Mental Health Help-seeking Behaviors and Attitudes in The Philippines

Abstract

Mental health situation in the Philippines has been deeply influenced by diverse culture from people during the pre-colonial era, Spanish and American colonization, and Japanese occupation that transpired in the past. This study aims to answer the problem of reluctancy of Filipinos to seek help from mental health problems. The factors such as economic factors, cultural beliefs, stigma, and family support system were identified to know whether it affects the mental health help-seeking behaviors and attitudes of Filipinos. The result showed that these factors also affected the underutilization of mental health services in the Philippines.

There were limitations in the study such as lack of existing studies about the topic and lack of Filipino living in Philippines as the sample study of the existing research papers.

Keywords: mental health; mental health help-seeking; stigmaIntroductionHistorical overview.

Introduction

The mental health situation in the Philippines has been deeply influenced by the diverse culture from people during the pre-colonial era, Spanish and American colonization, and Japanese occupation that transpired in the past. During pre-colonial era, Filipinos had believed that mental illnesses were initiated by natural or supernatural forces since there were not much information available regarding these phenomena at that time.

The Spanish, on the other hand, has introduced us Roman Catholicism and rituals which then on attributed to how Filipinos back then explain mental illness and conditions. Moreover, during the Spanish regime, it was also believed that psychological disorders and abnormal behaviors were influenced by supernatural forces such as gods, spirits, and deities, or individuals with supernatural powers such as mangkukulam, who uses wicked chants and incantations to get back at someone while pricking dolls, and mangagaway, who curses people with illnesses. (Samaniego, 2017; Tuliao, 2014;).

The first-ever institutional care unit for mentally ill was also established in Hospicio de San Jose. The facility was mainly run by nuns and one physician. It was only during the American colonization that mental disability was finally coming into light and being considered as medical illness. The Insane Department of San Lazaro Hospital, under the Bureau of Health, was the first hospital that specifically provides services for the mentally ill people. Lastly, during Japanese occupation, treatment-wise, electroconvulsive therapy became the foremost therapeutic modality using antiquated Japanese apparatus, followed by using local medicinal herbs. (Samaniego, 2017; Conde, 2004)

Current Mental Health Situation in the PhilippinesIn 2004, World Health Organization had reported that there were 4. 5 million of cases of depression in the country but only three percent of that were clinically diagnosed. Among those three percentage of reported cases of depression, only one third of which will seek help while the others will suffer from the symptoms while not knowing what is wrong with them or be ashamed and reluctant to seek help (as cited by).

According to Philippine Statistics Authority (2013), there were 16 per 1000 population who had disability including mental disability. In 2007, a study by Department of Health revealed that 15 out of 900 teenagers commit suicide. The WHO-Assessment Instrument for Mental Health Systems (AIMS), on the other hand, revealed that schizophrenia, mood disorders, and substance abuse disorders were the top three most frequently diagnosed cases in all mental health facilities in Philippines.

Then, the pioneering, seven-nation, World Health Organization (WHO) Collaborative Studies for Extending Mental Health Care in General Health Care Services in 1980, conducted in three primary health centers in an urban slum in Manila, revealed that 17% of adults and 15. 67% of children had mental disorders (Climent et al. 1980; Harding et al. 1980; Ignacio 1984 as cited by Tuliao, 2014).

The previous author also stated that according to the roster of specialist psychologist of the Psychological Association of the Philippines, there are 98 assessment psychologists, 114 clinical psychologists, 82 counseling psychologists, and 24 developmental psychologists that are presumed able to provide psychological assessment and intervention. On 20th June of 2018, President Rodrigo Duterte has signed and approved the Republic Act No. 11036 or “Mental Health Act. ” It states that “it affirms the basic rights of Filipinos to mental health as well as the fundamental rights of people who require the mental health service. ”The problem identified in this study was the reluctance of Filipinos living in the Philippines to seek professional help for mental health problems. Most mental health facilities and institutions are situated in National Capital Region which keeps them inaccessible to families who are living far from the city.

On the other hand, resources for mental health were also very limited. Only 5% of the overall health expenditures of government is allocated for mental health; of this amount, 95% is spent on running mental hospitals. The national social insurance scheme, PhilHealth, covers mental disorders but is limited to acute inpatient, according to the WHO-AIMS (2007).

