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The Problem of Mental Health in the Philippines

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Guidelines for contributions: How severe is the problem of mental health in the country today? What research efforts can we cite to prove the state of mental health in the country? Looking at the past, how has the government fared in managing the problem of mental health? What are the prevalent cases of mental illnesses in the country and their causes? Do we see a trend in the severity or improvement of mental health among Filipinos over the past years? Mindset:

The result of research here should help us form our opinion on the relevance of Bill 6679 to the current state and whether its purpose is right on the dot in addressing these problems.
Research by Adrian Jeric Pena: In a disability survey conducted by the National Statistics Office in 2000, the survey revealed that mental illness is the "third most common form of disability" after visual and hearing impairments. The study conducted in 2000 also said that there is an average of 88 reported cases of mental illness per 100,000 Filipinos. In a separate study by the Social Weather Stations, it was said that 0.7% of the total household in the Philippines during the year, 2004, have a member with mental disability. The most reported cases of mental illness are often linked with familial or hereditary mental disorders including schizophrenia alongside with mental illness linked with psychosocial development. Also in the Philippines, it was noted that substance abuse (narcotic drugs, other chemicals, etc.) are the leading direct and indirect causes of mental illness. What is more surprising is that a World Health Organization study revealed that in three primary health centers in Manila, one out of 5 adults and one out of 10 children ages 5 to 15 consulting to these centers have mental disorders (Department of Health, 2005). Reference: Department of Health, (2005). National Objectives for Health Philippines 2005-2010. Manila, Philippines: Department of Health.

= Research by Frank Trazo (http://www2.doh.gov.ph/noh2007/NOHWeb32/NOHperSubj/Chap4/MentalHMD.pdf) I think my research was the same as the previous one. I'll research more about mental health.

Mental Health and Mental Disorders The WHO defines mental health as a state of well being that enables a person to realize his or her own abilities to cope with the normal stresses of life. It emphasizes that mental health is more than just the absence of psychiatric disorder or illness but also includes a positive state of mental well being. Mental illness is not a fatal disease. Even those who have been mentally ill for most of their lives rarely die of mental illness. However, there is a growing concern for the increasing trend of mortality rate from suicide and self-inflicted injuries which has reached a level of 1.8 deaths per 100,000 population in 2000 (PHS). The public health impact of mental illness lies in the fact that it can cause disability for prolonged periods. In a disability survey by the National Statistics Office in 2000, it was found

that mental illness is the third most common form of disability after visual and hearing impairments. In this survey, the prevalence rate of mental illness in the Philippines was 88 cases per 100,000 population in 2000. The region with the highest prevalence rate of mental illness is Southern Tagalog at 132.9 cases per 100,000 population, followed by NCR at 130.8 per 100,000 population and Central Luzon at 88.2 per 100,000 population. This report is strengthened by the Social Weather Stations Survey commissioned by DOH in June 2004 which revealed that 0.7 percent of total households have a family member with mental disability. In another study, the Baseline Survey for the National Objectives for Health (BSNOH) conducted in 2000, the more frequently reported symptoms of mental health problem cited by the sampled household respondents were excessive sadness, confusion and forgetfulness, no control over the use of cigarettes and alcohol, and delusions. Excessive sadness, forgetfulness and confusion increase with age while cigarette and alcohol abuse affect adults and adolescents more than they do the older persons. The prevalence of mental illness, since it can be chronic, is reportedly highest among the older age groups. Related to mental illness is the problem of drug abuse. The Dangerous Drugs Board in 1998 estimated that there are about 1.8 million regular users and 1.6 million occasional users of dangerous drugs in the country or around 2.5 percent regular users and 2.2 percent occasional users. The first dangerous drug of choice is methamphetamine hydrochloride or shabu and the second is marijuana. Other predisposing factors in the development of mental illness include familial or hereditary mental disorders like schizophrenia, and disorders related to psychosocial development. Some mental illnesses are due to inability to cope with stress brought about by daily living such as migration, urbanization, industrialization, poverty and abuses. The distressing experiences of vulnerable population like children and other persons in difficult circumstances can make them susceptible to mental illness. Persons who are socially deprived are least likely to obtain help for mental and physical trauma, according to a United Nations report. About two thirds of people known to have mental disorders do not obtain help from health professionals. TheWHO identified that stigma, discrimination and neglect have prevented care and management from reaching persons with mental disorders. Psychiatric patients in the Philippines are usually managed in a mental hospital setting. There is now a shift in the management of persons with mental disorders at psychiatric wards in university and private hospitals. Community-based mental health care is also encouraged. Several policies were made to address mental health and mental disorders in the country. Since substance abuse is the leading direct and indirect cause of mental illness among the economically productive age group, the passage of RA 9165 (Comprehensive Dangerous Drugs Act) would impact positively on the control of mental illness in the country. In 2001, the National Mental Health Policy was issued by the DOH, prescribing the framework toward the attainment of optimum state of mental health for all Filipinos. The policy aims to raise the professional and public awareness that mental health is an integral component of total health care. The National Mental Health Policy needs to be translated into action programs by the various partner agencies with the DOH taking the lead in mobilizing partners and ensuring implementation. The social stigma associated with mental illness is a major cause for non-use of health and psychosocial services by Filipinos. The lack of understanding of mental illness and the importance of mental health among Filipinos is as serious as the lack of a regular and useful

