CPBRD Policy Brief

No. 2023 -02

Underscoring the Mental Health Agenda

in the Philippines

Congressional Policy and Budget Research Department

House of Representatives
 Abstract

This paper aims to refocus attention on the mental health agenda, emphasizing the continued
inadequacy in addressing the issue despite the issuance of the National Mental Health Policy
in 2001 and the enactment of the Mental Health Act in 2018. It examines the current mental
health situation, considers the initiatives undertaken by the Department of Health, identifies
the issues and challenges confronting the mental health sector, and provides an overview
of existing legislative proposals. The paper reveals that the country’s mental health situation,
exacerbated by the pandemic, has not gained sufficient priority and attention even with
its evident decline. The scenario was already worrisome pre-Covid 19, and then more so
after. Social stigma, high treatment cost, limited primary care, low public spending on the
sector, and lack of a national registry of cases present further complications. To underscore
the mental health agenda, key recommendations include the passage of a telemedicine
law, increased visibility for the Philippine Mental Health Council, reassessment of mental
health integration in the education system, democratization of mental health service access
through PhilHealth, and greater representation in the budgetary allocations, among other
measures.
The views, opinions, and interpretations in this report do not reflect the perspectives of the House of
Representatives as an institution or its individual Members.
 1
Underscoring the Mental Health Agenda
in the Philippines*

Despite advances in policy, knowledge, and research on mental health, progress has been
discernibly slow in the availability of psychotropic medicines, public education, community
involvement, and primary care treatment (WHO, 2022). Actions in these areas have already
been put forward in the landmark 2001 World Health Organization (WHO) report on Mental
Health: New Understanding, New Hope.

The COVID-19 pandemic has further hindered the implementation of mental health interventions
(Campion et al, 2022). The WHO (2020a) found that 93% of mental, neurological, and
substance use (MNS) services have been disrupted, and only 17% of countries have provided
full funding for mental health and psychosocial support services (MHPSS) interventions. Not
surprisingly, depression and anxiety have increased to around 26% to 28% in the first year of
the pandemic (WHO, 2022; Santomauro, 2021). The United Nations cautioned that a parallel
mental health crisis or what Thornicroft (2021) coined as a silent pandemic1 may be in the
offing.

The consequence of continued inaction is significant. Estimates from 2010 indicate that the
total direct and indirect costs of mental health conditions amounted to $2.49 trillion, and
projected to rise to $6.04 trillion by 2030 (Bloom et al, 2011). In the Philippines, the WHO
(2021) reckons that the burden of mental health conditions in 2019 amounted to as much as
0.4% of gross domestic product, equivalent to about P68.86 billion ($1.25 billion at P1: $55)
in productivity losses.

This paper aims to bring the spotlight back to the mental health agenda. Even with the
issuance of the National Mental Health Policy as early as 2001 (DOH Admin. Order 8) and the
enactment of the Mental Health Act (RA 11036) in 2018, attention to this issue is still wanting.
The paper is divided into four sections. It will present the mental health landscape, delve
into the various initiatives of the Department of Health (DOH) in relation to RA 11036, and
provide a summary of current legislative proposals. The paper concludes with some insights
on pushing the mental health agenda at center stage given the upending pandemic and how
such agenda can be mainstreamed into the strategies for a Matatag, Maginhawa, at Panatag
na Buhay for Filipinos as envisioned in Ambisyon 2040.

*
Prepared by Elyzabeth F. Cureg-Estrada, Rosemarie R. Sawali, and Manuel P. Aquino
1
Silent pandemic refers to the possible consequences and differing impacts of COVID-19 on mental health, such as on individuals
with pre-existing mental illnesses, on frontliners or those providing essential health services, on COVID infected population, and
on other different groups (by age, gender, nature of employment, etc). Thornicroft argued that these effects may be considered
a global phenomenon.
 2

I. The Philippine Mental Health Situation

The virulent COVID-19 health crisis notwithstanding, Filipinos tend to be relatively optimistic
about their future health outlooks compared with their Asian neighbors2 (EIU and Prudential,
2021). However, even though Filipinos have demonstrated resilience and optimism in the face
of numerous environmental and societal stressors, there appears to be a deterioration in the
overall mental health situation in the country.

Pre-COVID-19: Rising cases of mental health disorders. The prevalence of mental health
disorders in the Philippines in the last three decades (1990-2019) ranged from 11.3% to 11.6%,
lower than the global prevalence rate of 13%. However, the number of cases with mental
health disorders have risen by 2.0% per annum on the average, reaching 12.5 million Filipinos
in 2019 from the initial 7.0 million count in 1990.3 Across the years, there are more females
(53.1%) than males (46.9%) experiencing these disorders. (IHME, 2019)

The two most common conditions experienced are anxiety (40.9%) and depression (22.8%).
Data from IHME (ibid.) indicate roughly 2.8 million Filipinos were afflicted with depressive
disorders in 2018. A substantial jump of 17.6% was noticeable in the DOH estimate of 3.3
million depressive Filipinos in 2019 (Chiu, 2021).

Deaths due to intentional self-harm ranged from 2,400+ to 2900+ between 2015 and 2019
(PSA, 2021). WHO (2020b) pegged the estimate at 5.4 deaths per 100,000 population, lower
than the global age-standardized suicide rate of 9.0 (WHO 2020c).4

Impact of the pandemic on mental health. The DOH reckoned that 3.6 million Filipinos
were struggling with different mental health disorders in 2020, with possible adjustments for
underreporting. The department likewise reported that a third of COVID-19 infected individuals
were diagnosed with neuropsychiatric condition within six months from infection. In December
2021, a mobile phone survey conducted by the DOH revealed that while 20% of adult Filipinos
required mental health services, only a third of them sought consultations. (Domingo, 2021)

The results of the National Survey on Mental Health and Well-Being (NSMHW) which will
provide a comprehensive data on the prevalence and characteristics of Filipinos experiencing
mental health disorders during the pandemic is scheduled for release this year.5 Nonetheless,
previous surveys conducted between 2020 and 2022 already indicate an increasing number
of Filipinos affected by the psychological impacts of the pandemic:

2
The Health of Asia Barometer surveyed 5,000 adults aged 21 to 55 between August to September 2020 from thirteen countries
namely, Hong Kong, Singapore, Taiwan, Myanmar, Laos, Mainland China, Cambodia, Malaysia, Thailand, Philippines. Indonesia,
Vietnam, and India. The research concluded that the three countries with the best longevity and economic figures (HK, Singapore,
Taiwan) tend to be less optimistic about their future health outlook than those with poorer health and longevity such as in
Philippines and India. Among the explanations they proffered were the level of health literacy, cultural attitudes, and the quality of
communication channels for health information.
3
These figures were processed from the available online data of the Institute for Health Metrics and Evaluation (IHME)/ Global
Burden of Disease Collaborative Network, from 1990 until 2019.
4
Age-standardized suicide rates refers to the number of suicide deaths per 100,000 population in a given demographic group or
adjusted in terms of the age structure. As explained in ourworlddata.org, suicide rates are highest among seniors aged 70 and
older, and generally follow a pattern of high death rates in the older age groups.
5
The NSMHW Report is currently undergoing technical review. Official results will be shared in the DOH website this year. For
details on the survey, see https://registry.healthresearch.ph/index.php/registry?view=research&layout=details&cid=2806.
 3

 During the initial phase of the lockdowns, three-fourths of the 1,879 online surveyed
respondents from 28 March to 12 April 2020 experienced mental health impacts, with
16.3% reporting moderate to severe psychological impacts, 16.9% with moderate to
severe depressive symptoms; 28.8% with moderate to severe anxiety symptoms; and
13.4% showing moderate to severe stress signals. (Tee et al, 2020)

 Almost a third of the 1,614 respondents from 580 low-income households surveyed
between December 2019 to August 2020 suffered from severe depression, which was
correlated with food insecurity. (Cho et al, 2021)

 Forty percent (40%) of adult Filipinos surveyed from August to September 2020 for
the Health of Asia Barometer reported experiencing symptoms of depression and
anxiety owing to the COVID-19 situation, with only 34% of them seeking help. (EIU
and Prudential, 2021)

 More than a majority (61%) of 5,868 private sector employee-respondents surveyed

by MindNation, a mental health services company, from September 2020 to June
2021 admitted being stressed, while 34% were depressed and 53% reported anxiety.
Whereas prior to the pandemic, survey respondents rated their mental wellness at
work as 8 out of 10, this dropped to 6.5 during the pandemic. (Gregorio, 2021)

 More than a majority (63%) of the 10,212 online Filipino respondents of the Statistica
and Rakuten Insights survey conducted on 12-30 May 2022 reported increased stress
or anxiety during the past 12 months. Additionally, 17% reported experiencing lower
levels of stress and anxiety compared to before, while 21% reported similar levels.
(Statistica, 2022).

