We need to talk about mental illness in the Philippines

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With headline-making metrics such as the World Happiness Index that indicate an increase in the overall emotional well-being of Filipinos, issues surrounding mental health take the backseat and easily fall beneath the cracks.

The reality, at least according to other numbers, is darker: the National Center for Mental Health's statistics project suicide rates of 2.5 for men and 1.7 for women per 100,000 members of the population. These numbers do not include unreported cases. According to a 2014 report of the World Health Organization, there were 2,558 cases of suicide due to mental health problems in the Philippines in the year 2012 alone. As a public health concern, mental illness hits the most vulnerable sectors of society — the young and the poor.

Living within a culture that emphasizes resilience and humor amidst pain and personal suffering makes it all the more difficult to talk about mental illness out in the open. The stigma surrounding mental illness only adds to the layers of struggle of people who suffer from various mental health conditions.

Naming the illness, confronting the struggle

I was a freshman in college when I was first confronted with serious problems regarding my mental health. I was sixteen then, freshly uprooted from the province to study in Manila. And while I could have easily ascribed my sadness to homesickness, the results of my university-required guidance tests showed otherwise. They painted a picture of depression and other various symptoms.

For the first time, I understood that all that raw, uncontrollable sadness and rage that sprang from within me was not because of some normal personality flaw. Rather, it was something more fundamental. I spent half a year in counseling trying out various methods of therapy, then without any medication.

And then I stopped.

Two years went by without any therapy, and my mental health deteriorated greatly. I went on to enroll in law school, a highly competitive and pressure-filled environment. The stress greatly amplified my symptoms, causing my academic performance to drop. A series of breakdowns finally led me to seek help from a psychiatrist, my mind filled with questions begging to be answered.

“You’re bipolar," the doctor told me. "Now at least it has a label, and you know exactly what you’re dealing with.” Somehow, her words were reassuring. Not that I wanted to be reduced to a label, but having a name for my condition was the beginning of my journey to look for answers and to get better.

Most people still perceive the therapist’s or psychiatrist’s clinic as a zone of last resort. Worse, getting professional help is offhandedly dismissed as an affliction that only hits the middle or upper class.

Areas for reform

With the considerable lack of public health and policy infrastructure to deal with the increasing need for mental illness treatment, most Filipinos are left to their own devices instead of seeking professional help. Admittedly, a trip to the psychiatrist or to the therapist, including medication, can set one back up to several thousands of pesos.

“You’re bipolar," the doctor told me. “Now at least it has a label, and you know exactly what you’re dealing with.” Somehow, her words were reassuring. Not that I wanted to be reduced to a label, but having a name for my condition was the beginning of my journey to look for answers and to get better.

The cost of counseling and treatment is not the only factor that sets back most Filipinos from going to doctors to get a professional opinion. Filipino culture encourages coping through social means. Even our language is devoid of nuances for various mental health conditions. And while such coping mechanisms cannot be discounted or done away with, there are instances or cases that require formal treatment depending on the condition. Self-diagnosis can also only worsen one’s condition.

Mental health policy in the Philippines is ripe for reform. Open public discussion by policymakers on mental health can ease the citizenry into more vibrant and critical debates regarding mental illness.

As of writing, the legal regime for mental illness in the Philippines is governed by the Magna Carta for Disabled Persons. The language of the law itself is limiting, as its aim is mainly rehabilitative and welfare-oriented. Legal rights that could empower those suffering from mental illness regarding treatment and other aspects of their everyday life are not well-articulated.

Further, the language used in Philippine law is outdated. It only recognizes the legal category of "insanity" as a catch-all for mental illness. The law fails to recognize that mental illness can exist in a spectrum or in different degrees, since its effects vary from person to person. While some may be rendered legally incapacitated by illness, others remain fully able and competent to live their daily lives.

As a State-party to the United Nations Convention on the Rights of Persons with Disabilities, the Philippines also needs to overhaul the domestic legal framework on mental illness. A specialized law on mental illness is needed not only to comply with international standards, but also to recognize it as a legitimate public health concern. In Europe, for instance, mental health laws emphasize anti-discrimination and patients' rights to make their own choices regarding treatment.

A bill proposing a national Mental Health Act was recently re-introduced in Congress. The bill recognizes the prevalence of mental health issues plaguing Filipinos and the lack of mechanisms and facilities to address such needs. Mental health legislation can help mitigate the stigma surrounding illness by bringing the conversation to a more serious yet accessible level.

Openness, acceptance

Change in legislation can only go so far as to change society’s attitudes towards mental health. A victory within the halls of Congress could in the end be empty and hollow if the dialog is contained within formal institutions.

Conversations should start within families and other social circles, where help is within reach. And while the law and medical treatment can be allies in treatment and rehabilitation, liberation from the shadow of stigma and discrimination should begin in the basic units of society.