database on the prevalence, manifestations, causation and risk factors of mental illness in the country.
Kathleen Toribio Study data regarding the prevalence of mental illness in the Philippines: Philippine Mental Health Country Profile.pdf _ Lubao study (1970s) 10.8%17.2% of adults and 18.6%29% of children consulting a health center were found to have psychiatric problems 75% of mental illnesses presenting at health centers were not recognized by the health workers Sapang palay study Results showed a prevalence of mental illness in 12 per 1000 people (the internationally recognized rate is 1/1000) If the above data were extrapolated (taking into account that the Philippines has a population of over 60 million), then the figures of mentally ill people according to the Lubao data would exceed 2,460,00 and 720,000 according to the Sapang Palay data. The differences between these two rates is that the Lubao study included mild cases of mental illness whereas the Sapang Palay study restricted its data to those with moderate to severe mental illness. The above data only pertains to those who are identified as having a psychiatric illness and not those who may have psychosocial or minor psychiatric problems. Another study of the WHO shows a Philippine study conducted in 3 primary health centers situated in an urban slum in Manila. The study showed that 17% of adults and 16% of children have mental disorders. In 1993-1994, a population survey by the University of the Philippines Psychiatrists foundation Inc, in collaboration with the Regional Office garnered the following results: The prevalence of mental disorders was 35%. The three most frequent diagnoses were : psychosis (4.3%), anxiety (14.3%) and panic (5.6%). For children and adolescents, the top 5 most prevalent psychiatric conditions were: enuresis (9.3%), mental subnormality (3.7%), adaptations reaction (2.4%) and neurotic disorder (1.1%).

Junalyn Camacho
Just want to add a graphical data on the researches of Jeric and Frank:

Reference: Department of Health, (2005). National Objectives for Health Philippines 2005-2010.

Manila, Philippines: Department of Health. HOW SEVERE IS THE PROBLEM OF MENTAL HEALTH IN THE COUNTRY TODAY?

House Bill 6679 states that according to WHO study, one out of five adults and one out of ten children of ages 5 to 15 years old have diagnosable psychiatric disorders.
At the GMA News online hub, there is was an article entitled "1 in 5 adult Pinoys have psychiatric disorders. It further says that more people are developing mental disorders due to extreme life experiences. Dr Lourdes Ladrido-Ignacio, a former president of the Philippine Psychiatric Association, said between 17 to 20 percent of the countrys adult population have psychiatric disorders. About 10 to 15 percent of children aged 5 to 15 are believed to have mental problems. Ladrido-Ignacio also noted that in remote barrios without doctors, 50 percent of adults who consult at rural health centers were diagnosed to have some form of psychological illness. The National Statistics Offices 2000 disability ranked mental illness as the third most common form of morbidity, or type of disease, after visual and hearing impairments among Filipinos. The same survey showed that 88 Filipinos out of every 100,000 population with mental problems. In 2004, a DOH-commissioned Social Weather Stations survey found that 0.7 percent of total Filipino households have a family member who has a psychological disorder such as depression, schizophrenia, epilepsy, and substance abuse. The World Health Organization defines mental health as a state of well-being that allows a person to realize his or her own abilities to cope with the normal stresses of life. The Department of Health, meanwhile, said extreme life experiences" such as natural disasters, armed conflict, and the increasing number of family members going abroad to work have contributed to more Filipinos developing mental disorders. Weve tried to identify the components that could influence the mental status of a person and we found that life experiences such as disasters and armed conflict (affect ones state of mind)," said Dr. Yolanda Oliveros, director of the National Center for Disease Prevention and Control. Oliveros said addressing mental illness as a public health concern remains as a challenge since there are only 400 licensed psychiatrists practicing in the country. Thats why we are telling them to decentralize, to train general pract itioners and healthcare providers since these people are (in the frontline) of primary care," she said.

Reference: http://www.gmanews.tv/story/52861/1-in-5-adult-Pinoyshave-psychiatric-disorders
Junalyn Camacho WHAT ARE THE PREVALENT CASES OF MENTAL ILLNESSES IN THE COUNTRY AND THEIR CAUSES?
Schizophrenia "It (cases of mental illness) increases as the population increases. For example for schizophrenia, if we are now 88 million, expect that 880,000 of us are schizophrenic," Reyes said at a recent health forum. Dr. Lourdes Ignacio, president of the Philippine Psychiatrists' Association, said some of the factors that trigger the disease include stress factors like traffic, loss of loved ones, disasters and even bombings. Among overseas Filipino workers, Ignacio said seamen were found to be the most vulnerable to

