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Mental Health Services in The Philippines: January 2019
Mental Health Services in The Philippines: January 2019
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Psychiatrist and Clinical Lecturer, The Act seeks to establish access to comprehensive
Department of Psychosis Studies, National information on mental health
Institute of Psychiatry, and integrated mental health services, while pro-
services in the Philippines indicates that there
Psychology and Neuroscience, tecting the rights of people with mental disorders
King’s College London, UK. Email: are substantial gaps and inconsistencies in the
john.lally@kcl.ac.uk and their family members (Lally et al, 2019).
delivery of mental healthcare. The recently
2
Psychiatrist and Clinical Lecturer, However, mental health remains poorly
enacted Mental Health Act legislation
Department of Psychiatry, Royal resourced: only 3–5% of the total health budget
College of Surgeons in Ireland, provides a platform for the delivery of
Beaumont Hospital, Ireland
is spent on mental health, and 70% of this is
comprehensive and integrated mental health
3
Psychiatrist and Clinical Lecturer, spent on hospital care (WHO & Department of
services. However, there remain many
Department of Psychiatry, St Health, 2006).
Vincent’s Hospital Fairview, challenges in the provision of accessible and
Accordingly, the majority of mental healthcare
Ireland affordable mental healthcare.
4
Psychiatrist and Clinical Lecturer,
is provided in hospital settings and there are
Department of Forensic and underdeveloped community mental health ser-
Neurodevelopmental Sciences,
Institute of Psychiatry,
vices. The National Center for Mental Health
Psychology and Neuroscience,
The Philippines is an autonomous republic was previously estimated to account for 67% of
Kings College London, UK located in the Western Pacific, with a population the available psychiatric beds nationally (Conde,
5
Psychiatrist, Section of of over 100 million and a large diaspora of 2004). More recent data indicate that there are
Psychiatry, Department of approximately 10 million people. It is the 12th
Neurosciences, Makati Medical 1.08 mental health beds in general hospitals and
Center, the Philippines most densely populated country in the world. 4.95 beds in psychiatric hospitals per 100 000 of
The Philippines is an archipelago of over 7000 the population (WHO, 2014). There are 46 out-
Conflict of interest. None. islands, with the majority of the population living patient facilities (0.05/100 000 population) and 4
Keywords. Asia; psychiatry; lower-
on the largest islands of Luzon (in which the cap- community residential facilities (0.02/100 000)
middle income; education and ital Manila is located), Visayas and Mindanao. (WHO, 2014). There are only two tertiary care
training. The country stretches towards Taiwan in the psychiatric hospitals: the National Center for
First received 17 Aug 2018
north and to Indonesia and Brunei in the Mental Health in Mandaluyong City, Metro
Accepted 26 Nov 2018 south, with the Pacific Ocean to the east, and Manila (4200 beds) and the Mariveles Mental
the South China Sea divides it from mainland Hospital in Bataan, Luzon (500 beds). There are
doi:10.1192/bji.2018.34
South East Asia. 12 smaller satellite hospitals affiliated with the
© The Authors 2019. This is an Most (90%) of the population is Christian, with National Center for Mental Health which are
Open Access article, distributed 80% Roman Catholic, and approximately 5% are located throughout the country. Overcrowding,
under the terms of the Creative
Commons Attribution licence Muslim. Filipino is the official language, although poorly functioning units, chronic staff shortages
(http://creativecommons.org/ English (the second language) is widely spoken. and funding constraints are ongoing problems,
licenses/by/4.0/), which permits
unrestricted re-use, distribution,
The Philippines is classified as a lower-middle- particularly in peripheral facilities. There are no
and reproduction in any medium, income country (defined as a gross national dedicated forensic hospitals, although forensic
provided the original work is
properly cited.
income per capita of between $1006 and $3955), beds are located at the National Center for
based on the 2017 per capita income statistics by Mental Health.
the World Bank (https://data.worldbank.org).
Economic improvements have been evident over
the past decade.
The Philippines attained full independence in Mental health staff
1946 after being colonised and occupied by for- There is 1 doctor for every 80 000 Filipinos
eign powers since 1545: first by Spain, then by (WHO & Department of Health, 2012); the emi-
the US and finally by Japan during the Second gration of trained specialists to other countries,
World War. This colonial history contributed to particularly English-speaking countries, contri-
the development of a unique Filipino culture, butes to this scarcity. This shortage is magnified
which also includes ancient and contemporary in psychiatry where, nationally, there are a little
Asian influences. However, it remains a country over 500 psychiatrists in practice. The ratio of
poorly understood in the West; it is often viewed mental health workers per population in the
as an apparent anomaly in the region due to its Philippines is low, at 2–3 per 100 000 population
belated achievement of independence and its (WHO & Department of Health, 2006). This ratio
uniqueness as a Christian-majority country in is lower than in other Western Pacific Rim coun-
Asia. tries with similar economic status, for example
Malaysia (4.9 mental health workers per 100 000
population) and Indonesia (3.1 per 100 000
Mental health services population). Data indicate that there are 0.52 psy-
The Philippines has recently passed its first chiatrists (Isaac et al, 2018) and 0.07 psychologists
Mental Health Act (Republic Act no. 11036). per 100 000 inhabitants, and 0.49 mental health
completion of residency training, an exit examin- Isaac M., Ahmed H. U., Chaturvedi S. K., et al (2018) Postgraduate
ation is performed with written and OSCE compo- training in psychiatry in Asia. Current Opinion in Psychiatry, 31,
nents, following which the title Diplomate of the 396–402.
Specialty Board of Philippine Psychiatry is
Lally J., ó Conghaile A., Quigley S., et al (2013) Stigma of mental
awarded to the candidates who qualify. illness and help-seeking intention in university students. The
Despite these structures, psychiatry remains a Psychiatrist, 37, 253–260.
less popular specialty for medical graduates in
the Philippines, and the numbers being trained Lally J., Samaniego R. M. & Tully J. (2019) Mental health legislation
in the Philippines: the Philippine Mental Health Act. BJPsych
are inadequate to meet a growing need. International, in press.