by: James Andrew Aves
Introduction
The Philippines is an archipelago of over 7000 islands, with over 120 languages, and numerous religions. The country has been occupied and colonized by many foreign powers since 1545 and it only gained full independence in 1946. This colonial history has contributed to the unique Filipino culture, yet the country remains poorly understood because of its late independence and of it being one of only two Christian-majority countries in the Far East (Lally et al., 2019).
The cultural beliefs of Filipinos vary in almost every respect. One of the popular beliefs is that depression and anxiety are non-existent, and that mental illnesses are something to be ashamed of. A qualitative study conducted by Tanaka et al. (2018) showed that this stigma is considered to be an effect of the public belief about mental disorders which consist of three themes: First is familial problems, wherein the family rejects or disowns the family member who suffers from a mental disorder because they believe that it can be inherited. Second is unrealistic pessimism and optimism about the severity of the disorder, wherein the mentally ill either would certainly suffer from severe functional impairment or would be able to overcome any psychological suffering by themselves. Last is the oversimplified chronic course, wherein people without mental illnesses apply an acute illness model to those ill, and expect full recovery in the short term.
Statement of the problem
The Philippines is an autonomous republic located in the western Pacific, with a population of over 100 million people (Philippines Statistics Authority, 2016). Despite its size and its reputation for highly trained healthcare professionals, there is a paucity of epidemiological evidence for mental disorders in the Philippines. What is known, according to the 2010 census, is that 200 000 people were identified to have a disability due to mental disorder (Philippines Statistics Authority, 2010). This equated to 14% of a total of 1.4 million Filipinos with disabilities. The incidence of suicide has increased decade on decade, rising from 0.23 to 3.59 per 100 000 in males and from 0.12 to 1.09 per 100 000 in females between 1984 and 2005 (Redaniel et al, Reference Redaniel, Lebanan-Dalida and Gunnell2011).
Mental illness has become the third most common disability in the Philippines, wherein six million Filipinos live with depression and anxiety. Because of this, the country has the third highest rate of mental disorders in the Western Pacific (Martinez et al., 2020). Also, the Philippine World Health Organization (WHO) Special Initiative for Mental Health conducted in 2020 showed that more than 3.6 million Filipinos suffer from at least one kind of mental, neurological, or substance use disorder (Department of Health, 2020). Suicide rates are reported to be at 3.2 per 100,000 population with higher rates among males (4.3/100,000) than females (2.0/100,000). However, these numbers may be underreported because suicide cases may sometimes be misclassified as “undetermined deaths” (Lally et al., 2019; Martinez et al., 2020).
The WHO estimated that 154 million Filipinos suffer from depression, 1 million from schizophrenia, and 15.3 million from substance use disorders, while 877,000 die due to suicide every year (Department of Health, 2018). Thus, mental disorders could greatly affect employment and levels of education, most especially in ages 25 to 52 years (Hakulinen et al., 2019). It was found in a study by Hakulinen et al. (2020) that individuals with a severe mental disorder had notably lower levels of employment before, and more especially after, the diagnosis of their disorder. Their overall incomes came primarily from transfer payments, and the most affected were those diagnosed with schizophrenia. After receiving a mental disorder diagnosis, more than half of these individuals received no employment earnings.
According to an article published by Kathleen de Villa in The Inquirer, there are only 3 mental health professionals for 100,000 Filipinos, and in a situation where mental health disorders are underreported, the Department of Health (DOH) is training local health workers to be proficient in this discipline to address the shortage. The health agency aims to double this number in five years. Increasing the number of mental health workers would also mean establishing a “specialist-oriented system,” which is not among the current priorities of the DOH.
These numbers highlight the need for legislative action on mental health. While the Department of Health has an existing mental health program, only legislation can ensure a sustainable policy with adequate funding, where patients’ rights are protected, and where the issue of mental health is given adequate attention.
