Mental health is defined as "a state of well-being in which every individual

realizes his or her own potential, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to her or his community".
The World Health Organization emphasized the importance of mental health by
including it in their definition of health as "a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity. "
Mental health care is the status of providing and maintaining psychological, psychiatric,
and emotional health by means of diagnosis, treatment, and prevention of mental
illnesses.
This article will survey the status of psychological, psychiatric, and emotional health
care in the Philippines from both past and present programs.

Existing conditions of mental health care in the Philippines

Processes in the Health Care System
There are three tiers in the health care system: primary, secondary, and tertiary. The
primary health care tier serves as a patient's first point of contact with a health
professional who can provide outpatient medical care. If the general practitioner cannot
address the problem of the patient, then the patient is referred to a specialist. Mental
health care specialists, which belong to secondary health care, include psychologists
and psychiatrists. In the Philippines, most psychiatrists are in private practice, although
some work in government institutions such as the National Center for Mental
Health. Psychiatrists provide the patient with services such as assessment, counselling,
and/or prescription drugs if needed. In the tertiary health care, patient would be referred
to institutions if the mental illness needs specialized care that is beyond the capabilities
of the specialist.
Some health care systems put psychologists and psychiatrists under the category of
primary care providers. In this case, short hospital stays and consultation-liaison
services to other medical departments would fall under secondary health care. Serious
mental illness would require rehabilitation, which is the scope of tertiary health care.
Institutions
Mental health facilities and institutions are maintained in the Philippines by both private
and public groups but access to them remains uneven throughout the country. [7] Most
facilities are situated in the National Capital Region (NCR) and other major cities in the
country, thus favoring those who live near these urban areas.
National Center for Mental Health
The National Center for Mental Health (NCMH), originally named Insular Psychopathic
Hospital, was established in 1925 under the Public Works Act 3258. At the time, the City
Sanitarium and San Lazaro Hospital are the only primary institutions that cater to the
needs of the mentally ill. However, due to the large volume of patients pouring in, there
was a need to build another institution that could provide for the needs of mentally ill
patients. The 64-hectare site is located in Mandaluyong.
The institution officially opened on December 17, 1928, accepting 379 patients who
were all crowding up in San Lazaro Hospital. In 1930, the bed capacity was increased to
800, although the total number of patients was at 836. Two pavilions were added to
increase the bed capacity to 1,600. By 1935, the City Sanitarium closed, and leaving
NCMH with 1,646 patients to serve.
Aside from being a hospital, NCMH is authorized by the Department of Health as a
Special Research Training Center. According to the NCMH website, the hospital is
"mandated to render a comprehensive (preventive, promotive, curative and
rehabilitative) range of quality mental health services nationwide". Aside from this,
NCMH also offers a 4-year psychiatric residency training program for doctors and a 2-
year psychiatric nursing program for nurses specializing in psychiatric care. There are
also affiliation programs that cater to students from the fields of psychology, pharmacy,
and nursing, among others.
NCMH currently occupies 46.7 hectares of land, with 35 pavilions/cottages, and 52
wards, as well as facilities such as medical infirmary, library, chapel, conference rooms,
tennis court, basketball court, multi-purpose hall and dormitories. As of 2011, the
numbers of staff are as follows: 88 doctors, 890 nursing staff, 116 medical ancillary
personnel, and 446 administrative support staff. The hospital also received from the
government a budget allocation worth PHP 523, 982, 000, which costs an average of
Php 118.61 per patient per day.
Currently, NCMH has a bed capacity of 4,600 and serves an average of 3,000 in-
patients on a daily basis, in addition to 56, 000 outpatients per year. Most patients come
from Metro Manila and nearby regions III and IV. They also serve patients from other
regions, often forensic cases referred by the courts. Subsidy for treatments is given to
87% of the inpatients which belong to classes C and D. The institution received its ISO
9001:2008 certification on December 2, 2015.
Philippine Mental Health Association, Inc.
The Philippine Mental Health Association, or PMHA, is "a private, non-stock, non-profit
organization dedicated to the promotion of mental health and prevention of mental
disorders." Its headquarters is located in Quezon City with nine chapters all over the
Philippines: PMHA Bacolod-Negros Occidental, Baguio-Benguet, Cabanatuan-Nueva
Ecija, Cagayan de Oro-Misamis Oriental, Cebu, Dagupan-
Pangasinan, Davao, Dumaguete-Negros Oriental, and Lipa-Batangas.
It was established on January 15, 1950 with Dr. Manuel Arguelles as president due to
the call for assessment of mental health problems induced by World War II At present,
their programs range from Education and Information Services (EIS), Clinical and
Diagnostic Services (CDS), and Intervention Services (IS).
The PMHA provides guidance and educational programs for the youth through
partnering with various private and public schools and colleges in the country. They also
organize seminars and workshops for youth mental health through their EIS arm.
The Association officially expanded its services to the adult population in 1960. They
now provide psychiatric, psychological, and counseling services to all sectors of society
under CDS. They also launched Rehabilitation Care Services in 1962 to assist in the
recovery and reintegration of patients into the community.
The Association's IS arm has two centers: the Center for Children and Youth (CCY) and
the Adult Work Center (AWC). The CCY provides various kinds of therapy sessions and
counseling along with special education for those with learning disorders and mental
retardation. The AWC provides life skills training and family programs to assist mental
health patients in their recovery and therapy.
Other Institutions
In the National Capital Region (NCR), most major hospitals (both public and private)
have a psychiatric department which caters to the need of people with mental illness.
Hospitals include The Medical City, Philippine General Hospital (PGH), Manila Doctors
Hospital, and University of the East Ramon Magsaysay Memorial Medical Center,
Inc.(UERMMMC), to name a few.
Webbline provides a list of mental health care facilities that can be found in the
provinces and in NCR.
Suicide Prevention Hotlines in the Philippines
Those who are in need of immediate assistance may opt to call a suicide hotline.
Suicide hotlines available in the Philippines include the Natasha Goulbourn Foundation
(NGF) and the Manila Lifeline Centre (MLC). The NGF suicide hotline can be reached at
(02) 804-HOPE (4673), 0917 558 HOPE (4673) or 2919 (toll-free for GLOBE and TM
subscribers). The MLC can be reached at (02) 8969191 or 0917 854 9191.
Mental Health in Other Laws
Certain laws contain provisions for the protection of the rights of the mentally ill. The
Magna Carta for Disabled Persons (Republic Act No. 7277) considers those suffering
from mental illness as disabled. This law protects their interests regarding employment,
education and health. This law states that the government will establish centers for
special education in all regions of the Philippines for those visually impaired, hearing
impaired and intellectually disabled. It also hold state universities to be responsible for
a Special Education (SPED) course if need be.
According to the Family Code of The Philippines (Executive Order No. 209), in the event
where the adoption of an adopted minor with mental disability is rescinded, the state will
provide a guardian over him/her
The Comprehensive Dangerous Drug Act (Republic Act No. 9165) was passed in 2002
in order to control problems with drug abuse. Drug abuse was seen both as a direct and
indirect cause of mental illness among people in the economically productive age group.
The law guarantees a minimum of 12 years in prison, as well as fines ranging from Php
100,000 to Php 10,000,000 against offenders. The act protects mentally incapacitated
individuals along with minors who are victimized by drug pushers (either by selling them
drugs or involving them in illicit activities). A person found guilty of the above shall be
given the maximum penalty.