The number of deaths due to intentional self-harm saw a disturbing increase of 57.3%, jumping
from 2,810 in 2019 to 4,420 in 2020 (PSA, 2021). According to the MindNation survey, 7.9% of
the private sector employee respondents admitted to having suicidal thoughts, with COVID-19
fears being identified as the main stressor, followed by personal issues, financial challenges,
work pressures, and loneliness (Lago, 2021).

Dr. Palma-Ongoco of the National Center for Mental Health (NCMH) revealed that their crisis
hotline received a total of 11,017 calls in 2020, with 1,322 of them (12%) being suicide-related.
By June 2021, the share of the high-risk calls already increased to 30.7%, accounting for
2,743 suicide-related calls of the 8,949 total calls received in the first half of the year alone
(CNN, 2021). The trend continued to worsen, with the share of high-risk calls reaching 33.4%
or 4,978 of the 14,903 calls by September 2021. The majority of the callers were from Regions
3, 4, and the NCR, with more females than males, and a significant portion of them aged 18
to 30 (Cuevas, 2021).

Special Focus: Mental Health Well-being of Young Filipinos. The mental health of young
Filipinos has been at risk due to various behaviors and circumstances, with the pandemic
further exacerbating the situation. Studies such as the nationwide 2021 Young Adult Fertility
 4

and Sexuality Study (YAFS5)6 for 15-to-24 year-olds and the quadrennial Global School-based
Health Surveys (GSHS)7 for students aged 13-to-15 (2003-2019) have provided information
on the challenging realities that have impacted their mental health.

 Bullying. Prevalence of bullying among 13-to-15 year-olds is consistently high,

ranging from 36.6% to 51.2% (Table 1). The UNICEF’s Longitudinal Study (2015-2020)
following a cohort of more than 3,400 children, pegged the prevalence at an alarming
65% (Faingold, 2022). Relatedly, the Department of Education (DepEd) reported in
February 2023 (Felipe, 2023) that there has been a rising trend in the number of cases
of school bullying, averaging 10,275 cases for the academic years 2013-2014 until
2019-2020. Reporting of cases increased threefold in school year 2014-2015, likely
as a result of the enactment of RA 10627, the Anti-Bullying Act of 2013. Beginning
academic year 2017-2018, the total reported cases reached five digits to 15,866,
increasing further by more than a third to 21,521 in the next academic year, then
tapering off to 11,637 in academic year 2019-2020. The decline was attributed to the
pandemic given the needed shift from face to face to online classes (Ramos-Araneta,
2023).

Table 1
Prevalence Rates Among High School Students Aged 13 to 15
on Select Indicators of the Global School-Based Health Surveys (2003-2019)
Indicators Prevalence Rates (%)
Percent of students who: 2003 2007 2011 2015 2019*
1. were bullied on 1 or more days during the past 30 days 36.6 47.9 47.7 51.2 41.8
2. seriously considered attempting suicide during the past 12 months 16.1 16.8 16.3 11.5 23.1
3. had no close friends 2.9 4.4 3.0 4.2 5.8
4. used drugs 1 or more times during their life ** 4.6 4.3 4.2 10.1 6.9
5. drank at least 1 drink containing alcohol on 1 or more days during the
past 30 days 18.2 15.8 18.7 18.2 23.5

6. spent 3 or more hours per day doing sitting activities (watch tv, play
computer, etc.) during a typical or usual day 28.0 29.5 32.3 31.0 36.4

Notes:* The 2019 GSHS survey was expanded to include 16 and 17 year olds. For the mental health indicator on the percentage
of students who seriously considered attempting suicide during the past 12 months, the figures were nearly the same: 23.1%
for 13-15 years old vs. 23.2% for 16-17 years old. For both age brackets, higher incidence rates were observed for females
compared to males: 27.2% vs 18.5% for 13-15 years old and 26.4% vs 20.4% for 16-17 years old.
**Drugs was replaced with the word” marijuana” in the 2019 survey. Also, for Indicator 6, the following activities were outlined
in the question for the 2019 survey: watching tv, playing computer games, talking with friends, when not in school or doing
homework.
Source: WHO’s GSBS (2019) for the 2019 prevalence rates and (2015) for the other years.

6
The 2021 YAFS is the fifth round in the series of surveys conducted by the University of the Philippines Population Institute
(UPPI) and the Demographic Research and Development Foundation, Inc. since 1982. It is the Philippines’ largest series of
nationally and regionally representative, cross-sectional surveys on the 15-24 age group. It has provided comprehensive and
timely information on Filipino adolescents and young adults, specifically on issues related to sexuality, fertility, reproductive
health, education, and employment aspirations and trajectories, health and lifestyle, media use, mental health, as well as their
attitudes on marriage, family formation, and norms, among others. For more details of the preliminary findings, please check
https://www.uppi.upd.edu.ph/sites/default/files/pdf/YAFS5_National_Dissemination_Slides_FINAL.pdf
7
This is a collaborative surveillance project of the WHO designed to help countries measure and assess the behavioral risk
factors and protective factors in 10 key areas among young people aged 13 to 17 years. It is a relatively low-cost school-based
survey which uses a self-administered questionnaire to obtain data on young people’s health behavior and protective factors
related to the leading causes of morbidity and mortality among children and adults worldwide. More details on the results of the
latest 2019 Philippines GSHS are available at https://doh.gov.ph/sites/default/files/publications/2019%20GSHS_Philippines%20
Fact%20Sheet.pdf.
 5

 Online abuse and exploitation. Based on data from the US-based National Center
for Missing and Exploited Children, the Department of Justice’s Office of Cybercrime
reported a substantial 264.6% increase in online child sexual exploitation cases during
the early stages of the lockdown from 76,561 cases between March to May 2019
to 279,166 cases in the same period of 2020 (Patag, 2020). Per the YAFS5, cyber
harassment among the youth (aged 15-24) doubled for males (from 6% to 13%) and
tripled for females (from 4% to 12%) between 2013 and 2021.

 Depression. Using the Center for Epidemiological Studies-Depression Scale8, the

YAFS5 found a substantial increase in the percentage of the youth who felt depressive
symptoms in the reference week, between the 2013 and the 2021 surveys. Specifically,
the share of those who felt depressed increased from 7% to 11%, lonely (7% to 12%),
sad (6% to 12%), disliked (6% to 12%), and who had restless sleep (9% to 14%).

 Self-harm. The DepEd revealed in a Senate hearing on 09 February 2023 that for
school year 2021-2022, 404 learners had died by suicide and 2,147 more made
previous attempts towards self-harm. Indeed, the GSHS (Table 1) evinces the recent
uptrend in suicide ideation with 23.1% prevalence rate in 2019, while the recent YAFS5
indicates that 17% of Filipino youth reported having considered committing suicide
at least once. Based on the YAFS5, only 2% of those who inflicted self-harm sought
professional help while 62% did not seek help from anyone. In fact, only 11% of all
the respondents were aware of suicide prevention service or program. Note that the
NCMH shared that as of June 2021, 17% of the callers in their crisis hotline were
minors, mainly aged 15 to 17 (CNN, 2021).

The worrisome numbers on bullying, online abuse, depression, and suicide have prompted
the PhilHealth to appeal for higher funding for mental health services for children, specifically
on primary care (Panti, 2023). Dr. Albert Francis Domingo, Director III of the PhilHealth’s
Health Finance and Policy Sector echoed the argument of the WHO (2020b) that mental
health issues should be addressed early on since up to half of mental disorders among adults
start even before they turn 14.