The main objective of this paper was to identify the factors influencing the mental health help-seeking behavior and attitude among Filipinos living in the Philippines. This paper also aims the following:1. To relate these factors to utilization of mental health services in the Philippines, and 2. To provide recommendations for further studies in the Philippines. The importance of this study is to educate the possible readers such as educators, parents, and mainly, youth about mental health situation in Philippines and to promote the culture of mental health help-seeking in Philippines.

However, there were limited existing studies regarding about mental health help-seeking among Filipinos that were done in the Philippines. Thus, this study will include information from studies done outside the country, that will potentially and hypothetically answer the factors influencing the mental health help-seeking behavior and attitude among Filipinos living in the Philippines and data from World Health Organization will provide information about utilization of mental health services in the Philippines.

Mental Health Services in Philippines

In Philippines, there are four general professions that are recognized to provide health services: guidance and counseling practitioners guidance and counseling practitioners (Guidance and Counseling Act of 2004); psychologists (Philippine Psychology Act of 2009); social workers (Republic Act No. 4373 (1965)); and those within the umbrella of the medical profession. According to the WHO-AIMS in 2004, the country has 46 outpatient mental health facilities available of which 28% of that were being used by children and adolescents only.

There were 24% outpatient facilities that provides follow-up care in the community while only 11% have mental health mobile teams. Meanwhile, psychotropic medicines of each therapeutic class (anti-psychotic, antidepressant, mood stabilizer, anxiolytics, and antiepileptic medicines) were available to all mental health outpatient facilities or pharmacy stores all year round. Moreover, the Philippines has only one psychiatrist for every 250,000 mentally ill patients, far from the ideal ratio of one to 50,000 patients. In Metro Manila, one private session with a psychiatrist will cost the patient 2000 to 3000 Philippine Peso (Php) in National Center for Mental health in Mandaluyong.

Stigma on Mental Illnesses

A study by Corrigan (2004) discussed how public stigma (a phenomenon where public impose a prejudiced to certain group of people) can potentially harm people who are labeled as mentally ill. This prejudice could strip important life opportunities from these people. He also stated that mentally ill-labeled people are frequently unable to land a good job and find it hard in keeping it.

In a study by Tuliao (2017), self-stigma or private stigma is said to mediate the relationship between public stigma and attitudes of seeking professional help. The lack of promotional programs on mental health contributes to a high stigma in the country. The derogatory terms such as “abnoy” and “baliw” were easily used to conversations between people (Rivera and Antonio, 2017) The stigma exist in school or work settings and the attitudes toward people with mental illnesses are also shown with humor or hatred.

According to Tuason, Galang-Fernandez, Catipon, and Carandang (2012), “present-day counseling still shows the vestiges of time-honored modalities that involve superstition and reliance on elders and traditional healers when addressing what the West would consider psychological difficulties. ” One study by Tan in 2008, documented how the physical and psychological illnesses are deemed as the effect of a curse from “violation of strict family values” or caused by God’s curse. These illnesses were also believed as an evil act resulted from engaging in delusions. In rural areas especially, there’s still that spiritual aspect tied to mental health, the belief that these disorders are a result of other-worldly spirits or witchcraft.

Family Support System

According to Abe-Kim et. al (2004) and Gong, et. al (2003), Filipino-American usually seek help from family and friends (which is also called lay system) or their general medical practitioners. Ilagan (2016) discussed how Filipino-American family’s support system was dependent on caring and reciprocity. He also stated that family support system is a primary way to cope up with emotional problems and mental illnesses. Support system from the family also plays a role in help-seeking behaviors and mental health care utilizations.

In Tuliao (2014), ibang tao is defined as being an outsider, while hindi ibang tao is defined as being ‘one-of-us’. Additionally, it has been suggested that for Filipinos to fully openup and express their emotions in therapy, a mental health professional needs to be seen as hindi ibang tao. Health care providers who are respectful, approachable, and are prepared to adapt and assist with the patients’ needs are perceived to be hindi ibang tao (Ilagan, 2016).

