The rocky road to a Philippine mental health law

On Dec. 12, 2017, Congress approved the Philippine Mental Health Act after a tedious review of its Senate (SB 1354) and House of Representatives (HB 6452) versions. President Rodrigo Duterte signed Republic Act 11036 or Philippine Mental Health Law last June 20.
The Philippines is among the last 30 percent in the world without a mental health law and remains the only ASEAN state without one. Yet, the urgent necessity for such a legislation is very clearly borne out by global as well well as local statistics.
The WHO estimates that:
• one in 20 individuals suffer from a mental health disorder;
• neuropsychiatric conditions account for 14 percent of the global burden of disease;
• among non-communicable diseases, they account for 28 percent of the Disability Adjusted Life Years or DALYs (a measure of the impact of a disease), more than cardiovascular disease or cancer;
• almost one million people die due to suicide every year (globally the third leading cause of death among young people);
• the most important causes of disability due to health-related conditions are unipolar depression, alcoholism, schizophrenia, bipolar depression and dementia;
• the global treatment gap is estimated to be between 76-85 percent for low- and middle-income countries, and 35-50 percent for high-income countries.
But are these statistics applicable to the Filipino population? Are we not supposed to be one of the happiest people in the world? In 2016, we placed fifth in the Positive Experience Index Score. Unfortunately, local studies tell a different story.
• 32 percent of 327 government employees surveyed in Metro Manila have experienced a mental health problem in their lifetime;
• almost one per 100 households (0.7 percent) has a member with mental disability;
• intentional self-harm is the ninth leading cause of death among those 20-24 years old.
Being the third most disaster-prone country in the world, we expect not only biological and psychosocial factors to place our mental health at risk. Climate change which has generated super storms have wreaked not only physical and economic havoc but mental health problems as well. The WHO in 2014 estimated over 800,000 people in Yolanda-hit areas had suffered different mental health conditions, with 80,000 requiring further medication and support.
Resources for mental health in the country remain severely inadequate. The number of mental health professionals is extremely inadequate to meet the mental health needs of the 130 million Filipinos. Less than 700 psychiatrists and over 1,000 nurses work in psychiatric care. Presently, there are only two tertiary care mental hospitals, one in the National Capital Region (4,200 beds) and another in Mariveles, Bataan (500 beds). All private mental health facilities are located in major cities.
Only three percent (2.36 billion in 2016) of a total health budget of P78.83 billion is allocated for mental health, 70 percent of which goes for hospital-based care. This brings the per capita expenditure on mental health per Filipino to P18.
International conventions on human rights impose appropriate and globally accepted standards for human conduct. Thus, a rights-based approach to health care which recommends that a health system’s performance be evaluated from a human rights perspective has increasingly become an accepted practice. The rights-based approach to health care emphasizes State obligations towards worldwide eradication of disparities in access to mental health care, quality of life, well-being and freedom from cruel, inhuman, degrading treatment.
A “human rights-based” approach to health pays equal attention to process (how people’s rights are respected within the health system) and outcome (the goal of improving health). It begins with the rights of every citizen and invokes the duties of the State towards protecting and enhancing those rights. Protecting human rights is synergistic with improving public health.

The Philippine Mental Health Act 
It is “an act establishing a national mental health policy for the purpose of enhancing the delivery of integrated mental health services, promoting and protecting the rights of persons utilizing psychiatric, neurologic and psychosocial health services, appropriating funds therefore and for other purposes.”
It is a rights-based legislation invoking the right of every Filipino to be mentally healthy, have access mental health care services and the duty of the State to ensure this through:
• the protection of those who have mental health conditions and their family from discrimination, cruel and degrading inhuman treatment and torture;
• defining mental health and mental health conditions, emphasizing that the mentally ill have the same rights as other people with a disability;
• identifying the rights of service users, career and mental health professionals;
• mandating the establishment of a National Mental Health Service to improve access to clinical services and community-based prevention programs and mental health services at all levels of the health care delivery system;
• the establishment of a complaint and investigation mechanism against abuse;
• research development and mental health education at all levels of our educational system;
• the creation an autonomous and funded Philippine Mental Health Council to oversee the implementation of the law;
• appropriating funds for the implementation of the law.
A rights-based mental health legislation is not a matter of time but of necessity. It is in compliance with the State’s obligations according to:
• the Philippine Constitution which invokes as one of its principles that “the maintenance of peace and order, the protection of life, liberty, and property, and promotion of the general welfare are essential for the enjoyment by all the people of the blessings of democracy;
• the Universal Declaration of Human Rights which, although not binding, has been upheld as the international standard for human and humanitarian conduct of all States;
• the Convention of the Rights of Persons with Disabilities in recognizing the State’s obligation to respect the human rights of all its citizens regardless of race, color, religion, politics and disability;
• the Convention and the Optional Protocol Against Torture which require all State parties to protect all individuals deprived of their liberty from “cruel, inhuman and degrading treatment.”

Mental Health Council
To ensure its autonomy and power to implement the law, this provision creating the Mental Health Council was scrutinized in the bicameral session.  The chair of the council shall be the secretary of health who will submit a list of nominees from among designated stakeholders to be approved and appointed by the President. The law will provide for the creation of a Division on Mental Health which will serve as the secretariat of the Council. The Council is empowered to determine the use of funds provided by the law.

By June Pagaduan Lopez, MD

The author is a retired professor of Psychiatry at the University of the Philippines.