Povertyand Mental Health:Accessand Attitudes Towards Treatment Submittedby:SusanetteAngelique E. Cruz17January 2017Schoolyear 2017-2018IntroductionThePhilippines is a developing country where it comprises of three main islands,Luzon, Visayas and Mindanao. With its 7, 107 islands that spreads to 132, 006miles of land area, it is the home of 100, 981, 437 Filipinos. (PhilippineStatistics Authority, 2015). According to the same source, more than 26 millionof Filipinos remain poor with almost half or more or less more than 12 millionwho are living in extreme poverty. It is one of the populous countries where ithas a population density of 249 people per square kilometer (Conde, 2001).
Asmall percentage of the national budget is allocated to health care which isonly 2-3% of the overall budget which is below the suggestion of the WorldHealth Organization (WHO) for developing countries such as the Philippines.There is a great impact in terms of poverty on the health as a whole of Filipinosthat is noticeable on the malnutrition and other leading causes of illness thecountry. Malnutrition is one of the main cause of mental health disorderespecially to kids that can lead to intellectual impairment on a developingchild. Primary health care is important in anydeveloping country where in focuses on providing essential health care which isbasically every human beings right.
It is the kind of health care that isdemanded in a certain population. It is highly required and needs the activeparticipation of the community itself and family (WHO, 1978: Declaration ofAlma-Ata). Mental health care is providing medical assistance such asdiagnosis, treating mental health and putting in strategies in preventingmental health disorders to worsen and making sure that quality mental healthcare providers are trained properly (WHO, 1990). LAMICor also known as Low-and-Middle Income Countries are distributed all over theworld namely, all of Africa, Asia, Europe and some island states of thePacific. Almost more than 80% of the population of the world lives in the LAMICarea, only 6% from that population (Saxena, S., Paraje, G.
, Sharan, P.,Ghassan, K., & Sadana, R. 2006) have been published from these countries.Step should be taken into consideration in terms of establishing Mental HealthCare facilities in areas in the LAMIC in order to develop and improve theresearch facilities and disseminate mental health.
Astudy on mental health on four developing countries (Harding, T. W., De Arango,V.
, Baltazar, J., Climent, C. E., Ibrahim, H. H.
A., Ladrido-Ignacio, L., &Wig, N. N. 1980) showed that primary health care practitioners in thesecountries observed mental health disorders with their patients. Though only aminority has been observed, 13% from the overall frequency of the study or 225cases from the 1,624 patients were suffering from mental disorders, it isessential to improve and develop their diagnostic skills in order to provide abetter service and expand the study to a larger scale. Interaction with thecommunity is also an important factor in treatment in order to change theattitudes towards mental health that people may be helped. Differentinterventions were also taken into consideration where different teams whichincludes training of health care professionals, supervision of all tasks,supplication of drugs to be used and the participation of the communityinvolved (Harding, 1978; WHO, 1979)Accordingto Dr.
Lourdes Ignacio in an interview of Philippines Star stated that, “withthe country hitting the 110 million population rank, the number of Filipinoswho have mental health problems could reach 28.48 million”. Based from thesurvey conducted by UP – Philippine General Hospital conducted at Visayas formore than 20 years ago, a staggering 36 percent of the population there suffermental health problems (Ignacio, 2017). Ignacio also emphasized that afterconducting surveys at municipalities, especially the cities hit by the typhoonYolanda way back 2013, and the amount of Filipinos who lost their homes,families, etc. developed mental illnesses such as depression after thetraumatic event.
Approximately 5% or only 4.45 million out of the more than 100million population rank cases have been detected and been given mental healthcare. It was also found out that sectors where in overseas Filipino workers,residents who have been hit by a tropical storm and lost a lot, and familieswho extreme and abusive parents tend to develop mental health disorders becauseof the extreme measures they have been exposed to. That being said, with therising number of population in the Philippines also means that the risingamount of Filipinos who have mental health disorders will continue to rise inthe next few years and if not given the proper treatment could lead tochaos. Depressionis one of the leading causes of burden in the world (Patel V., 2007). It is atopic that is widely researched on but not in areas in low-and-middle incomecountries.
Students who are experiencing mental disorders are suffering insilence and at the same time, placing their academic and social factors atrisk. Prevention especially at young adults should be prevented at all costs.Financial factors, peer relationship and parental relationships should be takenin consideration in conducting studies because they are the ones who are atgreatest risk of depression in the country according to the results of thestudy (Lee, R., Sta. Maria, M., Estanislao, S.
, & Rodriguez, C., 2013).Alcoholconsumption has been rampant in the Western Pacific Region is rising in analarming rate with a percentage of 75 at an average of two to three times aweek. (WHO). That being said, it is observed that there is a poor and not goodawareness of the harmful side effects of alcohol abuse in the country. It wasalso observed that the youths are now drinking at an early age than theprevious generations.
It has become a norm in the society today. In MetroManila, it was observed that students that was part of the study resulted withalmost the same percentage of alcohol users of High School students in Westerncountries (Pagkatipunan, 2017). Despite it being from different from CollegeStudents in Metro Manila and High School students in other countries, they arethe same in terms of age. ‘Every single suicide is still a tragedy..
. The message wewant to pass on is first of all, having suicidal thoughts is nothing to beashamed of,’ (Gundo Weiler, WHO, 2016). The Department of Health launched anational hotline last September 13, 2016 that will help provide initial helpfor people suffering with mental health concerns. It is a 24/7 project releasedby the government in order to address people who are suffering depression andsuicide. The Philippines is places in the 150th position in a listwhere 170 countries are included in dealing with suicide. The suicide rate inthe country is 2.
