MENTAL HEALTH Benny A. Vicente, MD, FPPA, MHA, CESO IV

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MENTAL HEALTH

• Benny A. Vicente, MD, FPPA, MHA, CESO IV
• Medical Center Chief II, NCMH

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Presentation Outline

• Mental Health/Disorder defined
• Magnitude of the problem
• Prevalence
• Mental Health Resources
• Financing
• Philippine Mental Health Policy
• Principles of Mental Health Care
• Recommendations

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Mental Health

• State of successful performance of mental
  functions
• Productive activities
• Fulfilling relationships
• Ability to adapt to change cope with adversity
• Indispensable to personal well-being, family
  personal relationships, and contribution to
  community

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Mental disorders

• Health conditions that are characterized by
  alterations in thinking, mood and behavior (or
  some combination thereof).
• Associated with distress and/or impaired
  functioning and spawn a host of human problems
  that may include disability, pain or death.
• Mental illness term that refers collectively to
  all diagnosable mental disorders

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Prevalence of Mental Illness

• Lifetime prevalence of mental illness globally is
  estimated at 20 (WHO-Shinfuku)
• Prevalence rates from developed countries 8 -
  32.8
• Prevalence rates developing countries 11 -
  44.
• iPhilippines 11-44 or approximately 22,745,162
  from a general population of 84,241, 341 (2005
  estimate)

World Mental Health survey consortium 2004
ifrom DOH records of published studies, Perlas
et al 1994, Pabellon 2004, Pabellon 2006
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Prevalence of Mental Illness

• 22,745,162 is based on prevalence rate of 27.5
  (average of 11-44)
• However, included in the above figure are
  substance related disorders which constitute 18
  of 27.5
• If substance related disorder is excluded,
  prevalence rate 9 or 7.5 million Filipinos is
  suffering from some form of mental disorder

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Prevalence of Mental Illness

• Correlating the above study with an earlier WHO
  study by Shinfuku (1993) which states
• About 1 of population suffers from severe mental
  neurologic disorders 842,413 Filipinos are
  suffering from severe mental neurologic
  disorder
• of which 1/3 is estimated to be suffering from
  psychosis or 280,804 Filipinos
• About 5 of population suffers from moderate to
  mild forms of mental neurologic disorder or
  4,212,067 Filipinos

(based on 84, 241, 341 population estimate in
2005)
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Infrastructure and Health Human Resource
WHO-AIMS 2005
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Infrastructure and Health Human Resource

• Human resources working in mental facilities or
  engaged in private practice 2,900
• Psychiatrists 388 (211 diplomates/fellows)
• 136 are practicing in NCR
• Ratio of psychiatrist per bed
• 0.10 in community based psych facility
• 0.01 in mental hospitals
• Doctors without formal psychiatric training
• 52 work in out patient facilities
• 56 in community-based psych in patient facilities
• 14 in mental hospitals
• Other mental health professionals (psychologists,
  medical social workers, occupational therapists)
• 88 in mental health facilities
• 61 in community based
• 53 in mental hospitals

WHO-AIMS 2005
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Distribution of psychiatrists by region
LEGEND
10 psychiatrists
from PPA data 2007
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Financing

• 5 of DOH expenditures directed to mental health
  
• Of which 95 goes to the operation, maintenance
  and salary of personnel of mental hospitals
• Cost of medicines vs. minimum wage
• Cost of anti-psychotic medication 0.46 or P
  1.30
• Anti-depressant 11.14 or P32

WHO-AIMS 2005 minimum wage P 279.50
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Financing
NCMH Budget
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Financing

• PhilHealth covers acute mental illness (acute
  psychosis) but limited only to in-patients.
• Outpatient mental health service included for
  the OFW upon its transfer from Medicare
• Recently included is PSP or Debriefing for OFW

of population with free access to essential
psychotropic medicines is unknown.
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History of Mental Health Facilities
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History of Mental Health Facilities
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History of Mental Health Facilities
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NCMH Average In-patients 1928-2007
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Plans, Policy and Legislation

• Philippine Mental Health Policy presented in
  2001.
• However, there is NO mental health legislation
• National Objectives for Health 2005-2010 includes
  mental health plans (w/c affirms the mental
  health policy)
• Shift strategies from an institutionally based
  mental health system to consumer focused with
  emphasis on supporting the individual in the
  community

