Not just for the ‘sirang ulo’

In the wake of the July 1990 Luzon earthquake, psychiatrists and psychologists, along with social workers, were sent to Cabanatuan, one of the areas hardest hit by the temblor, to offer debriefing and stress counseling services to the survivors.

“We were not exactly welcomed,” recalls Dr. Lourdes L. Ignacio, a psychiatrist and current president of the World Association for Psychosocial Rehabilitation-Philippines. The mayor of the city at the time, she remembers, didn’t see the need for their presence. “Walang sirang ulo dito (There are no crazy folk here),” he told them.

At a meeting among the local government, community representatives and national government officials, the locals again reiterated that they didn’t need psychosocial services. But then President Cory Aquino, who had rushed to Cabanatuan to observe the rescue and relief efforts especially at the collapsed six-story school building where 154 people, most of them students, had died, urged them to change their minds. “Kahit ako hindi makatulog nang mabuti dahil sa nakita ko dito (Even I can’t sleep well at night because of what I’ve seen here),” she told them.

Things are different now, but not by much, observes Dr. Ignacio. Psychosocial interventions in the wake of untoward events – floods, typhoons, conflicts and accidents – are now welcomed as a way of “processing” the experience and helping survivors cope. But there is still some resistance to counseling and treatment, largely because of the stigma that is attached to mental and emotional disorders.

From July 28-30, the World Association for Psychosocial Rehabilitation (WAPR)-Philippines and Philippine Psychiatric Association Inc. hosted the Second Asia-Pacific Conference on Psychosocial Rehabilitation. The event, which had P-Noy as keynote speaker, drew resource people from all over the region to discuss ways to bring psychosocial services to more people, especially in areas where health services are poor. Theme of the conference: “Reaching the Unreached: Islands of Hope.”

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“Islands of hope” are indeed needed in the Philippines, where a recent survey by the UP-PGH Psychiatrists Foundation Inc. (UPPPFI) found that one of three Filipino households have members with mental health problems. But Ignacio clarifies that “to have a mental health problem may simply mean that one’s thoughts, feelings and behavior show disturbances which threaten the balance and stability of (a person) in his daily life.”

Many of these “disturbances” can be called “reactions by those rendered vulnerable to extreme life experiences like disasters, (and) individual and community violence,” but others can be traced to difficulties and anxiety triggered by changing life circumstances. “Among the vulnerable groups in the population,” cites a backgrounder on the issue, “are the majority of Filipinos who have mental health problems and who remain untreated and the emerging vulnerable population like the overseas Filipino workers (OFWs); children in difficult circumstances; victims of domestic violence, even terrorism and destabilization and insurgency, and those affected by disasters.”

Ignacio points out that “OFWs like seamen suffer from isolation and often turn to drug and alcohol abuse; other OFWs struggle through the demands of acculturation and adaptation in the new country as well as the separation, even guilt, at leaving families especially children behind.”

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Climate change, which seems to have ushered a wave of disasters that follow no predictable seasonal patterns and have struck even areas previously thought invulnerable, will only intensify the level of stress, anxiety and helplessness felt by individuals, families and communities.

And yet, notes Ignacio, there are not enough facilities or trained personnel to cope with the coming deluge of mental health problems. For one, there are only 430 psychiatrists for 90 million Filipinos, and most of them are in the National Capitol Region. “Our psychiatric facilities can only provide one bed for every 100,000 Filipinos,” adds Ignacio, “and worse, the few facilities that we have are already overcrowded and understaffed.”

To increase government funding for mental health programs and initiate moves to train a greater number of trained personnel, especially in underserved areas, the mental health community is backing the passage of a “National Mental Health Care Act.” In the last Congress, former Speaker Prospero Nograles and Rep. Arthur Pingoy jointly filed a bill that would establish a “National Mental Health Care Delivery System” and the “Philippine Council for Mental Health.” The bill has been re-filed, but it has yet to hurdle committee hearings.

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In the meantime, says Ignacio, mental health experts are working with community health center personnel and even community health volunteers on the application of a simple questionnaire to determine if an individual is suffering or beset by mental and emotional difficulties.

“The questions are quite simple, like ‘Are you having difficulty sleeping?’ ‘Has your appetite decreased?’ ‘Can you do the same level of work?’” The amazing thing is that very often, mental health problems can manifest as physical problems, such as sleeplessness, hypertension, inertia, and all it takes is a sensitive listener to hear the mental or emotional roots of a physical ailment.

The WAPR-Philippines is also reaching out to different sectors to help them train more competent mental health professionals. Says Ignacio: “We need all hands –local government units, the DSWD, the DoH, non-government organizations, and special services. We really need to go out there and tap unconventional resources.”