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MANILA, Philippines—Mental illnesses are often invisible that official data from the Department of Health (DOH)—3.6 million suffering from it in 2020—were likely to be higher since many Filipinos don’t seek help because of economic and social barriers.
According to World Health Organization (WHO), 450 million people all over the world are suffering from mental illnesses, which already account for about 14 percent of disease burden worldwide.
In the Philippines, the DOH said based on the WHO Special Initiative for Mental Health that was conducted in early 2020, 3.6 million Filipinos are suffering from at least one type of mental, neurological, or substance use disorders.
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WHO said the Philippines has the third highest rate of mental health problems in the Western Pacific Region and that mental, neurological, and substance use illness is the third most common disability in the Philippines.
Based on WHO data, 154 million people are suffering from depression and one million from schizophrenia while in the Philippines, the National Mental Health Program said 1,145,871 and 213,422 people are suffering from the same conditions.
This was the reason that the WHO stressed that mental, neurological, and substance use illnesses, like depression, anxiety disorders, psychosis, epilepsy, dementia and alcohol-use disorders, “pose a significant challenge in the Philippines.”
On June 20, 2018, then President Rodrigo Duterte signed Republic Act No. 11036, or the Mental Health Act, to enhance the delivery of integrated mental health services and protect the rights of individuals who need these services.
Back then, Sen. Risa Hontiveros, who is one of the proponents of the law, said: “No longer shall Filipinos suffer silently in the dark. Mental health issues will now cease to be seen as an invisible sickness spoken only in whispers.”
According to MentalHealthPH, the law was eventually backed by the passage of RA No. 11223, or the Universal Health Care Act, on Feb. 20, 2019, which mandated significant changes in health financing, service delivery, and governance.
So what is the problem?
According to Martinez, et. al. in their research “Filipino Help-Seeking for Mental Health Problems and Associated Barriers and Facilitators: A Systematic Review,” despite the existence of these laws, hesitancy to seek professional help remained high.
They said results from quantitative community studies revealed that the rate of Filipinos seeking help through formal channels for their mental health problems ranged only from 2.2 percent to 17.5 percent. Some qualitative studies showed that some did not seek help at all.
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“The rate of formal psychological help-seeking of local Filipinos was at 22.19 while overseas rates were lower and ranged from 2.2 percent of Filipino Americans to 17.5 percent of Filipinos in Israel,” the researchers said.
Martinez, et. al. stressed that both local and overseas Filipinos indicated that professional help is sought only as a last resort because they were more inclined to get help from family and friends.
These Filipinos, regardless of where they are, nurture a negative perception of help-seeking, except for later-generation Filipinos who migrated to a place where there is higher positive perception of mental health specialists.
Social, economic barriers
According to MentalHealthPH, stigma surrounding mental health illnesses, more specifically those seeking professional help or counseling, remained to be one of the top reasons people hesitate to seek help.
Martinez, et. al. stressed that in the Philippines, the themes on barriers against formal help-seeking are:
- Psychosocial barriers, which include lack of social support from family and friends, perceived severity of mental illness, awareness of mental health issues, self-stigmatizing beliefs, treatment fears, and other individual concerns
- Socio-cultural barriers, which include the perceived social norms and beliefs on mental health, social stigma, the influence of religious beliefs, and language and acculturation factors
- Systemic/structural and economic barriers, which include financial or employment status, the health care system and its accessibility, availability and affordability, and ethnicity, nativity, or immigration status
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They said among the barriers to getting help, these are most common, especially in the Philippines:
- Financial constraints because of high cost of professional service, lack of health insurance, or unstable jobs
- Self-stigma, with associated fear of negative judgment, sense of shame, embarrassment and being a disgrace, fear of being labeled as ‘crazy’, self-blame and concern for the loss of face
- Social stigma that puts the family’s reputation at stake or places one’s cultural group in a bad light
MentalHealthPH said stigmatic belief held by someone and the people near him or her may be because of reasons, like lack of knowledge about mental health, and avoidance behavior toward individuals who suffer from mental health problems.
Vogel, et. al. had said the fear of the label placed on a person experiencing mental health problems and the strong stigma related to these illnesses, may be the reasons for the stage of denial on mental health.