This study aims to highlight milestones in the evolution of the mental health laws in the Philippines. While doing that, this study also aims to determine the efficiency of mental health laws in the Philippines at the local level and national level.
Significance of the study
The findings of this study hoped to serve as a basis for future legislation in protecting those seeking treatment through psychological help. The findings of the study also hope to educate the readers of the Philippine Mental Health Act and appreciate its evolution.
Definition of terms
- Psychological disorder or mental disorder – It is a psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected
- Mental illness – term formerly used to mean psychological disorder but less preferred because it implies that the causes of the disorder can be found in a medical disease process.
- Republic Act No. 11036 – An Act Establishing a National Mental Health Policy for the Purpose of Enhancing the Delivery of Integrated Mental Health Services, Promoting and Protecting the Rights of Persons Utilizing Psychosocial Health Services, Appropriating Funds Therefor and Other Purposes. This is otherwise known as the mental health act
- Mental Health Condition – According to the Philippine Mental Health Act (RA 11036), it refers to a neurologic or psychiatric condition characterized by the existence of a recognizable, clinically-significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a genetic or acquired dysfunction in the neurobiological, psychosocial, or developmental processes underlying mental functioning. The determination of whether a mental health condition exists shall be based on the best available scientific and medical evidence’. The new bill covers all mental disorders, inclusive of substance-related disorders, and involves active treatment of substance-related issues and preventive measures such as incorporation of psychoeducational topics in the education system, from elementary school onwards.
Methodology
To determine the evolution of mental health laws in the Philippines, I will be researching articles with supporting legal bases, specifically RA no. 11036. RA no. 11036 is the first mental health act legislation in the history of the Philippines. It has been officially signed into law and was enacted on 21 June 2018. It provides a rights-based mental health bill and a comprehensive framework for the implementation of optimal mental healthcare in the Philippines. I will also be citing survey results from the World Health Organization, and their data on the mental health of Filipinos.
For me to determine the efficiency of mental health laws at the local level, the researcher will be doing personal interviews with psychiatric professionals, since they are part ones who are the ones benefiting from these laws. To determine the efficiency of laws at the national level, the researcher will also be doing interviews with psychiatric professionals, and at the same time will use the data of the effectiveness that RA no. 11036 provides, this will be done with supporting legal bases.
Discussion
The emergence of the Philippine Mental Health Act
Above and beyond the aforementioned mental health issues, one of the enduring challenges is that the Philippines had to deal with the absence of a national mental health law. That is not to say that attempts toward the development of mental health policies and plans were wanting, as evidenced by the very first mental health policy, the DOH Administrative Order series No. 8, instituted by the DOH in 2001. This was followed in 2016 by the Administrative Order No. 0039, Revised Operational Framework for a Comprehensive National Mental Health Program (World Health Organization: WHO Special Initiative for Mental Health, Philippines Situational Assessment. Geneva, Switzerland: WHO, 2020)
Somewhere along the long and laborious process, the Philippine Psychiatric Association (PPA) imitated a partnership with the DOH and embarked on a broad multisectoral consultation with various public and private stakeholders, starting with the patients and their families, youth groups, civil society organizations, the media, the Commission on Human Rights, the Philippine Neurological Association, the Philippine League Against Epilepsy, the WHO, the Philippine Mental Health Association, the Psychological Association of the Philippines, and other various mental health institutions. It started off with small technical working groups which transitioned into the major conferences. Such platforms served as venues where the said formal groups were consulted and asked to provide their respective inputs. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
In the end, the exertions of the dedicated multi-stakeholders came into fruition and the country’s first-ever mental health act was birthed. On May 2, 2017, its senate version was passed, and a few months later, on November 20, 2017, it followed the passage of the house bill version. Finally, on June 21, 2018, it was formally signed into a law (Lally J, Samaniego RM, Tully J: Mental Health Legislation in the Philippines: the Philippine Mental Health Act. United Kingdom: BJPsych International, 2019)
The milestones
Above and beyond the aforementioned mental health issues, one of the enduring challenges is that the Philippines had to deal with the absence of a national mental health law. That is not to say that attempts toward the development of mental health policies and plans were wanting, as evidenced by the very first mental health policy, the DOH Administrative Order series No. 8, instituted by the DOH in 2001. This was followed in 2016 by the Administrative Order No. 0039, Revised Operational Framework for a Comprehensive National Mental Health Program (World Health Organization: WHO Special Initiative for Mental Health, Philippines Situational Assessment. Geneva, Switzerland: WHO, 2020)
