mental health in the philippines mental health in the philippines mental health in the philippines is a survey of the status of psychological, psychiatric, and emotional health care in the philippines from both past and present programs. definition of mental health mental health is defined as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community". the world health organization emphasized the importance of mental health by including it in their definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." mental health care is the status of providing and maintaining psychological, psychiatric, and emotional health by means of diagnosis, treatment, and prevention of mental illnesses. existing conditions of mental health care in the philippines processes in the health care system there are three tiers in the health care system: primary, secondary, and tertiary. the primary health care tier serves as a patient's first point of contact with a health professional who can provide outpatient medical care. if the general practitioner cannot address the problem of the patient, then the patient is referred to a specialist. mental health care specialists, which belong to secondary health care, include psychologists and psychiatrists. in the philippines, most psychiatrists are in private practice, although some work in government institutions such as the national center for mental health. psychiatrists provide the patient with services such as assessment, counselling, and/or prescription drugs if needed. in the tertiary health care, patient would be referred to institutions if the mental illness needs specialized care that is beyond the capabilities of the specialist. some health care systems put psychologists and psychiatrists under the category of primary care providers. in this case, short hospital visits and consultation-liaison services to other medical departments would fall under secondary health care. more severe mental health diagnoses would require more rehabilitation, which is within the scope of tertiary health care. institutions mental health facilities and institutions are maintained in the philippines by both private and public groups but access to them remains uneven throughout the country. most facilities are located in the national capital region (ncr) and other major cities in the country, thus favoring individuals who live near these more urban areas. national center for mental health the national center for mental health (ncmh), originally named insular psychopathic hospital, was established in 1925 under the public works act 3258. at the time, the city sanitarium and san lazaro hospital were the only primary institutions that catered for the needs of the mentally ill, however, due to the large volume of patients pouring in, there was a need to build another institution that could provide for the needs of patients with mental illness. the 64-hectare site is located in mandaluyong. the institution officially opened on december 17, 1928, accepting 379 patients who were all crowding in san lazaro hospital. in 1930, the bed capacity was increased to 800, although the total number of patients was over 836. two pavilions were added to increase the bed capacity to 1,600. by 1935, the city sanitarium closed, and leaving ncmh with 1,646 patients to serve. aside from being a hospital, ncmh is authorized by the department of health as a special research training center. according to the ncmh website, the hospital is "mandated to render a comprehensive (preventive, promotive, curative and rehabilitative) range of quality mental health services nationwide". aside from this, ncmh also offers a 4-year psychiatric residency training program for doctors and a 2-year psychiatric nursing program for nurses specializing in psychiatric care. there are also affiliation programs that cater to students from the fields of psychology, pharmacy, and nursing, among others. ncmh currently occupies 46.7 hectares of land, with 35 pavilions/cottages, and 52 wards, as well as facilities such as medical infirmary, library, chapel, conference rooms, tennis court, basketball court, multi-purpose hall and dormitories. as of 2011, the numbers of staff are as follows: 88 doctors, 890 nursing staff, 116 medical ancillary personnel, and 446 administrative support staff. the hospital also received from the government a budget allocation worth php 523, 982, 000, which costs an average of php 118.61 per patient per day. currently, ncmh has a bed capacity of 4,600 and serves an average of 3,000 in-patients on a daily basis, in addition to 56, 000 outpatients per year. most patients come from metro manila and nearby regions iii and iv. they also serve patients from other regions, often forensic cases referred by the courts. subsidy for treatments is given to 87% of the inpatients which belong to classes c and d. the institution received its iso 9001:2008 certification on december 2, 2015. philippine mental health association, inc. the philippine mental health association, or pmha, is "a private, non-stock, non-profit organization dedicated to the promotion of mental health and prevention of mental disorders." its headquarters is located in quezon city with nine chapters all over the philippines: pmha bacolod-negros occidental, baguio-benguet, cabanatuan-nueva ecija, cagayan de oro-misamis oriental, cebu, dagupan-pangasinan, davao, dumaguete-negros oriental, and lipa-batangas. it was established on january 15, 1950, with dr. manuel arguelles as president due to the call for assessment of mental health problems induced by world war ii. at present, their programs range from education and information services (eis), clinical and diagnostic services (cds), and intervention services (is). the pmha provides guidance and educational programs for the youth through partnering with various private and public schools and colleges in the country. they also organize seminars and workshops for youth mental health through their eis arm. the association officially expanded its services to the adult population in 1960. they now provide psychiatric, psychological, and counseling services to all sectors of society under cds. they also launched rehabilitation care services in 1962 to assist in the recovery and reintegration of patients into the community. the association's is arm has two centers: the center for children and youth (ccy) and the adult work center (awc). the ccy provides various kinds of therapy sessions and counseling along with special education for those with learning disorders and intellectual