Let’s talk about mental health

“Baliw,” “kulang-kulang,” “luka-luka.” (Crazy, imbecile, lunatic.) Over the years, I have heard these obnoxious terms repeatedly screamed at potentially mentally ill individuals roaming the streets, the mocking often followed by laughter. This is but the most common manifestation of Philippine society’s deep-seated and overlong neglect of the issue of mental health.

Our disregard for mental health has become more visible as the COVID-19 pandemic has further exposed the poor state of our health care system. Despite the passage of Republic Act No. 11036 or the Philippine Mental Health Act in 2018, it is unclear how the growing demand for mental health services will be addressed during the pandemic.

The Philippines has only around 600 psychiatrists for its over 100-million-strong population. At least 3.6 million Filipinos suffer from some kind of mental, neurological, or substance use disorder, according to the World Health Organization (WHO).

In my recent conversation with Dr. June Pagaduan Lopez, retired professor of psychiatry at the University of the Philippines and principal crafter of the mental health law, she said that finding the budget will be the biggest problem in the implementation of the law.

“We, the drafters of the law, are not happy about the budgetary provision for it as passed by Congress. The final version disregarded the Senate version requiring that 5 percent of the national sin tax be allocated for mental health and psychosocial services,” she pointed out.

“A law is only as good as the political will and the governance structures that will support its implementation,” she added.

The landmark law is supposed to provide “accessible, available, affordable, and acceptable” mental health services and protect the rights of people with psychiatric, neurologic, and psychosocial health needs, as well as their families.

As someone who was clinically diagnosed with major depressive disorder, I find some hope in the law. But like others, I also feel that the law remains a mere piece of paper waiting to be actualized outside the corners of our government agencies.

Many of us still suffer from discrimination and limited access to mental health care. I can’t access help for my psychiatric treatment from my private health insurance as it does not cover medical claims related to psychiatry, as a general rule. Likewise, PhilHealth does not cover my psychotherapy and medications.

Just last year, my application for life insurance was denied due to my psychiatric diagnosis, even though the results of my medical exam, which was conducted by the insurance company itself, were all normal. I sought help from the Insurance Commission, but the agency is mum on the issue.

Annually, I spend almost P100,000 for medications and psychotherapy alone—a huge amount that not all could afford. Even with the enactment of the Universal Health Care Act in 2019, free or affordable mental health services and medications remain inaccessible to most Filipinos, particularly those in the countryside.

So, it is appalling to learn about the recent PhilHealth corruption scandal amid the pandemic. While patients are fearful about the stigma and burden of falling ill, corruption persists in our health care system. The shame should not be on the sick, but on the powerful who rob us of a chance to heal.

Nevertheless, we remain hopeful that sooner rather than later, the country will extend more investment and commitment to mental health, so we can truly “heal as one.” Until then, all we can do is hope and let our voices be heard, like the following patients who spoke out but requested anonymity:

“I hope that we can consider how national issues affect our mental health. A proper work environment, dependable mass transportation, green and open spaces, and affordable housing are good for our mental health. It’s not always about self-care and personal development. It’s a social concern that requires a holistic perspective.” —Government worker with depression and anxiety, 31

“I wish for more involvement by LGUs in promoting mental health awareness among people, whether rich or poor, young or old. Access to cheaper consultation with psychiatrists should also be made.” —Copy editor with bipolar disorder, 27

“It would be helpful, if aside from the National Center for Mental Health, other public hospitals are able to cater to the needs of mental health patients. I hope they can provide free or affordable medicine.” —Travel consultant with PTSD, chronic depression, and bipolar disorder, 24

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Mark Toldo (marktoldowrites@gmail.com) is a freelance journalist and a former TV documentary producer and writer. He also leads the communications arm of an international humanitarian research organization.