Somewhere along the long and laborious process, the Philippine Psychiatric Association (PPA) imitated a partnership with the DOH and embarked on a broad multisectoral consultation with various public and private stakeholders, starting with the patients and their families, youth groups, civil society organizations, the media, the Commission on Human Rights, the Philippine Neurological Association, the Philippine League Against Epilepsy, the WHO, the Philippine Mental Health Association, the Psychological Association of the Philippines, and other various mental health institutions. It started off with small technical working groups which transitioned into the major conferences. Such platforms served as venues where the said formal groups were consulted and asked to provide their respective inputs. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
The Philippine Mental Health Act, also known as the Republic Act (R.A.) No. 11036, is “an act establishing a national mental health policy for the purpose of enhancing the delivery of integrated mental health services, promoting, and protecting the rights of persons utilizing psychiatric, neurologic, and psychosocial health services, appropriating funds thereof, and for other purposes” (Hudson B, Hunter D, Peckham S: Policy Failure and the Policy Implementation Gap: Can Policy Support Programs Help? United Kingdom: Policy Design and Practice, 2019.) It is a 26-page document comprising 49 sections, which is congregated into 10 main divisions
Prior to this bill, the Philippines were one of a minority of countries with no mental health legislation. Clinicians lacked guidance on legal and ethical aspects of their practice, and patients’ rights were not clearly defined – for example, the usual practice was for patients who lacked capacity to be ‘signed in’ by a next of kin. The passing of this bill is a major milestone in the history of psychiatry in the Philippines. The bill, the first in the country’s history, provides a rights-based mental health legislation. It mandates for the provision of psychiatric, psychosocial and neurological services in all hospitals, and basic mental health services in community settings. Compulsory treatment is limited to hospital settings, and the Act does not provide for compulsory community treatment.
The divisions of the Mental Health Act cover the following; rights of service users and other stake holders, consent to treatment and safeguards, mental health services, education and promotion of mental health in educational institutions and in the workplace, capacity building and research and development, duties and responsibilities of government agencies, the Patient Centered Medical Home (PCMH – an approach to delivering high-quality, cost-effective primary care. Using a patient-centered, culturally appropriate, and team-based approach, the PCMH model coordinates patient care across the health system), mental health for drug dependents, and miscellaneous provisions.
Under its provisions, the Philippine Mental Health Act protects the rights of patients as follows: ‘a right to freedom from discrimination, right to protection from torture, cruel, inhumane, and degrading treatment; right to aftercare and rehabilitation; right to be adequately informed about psychosocial and clinical assessments; right to participate in the treatment plan to be implemented; right to evidence-based or informed consent; right to confidentiality; and right to counsel, among others’.
Mental Services
The law covers the standards of psychiatric, psychosocial, and neurologic services which need to be upheld in all regional, provincial, and tertiary hospitals, both government and private. Periodic review of such standards shall be ensured by the Philippine Council for Mental Health based on reportorial requirements made and submitted by the local government units through their respective health offices. It also requires all local government units and academic institutions to create programs that encompass wellness promotion, prevention, and rehabilitation, in collaboration with the related organizations engaged in mental health services at the community level. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
Furthermore, the duties and responsibilities of these community-based mental health care facilities should cover drug screening services; protocols for suicide intervention, response, and prevention strategies, with particular attention to the concerns of the youth; as well as public awareness through a nationwide multimedia campaign on mental health and nutrition, stress management, guidance, and counseling, as well as promoting the rights on persons with psychosocial disabilities. Such services should employ the minimal use of restrictive care and maintain a registry containing information on all medical treatments and procedures administered to the patients and compliant to the Data Privacy Act. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
Capacity building, research, and development
This expounds on the need for mental health professionals and other allied service providers to undergo capacity building, reorientation, and training to continuously develop their ability to deliver evidence-based, gender-sensitive, culturally-appropriate, and human rights-oriented mental health services. Such training is to be cascaded down to the barangay health workers. To note, a barangay, meaning “neighborhood” in Tagalog language, is considered as the basic unit in the Philippine government.
