“‘Pag pupunta ka lang sa psychiatrist, sasabihin ng ibang tao na baliw ka na. ‘Baliw’ agad ‘yung term,” shares Dr. Reggie Pamugas, Vice Chair of Health Action for Human Rights. As someone who’s been in the field for more than 19 years as a community-based physician, Pamugas knows all too well the stigma associated with mental illnesses in a country like the Philippines. From offensive slurs, to brushing off mental health issues with a dismissive “nasa utak lang ‘yan,” to the appalling insufficiency of mental health services, the discussion around mental illness is one that is long overdue.
(If you’ll just go to the psychiatrist, other people will call you crazy. ‘Crazy’ is immediately the term being used.)
(It’s all in the mind.)
And in the time of COVID-19 wherein various systemic issues are exacerbated and mental health services are even more paralyzed, Filipinos are being left behind in more ways than one.
On a medical mission in Samar years ago, Pamugas found himself riding a boat to a remote location to pick up a patient in the middle of a psychotic episode and take him to the city for adequate treatment. Minutes passed, and there was no sign of him. One of his companions came back, saying, “Doc, antay lang konti kasi ‘yung pasyente, hinahabol pa.” The patient had apparently fled into the mountains, and Dr. Pamugas eventually had to leave without him.
(Doc, just wait a bit more, the patient is still being chased.)
He explains that this is a common occurrence in far-flung places, where harmful stigma and socioeconomic inequalities bar people from getting the help they need. “‘Pag pumunta na sa amin minsan, malala na.” says Pamugas, adding that usually, by the time these patients seek professional help, their initial symptoms of loneliness, anxiety, and decreased self-esteem have already worsened into attempts at suicide and self-harm or even violent tendencies.
(Sometimes, by the time they consult us, their condition is already severe.)
For Pamugas, the hallowed narrative of Filipino resilience can actually do more harm than good. A long enduring reality of systemic issues has unresolved problems that have persisted long before the pandemic, leaving a lot of people with no one to turn to but themselves. As a result, it is often that people have to simply carry on and do whatever is necessary to make ends meet.
Not “essential” enough
Although the Philippines passed its own Mental Health Law in 2018, Dr. Ronald Del Castillo, Doctor of Psychology and former professor at the College of Public Health in the University of the Philippines Manila, asserts that there has not been enough progress, and neither has the law been given an adequate budget. “You have this beautiful law,” he expresses, “but then you have very little funding to carry [it] out.” And as if the country’s progress wasn’t slow enough, the government has completely swept mental health under the rug in its COVID-19 response—by not accounting for it at all in the Bayanihan law.
“Mental health professionals are not designated as essential workers,” Del Castillo states, explaining that the lockdown rendered them unable to attend to their respective clinics or institutions. To make matters worse, the majority of mental health services aren’t even covered under PhilHealth insurance. “Many of your colleagues or classmates are now doing online therapy, which is great, but insurance won’t cover it,” he laments.
This leaves many regular patients who depended on these institutions for regular consultation services and medical prescriptions without these benefits. While many have begun offering online psychotherapy as an alternative to physical consultations, it is simply another band-aid solution to a deeper, underlying wound. “That’s also a question of access, right? Because you need internet connection,” he explains. In addition, the online setting does not pose challenges only for the patient but for the professional as well, as it is common for online consultation sessions to be hampered by distorted audio, delays, and other technical issues, which can create more tension and anxiety for the patients.
Even though mental health seems to have recently risen in importance among Filipinos, this development is unfortunately felt only by a privileged few. “If you’re educated,” Del Castillo elaborates, “you’re more probably more open to going [to therapy] versus your peers who don’t have the kind of education that you have.” Especially with how the pandemic has limited access to information and education, the socioeconomic divide will undoubtedly hinder the equal spread of mental health awareness across the country.
Notably, the lockdown has also taken a heavy toll on the daily routines of working mothers and wives, given the traditional role of women in the family as the “ilaw ng tahanan.” Del Castillo elaborates that in the very much traditional culture of the Philippines, “there’s a more gendered view of people’s roles within families, and mothers, in particular, still take up much of that caregiving role.”
Not only do they have to do household chores, but they also have to guide their children through online learning on top of their own demanding jobs. “You’re still taking care of the family or the children,” he says, “and you’re still doing your Zoom meetings and other responsibilities at home.”
Heal as one
The COVID-19 pandemic may have brought much-needed attention to the physiological well-being of Filipinos, but it has left mental health further behind than it was before—proving that mental health has yet to become a priority for both the citizens and their government. “Marami pa kailangan gawin para ma-address ‘yung mental health stigma sa mga Filipinos,” Pamugas bemoans, hoping that the youth will pave the way in creating a future where Filipinos care for their emotions as much as they care for their physical conditions.
(There’s still a lot to be done to address the mental health stigma among Filipinos.)
As the Philippine mental health crisis seems to continue its downward spiral, Del Castillo hopes for readers—especially the younger generations—to protect their mental well-being. Reminding us not to sacrifice health for productivity nor to base our worth on our performance, he contends that “we should be valued because we’re people—period.”