COMPOSITE IMAGE: JEROME CRISTOBAL FROM INQ STOCK PHOTOS
MANILA, Philippines鈥擥iven the inaccessibility of mental health services, the tragic state of the National Center for Mental Health (NCMH), which Sen. Raffy Tulfo likened to a 鈥減ig pen,鈥� seemed like a deadend for Filipinos with mental health illnesses.
Dr. Dinah Nadera, a psychiatrist, said with Tulfo鈥檚 revelation of the 鈥渉eartbreaking鈥� condition of patients at the NCMH, families of patients 鈥渨ill be discouraged from seeking help鈥� from the government鈥檚 leading mental health institution.
But families being discouraged is only the tip of a more complex issue, especially since when it comes to a patients鈥� access to health care, 鈥渨e can say that services are not available, accessible and affordable in several areas.鈥�
鈥淲here will the persons with mental health condition[s] go if services are not available in general hospitals?鈥� said Nadera, a highly regarded psychiatrist actively involved in training primary health care workers in assessing and managing people with mental health illnesses.
READ: 鈥楶ig pen鈥� conditions at NCMH mirror state of PH mental health care
She said this was the reason that the World Health Organization (WHO) encouraged governments to decongest mental hospitals and make mental health services accessible in communities.
This, as she stressed that in many countries all over the world, stand-alone psychiatric facilities are said to have poor conditions and that the NCMH in Mandaluyong City, which was established in 1925, is not an exemption.
As psychiatrists John Lally, John Tully and Rene Samaniego stated in an article published by the National Center for Biotechnology Information, there are 鈥渟ubstantial gaps and inconsistencies in the delivery of mental health care鈥� in the Philippines.
Struggling with poverty, mental illness
It was Good Friday (April 7)鈥攁 house in Ramon, Isabela was as silent as the rest of the barangay or village, but if not because of the provision of medicines from the local government, this would not have been the case.
Staying inside an old and crumbling house are siblings Remedios, Salome, and Martin (not their real names), who are all with mental health conditions. Their mother, Virginia (not her real name), is the only one taking care of them.
STRICKEN WITH SICKNESS, POVERTY. Now calmer, Remedios and Salome (not their real names) try to live a normal life inside their old and crumbling house. PHOTO BY KURT DELA PENA
Virginia told that it was in the 2000s when Remedios and Salome fell sick, then years later, Martin became sick, too. The condition of the siblings made life tougher, she said, especially since all of them were already in poverty even before the siblings became ill.
There were a few instances that the three had been checked by a psychiatrist, and as Virginia shared, they were told that the siblings will get better if all of them would consistently take their medicines.
鈥淭his happened,鈥� she said, but not to all of them. 鈥淥nly Salome is taking her medicines regularly, so her condition improved from always being naked and often having outbursts to being silent and calm.鈥�
NOW CALM. Salome (not her real name), diagnosed with schizophrenia, is now calm after taking medication regularly, an improvement from her previous condition of always being naked and often episodes of outbursts. PHOTO BY KURT DELA PENA
Lally et. al. stated that the 2005 WHO Health Survey indicated that 鈥渙nly a third of people with a diagnosis of schizophrenia were receiving treatment or screening (although antipsychotic medication was not specified as the treatment).鈥�
Virginia said if access to mental health care did not come late, the condition of the siblings would not have been 鈥渨orse鈥� and that all of them, especially Remedios, would still have been able to work and provide for the family.
She said confining the siblings to a mental hospital also came to her mind, but she feared that their condition would only get worse inside: 鈥淚 was afraid that they might get harmed by the other patients and that care might not be enough.鈥�
NCMH鈥檚 sad state
Take what Tulfo said of Pavilion 4, the NCMH鈥檚 Forensic Ward, which houses patients with pending cases. He said that the cramped pavilion with poor ventilation has roughly 50 patients even if its capacity is only up to 10 people.
READ: Probe into state of National Center for Mental Health sought
He also recalled his visit to Pavilion 8, or the mental health institution鈥檚 Female Ward. He said the ward 鈥渟melled of patients鈥� feces and urine, which was made even awful by the smell of garbage dumped outside.鈥�
GRAPHIC Ed Lustan
鈥淚t is heartbreaking to see the tragic condition of the patients at the NCMH [鈥 If you are squeamish, I鈥檓 certain that you鈥檒l throw up because of the wards鈥� foul smell, which is worse than the smell of a pig pen.鈥�
He said: 鈥淭hey are sleeping on the floor without any mat, blanket or pillow. They are cramped like sardines in a can, and the heat is like you are in an incinerator because there is poor ventilation and lack of electric fans.鈥�
Tulfo said patients are 鈥渘ot receiving the specialized care and treatment they deserve because of the hospital鈥檚 poor facilities.鈥� Tulfo made an inspection at the NCMH last March 27 after receiving a tip.