With regard to research and development, it is mandated that all academic institutions, as well as local psychiatric, neurologic, and other related specialty societies, undertake the necessary research to come up with evidence-based data, from which a national mental health program can be developed, and the one which is relevant to our local culture, for instance, the inclusion of indigenous concepts and practices related to the local mental health scene. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
Duties and responsibilities of the different government agencies
This division enumerates the duties and responsibilities of the concerned government agencies such as the DOH, including the development of a national mental health program; regulation, licensing, monitoring, and assessment of all mental health facilities; integration of mental health into the mainstream health information system; regular collation of data geared toward improving mental health service delivery; improving research capacity and academic collaboration; and coordination with the Philippine Health Insurance Corporation to ensure that packages equivalent to those covering physical disorders are also extended to mental health conditions.
There are also the Commission on Human Rights, which is responsible for addressing issues of impropriety and abuse in the treatment of patients; the Department of Education, which is to integrate age-appropriate mental health topics into the school curriculum, as well as implement programs which promote mental health and well-being; and the Department of Labor and Employment and Civil Service Commission, which, just like the Department of Education, is to develop mental health programs in the workplace specifically geared toward addressing stigma and discrimination against the working class with identified mental health conditions.
Finally, we have the Department of Social Welfare and Development which shall assist patients and make the necessary referrals to mental health facilities and other service providers for the appropriate care that they need. They shall also facilitate access to livelihood training or other skills development program which may include psychosocial skills training such as community resilience or psychosocial well-being during and after natural disasters and other calamities. (Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
Updates on the Philippine Mental Health Act:
To date, the current developments and updates of the Philippine Mental Health Act have been in relation to the enactment of its Implementing Rules and Regulations, signed on January 22, 2019, and came into effectivity on February 15, 2019. In relation to this, a 3-year strategic plan has been developed and subsequently approved in November 2020.
The Interview
The researcher had an interview with a mental health professional to obtain additional information on the efficiency of mental health laws. This interview was conducted with Achilles Isodore. He is a registered Psycohmetrician, MA in Psychology major in Counseling Psychology III Part-time Instructor, Dept. of Psychology, Silliman University Project Evaluation Officer III, DSWD FO VII.
Q: What mental health laws have your clients benefited the most from your practice? How have these mental health laws changed the way you practice? How efficient are the mental health laws in the Philippines?
As for me, as a major of counseling psychology and as a psychometrician, the PAP Code of Ethics for Psychometricians & Psychologist really serves well in guiding our day to day interactions at work. It gives us a clear set of ethical standards in our profession which is highly followed by all experts in our profession. Moreover, the RA 10029 / Philippine Psychology Act of 2009 was the act that professionalized psychology in the Philippines, thus there became a set of requirements for a person to become licensed psychometricians and psychologist. For me, this act is very helpful considering our profession requires skills on clinical assessment & psychotherapy, and decision making. Anyone without the license cannot conduct psychological assessment and testing. On the other hand, RA 11036 / Mental Health Act is an opportunity for the community to create a safe space, maybe in the community, workplace, school, and other settings, for individuals in need of accessible psychological interventions. This act serves as a revolution towards the recognition of mental health awareness in the society especially considering that only 5% of the annual budget in the PH is allotted for mental health and the experts in the field are in great scarcity. Although this is not in full operation yet as this is a very young act and might be in need of enhancements and revisions, this is a good start but yet a long way to be fully recognized and institutionalized in different settings in the society.