National legislation
Mental Health Law
The Mental Health Law (Republic Act 11036) proposes a mental health policy that aims
to enhance integrated mental health services, the promotion of mental health services,
protection of people who use said services, and the establishment of a Philippine
mental health council. These goals are based on international human rights standards.
The purpose of this law is to incorporate comprehensive mental health services into the
Philippines' national healthcare, for accessible mental healthcare especially to the
impoverished and those at high risk.
The law mandates the Department of Health, Commission on Human
Rights, Department of Justice, and various hospitals in support of those with mental
health problems. Mental health services are proposed to be accessible from large-scale
hospitals, down to the barangay level. Health and medical courses will include
mandatory courses in mental health, so as to fully equip healthcare professionals.
National Mental Health Program
The Philippines has a National Mental Health Program or Mental Health Policy
(Administrative Order #8 s.2001) signed by then-secretary of the Department of Health,
Manuel Dayrit.
This policy aims to promote quality mental health care in the country, to reduce the
burden of mental illness, and to protect the rights of people afflicted by mental illness.
Programs of the Department of Health under the Mental Health Policy include the
improvement of the promoting of knowledge of mental health, national and local
provision of services and facilities regarding the treatment of mental health, support for
the research and training on mental health, and other initiatives. The National Program
Management Committee and the Program Development and Management teams were
organized in order to oversee and manage the development of the program and to
create the protocols regarding the specific policies that were implemented.
Other stakeholders or partners for this program include the Philippine Psychiatric
Association (PPA), the National Center for Mental Health (NCMH), the Philippine Mental
Health Association, and Christoffel Blindenmission (CBM), an international organization
that advocates for the disabled in poor countries.
The Philippine government spends around 5% of the health budget on mental health,
mostly going to the maintenance of mental hospitals. Medicine for mental illnesses are
provided in government-run mental health institutions. Social insurance covers mental
health concerns, but only for acute inpatient care.

