CEBU

Lahug Wellness Center a one-stop shop, multi-service facility

Lahug Wellness Center will be a ‘one-stop shop’, multi-service facility housing the country’s first ever established BBHU pursuant to the ordinance sponsored by Deputy Mayor for Health Mary Ann De Los Santos. She said it is a dream come true for their team to finally have a BBHU, as they have been advocating for comprehensive health services that includes mental health for years. With a BBHU, they would be able to address the very roots of problems in society like drugs, depression, domestic violence, juvenile delinquency, family and relational conflicts and the like.

Barangay Behavioral Health Unit

Rationale

The first thing that comes to mind about mental health is the “taong grasa” wandering in our streets. Unfortunately, this has become the basis of our understanding of mental health – “buang”. In the countryside, what comes to mind is possession by evil spirit – a myth that explains why a mentally disturbed person is tied to a “doldol” tree. These distortions do not come close to what mental health is. We miss the mark when we view mental health through its illness.

Mental health in the Philippines is defined as “crazy”. Pathetic, but how can health be defined by its illness? This misnomer reflects the condition of “health” in our country, a lopsided view of health that focuses only on the medical side, neglecting the mental side. A better view of health should be an integrated concept, that considers a healthy body and a sound mind. Mental health therefore refers to a sound mind which means a mind that is free of injury or disease and is capable of showing good judgment or sense. It also brings us to the fact that mental health is equally important as medical health and must be given our full attention.

The rising number of murders, rape, rage, addiction, incest, suicides, child pornography, domestic violence, and many more plague us with desperation and makes us wonder what in the world is happening today. Never did it occur to us that these are all mental health concerns and issues. We do not know that our behavior is a result of what is in our minds (thinking) and how we feel (emotions), our everyday life. This is mental health – living life. But where are we in all this? How many people are aware? How can we help ourselves achieve a state of well-being when we don’t know what we are up against?

It is evident that we need to educate the people so that they can be empowered to help themselves. It is evident that we need to support them so that they can be guided in the process of facing their problems. It is also evident that we need to provide treatment services so that they can be confident in their recovery. With only one hospital and a handful of psychiatrists in cebu city, it is herculean to accept the challenge of redefining mental health. For this reason, the barangay behavioral health unit (bbhu) can help bring mental health into the picture for people to grasp the meaning of mental health and lessen their stigma. With the barangay behavioral health unit, mental health is brought down to the barangay level, a better way of reaching out and delivering the basic primary care of mental health.

Barangay Behavioral Health Unit (BBHU)

BBHU is designed to reach out to the people in the barangay level. With the stigma, where people are reluctant to address mental problems, the BBHU will be a good way to make them feel safe and confident since their problems are common knowledge in their barangay or Sitio. It is also in the barangay level that the psychosocial background is more visible and accessible.

Further, it is also intended to redefine mental health and to provide the necessary primary mental health treatment limited to diagnosis, crisis intervention and referral.

BBHU, however, is not a hospital or clinic and does not treat severe cases. However, its thrust is in education, support, and primary care treatment. Please note that primary care treatment means diagnosis (the first step in treatment), crisis intervention (psychiatric emergencies), and referral (referral of severe cases to the right professionals and hospital).

BBHU is a unit directly under the barangay captain and is backed up by ordinance no. 2479 and has its own budget. It is located in the barangay health center of barangay lahug. It has two rooms, one for consult and the other for examination. It is run and managed by a technical working group (twg) headed by a program director with one psychiatrist (on call), one psychologist, and one social worker as members. It is also assisted by the barangay health workers assigned to the unit and the gender and development group who acts as community organizers.

Bbhu works closely with vicente sotto memorial medical center, mental health facilities and rehabilitation centers for its referrals. It also operates in collaboration with other government agencies; DSWD, DEPED, TESDA, DOH, PNP, DILG, PDEA, and DDB.

BBHU PROGRAM

BBHU program is an outpatient program with three main objectives: (1) educate, (2) support, and (3) treat (primary treatment limited to diagnosis, crisis intervention, and referral).

Educate

Ignorance about mental health is evident. Information about mental health concerns and issues need to be discussed. This is covered by the program through a regular (weekly) educational forum which can be conducted in the barangay hall or in the sitio. Information is comprehensive and specific and simplified for easier understanding. Topics have a wide range but are arranged to make it digestible for the audience.

Support

A person in a crisis needs assistance. With mental problems, a lot of moral support is needed through group sessions or individual sessions. The support group also serves as an aftercare service which provides a shoulder that an afflicted person can lean on and acts as a monitoring arm to see how they are progressing.

Treatment

Treatment is limited to primary mental health care as follows:

Diagnosis – is conducted by a doh accredited psychiatrist (member of the technical working group). The venue for treatment is in the bbhu clinic in the barangay on a regular weekly schedule. Cases are assessed and appropriately referred.

Crisis intervention –is performed for psychiatric emergencies. The barangay health workers (including some tanods) are properly trained to handle these situations.

Referral – a system established for cases that need intensive or more serious treatment. A memorandum of agreement is created between bbhu and the appropriate hospital, facility, center or professional to expedite the treatment.

