Editorial: Filling psychiatric gaps

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Sunday, August 17, 2014


A CONSTRUCTION worker who suffered from a nervous breakdown for the past two years killed his son and was about to harm his daughter when his partner intervened.

According to an Aug. 15 report by Sun.Star Cebu’s Jill Tatoy-Rabor, Roberto Umpad, 29, felt he was too ill to work but his partner quarreled with him and urged him to work.

It was while she had gone to buy food that Umpad attacked their children last Aug. 14.

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His relatives said that Umpad was suffering from schizophrenia but had not been taking his medicine lately. He was brought to the Vicente Sotto Memorial Medical Center Psychiatric Ward for evaluation. His partner and daughter were taken to the Cebu Metropolitan Cathedral for counseling with a priest.

Last Aug. 13, a train of the Metro Rail Transit (MRT 3) train derailed near Taft station during the afternoon rush hour. Scores of commuters, including children, were hurt in the ensuing stampede. While the victims were immediately taken to hospitals for treatment of their physical injuries, many complained about their inability to receive counseling to deal with trauma.

Crisis

The Aug. 11 suicide of actor Robin Williams focused on a US crisis on mental health, especially on institutional inadequacies to give access to those placed at risk of depression and suicide.

However, as shown by the incidents in Cebu and Manila occurring during the same week as Williams’s death, the stigma and burden also affect Filipinos.

On July 26, 2007, GMA News reported that one in five adult Filipinos or between 17 to 20 percent of the country’s adult population suffers psychiatric disorders due to “extreme life experiences”.

Dr. Lourdes Ladrido-Ignacio, a former president of the Philippine Psychiatric Association, said that in barrios where there are no doctors, as many as 50 percent of adults were evaluated by rural health workers as having some form of psychological illness.

The same report cited Ignacio’s assessment that about 10 to 15 percent of children aged five to 15 have mental problems.

The situation has worsened. In 2000, the National Statistics Office ranked mental illness as the third most common form of morbidity (type of disease) affecting Filipinos, after visual and hearing impairments.

The same GMA News report cited a Department of Health (DOH)-commissioned Social Weather Stations Survey in 2004, which found 0.7 percent of Filipino families have at least a member suffering from depression, schizophrenia, epilepsy and substance abuse.

Filipinos are increasingly vulnerable to psychiatric problems due to their exposure to “extreme life experiences”. The National Center for Disease Control and Prevention was quoted by GMA News as saying that disasters, armed conflict, and separation of families brought about by overseas work affect the state of mind.

Reforms

During the 2007 convention of the Philippine Psychiatric Association Inc., doctors urged for reforms to address the mental health crisis. To fill the vacuum left by only 400 licensed psychiatrists practicing in the country then, there is a need to “decentralize” and train the frontline providers of primary care, such as general practitioners and other healthcare providers.

Based on a March 19 GMA News report on mental health reform written by Lila Ramos Shahani, head of communications of the Human Development and Poverty Reduction Cabinet Cluster, Filipino families and the state continue to be challenged in terms of personal, legal and financial resources for helping over 200,000 people with mental disability, representing 14 percent of the 1.4 million Filipinos with disabilities identified in the 2010 National Census.

High demand and lack of funding hound two of the country’s largest mental health facilities, the Sanctuary Center for psychotic female vagrants and the National Center for Mental Health (NCMH) in Mandaluyong City. These institutions treat and rehabilitate in- and outpatients with various mental disorders, including schizophrenia or psychosis, which makes them a potential threat to themselves and others.

The March 19 GMA News report revealed that despite the “ballooning number of patients” and “rising costs of operation,” the DOH only allots P150 per bed to the NCMH: P78 for utilities, P60 for food, and P12 for medication.

The lack of a comprehensive mental health law and the decentralization of health care services worsen the situation in other parts of the country, where local government officials and health care professionals at the grassroots lack awareness of and training in mental health, observed Shahani.

According to the NCMH, some rural health doctors still don’t refer a person to see a psychiatrist even after the persona has made a third attempt at suicide. Capacitating grassroots health workers can immediately address the mental health needs in communities and decongest centralized facilities, which can address the advanced cases.

But to address disasters, nongovernment organizations, such as the Citizens’ Network for Psychosocial Response to Disasters and the Philippine Mental Health Association, are crucial for augmenting the government’s resources to come to the aid of traumatized survivors and families.

Published in the Sun.Star Cebu newspaper on August 18, 2014.

Opinion

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