As the number of the infected swells and threatens to overwhelm the healthcare system, the country’s medical frontliners have wisely called for the reassessment and reform of what passes for the Duterte regime’s anti-COVID-19 strategy. But they did not include in their proposals the need to address the possibility that we may also be in the middle of a mental health crisis that will quite possibly have a long-term impact on Philippine society. The physical and mental well-being of its people is after all among a nation’s chief assets, since only mentally healthy citizens can function as productive and responsible members of the community.
As entire economic systems break down, and recessions and even a repeat of the Great Depression of the 1930s become more and more likely, not only unemployment and want have distressed millions in the heels of the COVID-19 crisis. Since it declared the contagion a global pandemic last March, the World Health Organization (WHO) has been warning the countries afflicted and the world at large that among its consequences will be a spike in mental health problems. The problems referred to include anxiety disorders, panic attacks, psychoses, clinical depression and even suicidal tendencies.
In its report last May on the extent of the COVID-19 problem and its prognosis for the future, the WHO not only warned that the disease “may not go away,” its Mental Health Department also noted during its virtual conference with health ministers in Geneva, Switzerland that COVID-19 is leading to a global mental health crisis that “has to be addressed urgently.”
The Department Director said that “the isolation, the fear, the uncertainty, the economic turmoil” that are among the consequences of the global pandemic “all cause psychological stress.” As a result, the world should expect an increase in mental illness, especially among children, young people and health workers.
The unique characteristics of the disease, and hence the steps being taken to combat it, make it particularly conducive to mental distress. The quarantine protocols needed to control it, among them working, teaching and learning from home, limiting physical mobility and avoiding crowds, have made the isolation that leads to loneliness, fear, despair and hopelessness the primary condition of existence for millions of people all over the planet. Because COVID-19 can be transmitted primarily through human-to-human contact, even if a vaccine were found, the fundamental preventive means of avoiding the company of others — at times including not only friends, neighbors, co-workers and associates, but even members of one’s immediate family — will continue to be among the preferred approaches to controlling the contagion, as contrary to the basic human need for companionship and social interaction as it may be.
In recognition of the long-term impact of the pandemic on the mental health of the world’s populations, the United Nations has urged governments to improve their capacity “to minimize the mental health consequences of the pandemic” by 1.) “adopting a-whole-of-society approach to promote, protect and care for mental health”; 2.) ensuring “the widespread availability of emergency mental health and psychosocial support”; and, 3.) enhancing citizens’ recovery from COVID-19 by building mental health services for the future.”
The first requires, among others, including mental health concerns in whatever “national response plan” a government may have, and reducing the number of incidents that harm mental well-being such as the “acute impoverishment” of its constituents.
The second includes strengthening social cohesion by helping those isolated at home to stay connected with others, and protecting the human rights of those with mental health issues by making sure they have access to appropriate care.
The third demands raising the capacity of governments to deal with mental health problems by investing in the reform of universal healthcare networks, which among others means including mental health among their priority concerns.
These are only a few of the recommended programs of action the UN recommends; there are several others. But even the implementation of these few is in the Philippines already problematic.
The punitive, arrest-and-jail-them-all orientation of the Duterte regime in dealing with the pandemic not only contributes to the spread of the disease by packing alleged violators of quarantine protocols into the country’s notoriously overcrowded prisons. It even adds to the fear and anxiety of much of the population.
There is also the already “acute impoverishment” of millions of disemployed Filipinos that the regime is unable to remedy due to the many “difficulties” — among them the corruption, inefficiency and sheer incompetence of many of its own officials — it has admitted it has had to cope with in controlling the economic impact of the pandemic on the citizenry.
Filipino psychiatrists have not been remiss in alerting the public and the government to the looming if not already existing mental health problem and have reported a notable increase in the number of consultations during the pandemic. But neither the citizenry nor the Duterte regime seems to regard it with any sense of urgency. Their indifference is consistent with mental health’s being least prioritized in Philippine governance and society. Part of the reason is the persistence of the thinking that those with mental health issues are somehow at fault and are to be shunned, despised, and even publicly humiliated and ridiculed.
And yet the problem is more common than mass and official prejudice seems to assume, and, as the WHO has cautioned, is thus likely to worsen. Even before the pandemic, according to the Department of Health, 5.3% of the Philippines’ 100 million plus population, or more than five million people, were already suffering from various forms of depressive disorders. Some 16% of students in their teens, a WHO study found in 2011, have contemplated suicide, while still others have actually attempted it once or even several times.
Such anecdotal evidence as the incidents of random, meaningless violence, and of individuals’ clambering up billboards and high-rise buildings and threatening to jump from them; the half-naked human derelicts one often sees roaming the streets mumbling to unseen beings; the suicides among the young that have become so common they merit only a casual mention in much of the media; and the fact that many Filipinos have a weird relative or two somewhere whom the family never mentions, support these findings. But the even worse news is that there are only a few thousand clinical psychiatrists in the Philippines, and mental health institutions few, inadequately staffed and funded, and absent in many areas.
It seems only reasonable to expect that in addition to devising effective means to halt or at least reduce the transmission of COVID-19, mitigating the economic impact of the pandemic and recovering from the economic recession, the government should also seriously look into reducing the mental health costs of the current public health emergency.
It can start with implementing what is doable among the steps the United Nations has suggested governments should take. It will admittedly take some doing in this country. But any government aware of its responsibility to protect its citizens and prevent the breakdown of Philippine society should be able to understand that it has no choice but to address the problem before it, too, becomes as widespread and as unmanageable as the social injustice, the mass poverty, the corruption in high places, the oppression and the inequality that, like the threat of COVID-19, haunt this country and its people.
Luis V. Teodoro is on Facebook and Twitter (@luisteodoro).