adequately pay for their services. (Philippine Information Agency, 2018). Guidance counselors in some of the universities in the country have created multiple awareness programs to promote mental health and prevent disorders in the university. In Far Eastern University (FEU), first year students are oriented with topics like how to identify symptoms of mental health issues, discussions on sexual harassment, bullying, and xviii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES HIV awareness. FEU director for guidance and counseling Sheila Marie Hocson who also manages Philippine Guidance and Counseling Association helped establish the Peer Organization of the Philippines, which is made up of senior high school and college facilitators trained in basic counseling skills and knowledge of referral systems. In Ateneo, they added more psychologists to correspond with the counselors. Programs in psychology and mental health awareness in the first year, and programs in grit, resilience, stress management, and time management in the later years are included in each university level. Animal-assisted activities and therapy is also being considered in preventing anxiety attacks. Ateneo has referral systems and plans to form a student branch to assist peer discussions. Universities outside Metro Manila such as Silliman University in Dumaguete, University of San Carlos in Cebu, Xavier University in Cagayan de Oro, also organized measures to promote mental health. These include peer outreach programs, consultation and referral services, counseling and development centers, and individual and group sessions. Due to lack of registered guidance counselors and psychologists, lack of budget to manage tests, and cultural influences, not all programs are offered in all universities (Bueno, 2018). The country also celebrates World Suicide Prevention Day (September 10), World Mental Health Day (October 10) and the National Mental Week (2nd week of October). The Republic Act 11036, otherwise known as the Mental Health Act was just signed into law last June 20, 2018. The Implementing Rules and Regulations was signed on January 22, 2019. The government is set to work on the integration of mental health into the educational system and educational institutions within two years from the affectivity of the IRR.
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES POLICY 2. Public Mental Health Organization Chapter III of the Republic Act 11036, commonly known as the Mental Health Act, discusses about the Consent to Treatment and Safeguards. Moreover, there is a section in the said provision which refers to legal representatives in making decisions of the person with any mental health illnesses. In Sec. 11 Legal Representative of the chapter, it discusses the designation of a legal representative through a notarized document executed for that prupose (Chap. III, Sec. 11, p. 5). In lieu with the designation of private legal representative, tribunal, and supporters, the alternative policy is about having a government organization that works as a tribunal as well as independent advocate. It aims to have a better platform for people with mental health issues in every class of the society. This will address the need of the people with mental disability who could not afford to appoint or designate lawyers, psychiatrist and a support group that they will need in legal actions, and other medical-related matters. The Implementing Rules and Regulations of the Mental Health Law, although does not provide the mentally ill person to have a legal representative and other professionals be appointed compulsory, presents how useful this tribunal and other support groups in order to give the people with mental health issues a smooth transaction in legal matters as well as a better medical assistance. Like any other organizations, government or non-government (i.e. Public Attorneys’ Office and Philippine Red Cross), the purpose of having a public mental health organization is to be able to extend its hands to the people with mental health issues giving them a just and equitable services, and assistance in legal and medical cases free of any charge. Building and
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES spreading local branches of the said proposal would be the best way to help many Filipino citizens. Aforementioned on the preceding paragraph, the mental health organization under the government control will act as a tribunal and independent advocate. Like a court of law, a tribunal is a panel that can tell the hospital or any mental health institution to discharge the person with mental health illnesses. Under the provisions of Mental Health Act 1983 from United Kingdom, a mental health tribunal is composed of a three-member panel: •
a judge – the chairperson of the panel
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a medical member – a psychiatrist (who does not work in the same hospital the patient is in)
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a lay person – a professional with relevant experience The tribunal hearing will happen on the hospital where the person with mental health
issue is sectioned or the hospital where he is being treated on a Community Treatment Order. A Community Treatment Order is where a psychiatrist says that a patient must have a certain treatment or live in a certain place in their local community. The tribunal will listen to the facts surrounding the case, and make sure that a person is only detained in hospital in keeping with the law. Patients have the right to be represented at the mental health tribunal by a legal representative who is appointed by them. They will also arrange for an independent medical examination to be carried out by a Consultant Psychiatrist. The function of the mental health tribunal is to either revoke or affirm an admission or renewal order. Mental health tribunals can also consider proposed transfers to the mental hospitals and proposals related to the use of psycho-surgery.