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Policy and Legislation

• Philippine Mental Health Policy signed in 2001
• Leader, collaboration and partnership
• Empowerment and participation
• Equity
• Standards for quality mental health services
• Human resource development
• Health service delivery system
• Stability sustainability
• Information
• Legislation
• Monitoring and legislation

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DOH Strategic Thrusts for 2005-2010

• Strengthen advocacy and public information
  campaign on mental health
• Establish data base and information system
• Integration of mental health into the provision
  of other public health services nationwide
• Develop model programs for prevention of
  substance abuse and risk reduction for mental
  illness
• Advocate for positive health seeking behavior

DOH National Objectives for Health 2005-2010
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Administrative Order 2007-0009

• The Operational Framework for the Sustainable
  Establishment of a Mental Health Program
• Signed by Sec. Francisco T. Duque III on March 9,
  2007
• The key features of AO 2007 0009 are the four
  priority sub-programs
• Wellness of Daily Living Focuses on attaining
  and maintaining the wellbeing of person/s across
  the life cycle through the promotion of healthy
  lifestyle with emphasis on coping with stress and
  other psychosocial issues.

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Administrative Order 2007-0009

• Extreme Life Experience Focuses on addressing
  the psychosocial consequence and maintaining
  mental health of person/s that experiences
  incidents that are out of the ordinary such as
  disasters, epidemic, trauma etc., which threatens
  personal equilibrium.
• Substance Abuse and other forms of addiction
  Focuses on the promotion of protective factors
  and prevention against the development of
  substance abuse and other forms of addiction in
  the following key settings (family, school,
  workplace, community, health care setting,
  industry) through existing DOH programs and
  responsible agencies
• Mental Disorder Focuses on the promotion of
  mental health and prevention of mental illness,
  such as clinically behavioral or psychological
  syndromes, across lifespan of an individual (i.e.
  children, adolescents, adults, elderly, special
  populations, such as the military, OFW, refugees,
  and PWDs)

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10 basic principles of Mental Health Care

• Promotion of mental health and prevention of
  mental disorders
• Access to basic mental health
• Mental health assessment (diagnosis, choice of
  treatment, determination of competence)
• Provision of lesser restrictive type of mental
  health care
• Self-determination

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10 basic principles of Mental Health Care

• Right to be assisted
• Availability of review procedures
• Automatic periodic review
• Qualified decision maker
• Right of the rule of law

From WHO, Geneva 1996
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Recommendation

• Passage of a Mental Health Legislation
• Establish community-based mental health care
• Integrate mental health care into general health
  services
• Review strengthen financing strategies
• Parity between resources the magnitude of
  problem

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Recommendation

• Structure programs and integrate resources of all
  stakeholders
• Establishment of internationally-accepted
  national standards, protocol and guidelines in
  the delivery of mental health care
• Make available the essential psychotropic drugs
  in all levels of health care
• Build up capacity for research

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Thank you!
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Reducing the Burden of Disease

• Formulate policies designed to improve the mental
  health of populations
• Assure universal accesses to appropriate
  cost-effective services
• Ensure adequate care protection of human rights
• Assess monitor of the mental health of
  communities
• Promoting health lifestyle reducing risk
  factors
• Support stable family life, social cohesion
  human development

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Reducing the Burden of Disease

• Formulate policies designed to improve the mental
  health of populations
• Assure universal accesses to appropriate
  cost-effective services
• Ensure adequate care protection of human rights
• Assess monitor of the mental health of
  communities
• Promoting health lifestyle reducing risk
  factors
• Support stable family life, social cohesion
  human development

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Infrastructure and Health Human Resource

• Quality of service - anchored on protocol,
  guidelines standards which defines the
  responsiveness of mental health care
  delivery system and the ability to promote mental
  health wellness.
• Establishment and licensing of mental health
  facilities - regulated by the DOH.
• Accreditation of mental health services -
  through PhilHealth standards but not all
  mental health facilities seek accreditation.
• Certification of psychiatrist as diplomates -
  regulated/governed by the Philippine Board
  of Psychiatry, the academic arm of the
  Philippine Psychiatric Association. It lays out
  the standards in training for psychiatry
  protocol of psychiatric practice
• Other mental health workers - educated
  through the academic institutions and are
  trained on mental health only when employed as a
  mental health worker.