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“MAGPAKONSULTA ka sa psychia? Nabuang ka? (You’re going to consult at the psychiatric center? Are you crazy?)”
These are the common words uttered among some Cebuanos when someone seeks mental health support. The stigma surrounding mental health continues to be a taboo subject for many Filipinos, casting a shadow over those who need help the most.
Despite these harsh words from patients seeking help, the mental health workers at the Vicente Sotto Memorial Medical Center (VSMMC) Department of Psychiatry-Center for Behavioral Sciences remain steadfast, using their skill and compassion to navigate the challenges and ensure every individual gets the care they need.
In a field where empathy and resilience are crucial, these professionals continue to offer hope and healing.
Amid a pandemic, a supertyphoon, and the relentless demands of their work, these mental health workers face their own battles, fiercely guarding their mental well-being with vigilant self-care and support.
Dr. Christine Joyce Villero, medical specialist II at the center, said mental health workers must be able to separate work from personal life, which can sometimes be challenging for some but is essential.
A common struggle among mental health workers is empathizing without becoming too affected by their patients' problems, which can take a toll on their own mental well-being if not properly managed.
Aside from facing the problems of others, mental health workers also have to deal with their own personal problems.
Villero said that their training as medical professionals emphasized the importance of setting boundaries early on, a critical skill to safeguard their own well-being amid the demands of their roles.
“We really need to set boundaries. Being empathetic, you understand your patient, you can be in their shoes, but you’re objective. It’s really important,” Villero said.
Villero entered the field of psychiatry to better understand people and is passionate about helping them return to their old selves or even become better versions of themselves.
“I personally have friends who went through mental health problems, but they never got the help needed because of the stigma. That’s also one of the things that motivates me,” Villero said.
The staff of the VSMMC psychiatric department and behavioral center can usually accommodate up to 100 patients daily and are willing to accept additional patients until 4 p.m.
The center offers a range of services, including outpatient consultations in general adult psychiatry, child and adolescent psychiatry, geriatric psychiatry, and forensic cases involving persons deprived of liberty with mental health issues, as well as in-patient crisis management, teleconsultations, and neuropsychological and neuropsychiatric evaluations.
With over 11 years of experience at the behavioral center of VSMMC, Villero has seen the changes of the department throughout the years.
“There have been a lot of good changes like we transferred to a better building. We are grateful for what we have right now kay we are able to accommodate more patients, bigger ang area for the outpatient department. We now have a pharmacy here. Before, the patients would go to the main hospital for their medications, but now, we have our own cashier, our social worker here. The services that we offer, mas daghan ma-cater,” Villero said.
Villero said the most important thing a medical health worker should build with patients is trust.
“Especially diri sa psych. Some of our patients are very paranoid and anxious. So you really have to build a therapeutic relationship. It’s important that you make them feel comfortable,” Villero said.
“Knowing that a patient has a safe space, it helps,” she added.
Being exposed to the difficult experiences shared by patients, Villero expressed that self-doubt is a constant challenge. Questions like “Will I be able to help? Will they understand me?” often creep into a mental health worker's mind, which is why self-awareness is also crucial.
“Simple breathing exercises in the day just to clear out your head. Starting your day on a clean slate. Maintaining a healthy lifestyle is important for my work,” Villero said.
“You have to learn how to set your boundaries nga I feel this way, but I need to put it aside first because now I’m the doctor. Now, I’m the therapist. Now, I am the healer,” she added.
“It really affected most of us… because of the uncertainty.”
The Covid-19 pandemic tested the resilience of the department, creating unprecedented challenges that required adjustments and heightened emotional fortitude.
“We really didn’t know what was going to happen. It was a lot of adjustments on our part,” Villero said.
She noted that the number of patients declined during the pandemic as many feared contracting the virus.
“I was also very scared because, after all, I am still human. But you always keep in mind that you still have a role to play. You’re still a doctor. Even if you’re scared, you have to keep doing your work because that is what’s expected of you and many people depend on you,” Villero said.
During the onset of the Covid-19 pandemic, the center was very cautious about admitting patients. Chronic patients already at the center were separated from others, and only a select few staff members were allowed to enter the ward to prevent virus transmission. Plastic barriers were also installed between patients for added safety.
“It was a challenge for our patients. Dili gane mosul-ob og sanina, mask pa kaha. Lisod gyud siya. But I know the staff were really doing well. Wala man gani mo makadungog nga naay breakout diri. Maka-proud ra pud nga wala mi ingon ana nga problems. Although naa mi challenges, manageable siya,” Villero said.