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Moreover, the mental health organization will act as an independent advocacy. According to POhWER, an example of an independent advocacy for mental health act in United Kingdom, it is a legal duty of the local authority and providers of care for patients detained under the Mental Health Act (including private mental healthcare providers) to provide information regarding independent mental health advocacy support to all eligible people, and to support communications and referrals for those patients who wish to engage with the service. An IMHA is an independent advocate who is trained to work within the framework of the Mental Health Act to support people to understand their rights under the Act and participate in decisions about their care and treatment. They must be a public health care provider. Independent Mental Health Advocacy services are independent, confidential and free of charge. IMHA’s service to people with mental health issues are optional, and may change their mind at any time. It does not replace other forms of groups, advocacy or legal support, but can work with them. According to the research of Susan Eades on the implementation of independent advocacy as an inclusion to the provisions in the Mental Health Act 1983 in U.K., although limited, qualitative research evidence has identified that IMHA support helps to empower their partners (referred to in the text as patients or patient partners) to be more self determined. This is an important finding, particularly for those patient partners detained under the Mental Health Act, given the often disempowering and autonomy reducing nature of mental illness and the characteristics of detained environments. However, a gap in the literature exists for quantitative outcome data identifying the specific impact that IMHA support has for patients. Obtaining measurable outcome data which seek to xxii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES understand how and why Independent Mental Health Advocacy support impacts its patient partners is essential for developing and validating outcome measures that can lead to best practice improvements in IMHA service delivery. Furthermore, this knowledge is pivotal in optimizing IMHA services’ potential for empowering patients and providing commissioners with the much-needed evidence for effective commissioning of such services. The proposed public mental health organization shall be an autonomous and independent office, but attached to the Department of Health and Department of Justice under the Mental Health Law (RA 11036). This shall be the primary office of the Government in extending free legal and medical assistance to indigent mentally ill persons in criminal, civil, labor, administrative, health, and other quasi-judicial cases. In the exigency of the service, the public mental health organization may be called upon by proper government authorities to render such service to other persons, subject to existing laws, rules and regulations. The public mental health organization is a proposed policy that caters the need of the people with mental health issues in legal and medical aspect free of charge. It is in line with the provisions in the Republic Act no. 11036 or the Mental Health Act on the intervention of legal representatives and tribunal in legal matters and in the cases of people undergoing a medication and the community treatment order. Designed for a widespread reach, this proposed policy will be having local chapters designated for easier access across the whole nation. The project would really need huge budget allocation for effective implementation. Thus, the main source of the budget allocation will be from the Department of Health as well as the Department of Justice, and some other organizations and agencies that that will be involved in the provisions of the proposed policy. There must be a strict implementation of the said policy for xxiii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES better results. This would require the different government agencies to work together, specifically the Department of Health for the mental health practitioners, Department of Social Welfare and Development for the conducive mental health center equipped with competent personnel for support and the Department of Justice for the legal services. The said public mental health organization should be accessible especially for the indigent mentally ill persons. All of the information, file, and cases gathered of every individual with metal health issues must be treated with utmost confidentiality. Public mental health organization aims to provide free legal and medical assistance especially for the indigent people with mental health issues. One of the advantages of the said proposed policy is giving an easier access to people with mental health illness for support from the government. Legal representatives as well as tribunals and supporters, as stated in the current Mental Health Act in the Philippines, are designated by the patient for them to participate in the decision making with the patient’s medical information. This designation would really require an amount of money for their professional services. With the aid of the proposed policy, everything that the patient would worry was about his state of mental health. Moreover, the proposed policy aims to reach until the very remote areas in our country. Dr Dinah Nadera of the University of the Philippines Diliman said, in rural areas especially, there’s still that spiritual aspect tied to mental health, the belief that these disorders are a result of otherworldly spirits or witchcraft. Aside from addressing the concern of mentally ill people, the proposed policy helps in overcoming the stigma of mental health disorder by raising awareness and providing information and education. One of the problems that this proposed policy may encounter must be the difficulty in budget allocation. Presented in the article from Philippine Star, under the law, the amount xxiv
