Navigating the Stream: Empowering Filipinos in their Mental Health Journey

Abstract

The Philippines faces significant mental health challenges, including high rates of depression, anxiety, and suicide, exacerbated by factors like poverty, natural disasters, and socio-economic inequalities. Mental disorders in the country affect an estimated 11.3% to 11.6% of the population, translating to about 12.5 million Filipinos suffering from various mental health conditions, predominantly depression and anxiety. Mental health is just as important as physical health. The right to access mental health services for any mental, neurological, or substance-abuse health condition, requires a multifaceted approach that is grounded on science, cultural sensitivity, and an ethic of care.

A mentally distressed Filipino (assuming they have positive help-seeking behaviours and adequate self-awareness) would have questions looming regarding their concern: “What am I going through?”, “Who do I talk to?”, “Am I sick?”, “Where can I get help?”, “How much will treatment cost?”, “Is this just a phase or something serious?”, “How will this affect me?”, etc.

An analogy often utilized in Depression and Suicide Prevention is the Parable of the Stream, which is evocative for understanding and addressing psychological challenges. Imagine a stream where people are struggling not to drown—this symbolizes the urgent need to rescue those in crisis, reflecting a downstream approach. As more people join to assist those in distress, mainstream services are provided to give ongoing support and treatment for those in need. However, some individuals decide to explore upstream and discover a blockage causing the water level to rise, highlighting the upstream approach focused on prevention by addressing root causes.

The parable teaches that effective mental health care requires a balance of all three strategies: responding to emergencies, providing support, and preventing issues before they escalate. If the stream was about mental health concerns, Filipinos struggling with mental health challenges represent those who have an urgent need for immediate support and are attended to by front liners found in schools, community centers, and clinics—the downstream approach. As professionals and communities rally to assist, mainstream services develop, such as government initiatives and non-governmental organizations that provide therapy, counseling, and perhaps even rehabilitation to those in need. However, some social scientists may choose to look upstream to identify the root causes of mental health issues, systemic issues, and determinants such as poverty, lack of access to education, and social stigma. By addressing these underlying factors, crises can be prevented from occurring in the first place, and mental health promotion can be more effectively sustained. Across all these ventures, a collaborative and interdisciplinary approach is necessary.

The past twenty years have seen the emergence of relevant legislations that have not only advanced conversations and awareness of mental health in the country, but have also expanded service delivery to complement the role of Psychiatry. The mental health landscape in the Philippines has undergone significant changes that further professionalized mental health service in the country. The Guidance and Counseling Law (RA 9258) enacted in 2004 and the Psychology Law (RA 10029) enacted in 2009, represent critical steps toward providing services by qualified and credentialed professionals. Both have made significant strides in formalizing mental health services in the Philippines, and have improved the regulation of guidance counselors and psychologists. Meanwhile, the Philippine Mental Health Act (RA 11036, enacted in 2018, integrates a mental health framework for mental health programs and policies, promoting awareness, education, and the integration of mental health services into primary healthcare settings. This landmark legislation established the rights of individuals with mental health conditions and promoted mental health care in various settings. Moreover, the launch of the Mental Health Gap Action Plan (MHGAP) in 2008 by the World Health Organization mainstreamed the integration of mental health services into primary health care. MHGAP training empowers primary care physicians and nurses all over the country and encourages community-based mental health care rather than facility-based care. The increasing positive reception of and implementation of supervised peer counseling and facilitation in schools have also multiplied gate-keepers of mental health support and care, especially among young Filipinos whether they are school-based or out-of-school youth.

In addition to professionalized pathways to service delivery and legislative support mechanisms to improve mental health care, it is vital to promote a culture of research and knowledge dissemination within the mental health field in the Philippines. The growing interest in mental health research has increased especially after the COVID-19 pandemic. It is crucial to invest in research that provides professionals with culture-sensitive scientific knowledge, practical skills, innovative well-being and treatment methodologies, and compassionate approaches to meet the diverse needs of individuals facing mental health challenges regardless which part of the stream they may be in.

Research can also help identify gaps in current practices especially in rural areas where access to and availability of mental health services and professionals are limited. It can also inform the development of comprehensive training programs for specialists and generalists alike, ensuring that mental health professionals are well-prepared to deliver effective and empathetic care. Ultimately, a strong foundation in research will empower mental health providers to improve outcomes and foster a more resilient and informed approach to mental health care.

To build a more effective mental health care system in the Philippines, we must embrace a holistic approach that combines immediate crisis intervention, ongoing support services, and proactive measures to tackle the systemic issues that contribute to mental health struggles. Only then can we create a resilient framework that truly supports the well-being of all Filipinos.