Sustainable mental health care (1)

For this year’s mental health month series, I present a key concern: how do we make mental health care sustainable in the Philippines? Today, I will highlight issues that plague the mental health landscape. Next week, I aim to address the financial cost and burden of mental health care. Part three of the series will focus on the challenges of professionalizing mental health work in our country. The last of the series will call for an overhaul of public mental health services.

Sustainability is a big challenge for mental health care in the Philippines. Services as they are—consultation, hospitalization, medication, psychotherapy—are costly, laborious, and require long-term commitment before we can see positive results. Most institutions, whether private or public, see mental health care as a money pit with no financial upside. This makes them generally reluctant to make significant investments in this area outside of short-term projects. However, mental health concerns are too big to ignore.

Prevalence rates of mental disorders in the Philippines range between 11.3 percent and 11.6 percent, which increases every year. Roughly, there were 12.5 million Filipinos diagnosed with a mental disorder in 2019, making it one of our most common disabilities. Despite the great number of Filipinos requiring mental health care, our services remain woefully inadequate. Mental health financing historically accounted for only 5 percent of our health-care budget, though we have seen significant increases in the last three years, from P57 million to P1.9 billion between 2022 and 2023. We have, however, seen a significant decrease in 2024 to P683 million, which means that we must remain vigilant.

The nature of mental health concerns varies greatly, from problems of daily living to more developmental or neurological conditions that require lifetime care. What affects our mental health vary even more. Almost everything affects our mental health: biological and genetic factors, physical environment, social networks and supports, and cultural norms and beliefs. Because there are rarely singular causes for such concerns, there is no single standard treatment or intervention per problem. This means that we must spend resources on multiple avenues toward mental health. We need to allocate funds for necessary medications and other medical interventions, including emergency care and hospitalization for acute cases. But we also need to offer adequate outpatient and nonmedical services like psychotherapy, skills training, and support services which are the interventions that can, on the illness end of the spectrum, help people go into remission and, for those on the health and wellness end of the spectrum, help achieve their growth and well-being goals. Such enormity of scope cannot be handled by a one-man office or of a group solely made up of volunteers. Either approach is ultimately unsustainable.

Aside from mental health care requiring multiple modes of interventions, it also necessitates long-term options. Some mental illnesses like depression, schizophrenia, and bipolar (coincidentally, also our most prevalent disorders) are generally life-long or chronic. How can the expanded PhilHealth Mental Health Benefit Package, which provides up to 12 consultations, be enough for such chronic conditions? Some will require more intensive management, such as weekly sessions. Are we able to provide such coverage? Inadequate coverage can be harmful, sometimes even fatal. We often witness people struggle to maintain their medication regimen due to lack of funds or access. For example, there is a shortage of ADHD medication recently, which has prompted a lot of our clients to have to make do without them, generating more challenges at school and at work. Being suddenly cut off from certain medication can also be dangerous. Some medications must be weaned off carefully, otherwise we risk a surge in suicidality. Sustained treatment can be the difference between life or death.

Nonpsychiatric mental health concerns are also not immune to such challenges. Very rarely do we have simple, one-off problems. Because of social rules, norms, and practices that invoke unnecessary stress and pressure and at the same time constrain our options for help and support, most problems of daily living also become chronic or complex by the time they reach out to a mental health professional. Imagine issues of uncommunicated needs in the family left unattended to, leading children to develop poor coping and their parents to be less attuned and empathic. Imagine experiencing stress at work with no safe way to express their struggle without being penalized or considered incompetent. Such challenges require multi-modal strategies: policy changes at the workplace, teaching skills of nurturance, and replacing long-ingrained habits and beliefs with ones that enhance each other’s well-being.

Mental health care in the country lacks long-term solutions. Striving for sustainability is key to ensure a mentally healthy community.

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