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES needed for the Mental Health Act implementation will be charged against the 2018 budget of the Department of Health. The items to be funded are maintenance and other operating expenses of the national mental health program, capital outlays for the development of psychiatric facilities among selected government hospitals and formulation of the strategic plan for mental health. For the succeeding years, the amount for mental health in the DOH budget and in the budget of other agencies with mandates stated in the law will be based on a strategic plan to be crafted by the Philippine Council for Mental Health. 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. Weighing the necessity, if the budget allocation for mental health would be increased, the other succeeding medical health issues must also increase proportionally. This would imply a decrease on allocation on other annual budgeting factors. Moreover, if the proposed policy aims to reach every Filipino in this archipelago, it would require huge amount of institutions and professionals to attend the needs of mentally ill people. In the current statistics, there are approximately 700 psychiatrists and 1000 psychiatric nurses in the Philippines. This is very insufficient to attend the needs of 88 cases of mental health problems for every 100,000 Filipinos as per the Department of Health. POLICY 3. National Monitoring and Mental Health Action Plan of the Republic Act 11036 or the Mental Health Act Philippines, being one of the lower middle income countries, faces a huge challenge concerning the mental health system. The status quo shows that there is a crisis with the available medical treatment for people with mental illness. There is an inadequate number of mental health professionals and facilities. Budget is insufficient to cater the health needs and xxv
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES to regulate the whole health system (Mental Health and Integration, 2016). Due to these conditions, it calls for the need of substantial changes and improvement in the mental health system of the country. Thus, the approved Mental Health Law is a great leap towards the improvement. Unfortunately, the law is still too vague and ideal to really create impact and evident changes in the status quo. On July 22, 2019, the Implementing Rules and Regulations of the Republic Act 11036 or the Mental Health Act was released and it contains the provisions that will be implemented concerning the mental health of every Filipino. The sections included in the IRR will take full effect within the two years from release. However, the IRR only encompasses the general provisions and actions that will be taken in the country without specifically including the necessary detailed plans and actions. In the Chapter I, General Provisions, Sec. 3 of the IRR, its objectives are as follows: a) Strengthen effective leadership and governance for mental health by, among others, formulating, developing, and implementing national policies, strategies, programs, and regulations relating to mental health; b) Develop and establish a comprehensive, integrated, effective, and efficient national health care system responsive to the psychiatric, neurologic, and psychosocial needs of the Filipino people; c) Protect the rights and freedoms of persons with psychiatric, neurologic, and psychosocial health needs; d) Strengthen information systems, evidence and research for mental health; e) Integrate mental health care in the basic health services; and
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES f) Integrate strategies promoting mental health in educational institutions, workplace, and in communities. Nevertheless, the IRR does not provide specific actions to achieve its objectives. It only provides general concepts that does not actually create a clear path towards achieving its established goals. This problem is mainly apparent in the Chapter IV, Mental Health Services of the RA 11036. One good example is in this paragraph from Sec. 15, stating that: “Further, mental health services shall be accessible, available, affordable, and acceptable; delivered by an adequate number of competent health workers who have been trained to provide mental health care according to their level and setting; provide reasonable accommodation to persons with disabilities; and guided by high professional and ethical standards.” This paragraph only reiterates the objectives established in Chap. 1, Sec. 3. It does not provide any specific solution as to how the services will be accessible, affordable, and acceptable. Also, Sec. 16, Mental Health Services at the Community Level, shows that the provisions indicated in the IRR does not make the national government responsible to impose specific plans that will be implemented from national up to the local level. In Sec. 17 of the same Chapter, the Community-based Mental Health Care Facilities, only indicates the obvious necessities in regards with the matter. It does not clearly specify the facilities being mentioned. It also excludes the required number of facilities per barangay. There are no specifics. These are mere goals with no certain plans for proper implementation and action. The IRR itself does not give assurance to the proper and strict implementation of the law. For the reasons mentioned above, it is indeed necessary to provide a specific action plan in the