Conceptual Framework

The conceptual framework envisions how stigma, economic factors, and family support system affects the behavior and attitude of Filipinos with regards to mental health help-seeking. Mental health in this paper, as defined in RA 11036, refers to the “state of well-being in which the individual realizes one’s own abilities and potentials, copes adequately, with normal stresses of life, displays resilience in the face of extreme life events, worked productively, and fruitfully, and is able to make a positive contribution to the community. ”

Mental health services, on the other hand, refers to “psychosocial, psychiatric, or neurological activities and programs along the whole range of mental health support services, including promotion, prevention, treatment, and aftercare, which are provided by mental health facilities and mental health professionals. Data on utilization of mental health services were obtained from the WHO-AIMS (2007) while the data for the factors influencing the mental health help-seeking behavior and attitude of Filipinos were obtained from the study by Tuliao (2014).

A historical overview of Philippines and current mental health status were also provided to give context to readers. Thematic analysis was used to discuss the results of the study. Second, the possible role of the current state of mental health services regarding the reluctance to seek professional help will be discussed. Finally, this paper will explore the role of cultural factors, such as family support system, and stigma regarding interpersonal relationships.

Results and Discussions

Based from the results gathered from different studies, the major themes were derived to answer the research questions in relation to mental health help-seeking in Filipinos. The themes were the following: Stigma and Utilization of Mental Health Services“Stigmatization of the mentally ill is a dilemma found in several cultures that serve as barriers in seeking psychological treatment. The way culture shapes attitudes and behavior s towards the mentally ill (public stigma) gets internalized, which subsequently results in low self-efficacy, shame, and reluctance to seek treatment.

Hiya and loss of face are cultural values that aim to preserve one’s integrity and to avoid real or imagined social transgressions. Hiya and loss of face, therefore, can hypothetically further compound reluctance to seek psychological help especially when the culture deems mental illness as an aberration. ” (Tuliao, 2014) Results also from Ilagan (2016) showed that one participant was concerned about shame and stigma. She stated that it would be the last resort (seeing mental health professional) if faced with difficulty.

Cultural Beliefs and Utilization of Mental Health Services

Culture also plays a big role in shaping attitudes and social interactions with individuals with mental illness, as well as in its treatment (Abdullah & Brown, 2011). This increases the Filipino’s reliance on traditional and folk healers which are more accessible and cheaper than mental health professionals. Beliefs about the origin of illnesses regarding natural and supernatural forces which could influence the intent to seek with traditional and folk healers.

Economic factors and Utilization of Mental Health Services

Filipinos may not be accessing mental health services because it is inaccessible and prohibitive. As previously discussed, most of mental health professionals and facilities are in the urban areas, mostly in National Capital Region, and the ration of professionals to population is below the minimum standards (WHO). Professionalization of counselors and psychologists is also in early stages. In Metro Manila, one private session with a psychiatrist will cost the patient 2000 to 3000 Philippine Peso (Php) in National Center for Mental health in Mandaluyong.

Family Support System and Utilization of Mental Health Services

Results from Ilagan (2016) showed the emphasis on importance of having support system with regards to coping up with emotional problems, mental illness, or difficult times. The author also said that if a good support system exists, then the person would not need immediate help from professionals. Furthermore, in a survey of 359 Filipino college students in the Philippines, few people in their lifetime sought professional help for an academic or non-academic problem and there was a higher preference to seek help from friends and family member than professional counselors and psychotherapist. (Bello, Pinson, & Tuliao, 2013; Bunagan, Tuliao, & Velasquez, 2011).

Conclusion

The researcher was able to gain further knowledge about the topics and was able to identify some of the factors that contributed to mental health help-seeking attitude and behavior of Filipinos. The factors that emerged on the study were the following:

1. stigma,
2. cultural beliefs,
3. economic factors, and lastly
4. family support system.

The study also showed that these factors are contributed negatively to the menta health help-seeking behaviors and attitudes of Filipinos. It factors also contributed to the underutilization of mental health services in Philippines.

Recommendations

Since there were limited studies available regarding this topic, future researchers should make a study with Filipino participants living in the Philippines. Most of the studies mentioned and discussed here had samples study of Filipino-American and Filipino-Australian descent living outside the country. The future researchers could also researcher more about the factors that could affect the mental health help-seeking behavior and attitude of Filipinos.