Guidelines for contributions:
What laws have been approved and enacted in the past concerning the issue of mental health in the country?
What were the strong features and shortcomings of each law?
What good and bad effects did each law contribute to the state of mental health in the nation?

Mindset:
The research here should help us review the laws in the past so we can judge whether this new Bill is an improvement or not. It will also answer whether the lawmakers were right in formulating the provisions of the Bill.



By Adrian Jeric Pena
The National Center for Mental Health was established through the Public Works Act 3258, which "aims at integrating mental health within the total health system, initially within the DOH system, and the local health system." Moreover, Republic Act 9165 or the "Comprehensive Dangerous Drug Act" was passed to control the number of cases of mental illness in the Philippines since substance abuse is regarded as the leading cause of mental illness in the country. Incidentally, in 2001, the Department of Health have issued the "National Mental Health Policy," which states the basic framework for the achievement of optimum mental health for all Filipinos. The said policy also aims to raise awareness of the general public on the importance of mental health as an integral part of "total health care".


By Janice Cabusas
The evident neglect of mental health awareness resulted in a rise in cases of psychiatric syndromes in countries of low or middle-incomes as noted by the World Health Organization. The onset of economic depression forced thousands of Filipinos to work abroad resulting to family disintegration that yielded prevalent psychoactive drug abuse among the youth as one of the unpleasant effects . In 2005, the University of the Philippines conducted a survey and found 45 percent of Filipino adolescents are struck with depression. Despite the compelling figures, the advocates of mental health management pioneered by NGOs such as the Philippine Mental Health Association have had to take the backseat for almost two decades to give way to government priorities that take in hand economic issues. Apparently, the government had not been keen with psychology for lack of funding and instead dismissed mentally-ill individuals such as psychotic vagrants (taong grasa) as social work cases, thus, leaving them in the hands of medically ill-equipped social workers.

Although there are existing laws against psychoactive drugs, particularly R.A. 9165, otherwise known as the Comprehensive Dangerous Drugs Act of 2002, which deals mainly on the prevention of the unlawful propagation of these prohibited drugs in the mainstream, criminal procedures, court proceedings and penalty on violations as well as rehabilitation of known confirmed users more particularly among the youth, the government failed to oversee the preceding scenario prior to drug abuse which should be considered a more important aspect in the promotion of mental health (i.e., prevention of mental disorders resulting from family disintegration and economic depression).


Research by Frank Trazo (http://www.doh.gov.ph/programs/mental_health)
National Mental Health Program
Program/Project
The National Mental Health Program (NMHP) now, under the Degenerative Disease Office of the National Center for Disease Prevention and Control (NCDPC), Department of Health. It aims at integrating mental health within the total health system, initially within the DOH system, and the local health system. Within the DOH, it has initiated and sustained the integration process within the hospital and public health systems, both at the central and regional level. Furthermore, it aims at ensuring equity in the availability, accessibility, appropriateness and affordability of mental health and psychiatric services in the country.
Brief Situationer
Mental health is an integral component of total health. Issues on mental health includes not only the traditional mental disorders but as important are the concerns of target populations vulnerable to psychosocial risks brought about by extreme life experiences (e.g. disasters, near death experiences, heinous and violent crimes, internal displacement brought about by religious and civil unrest) as well as the psychosocial concerns of daily living (e.g. maintaining a sense of well being in these difficult times).
Services for mental health must be available within the public health as well as the hospital system of the country. Such services must have promotive, preventive, curative and rehabilitative component.
Vision
Full integration of Mental Health in the national system
Mission
To make available, accessible, affordable and equitable quality mental health care/services to the Filipinos especially the poor, the underserved and high risk populations.
Mandate
To provide the Department of Health with necessary services related to planning, programmming and project development in mental health.
Functions
  1. Advisory body to the Secretary of Health regarding mental health concerns.
  2. Acts as a policy making body regarding mental health concerns
  3. Involves itself in training, research, supervision and, monitoring of mental health resources/programs services.
  4. Mobilizes mental health resources for advocacy, planning, implementation and service delivery.
Guiding Principles
  • Mental health is not only limited to traditional mental illnesses but also includes the psychosocial concomitants of daily living.
  • Mental health programs must recognize the importance of community efforts with multisectoral and multidisciplinary involvement.
  • Mental health programs must address the promotive,preventive, curative and rehabilitative aspects of care.
  • Psychiatric patient care extends beyond the mental hospitals, and must be made available in general hospitals, health centers and homes.
  • Mental health activities and interventions must be done closest to where the need or the patient is.
Strategies
  • National diffusion and democratization of capabilities of mental health facilities.
  • Intensification and strengthening the training in psychiatry and mental health.
  • Peripheral development
  • Development of clinical policies
  • Institution building
  • Focus on research
  • Advocacy
  • Networking
Priority Areas of Concern
  • Substance abuse
  • Disaster and crisis management
  • Women and children and other vulnerable groups
  • Traditional mental illnesses (schizophrenia, depression and anxiety)
  • Epilepsy and other neurological disorders
  • Overseas Filipino workers


Liezl

Current Mental Health Program



By Kathleen Toribio
For almost 5 decades, the mental health origram has largely been centeres in the treatment of those afflicted with mental disorders in amental hospital. The first real effort to comprehensively adrrerss the growing mental health problem including the need to reform the mental health delivery system happened in 1986, foloowing the change of government from the Marcoses.