This is a start towards the revolution of mental health awareness in the Philippines and recognizing the professionalism of this scientific study on human behavior and mental processes.
Q: Are there mental health laws that benefit people more locally in the national level versus the local level?
I think it’s the domino effect of RA 11036 that gave ways to the society in the creation / implementation of different programs and policies dedicated to serve psychological interventions in the society. One example is is the Community-Based Drug Rehabilitation Program (CBDR) of the DOH that helps rehabilitate drug personalities and focuses on the healing through counseling and other therapuetic sessions. The training of Barangay Health Workers in the conduct of Psychological First Aid is also an on-going program that could facilitate in the prevention of more serious mental disorders.
Q: What are some of the mental health services or programs being implemented for the
college students? Are these programs the same for the whole population or are there particular programs implemented for a certain group?
I think the very important program the university/school should ensure is a proper guidance and counseling program because it would serve as the first in line “catchers” of probable students going through difficulties especially on adjustments and career orientations. A proper guidance and counseling program is a form of a preventive measure to students to experience more serious mental disorders. With RA 9258 / Guidance and Counseling Act of 2004, this professionalizes guidance counselors in their field and that hiring of guidance counselors in the university must also adhere to this act.
Q: With the skills and the experience you have garnered, what are some suggestions that to you, would help students in dealing with mental health issues that the university may establish as part of the current programs and services?
I think it’s very important for students to recognize their current emotional, physical and psychological state in order to facilitate the proper interventions necessary. The problem is that people are reluctant for formal help-seeking because of the stigma society puts on these issues. According to a research study from Brown, Co, Lau & Matrinez (2020), cultural variables such as shame, stigma and collectivist beliefs such as over fatalism discourage Filipinos to seek formal help in mental health.
Conclusion
The low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. (Lally et al., 2019; Martinez et al., 2020).
Notwithstanding, even if our mental health law has provided the much needed legislative framework for the formal delivery of a comprehensive mental health care, the main challenge is now shifted to ensuring effective policy designs and implementation and how they can be strengthened and supported. The concept of “policy–implementation gap” is a well-established confounding phenomenon that is viewed to be complex, multifaceted, and multileveled, influenced by prevailing factors that are resistant to change as well as potential solutions that vary in time and place according to its local context (Hudson B, Hunter D, Peckham S: Policy Failure and the Policy Implementation Gap: Can Policy Support Programs Help? United Kingdom: Policy Design and Practice, 2019)
For instance, factors behind legislation implementation failure need to be identified. Three established key problems recognized are lack of leadership, inadequate support for those implementing requests, and failure to realize that implementation is a process requiring long-term commitment (Neuman L, Calland R: Making the Access to Information Law Work: the Challenges of Implementation. New York: Columbia University Press, 2007)
To conclude, the Philippines has made history through the passage of the first-ever Mental Health Act on June 21, 2018, now known as R.A. 11036. This piece of legislation has been spearheaded by the PPA through a multisectoral lobby in the drafting of the bill. It took 16 years, and 31 drafts before R.A. 11036 became a reality (Casimiro-Querubin Maria Luz S: Philippine first mental health act: a historic event on 21 June, 2018. Bulletin of AFPA (Tokyo) 2018; 5: 27-8)
As mental healthcare remains to be an under-resourced and neglected aspect of healthcare in the Philippines, it should be given more attention. Until now, the country has lacked a formal structure in which to enshrine the rights of those people with mental illness, their families, and the rights and responsibilities of mental health professionals and government in relation to mental health. The Philippine Mental Health Act of 2017 has created an environment for the organization and provision of hospital- and community-based mental healthcare in the Philippines, while providing specific legislative checks to ensure the rights of patients receiving mental health care and treatment are protected.
