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Taiwanese Journal of Psychiatry (Taipei) Vol. 31 No.

2 2017 • 101 •

The Evolution of Psychiatry and

Mental Health in the Philippines

Réné M. Samaniego, M.D., F.P.P.A.1*

The Philippines is an autonomous Southeast Asian country which portrays a

rich history combining Asian, European, and American influences. This overview
is examining the country’s distinctive historical narratives in the domain of psy-
chiatry and mental health, chronicling the evolution of Philippine psychiatry in
four periods namely, the pre-Spanish and Spanish era, the American regime, the
Japanese occupation, as well as American liberation. Concurrently, it highlights
the key figures and institutions that contributed to the progress of psychiatry in the
Philippines. It also touches on the existing national mental health systems and
specialty societies which were developed to address the expanding gap between
the country’s mental health needs and the excessive burden of our earlier local
mental institutions, thereby promoting the mental health activities in the country
through the provision of clinical services and public education. A review of the
current status of the psychiatric training in the Philippines is also provided. On the
undergraduate level, it expounds on the country’s medical schools and its milieu in
terms of duration of education as well as modes of instruction by the training fac-
ulty. Furthermore, it discusses the current post-graduate training institutions, the
duration of the residency programs, modes of instruction and assessments, as well
as the process of qualifying for certification in addition to becoming a diplomate
and fellow of the national specialty society after the completion of training. Fi-
nally, it highlights and expounds on the Philippine Mental Health Act, a currently
important and critical mental health advocacy of the country. Being one of the re-
maining minority countries without a national mental health law, the Philippines’
stakeholders in mental health are advocating and working towards the passage of
the first ever mental health law which is in keeping with the existing administra-
tion’s aim of having mental health in the forefront of its health agenda. At the end
of the overview, the author elaborates on the four important grounds of the bill, its
highlights and objectives, as well as its most recent status in the Philippine senate
and congress.

Key words: the Philippines, Philippine Mental Health Act, psychiatric care, psychiatrists
as subspecialty doctors
(Taiwanese Journal of Psychiatry [Taipei] 2017; 31: 101-14)

Section of Psychiatry, Department of Neurosciences, Makati Medical Center, Makati City, the Philippines
Received: May 6, 2017; revised: May 14, 2017; accepted: May 14, 2017
*Corresponding author. Suite 1614 Medical Plaza Makati, corner Amorsolo and Dela Rosa Street, Makati City 1200, The Philippines
E-mail: Rene M. Samaniego <>
• 102 • Psychiatric Care in the Philippines

