Mental

Zorro of the University of the Philippines Diliman is famous. He roams the campus freely in his — well, what else but — Zorro outfit, alternately directing traffic, chatting up people, even joining rallies.

There are similar Zorros everywhere, who have mental health problems but get along with life, each with their own life story sometimes known to all, sometimes the subject of urban legends — as with Zorro (one version is that he is a former professor).

The Zorros in our towns give the impression that in this country there is no stigma attached to mental illness, belying the fact that many thousands more Filipinos have to live with their illnesses in secret, sometimes untreated. But “mental” in the Philippines still means “crazy” and, in Metro Manila, it means “mental hospital.” Some residents of Mandaluyong City, when asked where they live, still reply “Mandaluyong, outside” — meaning outside the National Center for Mental Health, which was first established with the horrible name “Insular Psychopathic Hospital,” which was changed to “National Mental Hospital” before the current NCMH.

People shun hospitals not only because of the cost but also because many mental health illnesses are still poorly understood, and given supernatural explanations: punishment from God, possession by spirits or the devil, “treatable” by traditional healers or evangelical pastors.

For the vast majority of Filipinos, psychological and psychiatric services are just beyond reach, so the patient is sequestered at home. In rural areas, there have been cases of patients chained by the family to the bed or to a post to prevent them from wandering.

Treatment

All this has to change, given that mental health illnesses are treatable, some even preventable. Even at UP, we’ve only begun to deal with these problems. About two years ago, I had our Office for Counseling and Guidance, which had been oriented to administering aptitude tests and career guidance, expanded and reoriented, putting a clinical psychologist, Dr. Violeta Bautista, in charge to offer psychosocial services.

The office now conducts training workshops for students and faculty to help them understand the common serious mental health problems, particularly depression (including bipolar conditions), which can lead to self-harm.

Other disorders are also being recognized only now, even something that seems as trivial as an anger management problem that can be very serious when students or faculty members vent their rage on colleagues.

Schools need to be able to help people understand these conditions and to provide “psychological first help,” detecting signs in colleagues (or in themselves) and knowing when to get psychosocial assistance.

With proper treatment, and support from relatives, friends and community, people with mental health problems can be functional in their family and work lives. This is why I particularly value our psychologists in UP, who will sit for long sessions with a student or faculty member, dealing not just with the mental illness but also with triggering factors that threaten to turn the illness into a very serious problem.

Note that substance abuse and dependency/addiction, whether involving drugs, cigarettes, or alcohol, are also mental illnesses, and that the current punitive approach to drug dependents can only aggravate the problems.  There is also the myth that all drug dependents have to be put in rehabilitation centers. In most cases, drug dependents can be treated at home, or in their communities, as long as there are regular consultations with mental health professionals.

Legislation

One indicator of the neglect of mental health problems is the fact that a number of bills concerning the issue have been shelved over the last decade. These bills would require the government to offer mental health services at all levels, from the primary level (barangays) upward.

The latest version was proposed by Sen. Risa Hontiveros, and a more active Philippine Psychiatric Association is pushing hard to get it passed.  An information campaign tapping celebrities has been launched. A change.org petition to legislators has been signed by almost 30,000 people.

The bill is very general but I hope that if it’s passed, implementing rules and regulations will go into details as to how various institutions can be linked up to the Department of Health and how psychologists can become more involved.

I’m going to repeat, from a previous column, the distinction between psychologists and psychiatrists, with a clarification on the requirements for the psychology licensure exam sent in by Dr. Bautista:

Many schools in the Philippines now offer 4-year degree programs — BA and BS — in psychology. In my earlier column, I erred in writing that one only needed a bachelor’s degree to take the licensure exam for psychologists. Turns out the bachelor’s degree only allows one to take the licensure exam for psychometricians, or people who can administer tests. To get a license to practice psychology, one needs a master’s degree in psychology plus 200 hours of supervised practice.

With that license to practice psychology, one can provide psychological counseling, but one cannot prescribe medicines. Only psychiatrists can do that. To become a psychiatrist, one needs a degree in medicine (M.D.) and additional hospital residency training in psychiatry.

I also want to respond to the rumor that the UP College of Medicine is no longer accepting psychology as a premed degree. Dr. Carmencita Padilla, chancellor of UP Manila, and Dr. Agnes Mejia, dean of the College of Medicine, have categorically denied this “false news.”  What they have done is to formulate a system to allow those with certain undergraduate degrees (for example, pharmacy, or occupational therapy) a greater chance to get into medical school. Psychology graduates are still most welcome to apply.

I was glad to hear the clarification, but I’ve also told our psychology faculty and students that I hope psychology takes its place in our academic institutions not merely as a premed degree but as an important profession in its own right. A comprehensive mental health law will be vital for opening new opportunities for the development of the profession.

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