Where’s the mental health response?

If a measure of a society is how well it cultivates mental well-being, the past 10 months are a clear indictment of our nation. Our state of mental health seems immaterial to government efforts to control the virus.

The pandemic offers a once-in-a-lifetime chance to jolt the system into advancing and strengthening the most basic standards set by the mental health law. The government is missing that opportunity. It is decoupling the act of policymaking from the act of implementing that policy, removing the psychological friction that can force consequential changes. Our collective mental health is suffering for it.

We may not have a full accounting of the consequences for years to come, but what little evidence we do have paints a grim picture. Researchers from the University of the Philippines looked at the psychological impact of the pandemic. One in four Filipinos reported moderate to severe anxiety, and one in six described similar levels of depressive symptoms. In a separate report, the World Health Organization Country Office and the Department of Health published a situational assessment of the mental health care system that amounted to nothing more than a regurgitation of previous reports—that is to say, very little transformative changes have been made.

Measures under the Bayanihan laws seek to prevent, detect, isolate, and treat COVID-19, but both policies are silent about COVID-19-related mental health. These laws also aim to protect health workers in COVID-19 facilities. However, many mental health professionals do not work in these facilities or are in independent practice; neither public nor private insurance cover their much-needed services.

The licensure exams for psychologists and occupational therapists have been rescheduled twice, while the physician licensure exam went ahead. It is evidently possible to hold safe and secure exams. We need more physicians, this much is true. However, the government cannot claim a public health approach to a public health problem if it prevents hundreds of young would-be professionals from other equally important and equally needed health fields from entering the workforce. It takes years to make a psychologist. It takes much less to develop a psychiatric problem.

The WHO and DOH also seem nonplussed. Both acknowledge the enormous mental health impact. Both call for achieving a better life for individuals and at-risk populations with serious mental disorders and their families. But these responses are predictably disorder-focused and problem-saturated. They recommend what we each can do if we feel anxious or sad, but are silent on the wide-ranging systems of health for which we can obtain appropriate assistance. They want us to reach out to a mental health professional, for instance, if things get really bad. And we should. But what are the systems-level changes to make that a bit easier? Is there an executive order to immediately allow PhilHealth to cover online psychotherapy? Do the Bayanihan laws or other health policies explicitly designate mental health professionals as essential COVID-19 workers?

A December policy dialogue is a testament to our limited strategies. The National Mental Health Program began with a quote from a United Nations policy brief—that mental health “must be front and center of every country’s response to and recovery from the COVID-19 pandemic.” And as the program proceeded with its strategic plans—development of community-based mental health guidelines, strengthening mental health advocacy and promotion, capacity building of rural health workers, and many others—it soon became apparent that these were for the longer-term strengthening of the mental health care system. This is meaningful work. But I was hoping to hear updates on actionable decisions and swift responses to COVID-19-related mental well-being. They never came.

The government has a herculean task. There are many things beyond its control. We may therefore allow a certain margin for error. We understand the messiness of policymaking. But consider the urgency: The UP research study and the WHO-DOH situational assessment were both done in March of last year. Imagine what that picture looks like now.

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Dr. Ronald Del Castillo was professor of psychology, public health, and social policy at the University of the Philippines Manila. The views here are his own.