He stressed 鈥渢he need to hold accountable those responsible for corruption or any lapses, negligence, or violations of laws, rules, and regulations governing mental health care services鈥� in the Philippines.
Health Undersecretary Maria Rosario Vergeire, Department of Health (DOH) officer-in-charge, said 鈥渨e are open to the investigation, and we are trying to improve the situation, and, of course, the convenience of our patients.鈥�
READ: DOH open to NCMH Senate probe; notes facility improvements
Access to mental health care 鈥榣acking鈥�
Nadera said there is 鈥渢eeming evidence that persons with mental health conditions can be treated as out-patients in communities,鈥� stressing the need to address the lack of knowledge and skills of health care providers in general hospitals.
GRAPHIC Ed Lustan
鈥淭here are reports of human rights violations partly because families and communities do not know how to deal with challenges faced when caring/encountering a person with mental illness,鈥� she said.
RELATED STORY: Each person鈥檚 mental health struggles need personalized solution 鈥� DOH
As Lally et. al. stated, 鈥渢here are only two tertiary care psychiatric hospitals鈥� in the Philippines: the NCMH in Mandaluyong City, which has a bed capacity of 4,200, and the Mariveles Mental Hospital in Bataan, which has a bed capacity of 500.
GRAPHIC Ed Lustan
There are 12 smaller satellite hospitals affiliated with the NCMH and are located throughout the country, but 鈥渙vercrowding, poorly functioning units, chronic staff shortages and funding constraints鈥� are problems being faced, especially in peripheral facilities.
WHO data, which was cited by Lally et. al. in the article, indicated that there are only 1.08 mental health beds in general hospitals and 4.95 beds in psychiatric hospitals for every 100,000 people in the Philippines.
Likewise, there are only 46 out-patient facilities, or 0.05 for every 100,000 population, and 4 community residential facilities, or 0.02 for every 100,000 population: 鈥淢ental health [care] remains poorly resourced.鈥�
Based on WHO鈥檚 2007 Assessment Instrument for Mental Health Systems, there are only 0.41 psychiatrist for every 100,000 Filipinos, a ratio that is way lower than the rest of Western Pacific countries with the same economic statuses.
Lally et. al. said together, 鈥渢hese figures equate to a severe shortage of mental health specialists in the Philippines. This is further illuminated when compared with the WHO-recommended global target of 10 psychiatrists for every 100,000 population.鈥�
鈥淧rohibitive economic conditions and the inaccessibility of mental health services limit access to mental health care in the Philippines. Further, perceived or internalized stigma has been shown to be a barrier to help-seeking behavior in Filipinos.鈥�
READ: Mental Health Day: The need to defuse a ticking time bomb for millions
Strengthen the law
Only 5 percent of the government health care expenditure is directed toward mental health even after the Mental Health Act and Universal Health Care Act were enacted, Nichole Maravilla and Myles Tan stated in an article published by the Frontiers in Psychology.
As Nadera stressed, the Mental Health Act, which was signed in 2018 in keeping with the United Nations鈥� Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care, is 鈥渨ell-written.鈥�
However, she said the law needs to be implemented properly: 鈥淒efinitely, the government should address the issue that the NCMH is facing and help NCMH achieve what it should achieve according to the Mental Health Act.鈥�
鈥淭hat it should evolve into a facility that is focused on research, development of models of care particularly in the area of public mental health. It is also envisioned that the Center evolves into a center for neurology and psychiatry.鈥�
GRAPHIC Ed Lustan
The law mandated the DOH to make sure that responsive primary mental health services are developed and integrated as part of basic health services.
It provided for access to mental health service at all levels of the national health care system, affordable essential health and social services for the purpose of achieving the highest attainable standard of mental health, evidence-based treatment of the same standard and quality, regardless of age, sex, socioeconomic status, race, ethnicity or sexual orientation.
Back in 2018, Malaca帽ang said the law 鈥渇orms part of the government鈥檚 mandate to design and implement a national mental health program and integrate this as part of the health information system, among others.鈥