NATIONAL MENTAL HEALTH PROGRAM

Background and Milestones19th Century - Clergy1904 - Insane Department of San Lazaro Hospital1925 - Insular Psychopathic Hospital1928 - renamed National Mental Hospital 1960s- NMH still the only government institution1970s- Baguio and Cebu Units integrated as department of psychiatry in respective regional hospitals

Background and Milestones1986 People Power Revolution - Project Team on Mental Health (Task Force on Mental Health) was created to reform the mental health care delivery system.

In 1988-90, a multi-sectoral consultation led to the organization of the National Program for Mental Health (NPMH) at the DOH.

1999 - The administration implemented the re-engineering of the Dept of Health and streamline the bureaucracy and almost reduced the NMHP to non-existence.

Background and Milestones

Administrative Order No. 8 , otherwise known as the National Mental Health Policy was signed on April 5, 2001 by Sec. Manuel Dayrit

2002 - The current National Mental Health Program (NMHP) was reactivated. It has been placed under the administrative authority of the Undersecretary for Health Program Development Cluster and lodged at the Degenerative Disease Office NCDPC.

Background and Milestones2002 The Dangerous Drug Act of 2002 was passed. Initiatives from the stakeholders to create Bureau of Mental Health and Substance Abuse was considered but situational analysis disclosed factors that made it difficult to institute BOMHSA Initial Draft of AO for the Implementing Guidelines was formulated after series of consultative meetings.

Consultation with experts was done on November 23, 2006, came up with the specific objectives and activities for the respective sub-programs

Background and MilestonesFinalization & Approval of AO No. 2007- 0009

June 28, 2007 the newly created NPMC & PDMT was convened

Mental health service delivery in the Philippines is described as illness-centered, institution-based, fragmented, inadequate and inequitably distributed.

SituationerInternational Studies1% of population have severe mental & neurological disorder4-5% mild- moderate neurological problems alcohol & drug abuse

SituationerLocal studies:36/1000 adults, children & adolescents-Pampanga17 % adults & 16 % of children -Sampaloc Manila Depressive reactions & adaptation reaction.12 cases / 1000 population adult with schizoprenia - Bulacan

SituationerDOH Mental Health resources:Total Bed Capacity 5,465NCR- 4,200 bedsCAR-40Region 2- 200 Region 3- 500Region 11- 200Regions 1,4,10,12,Caraga, ARMM- none27- DOH medical centers- mental health faciltyCavite - only province with mental health facility.Need to train health manpower

Mental HealthA state of well being where a person can realize his or her own abilities, to cope with normal stresses of life and work productively.

Mental ill Health Disturbance in a persons thoughts , feelings and behavior.It affects and is affected by a persons interaction with others, ones environment and even ones own self esteem.

Mental DisorderMedically diagnosable illness that results in significant impairment of ones cognitive, affective or relational abilities and is equivalent to mental illness.

Four Facets of Mental Health ProblemsDefined Burden- Burden currently affecting persons with mental disorders and is measured in terms of prevalence and other indicators such as the quality of life indicators and disability adjusted life years ( DALY).

Four Facets of Mental Health ProblemsUndefined Burden- Burden related to the impact of mental health problems to persons other than the individual directly affected. Felt heavily by the families & communities both human & economic lossMental ill health affects the persons functioning , thinking process, diminishes the persons social role and productivity to the community.Tremendous burden on emotional & socioeconomic capabilities of relatives who care for the patient .

Four Facets of Mental Health ProblemsHidden burden - Refers to the stigma & violations of human rights. A mark of shame , disgrace or disapproval that results in a person being shunned or rejected by others.Generally increases as his behavior differs from that of the norm.

Four Facets of Mental Health ProblemsFuture burden burden in the future resulting from the aging of the population , increasing social problems and unrest inherited from the existing problem.