(It was a challenge for our patients. If they have difficulty wearing a shirt, how much more with masks? It was really tough. But I know the staff were really doing well. We haven’t even heard of any outbreaks here. It’s something to be proud of that we haven’t had such problems. Although we did face challenges, we were able to manage.)
Due to the pandemic, it was also challenging for mental health workers to follow up with patients, and those who returned often had to restart their treatment.
Anxiety and depression were the most prevalent mental health conditions during the time of the pandemic.
Villero said the pandemic also took a toll on the mental health of their existing patients.
“It had a great impact on them as well. Even people without prior mental health problems developed issues during the pandemic, and those who already had issues experienced heightened anxiety. So, it had an even greater impact on them,” Villero said.
One of the most difficult aspects of the pandemic was hearing the various stories from her colleagues while also trying to keep herself sane and find an outlet to de-stress.
To address the fears that had arisen among her colleagues, Villero said they established a rule at that time to provide support to their colleagues.
“Part of our role during the pandemic was to give psychosocial support to the staff. We had different sessions for every department. We would have Zoom sessions with the residents. To talk about how they are. To talk about their mental health. Mga debriefing sessions. Those who suffered losses,” Villero said.
The center’s services remained steadfast during the pandemic, as it adapted to changing times to continue accommodating those in need of help.
To adapt to pandemic restrictions, the VSMMC offered online consultations for acute or first-time patients.
Patients and healthcare workers used the web-based telemedicine platform doxy.me, designed specifically for healthcare providers to conduct video consultations with patients.
The department also offered a traditional teleconsultation platform, allowing patients to connect with the center via phone.
“It’s easier. Everybody has cell phones. For chronic patients, the staff sets the appointments, they call in. It’s easier for them because they don’t have to travel,” Villero said.
Since face-to-face consultations were freely available again, online consultations have also declined.
“The challenge of online consultations is that they do not have good internet access. Others are not that techie,” Villero said.
Villero noted that although they accept patients from all walks of life, most of their patients come from low-income families and face difficulties accessing these services.
She said she foresees a time when these technological advancements will be made available through barangay health centers or close to those who have a hard time traveling.
“Hopefully, in the future, we could have a program or ask guidance from the DOH (Department of Health) if they’re doing it also (innovations in communication). It’s going to be another option for our patients, the capacity to do it online. Mas maayo kung naa na siya nga services nga ma-offer sad namo,” Villero said.
Villero highlighted that there are numerous online platforms available to help patients communicate with doctors and encouraged them to utilize these resources. Patients who already have doctors on these platforms and wish to transfer their care can do so through a referral.
“If they want to transfer here sa government, puwede ra man. The private doctor could actually issue a letter to my patient, ‘I am managing this case,’ say, anxiety, siguro due to financial constraint, so puwede ra,” Villero said.
Apart from the Behavioral Center’s teleconsult platform, VSMMC’s crisis helpline, Tawag Paglaum Centro Bisaya—a collaborative program with the DOH-Central Visayas—also readily accepts calls 24/7 from individuals in emotional crisis or those with lingering thoughts of suicide.
The hospital also has a dedicated team of experts for individuals wanting someone to talk to.
“Roughly, we see around 100 patients on a daily basis sa psychiatry and behavioral sciences department ra. Part of that goes to teleconsults. Daghan-daghan gyud siya nga number (the number is very large),” Villero said.
Although teleconsultations can be challenging, the staff at the center are dedicated to accommodating everyone who seeks help.
“The doctors here are very much welcome to see patients. Mas daghan na siya karon compared to before. Mas daghan na mi residents. Now we have a lot of resident (doctors),” Villero said.
Adapting to change was one of the key lessons the department learned from the pandemic. They explored various methods to reach out to patients and assist them using technology.
In December 2021, Odette, a powerful and rare tropical cyclone, pounded the Philippines, affecting the lives of Filipinos, especially the Visayas and Cebu. This opted for the psychiatry and behavioral science department to transfer from the old building to a new one.
Villero explained that they had no choice but to relocate. The old building was no longer usable, with some records damaged by water, and even personal belongings were drenched by Typhoon Odette.
She said that everybody had to be active and constantly moving at that time in transferring things from the old building to the new one.
“We had to mobilize everybody. Dili man gud pwede ma-stop amoang services,” Villero said.
While the transfer was ongoing, Villero said they also had to attend to patients who became anxious due to the storm, especially those who were gravely affected.
Fortunately, when she visited the center, no one was hurt due to the storm. Most of the reports she heard were about structural damage rather than human concerns.
She said this is the case because most of the staff are trained to handle unavoidable circumstances, such as during typhoons.
Water supply was their main struggle at that time, but since many areas hit by Odette faced the same issue, Villero said it was not a problem unique to them.