The country’s highest point is Mount Apo

Introduction standing at 2,954 meters (9,692 feet) in Mindanao,
while its lowest is the Philippine Sea at 0 m. The
The Geographical Milieu longest river which spans 217 miles in length is
The Philippines is an autonomous Southeast the Río Grande de Cagayan, located in Luzon.
Asian country situated in the Western Pacific Just southeast of the capital city of Manila is the
Ocean. It is an archipelago that consists of a gath- largest lake, Laguna de Bay. Lake Taal, also south
ering of 7,641 islands, the land area of which to- of Manila, occupies a huge volcanic crater and
tals to 301,780 square kilometers [1]. Interestingly, contains an island that is itself a volcano (www.
the country’s 11 largest islands occupy 95% of its WorldAtlas.Com).
total land area. Three of these 11 islands comprise
the country’s main geographical divisions from A Brief Historical Perspective
north to south, namely: Luzon, with a land area of The Philippines has a population of about
about 105,000 square kilometers; Mindanao, at 100,900,000, making it the 8th most populated
about 95,000 km2; and Visayas, at about 71,500 country in Asia and the 12th most populated coun-
km2. Its capital city, Manila, is located in Luzon try in the world. Moreover, an estimated addition-
which happens to be the largest among its vast al 10 million Filipinos lived overseas which ac-
collection of islands. The country is bordered on counts for one of the world’s largest diasporas [2].
the west by the South China Sea, on the East by In 1521, the arrival of a Portuguese explorer
the Philippine Sea, and on the southwest by the Ferdinand Magellan in Homonhon, Eastern Samar
Celebes Sea. It shares naval frontiers with Taiwan marked the beginning of the Philippine’s Hispanic
to the north, Vietnam to the west, Palau to the colonization. Magellan’s sojourn to the country
east, as well as Malaysia and Indonesia to the was part of a Spanish expedition which turned
south. into the first ever circumnavigation of the earth. In
The Philippine islands are mostly mountain- 1543, the archipelago was given its very first
ous with narrow coastal plains and mostly cov- name “Las Islas Filipinas” by the Spanish explor-
ered by tropical rainforests. Positioned on the er Ruy López de Villalobos in honor of Philip II of
“Pacific Ring of Fire,” a horseshoe-shaped area in Spain. The first Hispanic settlement was estab-
the basin of the Pacific Ocean which is strongly lished in 1565 with the arrival of Miguel López de
correlated with oceanic trenches and volcanic Legaspi from Mexico City. Having been a part of
movements, the Philippines is rather predisposed the Spanish Empire for more than 300 years,
to typhoons, earthquakes, and volcanic eruptions Roman Catholicism came to be the predominant
( Ascertained to be religion in the country [3].
the most active volcano, the Mayon, found in the At the turn of the 20th century, the Philippine
province of Albay in the Bicol region, is also Revolution gave birth to the First Philippine
deemed to be one of the most perilous worldwide. Republic. Still, this was short-lived as the Japanese
Nonetheless, the eruption of Mount Pinatubo in and American occupation soon supervened, with
the Zambales mountains in 1991 has demonstrat- the latter retaining sovereignty until after World
ed to be one of the most fateful volcanic eruptions War II. Thereafter, the Philippines was officially
in recorded history. recognized as an independent nation [3]. Through
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the years, the Philippines has had a tumultuous were referred as having a mental illness were
experience with democracy, including the histori- thought to have offended or displeased dieties;
cal ousting of a dictatorial administration through having incensed witches or mangkukulam who
a non-violent revolution [4]. would get back at them by casting wicked chants
The Philippines is a founding member of the and incantations or pricking mystic dolls with a
United Nations, World Trade Organization, needle; and devilmen or manggagaway who
Association of Southeast Asian Nations (ASEAN), would make them mentally ill by praying to the
the Asia-Pacific Economic Cooperation (APEC) dark forces [5].
forum, and the East Asia Summit. It also hosts the Management-wise, these supposed mentally
headquarters of the Asian Development Bank. At ill individuals were brought to churches for purifi-
this time, the Philippines is considered to be an cation and exorcism. Alternatively, they were
emerging market and a newly industrialized coun- brought to folk healers or herbolarios who would
try, which has an economy transitioning from be- subject them to physical and psychological dis-
ing one based on agriculture to one based more on tress in an attempt to chase off their mental ill-
services and manufacturing. ness. As an example, an individual would be
wrapped in a mat and subsequently flagellated
Chronicles of Philippine with a dried tail of a stinger fish or a bamboo stick.
Psychiatry in Four Decades At other times, they were made to drink herbal
and other plant potions while hot pots were stead-
The evolution of psychiatry in the Philippines ied at the top of their heads. Still, there were in-
can be better appreciated by considering its high- stances when they were taken for a boat ride and
lights through the historical interludes, from the in the midst of a river be precipitously flung over-
pre-Spanish period, Spanish periods, the American board. Curiously, the distressing experience
regime, the Japanese occupation, and the eventual would often be beneficial, especially in purported
American liberation. cases of hysteria [5].
The Spanish era has not highlighted any key
The Pre-Spanish era figures in the domain of mental illness and its
Preceding the Spanish era, there was not management. But it has been detailed that the first
much information available regarding the phe- ever institutional care of the mentally ill originat-
nomenon of mental illness, more so how it was ed at the turn of the 19th century in Hospicio de
managed. All maladies psychiatric or otherwise San Jose, the first Roman Catholic social welfare
were simply believed to be instigated by natural institution in the country founded in 1782 which
and supernatural occurrences. also operated as a foster care agency to orphans,
the abandoned, those with special needs, and the
The Spanish era elderly. Around 1810, upon the appeal of the
During almost four centuries of the Spanish Spanish naval authorities for confinement of its
ruling, from 1521 to 1898, mental illness and con- mentally ill seafarers, the institution started to
ditions manifesting with aberrant thinking and be- take into its fold the mentally ill as well. Its work-
havior were attributed to religious factors and su- force mainly consisted of nuns with only one phy-
pernatural forces. For instance, individuals who sician on-board. On the other hand, its ward de-
• 104 • Psychiatric Care in the Philippines