Issues and Challenges

The promotion of a mental health agenda in the country is greatly affected by a host of issues
including high treatment cost, limited primary care interventions, need for sustained support,
and the continuing challenge of generating timely and reliable mental health information. The
mental health situation is further complicated by other social and economic conditions.

Stigma. Filipinos are reluctant to seek professional help because of cultural factors like shame,
stigma, and collectivist attitude within the family or community. The WHO (2021) cited the
results of a study by Bressington et al (2017) that describes the mental health stigma: 65% of

8
Developed by L. S. Radloff in 1977, this is a 20-item self-report measure of depressive symptoms in the general population.
The items of the scale are symptoms associated with depression which have been used in previously validated longer scales.
https://conservancy.umn.edu/bitstream/handle/11299/98561/v01n3p385.pdf
 6

respondents believed that people with mental health conditions have little chance of recovery;
48% believed that they will be looked down on; 62% believed that it would be embarrassing
to go out with a relative with such a condition; and 51% reported that they preferred not to tell
others if they had a mental illness.9 Since mental health disorders are viewed as unacceptable
and associated with loss of face, they choose the more socially acceptable course of action
which is to ask friends and family members for help and would seek professional mental
healthcare only as the last resort. Formal mental health help-seeking behavior ranges from
2.2% to 17.5%, based on a systematic review of 15 studies published from 2002 to 2018.
(Tuliao, 2014; Martinez et al, 2020)

High cost of treatment and medication. While the range of outpatient consultation fees is
wide, it is generally expensive. The NCMH bills P400 for consultation, with first day in-patient
admission at P1,650 and P500 for the succeeding days. In Metro Manila, the prices of therapy
usually range from P1,000 to P4,500 per session. Affordable options such as in the NCMH
or private institutions with price offering that ranges from P100 (UERMMC in Manila) to P600
(SLU Sunflower Children’s Center in Baguio City) are very difficult to secure. (Moneymax,
2021) And even the cheapest P100 per session therapy rate is already 17.5% of the current
daily NCR minimum wage10. In addition, residents who live away from the cities have fewer
organizations and specialists to turn to.

The PhilHealth has excluded outpatient11 psychotherapy and counselling for mental health
disorders, and drug and alcohol abuse or dependency treatment among the benefits covered.
It only included hospitalization benefits for mental and behavioral disorders for a first case
of up to P7,80012. Children with developmental disabilities can avail of PhilHealth’s Z benefit
package for assessment (P3,626 to P5,276) and rehabilitation therapy sessions for a
maximum of nine sets of therapies annually (P5,000 per set). Thus, individuals with mental
health conditions and their families will basically have to rely on out-of-pocket spending for the
rest of the consultations and counselling.

The cost of medication varies, depending on the brands of antidepressant or antipsychotic

drugs. Affordable tablets cost around P6.50 (Escivex) while moderately priced ones are at
P65/tablet (Lexapro), both for the treatment of depression and anxiety. More known brands
like Xanax and Prozac come at a steep P130 per tablet. (Moneymax, 2021).

Limited primary care intervention. Mental health interventions in the Philippines generally
follow the Western clinical approach with more attention given to the neurologically ill and less
interventions are offered to the majority who are asymptomatic (Lazo, 2019). This explains
the concentration of mental health services in specialist psychiatric hospitals, with available
services in general hospitals for outpatient care, and only limited primary health care integration
and informal community care (Cuevas, 2021). The Mental Health Act is overturning this clinical

9
The study which sought to examine depression literacy and the associated health-seeking attitudes among urban adults
involved a total of 455 respondents from Cambodia, Philippines, and Fiji. https://pubmed.ncbi.nlm.nih.gov/29860568/
10
P570 effective 04 June 2022, according to the National Wages and Productivity Commission.
11
Outpatient services covered by PhilHealth are ambulatory or day surgeries, radiotherapy, hemodialysis, and outpatient blood
transfusion. For example, for the case of radiotherapy, the case rate for cobalt treatment is PHP 2,000/session and for linear
accelerator PHP 3,000/session. Up to 45 days per year is allowed, one session is equivalent to one day.
12
PHP 5,460 for the health care institution, PHP 2,340 for the professional fee.
 7

framework and is facilitating the shift to a decentralized, integrated, and community-based

mental health care paradigm.

Lagging performance in mental health indicators. Compared to the global median, the
Philippines needs to catch up on its performance on select mental health indicators such
as the number of mental hospital beds per 100,000 population and mental health workers
per 100,000 population. The country’s performance in the number of social workers per
100,000 population and the share of mental health expenditure to domestic government health
expenditure were above the global median (Table 2). While it fared better than the median
performance of low-income countries in most indicators, the WHO (2020b) pointed out the gap
in the availability of mental health practitioners in the provinces.

Table 2
Performance of the Philippines in Select Mental Health Indicators, 2017/2020
Median Performance by
Indicators Global Mediani Philippinesii
Income Groupi
1. Number of mental hospital beds per 100,000 11iii <2 low income 4.13
population 25+ high income
2. Mental health workers per 100,000 population 13 <2 low income 2.02
60+ high income
3. Number of psychiatrists per 100,000 population 1.7 0.1 low income 0.5
8.6 high income
4. Number of psychologists per 100,000 1.4 0.1 low income 0.1
population 10.7 high income
5. Number of social workers per 100,000 0.7 0.1 low income 1.2
population 2.9 high income
6. Government expenditure on mental health per $7.49 $0.08 low income $0.47
capita $52.73 high income
7. Mental health expenditure as % of domestic 2.13% 1.05% low income 2.65%
government health expenditure 3.80% high income
i
Information collected from the 2020 Mental Health Atlas.
ii
Except for Indicators 1 and 2 which were culled from the 2017 Mental Health Atlas, the rest of the figures were from WHO
(2020b). Note that for Indicator 2, mental health worker per 100,000 population, Sec. Duque in a 2020 DOH press release
revealed that the country only actually has less than one mental health worker for every 100,000 Filipinos.
iii
The consensus of the Delphi panel managed by Mundt et al (2022) is that less 15 beds:100K reflect severe shortage, 15-to-25
beds:100K show moderate shortage, and 25-to-30 beds:100K show mild shortage. The panel of experts agreed on 30:100,000
as the minimum ratio and 60:100,000 as the optimal number.

There are four facilities with the most hospital bed-capacity. Two of these four facilities are
listed by the DOH as public psychiatric health centers – the Mariveles Mental Wellness and
General Hospital with 700 psychiatric beds plus 100 general beds, and the Cavite Center
for Mental Health with 250 beds. In the Visayas, the Vicente Sotto Memorial Medical Center
and its Center for Behavioral Sciences made room for 200 beds. The NCMH which has a
3,500-implementing bed capacity (from a 4,200-authorized bed capacity) is classified as a
specialty mental hospital, the only tertiary medical center of its kind. Based on a 2016 tally,
there are 58 private psychiatric facilities nationwide, of which 32 are located in the NCR.13 To
complement these facilities, the DOH plans to tap the 20,000+ primary health care clinics in
the barangays.

13
DOH 2016 and 2020 Hospitals Profile Reports.
 8

Low spending on mental health. The per capita public sector expenditure on mental health
of $0.47 is 16 times lower than the global median. However, the country’s mental health
expenditure as percentage of public health spending of 2.65% is higher than the global
median (Table 2). The Mental Health Strategic Plan (2019-2023) targeted to further increase
the percentage of mental health allocation to total government health expenditure from 2.75%
in 2020 , 3.5% in 2021, 4.25% in 2022, to 5.0% in 2023.

The UNDP and the WHO (2021) joint report found the public sector expenditure for mental
health still wanting. They pushed for an investment worth P143 billion ($2.61 billion at P1:
$55) or P1,306 per capita ($23.75 at P1: $55) over a decade.14 Investing in an integrated set
of evidence-based, cost-effective interventions is projected to save 5,000 lives and bring the
economy P217 billion ($3.95 billion at P1: $55) worth of benefits in the next ten years.

