OP-ED EDITORIAL | Beyond mental health insurance

The Philippines has come a long way from its conservative mindset over mental health. Now, it’s not only openly discussed but has become part of the national conversation and agenda with policymakers recently considering the inclusion of mental health care under the coverage of the Philippine Health Insurance Corp. (PhilHealth).

Consultation and medical costs for mental illness can be prohibitive and Filipinos who are confronted with more urgent needs like putting food on the table are likely to ignore the problem than address it. This is why this proposal to include mental health care under PhilHealth’s medical insurance packages is a welcome move.

Widespread awareness and understanding of mental health have encouraged more and more people to become proactive in seeking professional consultation. But this has also led to an increase in reported cases—a good development nonetheless because it means the public is now more open to seeking help for their mental health issues.

Shortage issue

The drawback is the severe lack of mental health professionals, i.e., psychiatrists and psychologists, a crucial aspect that government must look into immediately before it can put in place any PhilHealth coverage.

This shortage issue, recently raised by former vice president Leni Robredo who chairs the nongovernmental organization Angat Buhay that offers medical “teleconsult” (E-Konsulta), is a huge barrier to making mental health services more accessible. Robredo noted that while there are many volunteer counselors for their online consultation service, they cannot extend further help to patients because they are not licensed to issue prescriptions. Unlike COVID-19 and other illnesses that a one-time consult can cover, mental illness requires several follow-up sessions. Because of a lack of enough psychiatrists and psychologists, there is a six-month-long wait list for patients, which is not ideal for an illness that requires immediate attention as negligence could lead to a tragic outcome for the patient.

Dismal conditions

Aside from a shortage of professionals, the country does not have enough mental health care facilities, and existing ones are poorly maintained. Just look at the National Center for Mental Health (NCMH) whose patients were found to be staying in dirty and crowded rooms. Last year, the Senate launched an investigation into the dismal conditions at NCMH, but no findings or solutions have been made public so far. An institutional report could at least spur the Department of Health (DOH) and other stakeholders into action including identifying those accountable for the lapses and negligence as well as improving the facilities.

Data provided by the DOH show that there are only 651 psychiatrists, 516 psychiatric nurses, and 133 psychologists nationwide, while there are at least 3.6 million Filipinos who suffer from mental, neurological, and substance use disorders as of 2020. In addition, according to a study published last February on the National Library of Medicine website, the Philippines only has 4.13 mental hospital beds compared to the recommended 60 psychiatric beds per 100,000 population.

Increasing mental health cases

The DOH said it was working on these gaps and expects to finish training 2,548 health personnel from 1,259 rural health units on mental health and psychosocial support services—by end of the year. But there is hardly time to wait given the rising number of mental health cases especially in schools. The Department of Education reported that 404 young students in various parts of the country took their own lives, 2,147 others attempted suicide, and 775,962 sought the assistance of guidance counselors during Academic Year 2021-2022 when most schools were closed because of the pandemic. The transition to in-person classes in late 2022 was expected to put more strain on students, thereby likely increasing cases of mental illness. But schools, just like hospitals and health centers, also lack mental health professionals.

Designed for optics

No doubt the country has progressed in raising awareness for mental health but this cannot be considered an accomplishment without offering adequate health-care services. To do so, the government must first improve facilities and address the shortage of mental health professionals, and equally important, ensure that they will be compensated properly. The last thing the government wants is to see an increase in the number of disgruntled health-care workers who are forced to beg for just compensation or leave the country for better work prospects overseas.The inclusion of mental health care under PhilHealth is indeed a timely response to modern world realities and must be pursued, but without government putting in place the conditions cited above, it will most likely end up as another problematic, under-supported program primarily designed for optics and not for the public’s well-being.