pendents were mainly natives, Chinese, and a few University for training in psychiatry, which at that
Spanish inhabitants [5]. time was merged with the neurology training
The American regime On December 18, 1928, the first hospital ex-
It was during the American regime, from clusively dedicated for the treatment of patients
1898 to 1946, when mental disability began to be afflicted with mental and nervous disorders was
recognized just as any other medical illness. Thus, formally opened and inaugurated. It was called
an advocacy towards a more humane approach to- the Insular Psychopathic Hospital, a 64-hectare
wards the mentally ill was fostered. Such para- estate which was constructed through a substan-
digm shift reflected the transitions concurrently tial government appropriation. In 1935, the City
ensuing in the Western countries. As a result, a Sanitarium closed prompting all of its existing pa-
good number of hospitals were established, an act tients to be transferred to the Psychopathic
that was perceived as an understated means for the Hospital and exaggerating the already overfilled
American colonist towards further subjugation of hospital wards. In response to the said predica-
the country [6]. ment, additional pavilions were put up subse-
November 1904 marked the establishment of quently expanding its total bed capacity from an
the country’s first ever hospital unit specifically initial 400 to 1,600.
dedicated for the mentally ill, the Insane Concurrent with the development of hospi-
Department of San Lazaro Hospital, under the tals for the mentally ill was the evolution of train-
newly created Bureau of Health. Through the ing programs in psychiatry under the various
years, supplementary units were even added to ac- medical institutions. In 1910, the Philippine
commodate the increasing demand for ward General Hospital was opened during which two
space. American physicians, Almond T. Gough and
The first Filipino psychiatrist was Elias Samuel Tretze, began to teach psychiatry to the
Domingo, an alumnus of the University of the medical students who rotated for their clinical
Philippines who, during his chief residency in practicum at the Insane Department of San Lazaro
Internal Medicine in 1917, was sent as Rockefeller Hospital and the Insular Psychopathic Hospital.
scholar to Pennsylvania, U.S.A. to undertake psy- U.S. trained Filipino psychiatrists also began to
chiatric training. Successively, he headed the teach psychiatry at the University of the
Insane Department of San Lazaro Hospital after Philippines College of Medicine. Eventually, a
returning in the country. few other medical schools and training institu-
In 1918, another psychiatric institution, the tions began to adopt psychiatry as part of their
City Sanitarium, was established at San Juan del trainees’ exposure, such as the University of Santo
Monte. Still, there was an unprecedented upsurge Tomas Faculty of Medicine and Surgery and the
of the mentally ill population. This was attributed Insular Psychopathic Hospital, later called the
to factors such as increased awareness for the National Psychopathic Hospital.
need for medical management of such individuals During those times, common modes of treat-
as well as the escalating socioeconomic difficul- ment for the mentally ill involved empirical so-
ties of the times. As a response to the issue, a num- matic therapies. For instance, for patients who are
ber of Filipino physicians were sent to Harvard having a manic episode, they would use fever
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therapy (fever induction through protein injec- The era of liberation