Studies on Filipino mental health

Studies and data on mental health in the Philippines are collected and transmitted
from mental health facilities to the government. Among the focus of mental health care
professionals from both national and international agencies at present include the
integration of provisions for mental health care of displaced civilian population due
to calamities and wars.
Victims of calamity
Disasters and tragedies tax the human mind and spirit and can cause severe mental
and emotional breakdowns. Losing loved ones and sources of livelihood, such as
farmlands and businesses can have mental and emotional effects on survivors.
Volunteers have provided psychological first aid, beginning with early intervention which
is implemented in the immediate aftermath of disaster. It is designed to reduce the initial
distress and foster an adaptive mechanism for survivors in all age groups. Effective
interventions can: restore function and enhance recovery; create a safe and secure
environment; reduce uncertainty, fear, and anxiety; and mobilize family and social
supports.
Typhoon Ondoy
To address the psychosocial concerns of the typhoon victims during Ondoy, a task force
on Mental Health Psycho-Social Support (MHPSS) was formed headed by the Health
Emergencies Management Staff of the Department of Health (DOH) as chair and lead
agency based on Memorandum 15 series of 2008 issued by the National Disaster
Coordinating Council (NDCC), and the DSWD as co-chair.
The members of the Task Force came from national government agencies (NGAs),
academe, non-government organizations and faith-based private sectors, with mental
health and psycho-social support programs. Some of the members of the MHPSS Task
Force visited the children in evacuation centers in Marikina, Philippine Sports Arena
(formerly ULTRA) and Bagong Silangan. The children listened to Bible stories told by
the volunteers, learned songs and played games. Likewise, the volunteers encouraged
the children to play with toys and draw pictures of their experiences. According to
Secretary Esperanza I. Cabral, the MHPSS Task Force conducted psychosocial training
and orientation, psychosocial and psycho/spiritual processing, and critical incident
stress debriefing to some 8,770 adult-victims of typhoon 'Ondoy' who were in
evacuation centers, as well as play therapy sessions with 3,075 children-victims and
704 service providers and disaster relief workers.

Filipina migrant workers

As of 2008, Filipino women (Filipinas) account for around 50 percent of the migrant
workers. In 2009, about forty percent of the Filipinas who migrated were household
service workers. Filipina domestic workers are most especially vulnerable to abusive
working conditions because of their work's live-in nature.
In a study published in 2011, interviewing 500 domestic workers who worked abroad
about 55% experienced stress during their time abroad, with more than half also
vulnerable to psycho-emotional symptoms during their stay abroad. Accordingly, the
number of psycho-emotional symptoms decreased while in the Philippines compared to
when they were abroad. It was the same trend among the psychological manifestations
of stress. Only three percent sought the help of a mental health professional, with the
majority opting to talk to a pastor instead about their psycho-social symptoms.
Labor migration in the Philippines is based on a passive nature, with many seeking to
work abroad to escape family division or economic failure. As a result, many perceive
one's success as whether they are able to make a new life for themselves abroad.
However, the lives they make for themselves abroad aren't always easy. Many face
barriers and challenges such as language differences abroad and separation from loved
ones. Migrant work also doesn't always ensure a rise in one's social standing. Women
who work abroad face social decline in their careers, racial barriers, and gender
limitations. Furthermore, Filpina migrant workers are often denied certain privileges
granted to other citizens and workers, often facing exclusion and abuse. For example, in
Singapore, Filipinas are not protected by the Employer Act and are thus vulnerable to
abuse by their employers, such as working longer hours and having to follow harsh
regulations.
These struggles are made even more evident in the lives of domestic workers and
caregivers. Filipina migrant workers who take on jobs as caregivers face the challenges
of developing emotional bonds with the children they care for. While such bond may
fulfill recognition that these women seek in their jobs, they often suffer from deep
emotional loss at job termination and detachment from their own families. The move of
Filipina migrant workers also poses a challenge to their familial relations, especially
between husband and wife. These women often face anxiety out of fear that husbands
are unable to perform their new role as both the father and mother at home. Husbands
taking on the domestic role are often seen as a threat to their masculinity and often
indulge in extramarital affairs or simply do not take on the duties of their new role.