Collaboration

A collaborative relationship is established with DSWD, DEPED, TESDA, DOH, DILG, PNP, PDEA, and DDB for the reason that these agencies can lend a hand in education, support, and treatment. A corresponding letter of undertaking is drawn in order to facilitate the relationship.

Operations manual

Legal basis

1) Ordinance no. 2479 creating the barangay behavioral health Unit within the barangay health center, and providing funds. Thereof (resolution no, 14-1829-2017 of the Sangguniang Panglungsod of the City of Cebu)

2) Objective

A. General

To introduce the integrated concept of health which includes the mental component.

B. Specific

To redefine mental health; changing the people’s notion of Mental health from “crazy” to “living life” thereby reducing the stigma through education

To provide the primary mental health care; diagnosis and assessment, crisis intervention, and referral through support and treatment

3) Application

This manual shall serve as the template and shall be used by all Barangay Behavioral Health Units of any barangay that wishes to establish a BBHU in the city of Cebu or the province.

Matter. The technical working group refered herein shall also serve as the technical working group for the other barangay Behavioral health units that will be established in the future.

Organization and personnel Organization

  1. Barangay captain
  2. BTWG
  3. Barangay councilors
  4. Barangay behavioral health unit
  5. Barangay health center
  6. BHW
  7. GAD
  8. BHW 7
The barangay behavioral health unit is a unit directly under the barangay captain and therefore reports directly to the barangay captain. As a component in the integrated health concept, its staff are from the barangay health center – the barangay health workers {BBHU). But because its design is extensive, it also utilizes the gender and development group of the barangay (GAD) who acts as community organizers.

The barangay behavioral health unit’s organization and structure supports the BBHU’s mission to bring mental health to the barangay level down to its Sitios, and its vision to redefine mental health.

The implementation of BBHU as supported by ordinance 2479 is made possible by the creation of the technical working group (TWG) composed of: (1) program director, (1) psychologist, (1) social worker, and (1) psychiatrist. The twg is in charge of initially setting up the unit and training the bhw so that they can manage and run the unit by themselves. The TWG will then act as a consultative body that will monitor and assist the operation of the unit.

Personnel

The personnel who will manage the unit will be composed of five persons headed by the barangay captain as overall administrator, a barangay health worker who will act as manager and three members who will head the three functions.
  1. Barangay captain
  2. BBHU manager
  3. Education
  4. Treatment
  5. Support
  6. GAD/BHW
  7. GAD/BHW
  8. GAD/BHW
Each function will be assisted by the GAD or BHW who will act as community organizers.

Duties and responsibilities of the personnel will be as follows:

Barangay captain:
  1. Oversee the accomplishment of the unit
  2. Oversee the selection, recruitment, appoitment and termination of the personnel assigned to the unit
  3. Facilitate the moa, letter of undertaking, to be used in the establishmen of working relationships with twg, government agencies, hospitals and facilities, professionals and volunteers
  4. Provide the budget needed by the unit for its operations
  5. Attend and preside in regular monthly and year-end meetings
  6. Act as overall administrator of the unit
Technical working group (TWG)
  1. Set up the unit
  2. Organize and train the personnel and system
  3. Provide the necessary materials
  4. Supervise implementation of the program
  5. Assist the personnel in the operation of the program
  6. Assist the barangay captain in the over-all administration of the unit
  7. Act as consultative body once the unit is established and running
  8. Monitor and evaluate the performance of the unit
Barangay health workers (BHW):
  1. Manager of the unit – overall management of the unit
  2. Head of each function – oversee the implementation of the functions
  3. Coordinate with gad
  4. Facilitate activities (physical preparations, etc.)
  5. Accomplish reports
  6. Recording, documentation and feedbacking
  7. Attend regular monthly and year-end meetings
Gender and development group (GAD):
  1. Perform community organizing work (identify, gather data or information, etc)
  2. Accomplish the schedule of activities, reports, etc.
  3. Prepare the pshysical preparations needed for the activities
  4. Act as catalyst with the consituents of the sitio
  5. Recording, documentation and feedbacking
  6. Attend regular monthly and year-end meetings
Equipment and physical set up

The barangay behavioral health unit (bbhu) is a clinic in the barangay health center. It is a two-room clinic; one for the doctor’s office where consult and assessment is conducted, and one for examination room/isolation room for psyschiatric emergencies. Although these rooms have their designations, the functions are all designed to serve a multi-purpose.

The equipment are minimal, that is, (1) stretcher, (1) weighing scale, (1) sphygmomanometer, (1) stethoscope, (1) medicine cabinet, (1) filing cabinet, (1) standard office table, (6) chairs.

Administration

The barangay captain is the primary administrator of the barangay behavior health unit BBHU aided by the barangay health workers (BHW).

The personnel, barangay health workers and gender and development group, will be under the barangay policies and regulations in terms of recruitment, selection, and appointment. The technical working group (twg), however, will be deployed based on a memorandum of agreement (moa) and will also be under the barangay captain.

Records management will be strictly followed. Records pertaining to diagnosis and assessment are classified as medical records and a separate record keeping will be maintained to protect clients and observe confidentiality. Accomplishment reports, progress reports, monitoring reports herein considered as documents are also maintained. Financial records are handled and kept separately and incorporated in the barangay operations.