Mental Health in the Different Stages of Life 18th week fetus reacts to various stimuli passing the amniotic sac such as sound, (music, noise) substances (drugs, alcohol)Infancy- the psychosocial & cognitive development is affected by the absence of the care taker, mother.First Crisis -Trust vs mistrust Consistent mothering is importantMothers living in conditions of stress and adversity

Mental Health in the Different Stages of Life Toddler stage greatly affected by motor and intellectual development .Child learns to master locomotion and impulses.Crisis- asserting independence against shame and doubt.The need for control & firmness on the part of the caretakerNegative exposure & punishment may cause shame & develop self doubt on the child.

Mental Health in the Different Stages of Life Pre school age the child can express complex emotions : love, unhappiness, jealousy and envy which are influenced by hunger & tiredness .Aware of their bodies, genitalia & gender differences .Concept of what they want & need- leads to choices between desire, the need to grow outside the homes & what parents restrict turning parental values into self regulating mechanism ( obedience, guidance & punishment) Milestone- development of conscience

Mental Health in the Different Stages of Life School age Education plays a big role in facilitating the childs well being & healthy social & emotional growth.They should be taught skills to improve their psychosocial competence.Problem solving, critical thinking, communication, interpersonal skills , empathy and coping with emotions. Children & adolescent develop a sound & positive mental health.

Mental Health in the Different Stages of Life Adolescence- psychosocial concerns : acceleration of cognitive development , consolidation of personality formation and development of morals.Adulthood: Very productive age Mental health concern- work related problemsEmphasis- aspects of work process that promote mental health.

Mental Health in the Different Stages of Life Elderly- Aging population is a result of increased life expectancy as a result of improved quality of life Must be able to live their lifes full potential.Healthy older person is a resource for the family, community and economy.

Concerns of Daily LivingPsychological consequences & suffering brought about by :MigrationUrbanizationIndustrializationEconomic policiesPolitical confusionPoverty & abusesVictims of disasterViolence & armed conflict OFWs & children in difficult circumstances are exposed to depressive circumstances

National Mental Health Policy (AO No. 8 s. 2001)

Vision Better quality of life through total health care for all Filipinos

Mission A rational and unified response to mental health

Goal Quality Mental health care

ObjectiveImplementation of a Mental Health Program strategy

(AO# 2007 0009)Operational Framework for the Sustainable Establishment of a Mental Health Program

Operational Framework for the Sustainable Establishment of a Mental Health Program (Administrative Order 2007-0009)It sets forth strategies for national reform from an institutionally-based mental health system to one that is consumer-focused with an emphasis on supporting the individual in their community

Wellness of Daily Living Focuses on attaining and maintaining the well-being of person/s across the life cycle through the promotion of healthy lifestyle with emphasis on coping with stress and other psychosocial issues. (AO# 2007 0009)

Extreme Life Experience Focuses on addressing the psychosocial consequence and maintaining mental health of person/s that experiences incidents that are out of the ordinary such as disasters, epidemic, trauma etc., which threatens personal equilibrium.(AO# 2007 0009)

Substance Abuse and other forms of addiction Focuses on the promotion of protective factors and prevention against the development of substance abuse and other forms of addiction in the following key settings (family, school, workplace, community, health care setting, industry) through existing DOH programs and responsible agencies(AO# 2007 0009)

Mental Disorder Focuses on the promotion of mental health and prevention of mental illness, such as clinically behavioral or psychological syndromes, across lifespan of an individual (i.e. children, adolescents, adults, elderly, special populations, such as the military, OFW, refugees, and PWDs)(AO# 2007 0009)

National Program Management Committee

LGUTMHRMHTPDMT For the Wellness of Daily LivingPDMT for the Extreme Life Experience

PDMT for the Substance Abuse & other forms of addiction PDMT for the Mental Disorder (AO# 2007 0009) Functional Management StructureDDO Secretariat17 Regions79 provinces, 115 cities, 1,495 municipalities 41,956 barangays

Implementing MechanismsNational Program Management Committee

Ensure the development of mental health measures for sub-programs and components;

Integrate the various programs, projects and activities from the various program development and management groups for each sub-program;

Manage the various sub-programs and components of the National Mental Health Program;

Oversee the implementation of prevention and control measures for mental health issues and concerns;

Recommend to the Secretary of health a Master Plan for mental health aligned with mandates and thrust of various government agencies.