Lack of a national registry of mental and neurological cases. The establishment of a registry,
including the development of national reporting and surveillance systems, was assigned to the
National Epidemiology Center and the Information Management Service through DOH-AO 8
s.2001. Nevertheless, generation of mental health information is particularly challenging.

The regular Philippine Statistics Authority (PSA) census provides limited data on mental health.
The initial inclusion of mental health and/or disability in census forms was in 2010. Even the
most recent National Demographic Health Survey (NDHS, 2017) did not contain mental health
items. It only had questions related to substance use (i.e. frequency and amount of alcohol
intake and smoking). While the issue of “stress” was raised, it was only as one of the possible
responses to the question on likeliness to have heart disease (i.e. those who are fat; those
who are under stress). Further, depression was mentioned as a reaction to an experience of
violence from a partner.15

In any case, the first 2016 National Disability Prevalence Survey covered mental health. It
asked about capacity to handle stress, recent experience on stress, feeling sad/low/depressed,
feeling worried/nervous/anxious, health-related depression, experiencing depression or
anxiety, etc. A National Survey on Mental Health and Well-Being (NSMHW) has also been
funded with results scheduled to be released in 2023.

14
The recommended P143 billion investments required is for selected clinical packages and population-based preventive
interventions over a 10-year period. Specifically, P63.2 billion for bipolar disorder, P29.1 billion for psychosis, P10.4 billion for
anxiety disorders, P9.8 billion for alcohol use/dependence, P7.5 billion for universal school-based interventions, P7.4 billion each
for depression and epilepsy, P6.1 billion for indicated school-based interventions, and P2.4 billion for pesticide ban. The estimated
absolute costs from 2020 to 2024 have been detailed at P6.39 billion, P7.26 billion, P9.51 billion, P10.65 billion, and P11.81 billion.
These estimates were derived using the OneHealth tool and custom-built Excel models, primarily incorporating WHO experts’
assumptions on four main resource cost categories which are inpatient care, outpatient and primary care, medication, and
program costs and shared health system resources. Unit costs for resource items under each category were obtained from local
sources like DOH, 2019 Drug Price Reference Index, and SSL, as well as the WHO-CHOICE database. The UNDP investment
case likewise shared its target coverage per intervention for 2040, using 2020 as baseline. For example, for basic psychosocial
treatment for mild cases of anxiety disorders, the target is to reach 30% coverage by 2040, from the 5% 2020 baseline. https://
www.undp.org/philippines/publications/prevention-and-management-mental-health-conditions-philippines-case-investment
15
Question: Did the following ever happen as a result of what your last husband/partner did to you? One of the possible answers
(Yes / No): You had Depression, anxiety, anger, sleeplessness, irritable, confused, feelings of isolation?).
 9

II. Government’s Response

This section presents the policy, plans, financing, and preliminary initiatives to provide for
mental health and psychosocial support services.

The Mental Health Act. The Philippines is among the 58 of the 148 WHO Member States
with updated mental health laws and one of the 75 members with updated mental health plans
(WHO, 2020c). RA 11036 was enacted in June 2018 and its implementing rules and regulations
were finalized in January 2019. The policy sought to establish a comprehensive and integrated
national mental health care system that capitalizes on the Philippines’ decentralized health
system. It also propels the shift from the traditional inpatient hospital-based management of
psychiatric, neurologic, and psychosocial needs to larger roles for community-based systems
and primary healthcare. The design of community mental healthcare is being tried out. The
DOH has undertaken the pilot implementation of the Community-based Mental Health Program
(Cuevas, 2021).

Strategic and Facility Plans. The 2019-2023 Mental Health Strategic Plan (MHSP) detailed
the priorities for the short to medium term. The DOH aimed to achieve 100% policy integration at
the national government level by 2023 across 32 NGAs, through NGA reports to the Philippine
Council for Mental Health (PCMH). The DOH and the Department of the Interior and Local
Government (DILG) will partner to integrate mental health policies and services at the local
level, starting with 58 implementation sites (49 provinces, 9 cities) in 2020. The DILG has yet
to provide information on the number of LGUs which enacted and implemented local mental
health policies.16 The DILG targets to have 15% of the LGUs (provinces, municipalities, cities)
providing mental health services in 2020, increasing to 30% in 2021, 45% in 2022, and 60%
in 2023.

Also, gradual decline in suicide deaths from 3.2 (2020) to 3.1 (2023) per 100,000 population
is being pursued. The pace of reduction approximates the target on suicide deaths embodied
in the Sustainable Development Goals. Likewise, being prioritized is the increase in treatment
service coverage by persons with epilepsy / psychosis/ depression / anxiety / substance use
disorder by an additional 2% in 2020 up to 8% in 2023.

Other agency members of the PCMH also drew specific target outcomes by 2023. The DepEd
is seeking the compliance of 30% of public schools on its mental health order, which requires
the integration of mental health education in the curriculum and the development of programs
to raise awareness on mental health. Both the CHED and the TESDA are enjoining colleges,
universities and vocational institutions to establish mental health policies and wellness
programs, and provide trained mental health service providers. The DOLE is focusing on
the compliance of 90% of inspected companies on adherence to mental health policies and
wellness programs.

16
DILG was not able to provide an update of its initiatives in the HREP Committee on Welfare of Children briefing held 20
February 2023.
 10

In the Philippine Health Facility Development Plan (HFDP) 2020-2040, mental health care
is considered as a specialty care service17. By virtue of RA 11036, psychiatric, psychosocial,
and neurologic services are to be made available at regional, provincial, and tertiary hospitals.
Mental health centers are included in the planned specialty centers. Based on the HFDP, a
total of P2.15 billion from 2023 to 2025 is needed for the establishment of these centers, or
2.6% of the P82 billion cost requirement for all the pipelined sixteen types of specialty centers.
Specifically, the amounts are P274 million (2023), P1.054 billion (2024), and P822 million
(2025).

Public spending for mental health. Mental health is not among the five priority areas allotted
with P15 billion in the 2023 GAA for specialty centers. As shared by the DOH in the 12 August
2022 budget hearing, said appropriation will be spent primarily for neonatal, heart, lungs,
kidney, and cancer centers. Even so, appropriations under the Health Facilities Enhancement
Program (HFEP) were made for medical equipment and infrastructure development of mental
health hospitals with large bed-capacities, as presented in Table 3.

Table 3
Appropriations for National Center for Mental Health and
Mariveles Mental Wellness & General Hospital
(In Million Pesos), 2020 – 2023
Year Hospital Infrastructure Medical Equipment Total*
NCMH 45 45
2020
MMWGH 30 30
2021 NCMH 68 68
MMWGH 24 24
2022 NCMH 85 21 106
MMWGH 50 90 140
2023 NCMH 90 20 110
MMWGH 100 100
*Removed the item – Motor Vehicle – in the presentation since there were no allocations.
Source: GAA 2020-2022; NEP 2023

Provisions from the DSWD programs and projects (PAPs) were reflected for the NCMH and
Mariveles Mental Wellness and General Hospital (MMWGH) for 2021 and 2022. An amount
of P154.2 million was appropriated in 2021 for the construction of a Wellness Center Building
in MMWGH and P14.1 million for a multi-purpose building in the NCMH. In 2022, at least
P110 million was appropriated for the MMWGH’s multipurpose buildings while the NCMH
was allotted at least P47 million for the completion of their Health Workers Cottage and
improvements in drainage and water systems.

Note that main budget documents like the national expenditure program (NEP), General
Appropriations Act (GAA), Financial Accountability (FAR) 118 have yet to include a dedicated
item or sub-program for mental health. It is therefore difficult to precisely establish how much

17
A Specialty Center is a unit or department within a licensed Level 3 hospital that offers highly specialized care addressing
particular conditions and/or providing specific procedures and management of cases requiring specialized training and/or
equipment (AO 2020-0019).” The different types of specialty centers are cardiovascular care, lung care, renal care and kidney
transplant, cancer care, brain and spine care, trauma care, burn care, orthopedic care, physical rehabilitation medicine, infectious
disease and tropical medicine, toxicology, geriatric care, neonatal care, dermatology care, eye care, and mental health. From
p.72 of DOH Philippine Health Facility Development Plan 2020-2040.
18
Statement of Appropriations, Allotments, Obligations, Disbursements and Balances
 11

is spent for the sector. Likewise, there are no mental health performance indicators in the NEP
or GAA.19 In any case, for tracking purposes, mental health spending falls under the DOH’s
Non-Communicable Diseases (NCD) Sub-Program of the Public Health Program (PHP).

