By Samuel P. Medenilla & Cai U. Ordinario | Reporters
& Roselin Manawis | Intern
IN the 18th century, Karl Marx called it alienation of man; today this is described by the collective phrase of mental health issues. And with the state issuing a policy addressing this social phenomenon, public and private initiatives are now converging to address the costs and effects of the issues on mental health.
For Cely D. Magpantay, a practicing clinical psychologist, the main problem is stigma. For labor unionists, the problem is related to stigma: treating mental health issue as the elephant in the room.
Magpantay, who is also a board member of the Psychological Association of the Philippines (PAP), said in certain situations, Filipino families tend to be secretive if a family member has a mental condition.
The same may be said of students and employees who do not disclose any psychological issues they may be experiencing in fear of judgement, she explained to the BusinessMirror.
Certain stereotypes are still prevalent today, and these hold many from seeking help and talking about their conditions, she added.
Such was the experience of Denise, who spoke about her condition only if her identity is not revealed.
Studying in one of the exclusive schools in the metropolis, Denise took a slide into her own world after failing to cope with the growing workload of her academic requirements.
From being one of the top performing in her class, she saw her grades plunge. “My stress level soared with every drop in my grades,” she told the BusinessMirror.
One of many
DENISE is one of the 3.3 million Filipinos suffering from depressive disorders, based on Department of Health (DoH) data.
Based on the DOH website, which was last updated in 2018, at least 19 million Filipinos suffer from schizophrenia, major depressive disorder, and are considered bipolar. The largest group, accounting for 17 million, are composed of those who suffer from major depressive disorder.
On top of this, the DOH’s Disease Prevention And Control Bureau-Essential Non-Communicable Disease Division said 5 percent of Filipinos older than 65 years old suffer from dementia and 600,000 Filipinos are epileptic.
The data was based on the “Global Epidemiology on Kaplan and Sadock’s Synopsis of Psychiatry, 2015” and “Kaufman’s Clinical Neurology for Psychiatrists, 7th edition, 2013.”
Further, the DOH unit noted that studies by the World Health Organization (WHO) showed that 16 percent of students between 13 and 15 years old have seriously considered attempting suicide; while 13 percent have actually attempted suicide one or more times during the past year.
Also, a study conducted among government employees in Metro Manila revealed that 32 percent out of 327 respondents have experienced a mental health problem in their lifetime.
The DOH said studies showed the incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005 while rates rose from 0.12 to 1.09 per 100,000 in females. Intentional self-harm, DOH said, was also the 9th leading cause of death among the 20-year old to 24-year old range.
WHEN it comes to workplaces, mental health is still far from the mind of employees.
Trade Union Congress of the Philippines (TUCP) Spokesman Alan Tanjusay admitted the issue is still seldom being taken up by workers during their respective collective bargaining agreement (CBA), where issues like wage and allowances are still paramount.
“It is still not mainstreamed in CBA since they are still trying to learn about it,” Tanjusay told the BusinessMirror.
However, Tanjusay noted labor groups including TUCP are now including it among their agenda amid the increasing number of their members who are complaining about mental related-issues.
“These slowly rising incidents are being raised in our discussions and conversations from our members,” Tanjusay said.
He said these complaints include work-related stress and burnout, which was recently recognized by the World Health Organization (WHO) as a legitimate “occupational phenomenon.”
This was supported by Federation of Free Workers (FFW) Vice President Julius Cainglet, who said they usually get such complaints from employees in the call-center industry.
“There are also countless tales of managers at the manufacturing assembly line, who breathe down the necks of their workers to meet orders and use foul language along the way,” Cainglet said in a previous statement.
The common causes of poor mental health in the workplace include stress, anxiety, mood and depression disorders, according to Magpantay.
THE TUCP and FFW are now banking on the pending Implementing Rules and Regulations of the Philippine Mental Health Law or Republic Act (RA) 11036 to promote the importance of mental health in workplaces.
Under RA 11036, the Department of Labor and Employment (DOLE) and the Civil Service Commission (CSC) are required to develop “standards on appropriate and evidence-based mental health programs for the workplace.”
As of September 2, the Bureau of Working Conditions (BWC) of the DOLE said the guidelines are still being finalized.
The said guidelines, however, may be not be sufficient to address the concerns of workers, especially since there is a shortage of professionals dealing with mental health.
Last week, the Philippine Health Insurance Corp. (PhilHealth) expressed concern over the lack of the said professionals in relation to the implementation of the mental health provision of the Universal Healthcare Law.
“Actually we do not have enough healthcare professionals. We lack about 30,000 medical professionals. But the shortage is more acute for psychiatrists and psychologists,” Philhealth President and CEO Ricardo C. Morales said.