implementation of the law. Specific rules and regulations must be observed. It xxvii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES should cover and answer the ideals indicated in the IRR. The Department of Health is now establishing the Philippine Council for Mental Health (PCMH) which is a policy-making advisory body which aims to develop a national multi-sectoral strategic plan. It is also being created to ensure the implementation through a monitoring and evaluation of policies and guidelines (IRR for Mental Health Act signed, 2018). However, the PCMH is still not working and it is not yet fully established. The alternative policy being proposed includes that of the necessary actions to be undertaken by this council. It should create a specific action plan to impose the rules and regulations for the RA 11036. This policy is quite similar to the Department of Budget and Management’s 2019 People’s Proposed Budget which aims to create specific steps and to designate specific actions towards the fulfillment of the IRR’s objectives. In creating the action plan for the Mental Health Law, it is necessary to truly include specific plans for action. The World Health Organization created a Mental Health Action Plan (2013) for the year 2013-2020. It follows six cross-cutting principles and approaches such as Universal Health Coverage, Human Rights, Evidence-based practice, Life-course approach, Multisectoral approach and Empowerment of persons with mental disorders and psychosocial disabilities. Furthermore, WHO’s core objectives are followed by specific actions to be undertaken in order to achieve those objectives (Mental Health Action Plan 2013-2020, p.11). Adopting this approach, the Philippines should create its own action plan to make sure that the objectives in the IRR will be met. Also, the action plan should be localized and put in the nation’s perspective in order to produce a more personal and closer actions. To ensure the just and proper regulation of the planned action, the council should also strictly monitor every programs and projects that was implemented. xxviii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES In Chapter IV, Sec. 18 of the IRR of RA 11036, it stated that LGUs should make a quarterly report to the PCMH through the DOH. The alternative policy also involves national monitoring, aside from the quarterly reports by different sectors. There should be quarterly visitation and assessment to every LGU in order to be assured that the action plans are being properly implemented. This will ensure that the action plans of the IRR are being implemented and done. Generally, this alternative policy will have essential implications. The Mental Health Act will surely create improvements and progress regarding the country’s Mental Health System. The objectives will be achieved and the law will be properly imposed towards the citizens. Also, it might lead to better fund appropriations because there will be specific programs, projects and number of facilities in the action plan. This will also secure that the plans will surely be enacted. The Department of Health is now making efforts to establish a comprehensive and effective Philippine Council for Mental Health that will be designed for the regulation and implementation of the law. The main advantage of this policy is that the RA 11036 or Mental Health Act will certainly be enacted and properly implemented. This alternative policy will provide specific steps and actions that will lead to the achievement of the objectives. Action plan will ensure that the ideals and general concept of the law will not just remain as a mere concept. This action plan is necessary because it will develop a more detailed and concrete steps to achieve the purpose of the law. This law will also guarantee that it will be put into action. It will also lessen the commonly occurring problems in government projects and programs such as corruption because it will be strictly monitored. xxix
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Conversely, there are also disadvantages in this policy. The creation of the action plan involves a lot of research-based programs in order to efficiently impose the policy. There should be a budget appropriated specifically for the purpose of research and the creation of the action plan. The monitoring processes will also need to be appropriately funded. COMPARING THE THREE ALTERNATIVE POLICIES I.
Institutions Involved
Policy 1. Mental Health Examinations in Education Institutions -
Department of Health, Department of Education, Commission on Higher Education
Policy 2. Public Mental Health Organization -
Department of Health, Other Government and Non-Government Organizations
Policy 3. National Monitoring and Mental Health Action Plan II.
Department of Health and Philippine Council for Mental Health Specific Goals
Policy 1. Mental Health Examinations in Education Institutions -
To include Mental Health Examinations as part of the programs being implemented in the secondary and tertiary education institutions.
-
To serve as the foundation of the research and development programs for Mental Health in the country.
Policy 2. Public Mental Health Organization -
To establish a Mental Health Organization that will cater the mentally ill people who are from the lower class of the society.
xxx
-
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES To create a government funded and supported organization exclusively for the legal representation, treatment, consultation, etc. of Filipinos who cannot provide for themselves.
Policy 3. National Monitoring and Mental Health Action Plan -
To create a detailed action plan stating all the necessary steps in order to achieve the Mental Health Law’s objectives.