Neither the enactment of RA 11036 in 2018 nor the issuance of its IRR in 2019 has resulted
in any superficial bump in the appropriations for the NCD/Non-Communicable Diseases Sub-
Program that may indicate due consideration for mental health. A perfunctory analysis of the
2023 NEP and 2018 to 2022 GAA indicates that the share of the appropriations for the NCD
Sub-Program took a downturn from 2018 until 2022 (Figure 1). The jump in 2023 is partly
attributable to the prioritization of NCD specialty centers, but wherein mental health received
no appropriations.

Figure 1
Share of NCD Sub-Program to Public Health Program &
DOH (OSec) New Appropriations, 2018-2023

Note: All appropriations for Prevention and Control of NCDs Sub-Program

fell under Maintenance and Other Operating Expense. Also, included only
2018 onwards since the DOH shifted from Major Final Output/MFO-based
nomenclature to its current standard program and sub-program names in
2018.
Source: GAA 2018-2022; NEP 2023
rs.

19
Examples of outcome indicators include number of malaria / filariasis / rabies -free provinces, percent of people living with
HIV or ARV, percent of public health facilities with no stock-outs, and percent of fully immunized children. A sample of an output
indicator is the percent of procured cancer commodities distributed to access sites. Even under Health Facilities Operation, the
number of mental health in/out-patients who consulted or were treated could have been included as an indicator. It focused
instead on hospital infection rate, and drug-related indicators like the percent of drug dependents who completed the treatment
program, drug abuse treatment completion rate, and the number of in-patient and out-patient drug abuse cases managed.
 12

Nonetheless, there seems to be an increase in mental health spending in recent years based
on the upward trend in total NCMH new appropriations (Figure 2). Prior to RA 11036 (2016-
2018), NCMH new appropriations were on a slow uptrend, plateauing in 2019, then followed
by sustained significant increases until 2023. The P843.5 million budget in 2016 increased
by around 155% to P2.15 billion in the 2023 proposal. The NCMH share from the DOH OSec
new appropriations has remained relatively stable, ranging from 0.7% to 1.27% (0.7% in 2016,
1.0% for 2017-2019 & 2022, 1.27% in 2020, 1.1% in 2021 & 2023).

However, the increase in new appropriations for the NCMH across the years has not been
manifested in corresponding increases in its share in the government current health expenditure
based on the Philippine National Health Accounts (PNHA20). The share has actually declined
from 2016 to 2018, then remained flat from 2019 to 2021. The downward trend may allude
to either differences in the rate of increases among health budget items, with the NCMH
having a snail-pace, or to the start of deinstitutionalization efforts, in keeping with RA 11036.
Deinstitutionalization is defined in RA 11036 as “the process of transitioning service users
from institutional and other segregated settings to community-based settings that enable
social participation, recovery-based approaches to mental health, and individualized care in
accordance with the service user’s will and preference.”

Figure 2
NCMH New Appropriations (In Billion Pesos) & NCMH New Appropriations Share
to Government Current Health Expenditure (%), 2016-2023

Note: General government current health expenditure, based on the 2022 released PNHA is used to represent the
domestic government health expenditure
Source: GAA 2018-2022; PSA’s Philippine National Health Accounts 2022

20
Data was sourced from PNHA 2022 released table: Table 4: Current Health Expenditure by Institutional Unit Providing Revenues
to Financing Scheme (figures only for Government). See available tables at https://psa.gov.ph/pnha-press-release/tables.
 13

The premise for deinstitutionalization may be gleaned from the resulting low combined
appropriations of the NCMH and the Operation of Dangerous Drug Abuse (DDA) Treatment
and Rehabilitation Centers (under Rehabilitative Health Care Sub-Program)21 . The shares
of their combined appropriations in relation to government current health expenditures
remained modest and has not increased above the 2016 share – 0.85% (2016), 0.77% (2017),
0.78% (2018), 0.79% (2019), 0.69% (2020), and 0.67% (2021). It can be surmised that a big
proportion of the estimated 2.65% mental health expenditure share in domestic government
health expenditure (Table 2) is not allotted for institution-based spending for mental health.
This may be a welcome development since high spending for psychiatric hospitals/facility-
based treatments is considered inefficient (WHO, 2022). However, it must be established
that some mental health illnesses need specialized, facility-based treatment such as those
for psychotic disorders and drug dependence. It is important that support for the continued
operation of facility-based treatments is still adequately financed.

Notable Programs and Initiatives. Cuevas (2021) presented interventions on mental health
and psychosocial support in the form of a pyramid with basic services and security forming
the base layer, followed by community and family support, focused non-specialized support as
the next higher layer, and specialized services in psychiatric hospitals/facilities at the narrow
peak. (Annex 1) Efforts of the DOH toward deinstitutionalization and strengthening community-
based and primary care are more pronounced with the discussion of the notable initiatives
under each pyramid layer.

 Basic services and security. Mental health education through webinars and face-to-
face events were conducted, information-education-activity materials were provided,
and the basic needs of vulnerable populations such as for food, transportation, financial
assistance, PPEs, temporary shelters/quarantine facilities, and online and face-to-face
medical consultations were delivered. (Cuevas, 2021)

 Community and family support. E-learning modules, playbooks, and videos that help
intensify and expand psychoeducation efforts were created. Online orientation on basic
psychosocial skills for Centers for Health Development (CHDs), LGUs, and quarantine
staff in partner hotels have also been undertaken. (Cuevas, 2021)

The health promotion efforts of the DOH under the Health Promotion Bureau (HPB) is
encapsulated under Healthy Pilipinas. There has been an 80.9% increase in the budget
allocation for health promotion from P292.2 million in 2019 to P528.7 million in 2022. Between
2020 and 2021, HPB worked with the Department of Labor and Employment (DOLE) and
offered training on mental health in the workplace for employees of more than 40 companies
and organizations. HPB released eight health promotion playbooks in 2020,22 which already
have ready-to-use template ordinances, evidence briefers, plans for implementation, M&E, and

21
To include substance use disorders
22
See https://adapt.ph/doh-playbooks/. The Peer Support Group for the Youth Playbook is available at https://adapt.ph/pa-5-
peer-support-group-for-the-youth/.
 14

communication, and prototype materials. Of the eight playbooks, one is specifically dedicated
for mental health – Peer Support Group for the Youth Playbook.23 (HPB, 2022)

In 2019, the DOH also partnered with the WHO for the localization of WHO’s Quality Rights
e-learning course. The free online course, which is also available in Filipino, covers subjects
such as tackling stigma, self-care, and supporting friends and family’s mental health. It can
be accessed by registering first at the WHO website.24 The official global rollout was in April
2022. Based on a joint media release of the DOH and the WHO, a national level training of
trainers Quality Rights workshop took place in September of 2019 to enable the Philippines
to form a pool of national experts and champions that will help in the e-learning course rollout
in the country.

 Focused, non-specialized support. To be able to offer basic emotional and practical

support, primary health care/ community-based workers first need to receive the necessary
training. Towards this end, the DOH and the USAID elevated the Department’s existing
e-learning management system and in 2019 launched the DOH Academy e-learning
platform, an open-source e-learning platform for online practical and healthcare training.
Among the 105 courses offered in the web portal25, two are dedicated on mental health.
These courses are Mental and Health and Psychosocial Support, and Mental Health Gap
Action Programme (mhGAP)26, both available beginning mid-2021 and can be self-paced.