Training programs will be determined and its facilitation will be based on requests. Sources of training programs will be 11.

Recommended by the TWG some of which will be taken from the inter-agency links working with the BBHU.

Training categories are as follows:
  1. Category 1: all barangay health center workers
  2. Category 2: barangay captain and officials
  3. Category 3: barangay public safety officers
  4. Category 4: barangay staff and volunteers
  5. Schedules will be determined by the barangay.
  6. Clinical operations and services
  7. BBHU
  8. Treatment
  9. Support
  10. Education
  11. Aftercare
Other facilities:
  1. PNP
  2. DILG
  3. TESDA
  4. DSWD
  5. DDB
  6. PDEA
  7. DOH
  8. DEPED 12
The BBHU has three main functions:
  1. Educate – regular educational forums on a weekly basis on general topics and specific topics based on the needs. This is headed by a psychologist who will perform pscyhoeducation on different topics in the different scheduled sitios. The preparations will be facilitated by the organizers (gad) using a standard format which begins with registration of participants, delivery of topic, and feedbacking
  2. Support–a support group established to reinforce treatment and is used as an aftercare bolster for clients to keep going. This is headed by a social worker who will determine the kind of support group needed and facilitate the group sessions (held in specific sitios) that is essential in the support process. The support group will also serve to link the clients to the needed support that can be provided by the inter-agency links. Regular monitoring system is also used to check maintenance of support group goals.
  3. Treatment – provide primary treatment limited to diagnosis, assessment, crisis intervention for psychiatric emergencies, and referral of cases that require confinement in hospitals, facilities or rehabilitation or specific professional care. This is headed by a doh accredited psychiatrist who will deliver primary mental health treatment, as mentioned above. Cases that require more intensive attention is referred accordingly. Venue for treatment is in the BBHU clinic in the barangay health center.
Aftercare is an adjunct service facilitated by the social worker of the support group. Linking the client to the different agencies and what they offer is part of the support group function. The venue will depend on the arrangement between the BBHU and the agency concerned. Enrollment of the client will be properly recorded and monitored by the support group.

Standard operating procedures

1. Pre-operation phase

A. Facilitation of documents (ordinance, moas, letters of undertaking)

B. Orientation and training of BHW, GAD, and other barangay officials and staff (important! Appointment of roles and responsibilities for all who will be involved in the operation of the bbhu shall be accomplished at this point)

C. Orientation (introduction of BBHU to the constituents of the whole barangay)

2. Operation

A. Regular weekly education forums will begin based on the attached bbhu calendar. The calendar will be formulated by the gad in coordination with bhw and twg. Twg will choose the topics to be delivered based on a consensual assessment while gad will take charge in prioritizing the district and sitio to be given the education forum. The forum will be held in the sitio level at a minimum of one forum to a maximum of two forums a day on weekends as a matter of policy.

B. Treatment will also begin based on a priority listing submitted by the bhw and gad. The venue will be in the bbhu clinic and clinic hours will be half to a full day depending on the availability of the psychiatrist and only on weekends, as a matter of policy.

C. Support group will follow the lead given by the psychiatrist. The social worker shall work closely with the psychiatrist to determine what group to set up. As a matter of policy, the social worker will attend to group sessions and other related work half to a full day on weekends only.

D. Records management must be accomplished simultaneous to the start of operation

E. Monthly meeting to assess the progress of the BBHU shall be done with the attendance of the barangay captain, BHW, GAD, AND TWG. The meeting will be every first week of the month. Attendance is compulsory.

F. A yearly calendar shall be accomplished in order to guide the BBHU of its activities. This shall serve as direction for the bbhu and making sure that its vision and mission is being adhered to. Yearly calendar planning meeting will be on the last week of the eleventh month of the year. Attendance is compulsory.

G. Confidentiality is an important factor to keep in mind because of the stigma attached to mental health. As an outpatient program, it may be difficult to maintain confidentiality. But to gossip about clients is another thing. It is unethical. Therefore, members of the BBHU must try to maintain confidentiality.

Mental health is relatively new to many people. The stigma that is attached to it repels people from even talking about it. This may be an obstacle that need to be overcome. For this reason, the approach needed in the introduction of BBHU must be from the perspective of life, of living life and not from the morbid disorders that are associated with abnormalities, weakness of genes, hopelessness, helplessness, incurability, and oddidty. A sensitivity to stigma can be avoided by using carefully selected words that are not sarcastic, condenscending, and mocking. Instead, the introduction must be guided by compassion, understanding and empathic. (PR)

VIEW COMMENTS
DISCLAIMER:

SunStar website welcomes friendly debate, but comments posted on this site do not necessarily reflect the views of the SunStar management and its affiliates. SunStar reserves the right to delete, reproduce or modify comments posted here without notice. Posts that are inappropriate will automatically be deleted.


Forum rules:

Do not use obscenity. Some words have been banned. Stick to the topic. Do not veer away from the discussion. Be coherent. Do not shout or use CAPITAL LETTERS!

Create your own user feedback survey