In 1988-1990, a multi-sectoral consultation led to the organization of the National Program for Mental Health (NPMH) at the department of Health. The NPMH identified 5 areas of concerns: patients with mental disorders, victims of disasters and violence, street children and victims of child abuse, substance abusers and overseas workers. The NPMH though has not been provided with a specific budget from the Department of health and initially depended don the favor who the Health secretary is at the moment. In 2000, changes it the Department of Health caused the dissolution of the NPMH and have been replaced in 2002 by the National Mental Health Program (NMPH).
The NMPH has identified 6 areas of concern which needs top priority: mental disorders; substance abuse; disaster and crisis management; women, children, and other vulnerable groups; epilepsy; and overseas Filipino workers.
There is no mental health law in the Philippines. The laws that govern the provision of mental health services are contained in various parts of the Administrative and Penal Code promulgated in 1917. Executive order no. 470 (1998) mandated the creation of the Philippine Council of Mental Health that never really convened.
The prevention, treatment and rehabilitation from substance abuse are covered in the Dangerous Drugs Act (revised in 2001). A Dangerous Drugs Board is responsible for the policy. A presidential Drug Enforcement Agency implements the policy and the Department of Health supervises and monitors the laboratories where drug-testing, treatment and rehabilitation takes place.
Administrative Order No. 5, Series 2001, also known as the National Mental Heath Policy, signed in April 2001, contains generic goals and strategies for the Mental Health Program. The said policy has yet to presented and implemented by the various stakeholders in mental health.
According to the National Mental health Program, 73 Republic Acts and executive orders have been reviewed to have touched mental health concerns b ut nos ingle legislation addresses mental health as a primary topic. Of theses 73 documents, 63 cover children either as a specific population of concern or together with other populations like women; 54 have implications on mental health (following the sub-programs on the NMHP: wellness of daily living, extreme life experiences, substance abuse and mental disorders); 20 of 73 documents directly mention mental health concerns, mostly on the provision of “counseling’. “Psychosocial” and Psychological services; 13 of the 20 documents are on children; the rest on women, solo parents, adoptive parents, the disables, victims of sexual abuse and trafficking and drug dependents. The Department of Social Welfare and Development is the lead implementing agency in half of the 20 documents that directly mention mental health concerns.

Some Programs enacted by the NMPH are as follow: (1) the demonstration project which involves the development of a ‘collaborating center for mental health’. The aim of which is to shift mental health care out of the hospitals to a variety of community-based services ranging in primary health care. (2) they have also sustained the Lusug Isip program and considers this its flagship program because the Department of Health has integrated it into some of its programs. The program is an annual advocacy and mental health promotion program directed at mental health concerns. It uses a ‘life course approach.


Junalyn Camacho
A review of the laws of the Philippines would show that issues related to mental health are touched upon by several codes, rules, and procedures. However, there is no single legislation which addresses mental health as a primary topic.

So far 73 EOs and RAs have been reviewed. 63 of the 73 documents reviewed cover children either as a specific population of concern or together with other populations(i.e., women, PWD). 54 of these have implications on mental health (following the sub-programs of the NMHP: wellness of daily living, extreme life experiences, substance abuse, and mental disorders).


20 of the 73 documents reviewed directly mention mental health concerns, mostly on the provision of “counseling”, “psychosocial”, and “psychological” services. 13 of these 20 documents are on children; the rest are on women, solo parents, adoptive parents, persons with disability, victims of sexual abuse and trafficking, and drug dependents. The DSWD is the lead implementing agency in half of the 20 documents that directly mention mental health concerns.


Earliest Mental Health Legislation

  1. Royal Decree of 1808 (Spain) – it established a hospital for the insane at Hospicio de San Jose, a charitable religious institution, to care for its first patient a sailor of the Spanish Royal Navy.
  2. Public Laws and Resolution no. 2122 of 1912 – The first government mental health facility was created at the Insane Department of the San Lazaro Hospital.
  3. THE 1987 CONSTITUTION, ARTICLE XIII HEALTH, Section 13 - The State shall establish a special agency for disabled person for their rehabilitation, self-development, and selfreliance, and their integration into the mainstream of society.
  4. Republic Act No. 8172 (1995). An act promoting salt iodization nationwide and for related purposes. (ASIN) Section 4. Defined iodine deficiency disorder's as a broad spectrum of deficiencies resulting from lack of iodine in the diet which leads to the reduction of intellectual and physical capacity affecting everyone who is iodine-deficiency and may manifest as goiter, mental retardation, physical and mental defects, and cretinism.
  5. Executive Order No. 470 (1998). Creating the Philippine Council for Mental Health. *The council was never convened.