PhilHealth also pilot tested a primary care mental health package in Metro Manila, Central
Luzon and Davao regions in the last quarter of 2022. The idea is to see how the existing
benefit package of P7,800 can be expanded to P9,000 for 12 primary care consultations
and diagnostics as well as an outpatient specialist care package of up to P16,000 for
similar number of consults and diagnostics. (Panti, 2023; Tendero, 2023)

 Specialized services revolve around provision of psychotropic medications, suicide

prevention, and tele-mental consultations. The availability of psychotropics and select
antipsychotic, antidepressant, anxiolytic, mood-stabilizing, and antiepileptic medications is
made possible through the Medicine Program for the Mental Health (MAP-PH)27 . MAP-PH
has been recognized as an innovative program found effective in bringing mental health
services closer to the community and primary health care level (IMC, n.d.; WHO 2020b).

23
The others are about active transport, diet and nutrition, hand hygiene, immunization, smoking, sexual and reproductive health,
and violence and injury prevention. The Youth Playbook was designed to assist LGUs in setting up community-level social
support structures and organizing youth-led peer support groups, to serve as early interventions to mental health problems
among the youth.
24
https://humanrights-etrain-qualityrights.coorpacademy.com/signup
25
As of 03 October 2022. https://learn.doh.gov.ph/
26
The mhGAP is a WHO program designed for low and middle-income countries which supplies non-specialists like primary and
community-based healthcare workers with evidence-based tools in assessing mental, neurological, and substance use disorders
(MNS) and offers an integrated intervention guide in managing these conditions. This has been piloted in Region IV (Batangas,
Rizal, Laguna, Quezon, Cavite) and training is planned for all regions. (Cuevas, 2021) Training for mhGAP has already reached
69% of LGUs as of November of 2022. However, only 14% of LGUs have staff who were equipped with the knowledge on mental
health and psychosocial support during disasters. (Tendero, 2022)
27
The MAP-PH forms part of DOH’s Medicine Access Program, which facilitates access to essential medicines for priority
diseases like for cancer, hypertension, leprosy, diabetes, malaria, and tuberculosis through pooled procurement, price negotiation
and parallel importation. See Briefer from ebrary.net (https://ebrary.net/122524/health/medicines_access_programs).
 15

The MAP-PH was launched in 2012 to guarantee that mental health drugs are available at
the community level (DOH, 2021b). As of May 2022, there are 362 access sites nationwide28,
where select psychiatric medications (for mental, neurologic and substance use disorders)
can be secured for free, but can only so far cover 25% of the total requested needs.
Access sites include DOH hospitals, Centers for Health Development (CHDs), Treatment
and Rehabilitation Centers (TRCs), LGUs, RHUs, DSWD, BJMP, and other institutions.29

On suicide prevention, the deadline for the WHO’s call for proposals for the development of
a national surveillance system for suicide attempts and self-harm was June 12, 2022. This
is part of the National Suicide Registry System Phase II. The DOH and WHO developed the
prototype of the National Suicide Registry (Phase I) in 2021. It was piloted in three hospitals
– NCMH, Vicente Sotto Memorial Medical Center, and The Medical City. This prototype will
be further pilot-tested as part of the Phase II proposal in 16 DOH-retained hospitals (1 per
region), one LGU hospital, and one private hospital. The DOH and WHO seek to establish
whether the prototype is compatible and interoperable with the Mental Health Information
System managed by the NCMH. Updates on this initiative will be available the earliest in the
first quarter of 2023 since the implementation timeline was until December 2022.30

Related to this, Cuevas (2021) reported that crisis helplines are available in eight regions. The
NCMH 24/7 hotline (1553 toll-free landline) is the busiest and can also be reached through
mobile numbers.31 As shared in the previous section (p.3), 12% and 33.4% of the calls in
2020 and 2021 respectively were suicide-related. These hotlines complement the NCMH’s
Telemental Health Response Program, or online sessions for remote psychosocial support
(De Leon, 2020).

The telemental health services generally fall under telemedicine, defined in the DOH-NPC joint
Memorandum Circular (MC) 2020-001 as the “practice of medicine by means of electronic and
telecommunications technologies such as phone call, chat or short messaging service (SMS),
audio- and video-conferencing to delivery healthcare at a distance between a patient at an
originating site, and a physician at a distant site.” The MC is however effective only during
periods of lockdown (declared enhanced community quarantine dates).

Indeed, as the COVID-19 pandemic transformed medical practice (Philippine Medical

Association, 2020) and expanded the opportunity to undertake telemedicine, it also reflected
the absence of a national legislation on telemedicine, making the DOH-NPC 2020-001 as the

28
Access sites available here, http://www.silakbo.ph/wp-content/uploads/2022/05/DOH-MAP-MH-Access-Sites-2021.pdf
29
At present, Region VIII has the most number of access sites (84) while Region XI (2), IX (3) and CARAGA (3) have the least.
As of January 2021, 39,000 service users have benefitted from MAP-PH. To avail of medicines, patients have to be enrolled
in the access site, which means they consulted with a health professional in the facility. Stocks may not always be available.
Among the types of medicines usually procured are first-generation/typical antipsychotics (e.g. chlorpromazine, fluphenazine
decanoate), second-generation/atypical antipsychotics (e.g. clozapine, olanzapine, quetiapine, risperidone), antidepressants
(e.g. fluoxetine, escitalopram), mood stabilizers (e.g. lithium carbonate, carbamazepine, lamotrigine), anticholinergics (e.g.
biperiden, diphenhydramine) and Cholinesterase inhibitor (i.e. donepezil). Grouping based on Lally et al (2019) but most recent
available meds based from Silakbo.ph
30
www.who.int/docs/default-source/wpro---documents/countries/philippines/calls-for-proposal/development-of-national-
surveillance-system-for-suicide-attempts-and-self-harm_setting-up-of-suicide-registry-system-phase-ii.pdf?sfvrsn=a649b1ff_1/
31
Globe/TM: 0917 899 8727; Smart/SUN/TNT: 0908 639 2672
 16

main reference. Still, the DOH has so far allowed eleven third party telemedicine providers
(Annex 2).

Even in the absence of congressional fiat, telemedicine digital platforms have prospered. This
is suitable for people with mental health conditions since they are inclined to be more open to
consult specialists through these platforms (Oi, 2021). The challenge is for the government to
be able to offer the necessary guidelines to make the most of the telemedicine and eHealth
platforms and establish the interoperability requirements so that they can be subsumed as
part of the NCMH’s Mental Health Information System being developed. Likewise, concerns
on technology adoption, privacy and data security, need for highly skilled practitioners, and
support infrastructure gaps remain (Asuncion, 2022).

19Th Congress Current Policy Proposals on Mental Health

There are currently 22 House Bills and two resolutions, and 19 Senate bills and one resolution
related to mental health filed in the 19th Congress (Table 4). Two House Bills (HB 6416, HB 6574)
have been transmitted to the Senate as of December 2022 and February 2023 respectively.
Both bills which aimed to strengthen mental health services in tertiary and in basic education
have counterpart Senate proposals. These proposals as well as those on the creation of
centers (HBs 3424, 3582, 4377), Magna Carta for public MH professionals (HB 296), and the
community-based MH service (SBN 1637) draw attention to the lack of psychologists and
psychiatrists, echoing the low psychiatrists/psychologists to population ratios in Table 2.

Legislators are likewise exploring institutionalization options through the creation of mental
health centers. However, this would be best discussed once the findings of the DOH pilot-
testing of its community-based mental health system efforts are out. This should also take
into consideration the current prioritization of Super Health Centers (SHC)32, which received a
total of P3.59 billion in the 2023 HFEP. The question is whether mental health consultations,
referrals or even tele-mental health consultations will be among the next set of priorities of the
SHC.