The Professional Regulation Commission (PRC) was able to register the first batch of 330 licensed psychologists only in 2013.
The following year another 571 got licensed for the practice of psychology. This rose to 894 and 1,010 for 2015 and 2016, respectively.
There is also a shortage in practicing psychologists and psychiatrists. Magpantay notes that there are fewer than 1,000 psychiatrists, and that there are also only quite a few practicing psychologists in clinics compared to the demand. “There are some provinces that have no psychiatrists and psychologists as well, and plus of course the facilities,” she points out.
HOWEVER, Magpantay said many cases related to mental health remain unreported.
“In reality, if you are in the field, there’s more than the number [reported to the DOH],” she said.
Magpantay surmises the cause would also be lack of access to services or awareness that mental health is part of what the government has addressed and is addressing.
For one, there’s the National Center for Mental Health (NCMH), “dedicated to delivering preventive, curative and rehabilitative mental health-care services,” in Mandaluyong City.
For 32 years now, the NCMH has performed as a Special Research Training Center and Hospital under the DOH. The NCMH has an authorized bed capacity of 4,200 inpatients and serves an average of 56,000 outpatients per year.
For 2019, the national government allocated P1.005 billion for the NCMH. This is composed of P779.515 million for personnel services and P225.442 million for maintenance and other operating expenses. There were no capital outlays for the hospital.
The amount allocated for the hospital is only 1.03 percent of the total budget of the DOH worth P97.65 billion.
Another tertiary-care psychiatric hospital is the Mariveles Mental Hospital in Bataan with an authorized bed capacity (ABC) of 500 beds.
According to a study by John Lally, John Tully and Rene Samaniego titled “Mental Health Services in the Philippines,” a dozen smaller satellite hospitals afﬁliated with the NCMH are located throughout the country.
“Overcrowding, poorly functioning units, chronic staff shortages and funding constraints are ongoing problems, particularly in peripheral facilities,” the authors said. “There are no dedicated forensic hospitals, although forensic beds are located at the NCMH.”
THE NCMH’s “Comparative Hospital Statistics” revealed its actual beds last year exceeded its implementing bed capacity (IBC) in 2017 by 112.16 percent. IBC is the actual beds use based on hospital and/or facility management decision, which for NCMH was at an annual constant of 3,151 beds from 2015 to 2018.
The NCMH’s ABC, or the approved number of beds as per issued license to operate in the hospital and other health facilities, was at an annual constant of 4,200 beds from 2015 to 2018.
Total admission of the NCMH peaked in 2016 at 11,616 from 10,547 admissions in the previous year. However, total admissions tapered off to 7,654 in 2017 and to 7,317 last year.
The NCMH’s average daily inpatients steadily increased from 3,149 in 2015 to 3,534 last year.
The average length of stay was at its lowest in 2017 at 99 days when the net death rate was at its highest that year at 3.58 percent. The highest average length of stay was in 2015 at 198 days. It went down to 128 in 2016, but increased from 2017 to 2018 at 107. The net death rate was at its highest at 3.11 percent in 2017, dipping slightly to 3.48 percent last year.
The NCMH’s total OPD patients attended steadily grew at a compounded annual growth rate of 4.95 percent from 64,055 in 2015 to 77,718 last year.
MAGPANTAY added there are also cost issues that shackle families from addressing mental health issues.
“The cost is also affected by the number of specialties, doctors, other health professionals, and then facility-wise,” she says. Most of the time, only private hospitals offer proper care for psychological and psychiatric needs. For public hospitals, it is usually only tertiary-level hospitals like the Philippine General Hospital (PGH) that offers the proper facilities for care.
Based on the current rates of the NCMH, a consultation costs P400. Some facilities like the PGH offer free consultation at times. On the other hand, for private institutions, consultation fees can start from an average of P2,000. A patient usually comes in for consultation once or twice a week or month, depending on the case.
Vanessa dela Cruz (not her real name) told the BusinessMirror her first therapy appointment four years ago was P2,400.
“The second was P1,800 and the succeeding ones were P800,” Dela Cruz said. “I had weekly therapy around two months to three months. Around the fourth month, it [consultations with my psychiatrist] became every other week.”
There’s also the matter of medicines.
Melissa San Juan (not her real name) said one of the drugs prescribed by her doctor had to be taken every day. San Juan said she only takes a half dosage since “malakas effect sa akin ng meds [The medicine’s effect is strong].”
She said at full dosage, the medicine she takes costs P60 a day or about P1,800 a month.
San Juan, who works at a call center, said there are other medicines she needs to take.