Provision of mental health support following Odette
Mental health services continued after the typhoon, but only a few patients came compared to usual as most people were focused on tending to their homes.
Even though their services continued after the typhoon, teleconsultations ceased because they were entirely dependent on network connections, which were not yet functional in the aftermath. Villero noted that some patients had to go to the hospital in person because they needed prescriptions.
Villero said most of the cases patients were diagnosed with after the typhoon were anxiety and insomnia.
She said one of their main focuses at that time was providing psychological first aid to patients in crisis.
When everyone went up on their backs recovering from the typhoon, Villero said they started to have meetings, talking about what to do if similar cases like that of Super Typhoon Odette reoccur.
After everything, drills on disaster preparedness were constantly conducted at the center, a cooperative effort between the staff and the patients.
The lack of public awareness about mental illnesses and patients' non-compliance with mental health workers' instructions remain the top challenges that mental health professionals face every day.
Villero also cited that psychoeducation and raising awareness about mental health in the community are major obstacles.
“With understanding comes compassion. Very important ang knowledge about the illnesses and understanding nganong kinahanglan og tambal, and then compassion follows,” Villero said.
Villero highlighted that community mental health services from their department are available, with resident doctors rotating through various locations to conduct mental health consultations.
She said that community involvement greatly benefits mental health by helping to decongest hospitals and raising awareness in various communities.
“Para sa ilahang level, ma-address na siya didto. They play a role. The communities that are involved in mental health have medications for their patients, they have programs. So it’s a good thing,” Villero said.
To maintain a secure environment, the hospital has implemented rigorous protocols, including extensive safety measures, regular staff training, and monitoring.
Villero also stressed that one of the barriers to seeking consultations is the stigma attached to mental illnesses.
“If people see seeking consult in a negative way, bisag unsa pa na nimo i-encourage, dili gyud siya,” Villero said.
Villero emphasized the importance of maintaining trust and comfort for patients during their consultations.
“We make sure to inform our patients that the information they share is private. We also have to document what we assess kay part man na siya, recordkeeping. And respecting cultures, diversity, lahi-lahi man ang moanhi pud. Aside from culture, gender sensitivity. So that is always something we take into consideration so that our patients would feel at ease and comfortable when they come here,” Villero said.
“I love what I do, grateful that I’m able to help and make a difference in other people’s lives. I think that’s what keeps me going.”
On her vision for the future of mental health in Cebu, Villero believes that it is something that is growing due to increasing need. She noted that during the pandemic, she saw a significant rise in individuals seeking mental health care support.
Villero said support has improved compared to the past. However, she hopes for one key development: an increase in government support.
“Of course, we also rely on what we receive from the government. Perhaps, if the government could allocate more funds for mental health or for healthcare in general,” Villero said.
Villero expressed that it is beneficial to talk about mental health and to mainstream the conversation. She encouraged everyone not to be afraid of talking about mental issues to someone trustworthy.
Admitting the need to consult a professional can greatly benefit both individuals and mental health workers, she said.
Resilience is essential for bouncing back from difficulties, and Villero said they aim to impart to patients that, while it is natural to feel sadness when facing problems, what matters is choosing not to dwell on them and instead seeking solutions.
“So, if you have that hope and resilience, it’s something you can pass on to your patients and coworkers as well. These are important values that are needed for someone who wants to go into this field, going into healthcare,” Villero said.
Villero said nothing feels better than seeing patients return to an improved state. In her experience, some have even gone on to become licensed psychologists or teachers.
"These are success stories that help us realize that indeed there is hope. Even if you are diagnosed with a mental health illness, it will not stop you from achieving your dreams and your goals,” said Villero.
“Whatever you are in, we play a role in society,” Villero said.
As a mental health worker, she wants to educate the patients that there is no health without mental health. It is an aspect that should go together with physical health.
“In the field of mental health care, we had to be the perfect example of being mentally, emotionally, and physically healthy,” she said.
Mental health is very important. Villero said that whatever one is struggling with, “if you think you need help, if you think you’re going through a mental crisis, it's okay to ask for help.”
By submitting one’s self to the humility of admittance, she said one can enjoy life to the fullest.
“We would be able to enjoy our lives, to appreciate the things that are happening to us, to enjoy the people we are with, the experiences, and of course, better cope with difficulties. That's the role of mental health. I hope that with awareness, comes understanding,” Villero said.
Respect and dignity are essential for individuals with mental health conditions. Though broken, they are still human beings deserving of these fundamental values.
Villero expressed her gratitude to her fellow mental health workers for their patience and perseverance in serving the community.
Painting and sketches used in this article courtesy of the Van Gogh Museum