VAT exemptions on select drugs and medicines were also proposed. Congress will have to
weigh the forgone income versus the impact on mental health medicine coverage, which is
at present 25% of total MAP-PH requested needs. Other proposals are on compensation
benefits and/or financial assistance, wellness leave, Magna Carta for MH professionals in
the government, celebration of the national youth mental health week, and enactment of a
telemedicine service guidelines or system

32
SHC are facilities described as bigger than a rural health center but smaller than a hospital (Casayuran, 2022).
 17

Table 4
Bills and Resolutions on Mental Health Filed in the 19th Congress
Focus Bill/ Resolution Title House Senate
Mental health services Accessible and Age-appropriate mental health services for 1: HB 429 1: SBN 220
for children children and adolescent population / Accessible &
and adolescents affordable early detection and intervention for children
with special needs
Mental health services Mandating the institutionalization of Mental Health 1: HB 7166
in educational Services in education institutions / Mental Health support
institutions package for public school teachers and educators 1: HB 7640
including mental health allowance
Strengthening the promotion and delivery of Mental 1: HB 6574 2: SBN
in basic education Health Services in Basic Education through the Hiring and substituted HBs 1795, 379
deployment of MH Professionals, and appropriating funds 929, 4162, 4194,
therefor 3691
1: HB 7405
in tertiary schools Strengthening the Mental Health Services of SUCs / 1: HB 6416 4: SBN
Higher Education and appropriating funds therefor substituted HBs 1796, 1630,
299, 1952 1786, 1508
3: HBs 4178,
4355, 5925
Creation of mental Creation of mental health centers in every Province 1: HB 3424
health centers Creation of mental health centers in every Region 1: HB 3582
Creation of MH Consultation desks and government-run 1: HB 4377
mental health hotline
Tax exemption on Exempting drugs and medicines prescribed for mental 1: HB 1483
medications health from VAT
Compensation Granting immediate compensation benefits for mental 1: HB 2789
benefits &/or financial health service users
assistance
Granting of wellness / Granting mental health wellness leave to all employees in 1: HB 1926 1: SBN 1817
mental health leave the private sector
Granting mental health wellness leave to all employees in 2: HB 4850, 6101
public and private sector
Magna Carta for Magna Carta for Public Mental Health Professionals 1: HB 296
Public Mental Health
Professionals
National youth mental Declaring last week of August as national youth mental 1: HB 1497
health week health week
Telemedicine service Expanding the scope of medical practice through 2: HB 1591
& EHealth system providing guidelines for telemedicine services
8: SBN 91,
Institutionalizing a national telemedicine system / eHealth 1: HB 5485 397, 1989,
system in the Philippines 1883, 1728,
1787, 400,
1569
Assessment of LGU Resolution urging DOH and PMHC to conduct an 1: HR 00098
compliance assessment on the compliance of LGUs to RA 11036
requiring the establishment of mental health care
facilities
Mental health crisis Resolution to conduct an inquiry on the seeming mental 1: HR 900
health crisis affecting the education sector
Disability Statistics Resolution urging DepEd, DOH, DSWD, DILG, and PSA to 1: SRN 335
collect, analyze, publish and update disability statistics
Community-based Hiring of at least one psychologist per city or municipality 1: 1: SBN 1637
mental health service
RA 11036 Amending RA 11036, the Mental Health Act 2: SBN
amendments 1717, 920
Source: www.congress.gov.ph/legisdocs/?v=bills, and http://legacy.senate.gov.ph/lis/leg_sys.aspx, as of 25 April 2023

1
 18

III. Conclusion and Policy Recommendations

Mental health has been recognized as a priority, albeit a relegated one. The COVID-19 has
worsened the mental health situation and laid bare the weaknesses in the current system of
providing mental health services. Ironically, the pandemic is both a cause and an opportunity
for improved mental health service provision.

RA 11036, enacted two years prior to the pandemic, has yet to fully address the gaps in
mental health interventions. Nevertheless, initial steps have already been undertaken under
the leadership of the PMHC. Funding allocated for mental health services is inadequate. It
also needs to be more prominently represented in the appropriations documents. There are no
specific mental health items in the NEP or GAA. Despite this, there are ongoing appropriations
being made, with additional provisions for select mental health facilities under the HFEP. An
update on the Mental Health Strategic Plan is due. If the government sticks with the pace of its
initially planned mental health spending targets, then RA 11036 would be a funded mandate.

The initiatives of the government to address the rising cases of mental health conditions
particularly during the pandemic are well recognized. Nonetheless, the following are being
proposed for consideration to underscore the mental health agenda.

 Integration of mental health care. Most organizations tend to work in silos and organize
interventions by clusters. But as the WHO 2022 report states, “When people with comorbid
conditions arrive in health care, they are usually treated for one or the other of their
conditions but not both. As a result, many conditions go unrecognized and untreated in
their early stages, increasing the risk of disability and premature death.”

Both policymakers and implementers must share a common vision of integrated mental
health care. This includes an understanding of how community-based mental health care
fits into the current structure and referral system of barangay health stations, rural health
units, super health centers, polyclinics, district/general hospitals, and specialized hospitals.
Most valuably, it also necessitates interoperability and institutional data-sharing of mental
health information systems.

 Deinstitutionalization and local policy integration are key components of RA

11036, which aims to shift the current mental health care delivery paradigm from being
predominantly hospital-based to a decentralized and community-based integrated system.
Recent efforts have been focused on piloting tools in select local governments to support
the implementation of community-based mental health programs. In finalizing the CBMH
framework for mainstreaming, operational translation of deinstitutionalization, especially
on financing and organizational commitments, is essential.

Local governments are expected to play a significant role in the implementation of CBMH
programs, and this should be reflected in their respective local mental health ordinances.
The DOH/Philippine Mental Health Council can seek feedback from the DILG to identify
social protection indicators in the Seal of Good Local Governance (SGLG) that can be
retired or replaced with mental health policy integration indicators. The idea of tapping the
 19

SGLG as mechanism to mainstream efforts in the sector has already been reflected in
the existing Mental Health Strategic Plan. The approach will facilitate faster and smoother
policy enactment. The recommended ordinance template must clearly outline the local
organizational structure, decision-making processes and functions, capacity building
requirements, available levels of services, access to information, appropriations, as well
as privacy and confidentiality provisions.

 Centralized inventory and referral system for medicines. Funding for medicines for
mental, neurological, and substance use (MNS) disorder is still lodged at the DOH through
the Medicine Program for Mental Health. Improving supply coverage above current 25%
performance is challenging but ideal. The establishment of a centralized inventory system
will facilitate faster referral and securing of stocks from access sites through a daily stock
reporting requirement.

 Democratizing mental health service access through PhilHealth. PhilHealth will be

releasing the guidelines of their primary care mental health package. This package has
the potential to make mental health services more accessible and affordable to a wider
population, depending on the outpatient benefit coverage and the availability of accredited
clinics, specialists, and telemedicine providers.

However, the implementation of the new package may pose financial challenges to
PhilHealth, as the scheduled additional 0.5% increase in premium contributions for 2023
has been suspended. To address this, PhilHealth can leverage the benefits of the mental
health package by advocating for the imposition of the additional premium increase
through aggressive information-sharing activities. Communicating to the public that the
additional health contribution is a small investment in maintaining a healthy mental state
can help garner support for the increase, leading to improved engagement of asymptomatic
individuals in consulting and assessing their mental health. This approach can ultimately
benefit both the public and the financial situation of PhilHealth, resulting in a win-win
outcome.

 Prioritize Telemedicine legislation. Telemedicine offers a two-fold advantage of

addressing both confidentiality concerns among individuals who fear social stigmatization
and facilitating easy and efficient access to necessary medical services. There are five
proposed bills (two in the HREP; three in the Senate) related to telemedicine which
have not gone past Committee level. Congressional imprimatur on telemedicine must be
enacted to provide the necessary requirements, incentives, regulation, and support for
eHealth platforms to flourish and be patronized by both the sick and asymptomatic, not
only for mental health but for all health concerns.

 Empowering primary healthcare workers. The backbone of focused, non-specialized

mental health support services as well as community and family support interventions are
the frontline primary health care workers. Being the first line of contact, they have the most
impact in fighting the stigma of seeking consultations and in raising awareness on the
symptoms and conditions.

But first, the frontline public healthcare workers need to be empowered since they will carry
the additional weight as mental health focal persons in their villages and communities. The
 20

DOH and LGUs must ensure that the full benefits of the Magna Carta for Public Health
Workers are implemented. Empowerment may additionally come in the form of remote
consultation options through open-sourced or government-developed teleconsultation
platforms.

 Revisit the integration of mental health into the educational system and the increase
in the number of specialist-practitioners. RA 11036 outlines the role of educational
institutions in delivering age-appropriate mental health discussions to be integrated in the
curriculum. The DepEd and Commission on Higher Education (CHED) can look at the
experiences in curriculum integration and share plausible or effective early intervention
school-based initiatives which may be tried elsewhere. For example, it may be helpful to
determine in which subjects are best to discuss stigma, bullying, discrimination and mental
health-seeking behavior.