So to give a ballpark, if the cheapest drug that could be bought at a popular drugstore is P20 minimum per tablet of one medicine, that would be P600 per month, San Juan said.
“So if you have a combination of meds, it will add by a factor of P600 per medicine per month,” she told the BusinessMirror.
A box of antidepressants costs an average of P2,000 per month to P3,000 per month, Magpantay estimates.
MAGPANTAY believes that mental health and its care can also impact the country’s economy, but she is not sure to what extent. She uses the workplace as an example and how productivity is affected.
“If there are a greater number of employees suffering from depression, burnout and even unmanageable or chronic stress, they will be absent,” Magpantay said.
Labor Assistant Secretary Benjo Santos M. Benavidez agrees, adding that when workers are too stressed to work and are absent, there will be less services and products produced.
With less services and products offered and bought, it is possible that the country’s GDP may go down, which can affect the country’s growth as a whole, Benavidez explained.
He said the DOLE is currently working on a department order to incorporate mental health care in the workplace.
The order will be made in collaboration with medical experts and the DOH, the DOLE official said, adding that it will set a list of standards and policies to be followed by both the private and public sectors, similar to the existing Occupational Safety and Health Law (RA 11058).
WHILE the pending order is applicable to several sectors, Benavidez acknowledges there may be some differences in execution based on the risks associated with a certain sector or job. It is also very difficult to exactly pinpoint the stressors that each job and position may have.
Benavidez explained that the risks to mental health in the field of manufacturing may be different from the field of interpersonal services, as one field deals with more people than the other. Some fields are more fast-paced than others as well, which can also contribute to a higher risk for mental health concerns, he explained.
While each sector has its own peculiarities and there may be no one standard to fit all of them, Benavidez gave assurances the standards to be set will be applicable to all, as they want to treat everyone equally.
“We need to ensure that everyone will be treated alike, whether if you’re of this mental condition or otherwise,” he told the BusinessMirror.
Removing the stigma
THE main goal of the department order is to remove the stigma in the workplace. Aside from the basic guarantees of the labor code such as minimum wage and overtime pay, all workers should have an equal chance when it comes to hiring, continued employment, promotion, access to training, training opportunities, and dismissal. No employee shall be dismissed without due process or denied a hiring opportunity only on the grounds of a mental health condition.
Factors outside the workplace are also considered in the department’s development of standards, according to Benavidez.
He said in the vernacular that it is difficult to apply the advice to workers not to bring family matters or problems in the workplace.
“But that cannot be avoided,” Benavidez said.
He says the lack of a proper work-life balance is also a factor they are considering.
Certain jobs call for more work hours than others, which can also cause a strain on workers, especially those who have travel times of multiple hours throughout the day. Workplace environments wherein workers cannot air their concerns also deepen possible mental health strain.
MANY nongovernment organizations (NGO) have also become more vocal and hands on with their efforts in helping and spreading awareness. Other private-led institutions such as Mental Health PH, Silakbo PH, Youth for Mental Health Coalition Philippines and the like are active in their efforts online and offline as well to help educate Filipinos on mental health.
Silakbo PH Research Head Katha M. Estopace said their organization addresses issues on mental health through different forms of art. They collect submissions that reflect, center or act as catharsis for different mental health concerns in the forms of poetry, paintings, playlists and other forms of art.
“It [art] makes you think, it makes you feel, it conveys a lot of things,” Estopace said.
Silakbo PH also hopes that with art, they can start a conversation and can encourage discourse and openness among others. Estopace and her organization believe that the first step to better understanding mental health is to start a discussion about what it is and educate one another through these discussions. The idea is that with art and telling stories, it will be possible to destigmatize and give more importance to mental health.
DIFFERENT groups alongside Silakbo PH hold informative talks and workshops around the country to better educate the masses on issues surrounding mental health. These talks sometimes take place in schools, companies or any place accessible to the masses. Many of these groups, like Mental Health PH, utilize social media to start conversations about the matter.
Magpantay said today’s technologies indeed have made it easier to de-stigmatize the issue. “Because of the awareness and the information that were available, people are more out, they are more courageous to tell and ask [for] help,” she told the BusinessMirror.
It will also help if more people come out with what Magpantay calls their “success stories.”
“Knowing that a certain condition is treatable, and there’s life after that, I think it will also give more courage and lower that stigma,” Magpantay added.
Estopace said the passage of the Mental Health Law is considered a win for those of them who support the cause.
However, she worries that there could be problems in its implementation.
While it’s a step forward for them to have a law to back them up, there is no assurance that it will be implemented well.
“There’s a lot to be desired. I mean it’s good that we have a foundation but [as] always, the devil’s in the details.”