disability. the awc provides life skills training and family programs to assist mental health patients in their recovery and therapy. other institutions in the national capital region (ncr), most major hospitals (both public and private) have a psychiatric department which caters to the need of people with mental illness. hospitals include the medical city, philippine general hospital (pgh), manila doctors hospital, and university of the east ramon magsaysay memorial medical center, inc. (uermmmc), to name a few. webbline provides a list of mental health care facilities that can be found in the provinces and in ncr. suicide prevention hotlines in the philippines those who are in need of immediate assistance may opt to call a suicide hotline. suicide hotlines available in the philippines include the natasha goulbourn foundation (ngf) and the manila lifeline centre (mlc). the ngf suicide hotline can be reached at (02) 804-hope (4673), 0917 558 hope (4673) or 2919 (toll-free for globe and tm subscribers). the mlc can be reached at (02) 8969191 or 0917 854 9191. mental health stigma in general, people with mental illness are discriminated against more in developing countries in asia compared to western countries. unlike somatic symptoms, psychological symptoms are seen as socially disadvantageous, affecting their work and marriage. furthermore, people with mental illness are seen as dangerous and aggressive. disturbed behaviors manifested by people with severe mental illness are more easily recognized, however, the public cannot easily distinguish this from more common and milder disorders. this results in a generalized view of mentally ill people as violent. in addition to the public, family members of the mentally ill can also be a source of stigma. it seems that there is a lack of information regarding mental illnesses in developing countries. in some asian cultures, there is a pervasive belief that supernatural forces are behind mental illness, and as such, religious and magical approaches are utilized to treat people. additionally, in many asian cultures, the culture is a collectivist culture and the discussion of mental health illnesses is not socially accepted. in more extreme situations, the discussion of mental health struggles is viewed as particularly disrespectful. this assumption of mental health illnesses in the philippines leads to the intense mental health stigma to continue. several programs and initiatives are pursued in order to strengthen mental health support and to lessen the stigma against mental illnesses and mentally ill people in the philippines. this includes studies conducted by both private and government entities, laws on mental health, government health programs, and mental health institutions.mental illness, psychological disorders and emotional dysfunctions are significantly widespread throughout the philippines, due to the large poverty population and the numerous out-of-school or out-of-work youths. these "psychotic vagrants", as some would call them, are gravely misunderstood. they are commonly called "taong grasa or "abnoy". the phrase "taong grasa" is referred to as a slang term, and is the english equivalent to "grease monkey" and/or is used when referencing a "dirty person". the phrase "abnoy" translates to "abnormal" in english, and it also used as a slang term to mean "weirdo". these phrases is used to demean another person, and are typically used when an individual has a mental illness. this type of interaction shows a generally simplistic attitude towards issues concerning mental health within the communities in the philippines. mental health in other laws certain laws contain provisions for the protection of the rights of the mentally ill. the magna carta for disabled persons (republic act no. 7277) considers those with a mental illness to be disabled. this law protects their interests regarding employment, education, and health. this law states that the government will establish centers for special education in all regions of the philippines for those visually impaired, hearing impaired and intellectually disabled. it also hold state universities to be responsible for a special education (sped) course if need be. according to the family code of the philippines (executive order no. 209), in the event where the adoption of an adopted minor with mental disability is rescinded, the state will provide a guardian over him/her. the comprehensive dangerous drug act (republic act no. 9165) was passed in 2002 in order to control problems with drug abuse. drug abuse was seen both as a direct and indirect cause of mental illness among people in the economically productive age group. the law guarantees a minimum of 12 years in prison, as well as fines ranging from php 100,000 to php 10,000,000 against offenders. the act protects mentally incapacitated individuals along with minors who are victimized by drug pushers (either by selling them drugs or involving them in illicit activities). a person found guilty of the above shall be given the maximum penalty. government initiatives on mental health care mental health law the mental health law (republic act 11036) proposes a mental health policy that aims to enhance integrated mental health services, the promotion of mental health services, protection of people who use said services, and the establishment of a philippine mental health council. these goals are based on international human rights standards. the purpose of this law is to incorporate comprehensive mental health services into the philippines' national healthcare, for accessible mental healthcare especially to the impoverished and those at high risk. the law mandates the department of health, commission on human rights, department of justice, and various hospitals in support of those with mental health problems. mental health services are proposed to be accessible from large-scale hospitals, down to the barangay level. health and medical courses will include mandatory courses in mental health, so as to fully equip healthcare professionals. initiatives made to pass the law there have been reactions to the lack of a mental health act by mental health professionals, as well as initiatives by the government. the philippine psychiatric association (ppa), in particular, has been trying to get in touch with the congress to legislate a mental health act. the ppa launched a petition at mhactnow.org in 2015, and garnered upwards of 10,000 supporters. however, their goal of 200,000 was not reached. there have also been social media