tions or the bite of malaria-infected mosquitoes); Following the widespread emotional impres-
metrazol shock (chemical shock induction through sions brought about by the casualties of the war
camphor oil injection; insulin shock (inducing a was the increased awareness and appreciation of
hypoglycaemic coma); Lock’s sol for those who the discipline of psychiatry. Subsequent to the end
are in a psychotic state; prolonged narcosis; of World War II, there was an extensive expansion
R1651 (Bromides) hyoscine injections; and hy- and rehabilitation of the existing psychiatric fa-
drotherapy. For general paretics or brain syphilis, cilities together with the subsequent training of
which was thought to be functional in nature at the workforce. In July 1946, the National
that time, they would employ fever therapy; or ad- Psychopathic Hospital was renamed National
minister tryparsamide or neo-salversamized se- Mental Hospital (NMH) and with financial aid
rum-giving intravenous mercury preparations. For from its benefactors, a new structure for paying
epileptics, they would administer phenobarbital; patients was constructed together with a few other
magnesium sulfate; perform spinal drainage; or charity sections. The said psychiatric endeavors
place the patient on a ketogenic diet. Depressed set the trend for other institutions to follow suit
individuals were also given Lock’s sol, barbitu- [7].
rates and electroshock treatments. In 1946, the Victoriano Luna General
Psychotherapeutic strategies were generally still Hospital established its own 100-bed neuropsy-
not implemented at that time. Nonetheless, ad- chiatric unit. The following year, the first ever pre-
junctive therapeutic approaches such as occupa- frontal lobotomy was performed by Major Romeo
tional and recreational therapies were already in Gustilo using his own improvised leucotone on a
effect. violent schizophrenic patient who failed to re-
spond to electroconvulsive therapy and other
The Japanese occupation available treatments. In December 1949,
With the eruption of World War II in Australia-trained Major Jaime Zaguirre performed
December 1941, the progress of psychiatry in the the first trans-orbital lobotomy on a schizophrenic
country was placed into a halt. Majority of the patient as well.
families of mentally ill patients felt compelled to In 1945, the University of the Philippines
bring them home despite the continued operation College of Medicine started to teach psychiatry as
of the National Psychopathic Hospital. Still, the a subject, then conducted by a professor of anato-
remaining inpatients were herded in small rooms my and neuroanatomy, Marciano Limson. In
and subsisted on limited food and medicine sup- 1950, a U.S.-trained psychiatrist and Rockefeller
plies given that the Japanese imperial army would scholar, Jorge Paras, returned to the country and
make use of the patient rooms in the said hospital started to teach psychiatry as well. Consecutively,
to stock their supplies. Treatment-wise, electro- a string of psychiatry experts from the U.S. came
convulsive therapy became the foremost thera- for a visit and developed the university’s under-
peutic modality using antiquated Japanese appara- graduate program. For one, University of
tus, followed by the use of local medicinal herbs. California Medical Center’s Department of
Psychiatry Chair, Carl Bowman, conducted two
visits under the China Medical Board of New
• 106 • Psychiatric Care in the Philippines