The Philippine Mental Health Act of 2017 is therefore a major step forward for mental health in the Philippines and a milestone for psychiatry in the country. Under the direction of the PPA, willing governmental support along with the driving enthusiasm of mental health professionals, patient groups and family members have led to the first comprehensive Mental Health Act legislation in the Philippines. Significant logistical challenges remain in the successful implementation of this legislation, but the Act is a significant step with the provision to comprehensively address, at a national and local level, the mental health needs of the population.
The researcher has seen his friends and family be gravely affected by mental health disorders. It really can destroy every aspect of your life. The researcher is grateful that the country is taking steps toward focusing on the mental health of Filipinos.
Recommendation
The researcher is aware that the Philippine Mental Health Act (RA 11036) is relatively new as it was enacted only in 2017, making it only 6 years old this year. However, it is just more than an act. With this act, we can use it as a tool or a weapon to slowly heal our country and the mental illnesses its citizens suffer from. The reasearcher is aware that the social stigma and discrimination is a part of the problem, and this paper won’t help with that. What the researcher recommends is to start the change within ourselves. It is up to us (citizens of the Philippines) to start the change gradually that is intertwined in the fabric of Philippine norms and beliefs.
We should drop the norm of Filipino resiliency because as seen in the statistics, so many Filipinos suffer from mental illnesses. The rate of how many Filipinos suffer mental illnesses is alarming. The Philippines is a developing country that struggles to obtain economic stability because of outdated ways that result in gaps in mental health promotion, which in turn, bleed into the economy. The increasing prevalence of mental illnesses bears a great impact on human, social, and economic capital. This may be true not only in the Philippines, but also in other developing countries. Moreover, depression and anxiety should be recognized as disorders, not mere illusions. Families must be listeners and comforters of the mentally ill, not castigators. Filipinos must also understand that there is a complex process in managing mental health issues and full recovery could not be achieved over a short period of time.
Mental Health Professionals must be deployed to the local and national level, for the main purpose of educating people and families about the dangers of mental disorders, eliminating stigma and discrimination.
Attention must also be given to the youth, since this is where mental disorders usually begin. We must take a deeper look at their mental state. Some useful things that would prevent disorders would be suicide intervention, prevention, and response strategies with particular attention to the concerns of the youth.
The researcher also recommends that the quality of mental health services be given more attention. Statistics can only do so much if the quality of the mental health services the Filipinos are receiving is inadequate. The researcher is aware that mental health professionals can only accommodate a number of people per day. As the article in The Inquirer stated, there are only 3 mental health professionals for every 100,000 filipinos. That’s an alarming rate! Based on the researchers own experience in looking for a mental health professional, there is really a scarcity. The waiting time alone to get one consultation would take you weeks for someone to accommodate you. With the growing number of mental professionals increasing as each year passes, the researcher hopes that there is enough “help” for everyone.
The researcher also recommends that the Philippine Mental Health act and its applications in the practice of the mental health industry be included in the education needed to be a mental health professional. The researcher, being a registered psychometrician, was not even exposed to any of the mental health laws during his review for the Psychometrician board exam. This would be great exposure to those aspiring students who want to practice clinical Psychology, or pursue any position in the mental health industry.
Adding to the preceding recommendation, with the students or young professionals being exposed to these laws at an early stage, they could spot any lapses in the law for its improvement. Yes, the ones who are already professionals may benefit from this first hand, but the researcher also believes that those who really study the law can spot issues early on.
As mentioned earlier, it is a relatively new law. And the Philippine Mental Health act or any other mental health laws in fact is a topic that needs to be explored and scrutinized. The mental health act does not mention specific types of treatment, such as electroconvulsive therapy, but its section on ‘Quality of Mental Health Services’ states that treatments must be based on medical and scientific research findings, responsive to individual and cultural needs, provided in the least restrictive setting and provided by mental health professionals and workers in a manner that ensures accountability.The researcher recommends that there be more specialized professionals in this field.