Program Development & Management TeamsThe functions of the PDMT are following:

Formulate and recommend policies, standards, guidelines approaches on each specific sub-programs on mental health;

Develop a plan of action for each specific sub-program in consultation with mental health advocates and stakeholders

Develop operating guidelines, procedures, protocols for the mental health sub-programs. Ensure the implementation of the program among all stakeholders

Provide technical assistance to other mental health teams according to sub-program thrusts

Regional Mental Health TeamsRMHT shall be established in each of the CHD with the Director of the CHD as the Chairperson. A vice-chairperson shall be nominated by the members of the RMHT.

Function of the RMHT is to oversee the planning and operation of the National Mental Health Program at the regional level.

Local Government Unit Teams for Mental HealthAn LGU Team for Mental Health (LGUTMH) shall be established by respective local government executives.

Suggested functions of the LGUTMH: To enact necessary legislative issuances and promote & advocate the implementation of community based Mental Health Program among their constituents in their respective localities.

Other Partners and Stakeholders Ensuring the availability of competent, efficient, culturally and gender-sensitive health care professionals who provide mental health services

Identifying mental health needs of the population and refer findings to the appropriate mental health care provider

Promoting and advocating for the implementation of the program within their respective areas of responsibilitymay contribute to the implementation of the National Mental Health Program by:

Expected Changes Decentralization of capabilities and services

More research initiatives

Development of relevant policies

Institutionalization of programs/services

Governance

Establish a coordinating mechanism for successful implementation, monitoring and evaluation of the NMHP which necessitates institutionalization of a functional management structure

Establish and implement a mental health research, monitoring and evaluating system

Health Financing

Expansion of the Philippine Health Insurance benefits package for Mental Health

Mobilize resources for MH from the private sector and funding agencies

Service Delivery

Integrate mental health services into the existing health programs in the DOH retained hospitals, LGU health facilities, NGOs and other concerned agencies Increase the number of DOH retained hospitals/medical centers and LGU health facilities capable of providing mental health services by 10% every year

Improve the competencies of health service providers on Mental Health Program

Develop a technical assistance package for national agencies, local government units, private sector and NGOs relating to Mental Health policies and programs

Strengthen school and workplace mental health programs

Regulation

Regulate custodial home care and clinics providing mental health services

Wellness/NormalHigh RiskMental DisorderRehabWellness of daily LivingExtreme Life ExperienceMental DisorderSubstance AbuseStressDistressDiseaseDisabilitySpectrum of Health Health Education Counseling Stress Mgt Consultation Socialization Healthy Lifestyle Sports Festival

Counseling Stress Mgt Psychosocial Support Consultation/risk screening Support Grp Bldg Emergency Mgt Case Finding Treatment & Rehab CPGs Development of Mid level MDs & other HW Development and Strengthening of referral system Re-entry to family and community

Advocacy, Service Provision, Research, Policy & Legislation, Capability Building, Public-Private Partnership, Data Base information, Development of Model Program, Monitoring and evaluationPerson with Disability Registration Health Education Development of Livelihood project Re-entry to family and community

Substance AbuseThe National Mental Health ProgramIntegrated Community-based Health Services

NEXT STEPSPush for Legislation of Mental Health ActLink with other sectors to strengthen community-based mental health programsDevelop training manuals for psychiatrists, psychiatric nurses, psychologists and psychiatric social workers Educate the public by providing IEC Materials regarding promotion of promotion mental health and prevention of mental disorder to the consumers and the community.Provide trainings and/or seminars to the community regarding mental health to minimize stigma and acceptance that mental disorders is just like any other illnesses.

NEXT STEPSStrengthen family education regarding signs of impending relapse of the patientProvide technical assistance to projects that would integrate mental health care in general hospital, i.e., Acute Psychiatric UnitsStrengthen the community outreach service of mental hospitals through effective networking with non-government organizations and local government units.Institute cost effective management of common mental health disorder in PHC through capability building of community based health workers using: locally relevant training materialsrefresher training course to primary care physiciansProvide community care services in coordination / collaboration with local government units and other organizations.