9 in a population of 100,000 (WHO, 2012) which indicates thatsuicide is really happening and a threat to each Filipino. There are 7.76 hospital beds and .41psychiatrists per 100,000 of the general population in the public sector in thePhilippines. The ratio of psychiatrists per general population working inmental health facilities that are centered in the largest city is 3.21psychiatrist per 100,000 of the general population which all together is 11.79%of the country’s population (WHO, 2007). Last 2005, only five percent of thefunds of health care provided by the government is directly funded to mentalhealth which are still divided into subparts in which 95% are spend on theoperation of the facilities, maintenance and salary of the employees of mentalhospitals.
The Philippines as a whole, has the means of providing mental healthcare to its citizens. According to the report of WHO last 2007, there are 2mental hospitals, 46 outpatient facilities, 4 day treatment facilities, 19community based psychiatric inpatient facilities and 15 community residentialfacilities. The number of people working in these facilities has the total of2,900 which includes 353 psychiatrists, 141 doctors not specialized inpsychiatry and 769 nurses (WHO, 2007).
This is a big number but needs moreadvocates and facilities to accommodate the general population of thePhilippines especially the ones living in poverty who cannot afford to go andbe diagnosed. In the year 2017, it has recently been approved by the House ofRepresentatives and the Senate the bill that would protect the rights of thepeople suffering from mental health conditions. The approval of the house billnumber 6452 also known as the “Comprehensive Mental Health Act” also indicatesthat every person has the right to access and undergo treatment to “the bestavailable” mental health care in the country. This is a big step forward in thesector of mental health advocates for a better knowledge, service and understandingfor people who are suffering with mental health disorders. Mental health is not a norm and isjust recently being discussed topic in the Philippines. According to a study,Filipino-Americans prioritize mental health care the least compared to otherAsian-American people (Abe-Kim et al.
, 2007; Gong et al., 2003; Ying & Hu,1994). A survey conducted on Filipino immigrants and American-Filipinoimmigrants showed that only 3% out of 2,285 participants asked for help intheir mental heal issues such as emotional problems or distress. Thecontroversial issue of Mental Health could also lead to stigmatization whichaffects an individual that discourages him in seeking out for help in terms ofmental health issues. Hiya is part of the Filipino culture which adds on thestigma that makes it hard for Filipinos to reach out for the fear of beingjudged.
Hiya in a sense of painful orhurtful emotion based from real or imagined scenarios of social norms orauthority figures, and its avoidance of having to interact with society(Bulatao, 1964). Hiya has not been directly studied before, but loss of face whichis almost at the same has been researched on (Abe-Kim et al., 2004; David,2010; Gong et al.
, 2003). Loss of face is described as threat or loss of anindividual’s social integrity, which relates to the social standing orrelationship of an individual to another person (Zane and Yeh, 2002). ForFilipinos, the results of loss of face showed that there is a positivecorrelation between the intent to seek face-to-face and online counseling Theresults indicates that Filipinos have a negative attitude towards the idea ofcounseling but positively negate the stigma by seeking help and receivingpsychological help online (Bello et al., 2013). Filipinosmay not be accessing mental health facilities because of its unavailability tothe public and that there is stigma by society (Tuliao, 2014). The mentalhealth facilities are mainly placed in urban and major cities in the countrywhich not all has access to it and the ratio between practitioners andpopulation is below average (WHO).
Lastly,the culture of ibang tao is very evident for Filipinos because they tend toseek help from lay networks rather than mental health care professionals (Abe-Kimet al., 2004; Bunagan et al., 2011; Gong et al., 2003; Hechanova et al., 2011;Thompson et al., 2002) which can be explained by one of the core values ofFilipinos: kapwa. Kapwa is described as treating other people as human beingsand as a belief that surpasses laws, avoid conflicts, and the simplisticIndividualism–Collectivism dichotomy (Pe-Pua & Protacio-Marcelino, 2000).Although it is described as treating others as human beings, it is stilldivided if one is labeled as Ibang Tao (outsider) or Hindi Ibang Tao(one-of-us).
Interactions between the patient and the professional varies onhow he is viewed by the patients (Pasco, Morse, & Olson, 2004) which is oneof the problems why Filipinos do not tend to seek professional help. It isexpected from practicing professionals in the Philippines to practicepakikipagkapwa-tao or pakikisa (oneness) which is highly valued by theFilipinos in order to be called ‘one-of-us’. Being sensitive to the patient(marunong makiramdam), share inner perception (concomitant skill pakikiramdam),fostering trust and avoiding being rude to the patient are valued traits byFilipinos (Pe-Pua & Protacio-Marcelino, 2000).
Filipinos have the tendencyfor indirect communication styles, and are highly sensitive to non-verbal cuesto be able to ‘feel for another’, is deeply- rooted to its practice. Mentalhealth care professionals generate trust among Filipinos by communicating non-verbalbehaviors and being sensitive to voice intonation when interacting withpatients. The Current StudyTheaim of the study is to provide mental health care awareness to the public in adeveloping country such as the Philippines which is home to over 26 millionFilipinos who are living in poverty. Inorder to successfully raise awareness and achieve the goals of the study, it isimportant to gather enough data to show how people living in poverty in thePhilippines see mental health care and their attitudes toward it. References:Abe-Kim,J.
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