Ruth Arellano-Bordado
V Medical Specialist III, National Center for Mental
Health
In the Philippines, one of the factors
in the development of mental health services is the report presented
in the World Health Organization (WHO) Collaborative Study on
Strategies for Extending Mental Health Care last 1984. It provided
several recommendations including that the government should take all
the necessary steps to improve mental health (MH) care at every
organizational level especially at the community level through the
integration in the primary health care (PHC) services and provision
for the appropriate mental health training of health care
professional and psychotropic medicines at the primary level. In
regards to these, the Department of Health (DOH) and non—
government organizations and institutions started conducting training
on MH among PHC workers. Pilot areas with integrated MH services in
their primary care level were established. Some of these areas
continue to provide MH services such as outpatient consultations and
provisions of psychotropic medicines while other areas eventually
discontinued the service. However, the progress of spreading the
integration nationwide was slow. Until 2014, after the devastation
caused by typhoon Haiyan in November 2013, the government and
humanitarian partners worked together on recovery operation. WHO and
Health partners focused on several health concerns including
neuropsychlatrlc disorders particularly on emergency MH and
psychosocial conditions. To insure access to MH care, WHO conducted
core and supplemental training on Mental Health Gap Action Program
(mhAP) for primary health care doctors and nurses
in the Visayas particularly the whole tastern Visayan region. These
led to region wide spread of integration of MH health services
including emergency services in the local government hospitals. In
addition, during the same year, under the “Aquino Health Agenda”,
a strategic planning of MH stakeholders was conducted by the DOH
National Program Management Committee on Mental Health (NPMC- MH),
under the Office of Special Concerns which resulted to the
development of breakthrough goals for 2014 to 2016, one of which was
to increase the number of provinces with integrated mental health
services in the primary health care (PHC) system including Camiguin
Province, Eastern and Western Samar, lloilo province, Bohol, Mindoro,
Tarlac, Cebu, Zamboanga and Quezon province. The second breakthrough
goal is to increase the percentage of tertiary hospitals with an
outpatient psychiatric clinic and/or Acute Psychiatric Unit (APU) to
100% by 2016. In light of the second breakthrough, documentation was
done last December 2014 to June 2015 regarding the integration of MH
services in selected areas of the country. The selection was based on
the breakthrough goal developed by DOH, literature reviews and
recommendation of expert statisticians, researchers and
psychiatrists. Integration of MH services in the PHC system of 2
municipalities, 2 cities, a province and a region were documented
based on the following issues: mental health services available in at
the PHC, financial aspect, governance, monitoring and evaluation and
challenges and gaps encountered. The documentation showed that the MH
services integrated in the PHC are outpatient consultations and
provision of free psychotropic medicines. Although some areas
provided psychosocial rehabilitation programs, referral services and
family support. For the financial support, during the integration
process, some areas received financial support from the local
government units (LGUs) and non-government organizations (NGOs) such
as WHO and Christoff Blinden Mission. DOH played a vital role in the
provision of psychotropic medicines
through the Medicines Access Program.
Governance or management of the integration is under the LGU and the
NGOs. For WHO, it provided for the training on MHGap and initiated
the integration, later on it transferred the management to the DOH
regional office and local government units. For the monitoring and
evaluation, areas under the NGOs and National Center for Mental
Health have monitoring and evaluation reports. The following are the
challenges and gaps encountered during the integration including
fragmentation of health services, LGUs political divisiveness, low
budget allocation, inaccessibility of the area, cultural beliefs and
few trained PHC workers on MH. There is no standard or best model in
the integration of MH services in the PHC system in the Philippines.
However, all these areas showed that the integration was initiated to
make MH sen/ices accessible. It also showed that collaboration
between LGUs and other mental health stakeholders helps in the
sustainability of the provision of MH services in the PHC. At
present, according to DOH, there are 11 provinces with integrated MH
services in the PHC system and still increasing. Finally, at present,
integration of MH services in the PHC is being supported for a
nationwide dissemination since it has been proven to be beneficial to
persons with mental disorders, PHC workers and the communities.
reference:
8th National Congress of Indonesian Psychiatric Association
15th Asean Federation for Psychiatry and Mental Health Congress
25-27 August 2016, Semarang - Indonesia
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