Different Ways of Approaching Mental Health Legislation
  1. No separate mental health legislation – provisions related to mental health are inserted into other relevant legislation
  2. Consolidated mental health legislation
  3. Combined approaches – have integrated components as well as a specific mental health law

Advantages and Disadvantages of these Approaches
No separate mental health legislation
· It reduces stigma and emphasizes community integration of those with mental disorders
· Benefits a much wider constituency
· Difficulty in ensuring coverage of all legislative aspects relevant to persons with mental disorders
· Procedural processes aimed at protecting the human rights of people with mental disorders can be quite detailed and complex and may be inappropriate in legislation other than a specific mental health law. It requires more legislative time because of the need for multiple amendments to existing legislation.

Consolidated legislation
· Has the ease of enactment and adoption, without the need for multiple amendments to existing laws.
· The process of drafting, adopting and implementing consolidated legislation also provides a good opportunity to raise public awareness about mental

· However, consolidated legislation emphasizes segregation of mental health and persons with mental disorders; hence, it can potentially reinforce stigma and prejudice against persons with mental disorders.

There is little evidence to show that one approach is better than the other. A combined approach, involving the incorporation of mental health issues into other legislation as well as having a specific mental health law, is most likely to address the complexity of mental health, particularly the needs of persons with mental disorders.

Reference: WILFREDO R. REYES, MPH, Program Manager, National Mental Health Program, Department Of Health (WHO RESOURCE BOOK ON MENTAL HEALTH, HUMAN RIGHTS AND LEGISLATION).

JANICE M. CABUSAS (excerpt from B. Conde's Philippines Mental Health Country Profile)
There is no mental health law in the Philippines. The laws that govern the provision of mental health services are contained in various parts of the Administrative and Penal Code promulgated in 1917 (Conde, 2004).
In the advent of a new government in 1986, the Secretary of Health made an attempt to address the mental health delivery in the country in a holistic approach by creating a team composed of faculty members from university psychiatric departments who worked with the staff of the National Mental Hospital.
The National Program for Mental Health was organized by the Department of Health in 1990 in order to oversee the prevailing socio-economic conditions that affect the mental health. As such, the NPMH identified the five most important areas of concern, to wit: patients with mental disorders, victims of disasters and violence, street children and victims of child abuse, substance abusers and overseas workers.
Task Force on Mental Health was organized to collaborate with government agencies concerned with mental health care in the regional and provincial areas.
Among these government and non-government sectors are:
The Department of Labor and Employment ( for overseas workers), the Department of Social Welfare and Development (for family, women and child’s welfare), the National Defense Department, through the National Disaster Coordinating Council (for disaster management). The Philippine Drug Enforcement Agency (concerning substance abuse programs. NPMH oversees rehabilitation, drug treatment, and drug test laboratories.)
However, the exerted efforts of the National Program for Mental Health have not been given substantial monetary support in order to realize its goals due to the change of government. In the Year 2000, a re-engineering of DOH rendered NPMH to a point of dissolution but was revived I 2002 and renamed as the National Mental Health Program . Despite the major setbacks at the National level, non-governmental organizations and university groups engaged in mental health programs have continued their work in line with the government programs.
In April 2001, the Secretary of Health signed the National Mental Health Policy, which is now known as Administrative Order No.5, Series 2001. Although signed in April 2001, the policy has still to be presented and implemented by the various stakeholders in mental health. Nevertheless, Relevant mental health programs that address the special concerns of other government agencies have been sustained and budgetary support has been forthcoming.
The Department of Labor and Employment (DOLE)
The department, through its Overseas Workers Welfare Assistance (OWWA) has recognized the importance of a mental health component in its policies.
Pre-departure policy.
Prior to departure, overseas workers must undergo neuropsychiatric screening and those found with symptoms of mental distress and symptoms are not certified to leave for overseas employment. Any reapplication must be accompanied by psychiatric clearance. A pre-departure seminar is compulsory. This prepares the overseas candidates for life abroad. Lectures on the culture of the country of employment, their expected stresses, including coping strategies are discussed.
These coping strategies are given high priority since the mental and emotional distress inherent with overseas working has transpired to be a major cause for concern. This policy addresses the need to minimize, if not totally prevent mental distress and possible disorders among overseas workers.
Provision of mental health services.
A memorandum of agreement has been signed between the Department of Health (DOH), the DOLE and the Department of Social Welfare and Development to appoint social welfare officers in Philippine Consulates who can provide counseling and social welfare assistance. Physicians in several consulates have been trained by the NMHP (DOH) to identify and manage disorders among the overseas workers.
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Conde, B (2004) Philippine mental health country profile, International Review of Psychiatry (February/May 2004)
16(1–2), 159–166,
From http://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Country_Profile.pdf