Reiner W. Gloor
IN HONOR of International Women’s Month, which just ended, we continue our story on particular health issues plaguing women today. But this time, we focus on mental health. According to the World Health Organization (WHO), despite being common, mental illness remains underdiagnosed by doctors. Only two in every five people experiencing a mood, anxiety, or substance use disorder seek assistance during the first year of onset. In a developing country like ours, where lack of education and awareness on these types of health issues intersect with a lack of proper resources, mental health is hardly prioritized.
According to an article in the Asia Pacific Journal of Counselling and Psychotherapy entitled “Mental health help seeking among Filipinos: a review of the literature” by Antover P. Tuliao, from an economic and contextual perspective, Filipinos may not be accessing mental health services because it is inaccessible and prohibitive. Most of the mental health professionals and facilities are located in the major cities, plus the ratio of the professional to population is below the minimum standards set by the WHO. Professionalization of counselors and psychologists is also in its early stages. This increases Filipinos’ reliance on traditional and folk healers, who are more accessible and cheaper than mental health professionals.
The same article found that when psychological distress was believed to be social in nature, Filipinos resort to their immediate circles for support, whether friends, family or other trusted persons. There are also fears of hiya or loss of face, which is a culture-specific hindrance and can hypothetically further compound the reluctance to seek psychological help, especially when the culture sees mental illness as abnormal. There are also social interaction norms that can influence who Filipinos seek for treatment of psychological distress. In other words, for Filipinos to see mental health professionals, they need to be viewed as familiar and trustworthy and not just “other people.”
These all pose a peculiar problem, especially for Filipinas. Studies have shown that biological factors do play an important role in mental illness. Women have lower serotonin levels than men and also process the chemical at slower rates which can contribute to fluctuations in mood. Females are generally more predisposed to hormonal fluctuations as well. And women are traditionally the recipients of all kinds of abuse that can trigger mental illness.
The WHO says women are two times more likely than men to develop certain mental health conditions such as depression, eating disorders, and panic disorders. Women are also two to three times more likely to attempt suicide even if four times more men die from suicide.
It is important for women to look after their mental health. Women traditionally take on the role of taking care of their families, making sure they are fed, clothed and sheltered. They also take on the burden of being caregivers when any of their family members are ill. This places women who care for their families in a position where they are more likely to suffer from anxiety or depression than women in the general population.
Women who juggle multiple roles are vulnerable, too. They may be mothers, wives, partners, caregivers or any combination of things, overwhelmed with meeting everyone else’s needs, and, oftentimes, neglecting their own. Those who are in low income and low status jobs or live in poverty tend to feel even more isolated and helpless. Not to mention, victims of physical and sexual abuse which can have long-term impact on mental health.
The WHO report on the Mental Health System in the Philippines says there is a bright side. It is apparent that the elements necessary for pursuing an effective mental health program in the Philippines are in place. The major resource in the country is a highly literate population that values education and personal development. Academic institutions and training centers have developed good programs to educate and develop mental health human resources, specifically psychiatrists, psychologists, social workers, nurses, and allied mental health professionals. These have developed a multidisciplinary group of professionals to address the mental health needs in the country, and have broadened the scope of the national mental health program. In some ways these changes have advanced the understanding of mental health disorders so that other agencies have initiated mental health programs relevant to their special needs.
The challenge is in motivating these professionals to stay in the country and sustain their involvement, especially in the community setting, because the country is continuing to lose this valuable and crucial resource to overseas employment.
But there are also more areas that can be improved. Only 5% of the country’s total health budget is spent on mental health (most of which go to operation and maintenance of its mental health hospitals). The existing mental health facilities are situated mostly in major cities, making it difficult for those in far-flung areas to get the help they need. And the Philippine Mental Health Act, filed by Senator Loren B. Legarda in 2014, has yet to be passed.
While there are many nongovernment groups that have been addressing mental health awareness and education, such as the Natasha Golbourn Foundation, the Philippine Psychiatric Foundation, and the Philippine Mental Health Association, among others, it is clear that there needs to be concerted effort involving government to move the mental health program along.
We have the highest incidence of depression in Southeast Asia, according to the WHO, and I am sure that is just the tip of the iceberg. It would be to everybody’s benefit if the law were passed and the proper resources devoted to enacting it. After all, investing in the mental health of all Filipinos means a more resilient and competent nation, able to withstand adversity and move forward to continued progress.