mental disorders because they tend to rely on alcohol or drugs to ease their homesickness. Reyes explained that the increase in the incidence of mental illness was also due to the widespread use of prohibited drugs. He said the Dangerous Drugs Board recently released data, which shows that eight million Filipinos are drug users. "Drug addicts or substance abusers have dual diagnosis: substance addiction or substance dependence, and psychiatric disorder whether its depression, anxiety," Reyes said, adding that these patients become drug addicts because they are self-medicating. "Some of the statistics in the hospital would say that yes, they started as saying they have psychiatric disorder but they end up being addicts. These factors add up to the mental health of the Philippines," he said. However, Ignacio said Filipinos have their own natural coping mechanism compared to other nationalities. She said Filipinos strong faith in God, sense of humor and concern for others, are among the mechanisms that help them cope with depression. "We are very much crisis-oriented and we have natural ways of coping with it," she said. Ignacio said they consider these as forms of coping with mental disorders even without scientific basis. Reyes said some mental patients could function normally again after being treated. "Of course, for example, a bank manager suffered from schizophrenia, he or she cannot go back as a bank manager, but as a clerk. There is some form of regression but in terms of symptoms, they are free from symptoms, but their functioning has already regressed in some form," he said. On the other hand, Ignacio revealed that the Philippines is facing an acute shortage of psychiatrists due to the unabated migration of mental health doctors who seek greener pastures abroad. She said there are only 400 psychiatrists in the country, and most them are in the National Capital Region. Ignacio said the provinces of Cotabato and Surigao, in particular, lack the service of psychiatrists. According to Reyes, some of the symptoms of schizophrenia include a change in behavior, forgetting basic functions such as in personal hygiene, social and occupational dysfunction like when the person does not want to go back to work.

Reference: http://www.asiafinest.com/forum/index.php?showtopic=103178

(by Janice M. Cabusas) A Philippine study conducted in three primary health centers in urban slum in Manila in 1993-1994 showed that 17 % of adults and 16 % of children had mental disorders. Prevalence of mental health disorders was at 35%. A study conducted by the University of the Philippines Department of Psychiatry in the rural areas in 1989 yielded similar findings, where 34% of those with mental disorders had social problems. The three most frequent diagnoses among the adults were: psychosis (4.3%), anxiety (14.3%) and panic (5.6%). For children and adolescents, the top five most prevalent psychiatric conditions were: enuresis (9.3%), speech and language disorder (3.9%), mental sub-normality (3.7%), adaptation reaction (2.4%) and neurotic disorder (1.1%)[[#_edn2|[ii]]] A study performed in the 1970s even showed that 12 out of 1000 Filipinos have severe mental disorder, quite an alarming rate if compared with the internationally recognized rate of 1/1000.[[#_edn3|[iii]]] In the past three decades, Filipinos have been exported as work force abroad in the

light of economic justifications to support their families. Of the 7.76 million Filipinos overseas in 197 countries, 2.86 million immigrants or permanent residents, 3.38 million documented OFWs, and 1.5 million irregularly documented overseas workers. 75% of these workers are women, majority of which work as domestic helpers in countries such as Saudi Arabia, Taiwan, UAE, Hong Kong and Kuwait. (Incidentally, these countries have not ratified the Migrant Workers Convention; and only Kuwait has ratified he International Covenant on Economic, Social and Cultural Rights, which embodies the right to health).[[#_edn4|[iv]]] Despite the alleviation from poverty due to increase of dollar remittances to their families, OFWs face a wide range of health-related problems,[[#_edn5|[v]]] including and more importantly, in mental health, while performing their jobs away from their loved ones. Seafarers, mostly male workers, find it most difficult during long periods of isolation out at sea specially those who work in cargo ships and tankers, in contrast to those who work on cruise liners whose ships dock more often, allowing them to interact with other people almost everyday. Filipinas working as domestic helpers abroad are exposed to situations that render them vulnerable to physical, sexual and psychological abuses. Aside from these on-site problems besetting our OFWs, melancholy or loneliness, the inability to adapt to other cultures and the unrealistic expectations from their families at home may sometimes add to their grievances, which when left unchecked, may further cause mental disorders that push them to commit suicide.[[#_edn6|[vi]]]
Reference:
Conde, B (2004) Philippine mental health country profile, International Review of Psychiatry (February/May 2004) 16(12), 159166, From http://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Country_Profile.pdf Quesada, A. T. (2005). Health at Stake: Access to Health of Overseas Filipino Workers 2005 Report , From http://www.achieve.org.ph/Philippine%20SoH%20Report.pdf Tan, M. (2008, July 13). Homesick, Heartsick, , Inquirer.net, From http://showbizandstyle.inquirer.net/sim/sim/view/20080713-148154/Homesick-Heartsick

Liezl:
Around 32 percent of government employee-respondents had experienced mental health problems at least once, 15 percent had specific phobias, 10 percent were alcoholics, and 6 percent suffered from depression. These are findings of a 2006 pilot study done by the Department of He alths National Epidemiological Center on several government agencies at the National Capital Region. The study involved employees from the 20 national agencies in Metro Manila (Salazar, 2008). Reference: Salazar, T. (2008, May 30). 32% of govt employees suffered mental health problem--study. Inquirer.net. Accessed fromhttp://showbizandstyle.inquirer.net/lifestyle/lifestyle/view/20080530-139836/32-of-govtemployees-suffered-mental-health-problem--study