-
To ensure that the plans in the IRR will be put into action.
-
To regularly check, monitor and assess the country’s status concerning the law.
III.
Target Beneficiaries
Policy 1. Mental Health Examinations in Education Institutions -
People with mental health conditions, students, researchers
Policy 2. Public Mental Health Organization -
Poor Filipinos with mental health conditions
Policy 3. National Monitoring and Mental Health Action Plan IV.
Every Filipino with mental health conditions Success Indicator
Policy 1. Mental Health Examinations in Education Institutions -
Decrease in the rate of people with mental health problems.
-
Active participation of students about Mental Health (campaigns, volunteers, etc.)
-
Improved research regarding the Mental Health in the Philippines.
-
Positive reports and feedback about the status of mental health.
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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Policy 2. Public Mental Health Organization -
Decrease in the rate of people in the lower social class with mental health problems.
-
Eradication of the stigma about Mental Health problems and its costly treatment.
Policy 3. National Monitoring and Mental Health Action Plan -
Successful implementation of the law and achievement of the general objectives in the IRR.
-
Regular monitoring and assessment should have a positive report regarding the Mental Health in the country.
Recommendation Various proposed policies regarding on the intensified implementation of a mental health law on the archipelago all can contribute towards concrete results. However, since the mental health law was promulgated last 2018, with which it is just starting on its implementation, the most possible one, and the necessary foundation towards strengthening its application is the execution of having a mental health examination among the high school and college students in the country. Having a mental health assessment should be the first one to be implemented in a proper way in accordance to the application of the mental health law. The usual scenario in our country is that, most of the Filipinos today tend on not knowing what the difference between a depression and a sadness, or being nervous to having an anxiety. The thing is, we tend to self - diagnose. Most of the citizens were not aware of a proper classification whether if someone has a depression or not. In that case, a proper mental health assessment should be the first one to be executed properly. xxxii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Furthermore, the sector of youth has the most number of people having cases on their mental health. Through this national assessment, it can help reduce the number of adolescents experiencing issues on their mental health, by this examination. In addition, in order to reach the objectives of the mental health law, with which is to solve problems regarding on mental health disorders, is determining whether if someone needs a professional help from medical practitioners specializing on mental health. This is the key foundation of the law itself. Also, it is the most possible one to be executed properly, especially on the case that this law is still fresh. By coordinating with the Department of Education, Commission on Higher Education, and other departments included on this responsibility must joined their hands together in order for this mental health assessment every year be done in a proper and in a purposeful way. Although it has its issue regarding on the disclosure agreement or privacy of a certain Filipino, the thing is, it is the protocol. Just like in a medical check - up, in order to cure a mental health disorder must undergo through its basic step, the assessment. Furthermore, the proposed policy also has its inclusions with regards to non - disclosure agreement between the parties thereof. The remaining two alternatives regarding on the current policy on the mental health status in the Philippines were also needed. However, there are some certain factors that makes the suggestion of having a mental health examination among students should be the first one to prioritize when it comes to implementation. A public mental organization here in the country is necessary as it helps to create, advocate, and to apply such programs regarding on how to overcome such mental health disorders. This proposed organization should include individuals who has a specialty or has a xxxiii
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES full knowledge on mental health. However, this seemed to be impossible to implement concretely as the status on the number of workers specializing on mental health is grossly inadequate. As of 2016, there are only 700 psychiatrists and 1000 nurses in the country, a disproportionate condition when compared to the number of Filipino suffering with regards to mental health (Magtubo, 2016). In fact, more than half of them are working on private institutions, since many of them are working for a higher income. With this case that the number of medical health practitioners specializing on mental health is lacking greatly, creating a public mental health organization that is impossible to form in this current year. If the country has its capability to solve this particular circumstance, by making the number of employees having an expertise on mental health increase and reach the right number, a public health organization can exist, and can extend its hand to help fight on mental disorders. Implementing a mandatory mental health examination to students as a part of assessment should be implement first. National Monitoring and Mental Health Action Plan of the Republic Act 11036 (Mental Health Act) is also necessary to be executed properly by the departments holding responsibility on observing the status of mental health of the Filipinos. It will serve as a way of an overall assessment on the implementation of the mental health law in the Philippines. It also suggests on increasing the number of facilities for those who have mental health disorders. However, this requires a large amount of fund from the government. In conclusion, if the government does not appropriate fund properly on the sector of mental health, the whole implementation of the mental health law will be impaired. It will lead to a domino effect that the mental health law will be affected adversely if there is no enough budget for its monitoring. xxxiv
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Rather than prioritizing on the national monitoring and a mental health action plan, it is more convenient to execute first the mental health examination on high school and college students as it will serve as the fundamental step on applying the law. When the national assessment of mental health to students have already implemented continuously, the national monitoring and the mental health action plan will include this particular step for them to observe the effects on it to people and to the country. Among the other suggestions on intensifying the mental health law, this should be the first one to be implemented, as it will serve as the main foundation for the execution of the mental health program. Public mental health organization, and the national monitoring and a mental health action plan will follow. Implementation After discussing the present act regarding mental health, examination for the mental health of the students was chosen as the additional provision of the Republic Act 11036. The process of implementing the mentioned proposal is stated below: 1.