In the February 2023 briefing for the HREP Committee on the Welfare of Children, DepEd
shared that it is urging DBM to increase the salary grades of guidance counselors as well as
create new positions for learner support services. CHED reported about its engagements
to build the much-needed human resource capacity for mental health. These are key
initiatives given that the country only has 0.1 psychologists per 100,000 population and
0.5 psychiatrists per 100,000 population. Beefing up the country’s human resources for
mental health should form part of the succeeding Mental Health Strategic Plan that will be
drafted.

 PMHC’s organizational visibility. Being a relatively a new council, the PMHC can
enhance its visibility through increased media exposure and broader networking efforts.
It can proactively engage with the HREP committees responsible for the mental health
bills being advocated in the current Congress. This can involve providing expert inputs,
participating in hearings, and advocating for the council priorities. In addition, the PMHC
should disseminate information on the activities and initiatives of its member agencies
in mainstreaming mental health services and in promoting CBMH. This can be achieved
through regular press releases and targeted communication strategies to raise awareness
about the council’s efforts. Furthermore, the PMHC should be prompt in releasing
statements and responses to news and events related to mental health. This can establish
the Council as a reliable and authoritative source of information for journalists and writers,
positioning it as the go-to organization for expert insights and perspectives on mental
health issues in the media.
 21

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24

Annex 1
Mental Health and Psychosocial Support Intervention Pyramid versus
Current Philippine Situation on Mental Health Services

Specialized
Services

Focused, Non- Specialized

Supports

Community and family supports

Basic services and security

BASIC SERVICES AND SECURITY
may include advocating for basic
services (food, health, shelter);
documenting their impact on
mental health/ well-being; and
influencing that delivery promote
MHP well-being. These basic
services should be established in
participatory, safe and socially
appropriate ways that protect
people’s dignity, strengthen local
supports and mobilize community
networks.
COMMUNITY AND FAMILY SUPPORTS
emergency response for people who are
able to maintain their MHP well-being if
they receive help in accessing key
community and family supports. Responses
include family tracing & reunification,
assisted mourning & communal healing
ceremonies, mass communication on
constructive coping methods, supportive
parenting programs, formal & non-formal
educational activities, livelihood activities
& the activation of social networks, such as
through women’s groups and youth clubs.
FOCUSED, NON-SPECIALIZED SUPPORTS SPECIALIZED SERVICES
supports necessary for people who
require more focused individual, family
or group interventions by trained and
supervised workers (but who may not
have had years of training in specialised
care). For example, survivors of gender-
based violence might need a mixture of
emotional and livelihood support from
community workers. This layer also
includes psychological first aid and basic
mental health care by primary health
care workers.
support required for the small
percentage of the population whose
suffering, despite the previous
supports, is intolerable and who may
have significant difficulties in basic
daily functioning. Assistance should
include psychological or psychiatric
supports, which include either (a)
referral to specialised services if they
exist, or (b) initiation of longer-term
training and supervision of primary/
general health care providers.

Source: Pyramid and description of each layer from IASC, 2007 (pp12-13); (edited) current MHS situation from
(Cuevas, 2021)
 25

Annex 2
Quick Review of Websites/FB Pages of DOH-vetted 3rd Party Telemedicine Service
Providers, 2022 - Part 1 of 2
Telemedicine service Information on mental Health Information on Other Remarks
providers Specialists in website/FB Fees/ Consultation
Rates
1. TelAventusMD No psychologists / psychiatrists in Not available. Can book appointment, chat,
website roster. Instead, mental Services offered: through website;
www.aventusmedical.com/ health specialists are from counseling, coaching,
www.facebook.com/TelAventusMD/
mindwell.ph or psychotherapy On-site consult also offered.
www.facebook.com/MindWellPH/, sessions, neurology,
their partner. psychiatry
consultations
2. MedCheck Wide range of specialization and Not available. Website allows online booking
options from among affiliated for specialists with enabled
www.medcheck.com.ph/ doctors. For example, they have online booking option
www.facebook.com/medcheckph
addiction psychiatrists, child and
adolescent psychiatrists, general For on-site, clinic-based
adult psychiatrists. specialists, location and clinic
hours shown, but no contact
numbers
3. SeeYouDoc Fully app-based. Must create Not available. App-based transactions for
account, book appointment, select appointments, consultation
www.seeyoudoc.com facility and doctor through app. queueing, etc.
www.facebook.com/seeyoudocph/
Website showed 2 psychiatrists
and 5 neurologists affiliated with
company
4. Mwell / Metro Pacific Health Fully app-based. Not available. App-based transactions for
Tech Corporation appointments, consultation
Per website, only 1 affiliated queueing, etc.
www.mwell.com.ph/ clinical psychologist
www.facebook.com/102333284961907/
posts/metro-pacific-health-tech- Offers emergency care and
corporation-mphtc-a-wholly-owned- hospital products, including
subsidiary-of-metro- insurance
p/326895995838967
5. KonsultaMD Fully app-based. Subscription-based, App-based transactions.
Can’t choose specialist, since e.g. P499/annual for 1 No appointments, queuing
https://konsulta.md/ queue-dependent. person, P799 annual system. Offers Fast Pass
www.facebook.com/konsultamd/
for 2 persons, P999 option, where maximum
annual for 5, but only waiting time is 5 minutes (with
for consults with moneyback guarantee)
general physicians
Can pay through gcash, credit
Mental Health support card. Can avail of per consult
24/7 is P600 per video session through online
consult and P399 for shopping platforms like
chat consult shopee, Lazada, etc.
6. HealthNow Fully app-based. Per FB page, P1,601 App-based transactions for
Allows client to select specialist psychiatry rate per appointments, consultation
www.healthnow.ph/ and book and appointment consult queueing, etc.
www.facebook.com/HealthNowPH/
On-demand video consults
similar to KonsultaMD’s
FB August 18, 2022 post queueing system with 20 mins
about partnership with max consult time
KonsultaMD and another
entity (AIDE). Can book appointments for
clinic visit, lab tests.

Offers medicine shopping and

door-to-door delivery

1
 26

Annex 2
Quick Review of Websites/FB Pages of DOH-vetted 3rd Party Telemedicine Service
Providers, 2022 - Part 2 of 2

7. TsekApp Fully app-based. Not available. App-based transactions.

No time limit on consults.
www.tsekapp.com/ May rate doctor after consult.
www.facebook.com/tsekapp
CloudPx Fully app-based. Not available. Fully app-based.
Website and FB accommodates P50 on top of doctor’s
https://econsult.cloudmd.com.ph/ chats and queries. billing Integrated payment in app,
www.facebook.com/cloudpx Paymaya platform.
8. TeliMed and MedGate Fully app-based. Offers subscriptions Fully app-based.
such as P999 per year
https://medgate.ph/ for unli-consult with Offers medicine delivery as
Telimed sites no longer functional.
gen physician for 1 well
person
9. CareSpan Not applicable. Not applicable. App-based. Organization-
focused.
www.carespan.ph Target client not the general
www.facebook.com/profile.php?
id=100064046799666
public but organizations, esp. Website and FB sites reflect
LGUs. org-partnership focus.
Rundown of LGU partners
reflected.
10. BizBox Not applicable. Not applicable. App-based. Organization-
focused.
www.bizbox.ph/ Target client not the general
public but organizations / Offers solutions such as on
companies hospital info systems,
electronic health records,
cloud telemedicine, online
appointment set-up/ queue
management system,
PhilHealth e-claims portal, etc.
Source: Reference list based on DOH list of vetted 3rd party providers (https://doh.gov.ph/list-of-doh-vetted-3rd-party-telemedicine-
service-providers). Details processed from individual websites and pages of the service providers.
 27

Congressional Policy and Budget Research Department

3/F Main Building, House of Representatives
Batasan Hills, Quezon City, Metro Manila, Philippines
Tel. No. (DL) 8-931-60-32 (Fax) 8-931-65-19