About the researcher
The researcher is a graduate of a course of BS Psychology in Silliman University. He graduated back then in March 2019, and took the board exam for Psychometricians the same year, and he passed. Unfortunately, the researcher did not want to pursue the medical route after graduating from Psychology. The researcher has a passion for helping people, especially those who could not help themselves due to some inability, may it be physically, mentally or financially. Since then, he has worked as an HR practitioner at Rockwell Land Corporation, a real estate company, from 2020 to 2022. That is where the researcher pursued his dreams in helping people, by giving them advice, giving them jobs (he was a recruiter), and basically helping the employees out in their day to day tasks. He was passionate with his job, but he learned that he had a bigger purpose in life. He resigned from his job to study law full time.
Bibliography
https://www.academia.edu/43163654/Abnormal_Psychology_An_Integrative_Approach_by_David_H_Barlow
Philippines Statistics Authority (2016) Highlights of the Philippine Population 2015 Census of Population. Philippine Statistics Authority.
https://psa.gov.ph/content/highlights-philippine-population-2015-census-population#:~:text=The%20population%20of%20the%20Philippines,Refer%20to%20Table%201.
Hakulinen, C., Elovainio, M., Arffman, M., Lumme, S., Pirkola, S., Keskimaki, I., et al. (2019). Mental disorders and long-term labour market outcomes: nationwide cohort study of 2 055 720 individuals. Acta Psychiatr. Scand. 140, 371–381. doi: 10.1111/acps.13067
Redaniel M. T., Lebanan-Dalida M. A., Gunnell D. (2011) Suicide in the Philippines: time trend analysis (1974–2005) and literature review. BMC Public Health, 11, 536.https://link.springer.com/article/10.1186/1471-2458-11-536
Martinez, A., Co, M., Lau, J., and Brown, J. (2020). Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Soc. Psychiatry Psychiatric Epidemiol. 55, 1397–1413 doi: 10.1007/s00127-020-01937-2
https://link.springer.com/article/10.1007/s00127-020-01937-2
Lally, J., Tully, J., and Samaniego, R. (2019). Mental health services in the Philippines. BJPsych Int. 16, 62–64. doi: 10.1192/bji.2018.34
(World Health Organization: WHO Special Initiative for Mental Health, Philippines Situational Assessment. Geneva, Switzerland: WHO, 2020)
https://www.who.int/docs/default-source/mental-health/special-initiative/who-special-initiative-country-report—philippines—2020.pdf?sfvrsn=4b4ec2ee_8
(Mental health legislation in the Philippines: Its beginnings, highlights, and updates, Santiago, M.D., 2022)
https://www.e-tjp.org/article.asp?issn=1028-3684;year=2022;volume=36;issue=2;spage=51;epage=58;aulast=Samaniego
(Lally J, Samaniego RM, Tully J: Mental Health Legislation in the Philippines: the Philippine Mental Health Act. United Kingdom: BJPsych International, 2019)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646847/
(Hudson B, Hunter D, Peckham S: Policy Failure and the Policy Implementation Gap: Can Policy Support Programs Help? United Kingdom: Policy Design and Practice, 2019.)
https://www.tandfonline.com/doi/full/10.1080/25741292.2018.1540378
(Casimiro-Querubin Maria Luz S: Philippine first mental health act: a historic event on 21 June, 2018. Bulletin of AFPA (Tokyo) 2018; 5: 27-8)
http://www.afpa.asia/pdf/AFPA_Bulletin_2018s.pdf
Philippine Mental Health Act: Just an Act? A Call to Look Into the Bi-directionality of Mental Health and Economy Maravilla, N and Tan, M.
https://www.frontiersin.org/articles/10.3389/fpsyg.2021.706483/full
Just 3 mental health pros per 100,000 Pinoys; DOH training more (Villa, K, 2022)
https://newsinfo.inquirer.net/1684893/just-3-mental-health-pros-per-100k-pinoys-doh-training-more
Philippine Legal Research 