ORGANIZATIONAL AWARENESS AND APPROVAL This step is the most significant because without the approval and awareness of these
organizations then implementing the proposed provision would be impossible. It will enable organizations such as Commission on Higher Education (CHED), Department of Education (DEPED), Department of Health (DOH), Psychology Association of the Philippines (PAP), etc. to have a grasp about the provision and have a chance to collaborate with each other, discuss about their concerns or suggestions and eventually to make the provision more reliable and attainable. -
Identify key institutions and organizations needed to approve the policy. xxxv
-
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Communicate to the key institutions to get included in meeting agendas for approval.
-
Set the date and place for meeting agendas with the key institutions.
-
Discuss the agendas regarding the implementation of the mental health examination for students.
2.
Ask for the approval of the implementation of the new policy from the key institutions. CONSTRUCTION OF MENTAL HEALTH EXAMINATION Construction of mental health examination is very crucial because this will be the center
of the provision. In fact, the mental health test will be a great factor in helping the students to be aware of their own mental health status and for them to receive immediate consultation from professionals in case of positive results. Thus, the structure of the exam should be filtered cautiously to make the exam efficient and effective. -
Seek for the compatible professionals who will facilitate the construction of mental health examination for the students.
-
Search for the target respondents who will take the pilot examination.
-
Validate the constructed examination thru reliability test of each question. In case of inaccuracy, revision of the exam is mandatory.
3.
HOUSE OF REPRESENTATIVES APPROVAL The implementation of mental health examination for the students is an additional
provision for the Republic Act 11036 that’s why approval of the House of Representatives is required. The bill will undergo in three separate readings and approval in each reading is essential in order to ensure the necessity and relevance of the bill. -
Pass the proposed policy to the Bill Drafting Division of the Reference and Research Bureau for the preparation and drafting of the bill. xxxvi
-
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES The bill will be filed with the Bills and Index Service for the first reading. The bill will undergo in Committee Consideration/Action. Bill will be referred to the Committee on Rules and will be scheduled for the second reading.
-
Engrossed bill will be included in the Calendar of Bills for third reading. Approved bill will be transmitted to the Senate for its concurrence. Bill will undertake the same legislative process in the Senate.
-
Members from each House of Congress will settle and reconcile the differences or disagreements on any provision of the bill. Transmittal of the bill to the President.
4.
APPROVAL OF THE PRESIDENT OF THE PHILIPPINES Approval of the president will now permit the mental health examination as part of the
education sector’s program for the students as a new provision of Republic Act 11036. With this, there will be new assigned RA entitled as the act amending the mentioned RA and will be transmitted to the House where it is originated. 5. CONDUCTING THE EXAMINATIONS After the approval of the amendment in the law, the examinations will be conducted in the secondary and tertiary education institutions. This will serve as the foundation of research and monitoring on the Mental Health status of the Philippines, particularly the students. -
Securing the confidentiality of the results.
-
Strengthening the Research and Development for Mental Health with the examination results as foundation.
-
Ensure that the necessary services for people who need it shall be provided.
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