Mental health services in the Philippines
John Lally, John Tully, and Rene Samaniego
BJPsy Int. 2019 Aug; 16(3):62-64.
abstract:
while the 2018 mental health (MH) law provides for the legal framework for a COMPREHENSIVE & INTEGRATED MH services, the challenge still remains for their ACCESSIBILITY & AFFORDABILITY
highlights:
I. MH services
>poorly resourced
--- 3.5 to 5% of total health budget (70% in hospital care) (WHO & DOH, 2005)
>underdeveloped community MH services
--NCMH = 67% psychiatric beds (Conde, 2004)
--1.08 My beds in gen hosp / 100k pop &
--4.95 beds in psychiatric hosp / 100k pop (WHO, 2014)
--46 out-patient facilities (0.05/100k pop) &
--4 community residential facilities (0.02/100k pop) (WHO, 2014)
--only 2 tertiary care psychiatric hosps:
(1) NCMH 4.2k beds
(2) Mariveles Mh 500 beds
plus 12 satellite NCMH-affiliated hops
--ongoing problems:
(1) overcrowding
(2) poorly functioning units
(3) chronic staff shortages
(4) funding constraints
--no dedicated forensic hosp
II. MH Staff
>severe shortage
--1 MD / 80k (WHO & DOH, 2012)
--brain drain issue
--500+ practising psychiatrists
--2-3 MH workers/100k pop (WHO & DOH, 2006)
--lower than other western pacific rim countries with similar economic status, e.g., malaysia (4.9) & indonesia (3.1)
--psychiatrists = 0.52/100k pop (ISaac et al, 2018)
--majority in private practice in urban areas, particularly in Metro Manila
--psychologists = 0.07/100k pop &
--MH nurses = 0.49/100k pop (WHO, 2014)
--vs WHO recommendation of 10 psychiatrists / 100k pop
III. Burden of Mental Disorders (MDOs)
>nb: little epidemiological evidence
>14% with MDOs (PSA, 2010)
>MH is 3rd most prevalent form of morbidity
>only 88 MH cases / 100k pop (DOH, 2008) is an underestimate
>0.4% SCHIZ (33.2% treated or screened in past 2 wks) &
>14.5% with DEPRESSION (14% treated or screened in past 2 wks)
>42% of 2,562 patients in 14 hosp (private & public) were treated for SCHIZ
>suicide:
--1984 to 2005: 0.23 --> 3.59 / 100k pop (males) &
--0.12 to 1.09 / 100k pop (females) (Redaniel et al, 2011)
IV. Access to Treatment
>issues:
--prohibitive ECONOMIC conditions
--INACCESSIBILITY of MH services
--STIGMA (perceived & internalized) is barrier to help-seeking (Tuliao & Velasquez, 2014) similar to west
--cultural drive to "save face" vis-a-vis threat to or loss of social position
--strong sense of FAMILY; thus, seek help from family & peers before medical help (Tuliao, 2014)
>only 1/3 people with SCHIZ treated or screened (WHO, 2005)
>most commonly used 2nd generation psychotropics (c/o DOH Medical Access Program for MH)
1. antipsychotics: clozapine, olanzapine, quetiapine, risperidone
2. antidepressants: fluoxetine, sertraline, escitalopram
3. mood stabilizers: lithium carbonate, valproic acid, carbamazepine, lamotrigine
4. anticholinergics: biperiden, diphenhydramine
5. benzodiazepine: clonazepam
6. cholinesterase inhibitor: donepezil
7. NMDA receptor antagonist: memantine
V. Psychiatry Training
>Psychiatry remains a less popular specialty for MD grads.
>47 accredited med schools
>psychiatry is core curriculum (ave of 2 wks teaching & clinical exposure)
>13 postgrad psycha trgn institutions (8 in MM, incl NCMH)
>2 postgrad trgn progs offering 2-yr fellowship in subspecs, e.g., CHILD & ADOLESCENT, CONSULTATION-LIAISON, COMMUNITY, & ADDICTION
>postgrad residency trgn: 3-4 yrs (3 mos Neuro + 2 mos IM)
VI. Conclusions
>M Heathcare challenges
--underinvestment
--lack of MH professionals
--underdeveloped community NH services
--although MH act gave legal framework, economic restrictions toward equitable access remains
--NEED: invest for recruitment & trgn of psychiatrists, nurses, psychologists, &social workers & other multidisciplinary team members esp vis-a-vis emigration
ps: thanks to Rey Lumawag, RN for giving me the source! :-)