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This, even if in 2012 alone, WHO said in a report in 2014 that there were a total of 2,558 suicide cases because of mental health problems, a clear evidence that the Philippines is still far from addressing the issue.
READ: The crisis within: Suicides rise as COVID takes its toll on lives, livelihood
Based on data from the National Center for Mental Health (NCMH), which was released in 2017, the prevalence of suicide in the Philippines is 2.5 for every 100,000 men and 1.7 for every 100,000 women.
‘Make mental health a top concern’
As the need to raise awareness about mental health has intensified over the years, October 10 of every year was declared as World Mental Health Day, with WHO saying that it is a day to increase awareness and mobilize support for mental health.
READ: Mental health in a time of pandemic: The invisible suffering
“The day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide,” it said.
This year, the celebration highlights the call to “make mental health and wellbeing for all a global priority,” especially since the COVID-19 crisis “continues to take its toll on our mental health.”
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“Many aspects of mental health have been challenged and already before the pandemic in 2019 an estimated one in eight people globally were living with a mental disorder,” the WHO said.
“At the same time, the services, skills and funding available for mental health remain in short supply, and fall far below what is needed, especially in low and middle income countries.”
The COVID-19 crisis, WHO stressed, created a global crisis for mental health, fueling short and long-term stresses and undermining the mental health of millions.
This, as WHO estimates that cases of anxiety and depressive disorders have risen by 25 percent in 2020. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened.
Last month, Reuters reported that scientists were already warning people and governments about the link of long COVID-19, which is a complex medical condition that can be hard to diagnose, to suicide.
“I’m sure long COVID is associated with suicidal thoughts, with suicide attempts, with suicide plans and the risk of suicide death. We just don’t have epidemiological data,” said Leo Sher, a psychiatrist at Mount Sinai Health System in New York who studies mood disorders and suicidal behavior.
Based on a 2020 study conducted by the University of the Philippines, a quarter of 1,879 respondents reported having “moderate to severe” anxiety issues due to COVID concerns.
Online help effective
Last year, the DOH reported that the number of calls received by the hotlines of the NCMH regarding mental health concerns—including suicide—has spiked in the time of COVID-19.
In the first quarter of 2021, the NCMH provided assistance to 3,006 individuals who called its hotlines. There were 867 suicide-related calls during the same period.
Back in 2020, the NCMH received 11,017 calls seeking mental health assistance, while 1,282 were suicide-related calls.
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Martinez et. al. found that while the rate of seeking help through formal channels among Filipinos was still low, constancy of reports of formal help-seeking from studies conducted in crisis centers and online counseling tended to be higher.
For instance, the rate of engagement in online counseling among overseas Filipinos was 10.68 percent, those receiving treatment in crisis centers was 39.32 percent while 100 percent of participants who were victims of intimate partner violence were already receiving help from a support agency.
Listen
Martinez et. al. said as barriers in the Philippines included financial constraints and inaccessibility of services, “they prefer seeking help from close family and friends.”
The Cleveland Clinic, a leading institution on mental health, said that in many instances, intentional self-harm can be prevented, especially when one knows the “risk factors and warning signs.”
The website healthline.com listed these as possible help lines for those exhibiting signs of committing suicide because of mental health problems:
- Take them at their word: Dismissing their mention of suicide invalidates their distress and they may feel “reluctant” to share their thoughts and seek professional help
- Pay attention to their language and behavior: Listen and have a close look because they often talk about it in vague ways. Their actions also show some signs
- Ask them directly: You can have a better glimpse of one’s risk by asking about important things
- Encourage them to talk about it: It’s normal to feel scared and to think that you’re not certain of the best response to give, but shying away won’t help
- Offer compassion: When you’re talking to someone having intention to end his life, what you say matters.
- Continue to offer support: When one feels better following distress, that doesn’t mean that they are completely fine. Stay in touch.
- Encourage professional support: While you can’t force them to seek professional help, you can still encourage them
If you or someone you know needs help, call the National Center for Mental Health hotline at 0917-899-USAP (8727); (02) 7-989-USAP; or 1553 and Mind Matters at 899-USAP (8727).