York appraising and assisting in the program en- In 1956, another Department of Psychiatry
hancement. Upon Bowman’s recommendation was established at the University of the East-
and under the sponsorship as well of the China Ramon Magsaysay Medical Center under the
Medical Board, they sent a resident in training, chairmanship of Jaime Zaguirre who held on to
Baltazar V. Reyes, Jr., to undergo further studies the post for two decades until his retirement from
abroad. Upon his return, Reyes assumed the chair- active practice. In 1977, the center created a divi-
manship in the newly instituted Neuropsychiatry sion called Neuroclinical Services and the depart-
Section under the Department of Medicine. In ment was unified with neurology, merely to regain
1959, the section formally launched a three-year its independent departmental status in the late
residency program. A few years later, in 1964, the 1980’s.
Department of Psychiatry was established as a
separate unit while Neurology remained as a sec- National Mental Health
tion under the Department of Medicine. In 1982, Systems and Specialty
the department formed its own Child and Societies
Adolescent Psychiatry division and fellowship
program [8]. The Philippine Mental Health Association
For the University of Santo Tomas, the The wide and expanding gap between the
Section of Neurology and Psychiatry was struc- country’s mental health needs and the excessive
tured under the Department of Medicine in 1947 burden of our existing local mental institutions
as headed by Leopoldo Pardo. It was then regard- impelled the founding of a private agency called
ed as a vestigial section as there were only four the Philippine Mental Health Association
beds allotted to it in the medical wards. Three (PMHA). In 1949, Toribio Joson of the National
years later, it was formally opened as the coun- Mental Hospital and Manuel Arguelles founded
try’s first privately run Neuropsychiatric institute the PMHA with the aim of promoting the mental
with a bed capacity of thirty and with the primary health activities in the country through the provi-
intent of diagnosis and management of acute men- sion of clinical services and public education. In
tal disorders. Its first two resident physicians were 1951, it pioneered a nationwide educational
given a chance to go abroad for further training. movement through the endorsement of the first
One of them, Gilberto Gamez, chose to go for National Mental Health Week, which subsequent-
psychiatry at the Universidad Central de Madrid. ly became an annual celebration. Likewise, the
Thereafter, he also completed neurology residen- first community mental health clinic in the coun-
cy training at the Neurologic Institute of try was originated hastening the addition of both
Columbia-Presbyterian Medical Center. urban- and rural-based rehabilitation services. In
Unfortunately, with the change in the university’s 1965, the PMHA funded the earliest known epide-
rectorship, the Neuropsychiatric institute folded miologic survey of mental disorders in the coun-
for a time being. In March 1968 it opened again try in Lubao, Pampanga obtaining a 36 per 1,000
with a formal residency program and was named population prevalence rate of mental illness in the
the Department of Psychiatry and Neurology with community.
Gamez as its first chairman and Leonor Feliciano
as its first graduate.
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The Philippine Society of Psychiatry and During the mid-80’s, to address the long-
Neurology standing apathy towards mental illness, the ad-
Despite the existence of the Philippine ministration mobilized a multi-sectoral involve-
Society of Psychiatry and Neurology during the ment particularly focusing on community-based
Second World War, it mostly lingered dormant interventions. The Department of Health created
until 1946, when it recommenced its activities the Task Force on Mental Health, later named
under the presidency of Leopoldo Pardo. Out of Project Team on Mental Health, which was main-
its 167 registered members by 1964, only 20 per- ly composed of psychiatrists aiming to come up
cent practiced psychiatry as a sole specialty, ow- with much needed recommendations on organiza-
ing to the distinctive conditions and attitudes to tional reforms. Its first initiative was the reorgani-
the discipline thereby limiting its prospects at that zation of the National Mental Health, now named
time. the National Center for Mental Health, signifying
its envisioned rôle as the country’s repository of
The Philippine Psychiatric Association technical and administrative expertise on mental
In keeping with the maturation and better- health.
defined distinctions between the two disciplines In the late 80’s, the Project Team was also
of Psychiatry and Neurology, individual depart- contributory in proposing two mental health bills
ments and training programs were established in highlighting to give priority to community-based
the various medical institutions. Concurrent with mental health care activities, as well as creating a
this movement was the decision of the psychia- national coordinating body for mental health.
trists at that time to form the Philippine Psychiatric However, it is rather untoward that despite such
Association in 1972 with Lourdes Ignacio as its attempts the aforesaid bills, in addition to several
founding president ( other propositions that came after, have not yet
been promulgated. As it stands, the Philippines is
The Succeeding Decades counted among the minority of countries that still
do not have an existing mental health legislation.
The progression of the succeeding decades
from the 70’s to the 90’s heralded the movement Psychiatric Training in the
of psychiatry towards the more biological ap- Philippines
proach to psychiatric illness. The psychopharma-
cological revolution in the West ushered in the Undergraduate training
usage of tranquilizers, non-barbiturate sedatives, There are currently 47 medical schools
and antidepressants. More cutting-edge treat- (Table 1) in the Philippines that are accredited by
ments resulted from the newer discoveries in rela- the Association of Philippine Medical Colleges
tion to the neurotransmitter theory. But it is worth Foundation, Inc. (APMCFI). Psychiatry is a sub-
noting that in the 70’s and 80’s, there was a rela- ject that is incorporated in the undergraduate
tive inactivity of psychiatric endeavors owing to training which encompasses four years in medical
government neglect and society’s indifference to- school. The training incorporates lectures, the
wards issues concerning mental illness and mental number of hours of which differ across the various
health. medical schools. Customarily, there is a year level
• 108 • Psychiatric Care in the Philippines

Table 1. List of medical schools by region

Region & Number of

Name of Medical School
Medical Schools
National Capital AMA School of Medicine; Ateneo de Manila University School of Medicine & Public
Region (17) Health; Centro Escolar University College of Medicine; Emilio Aguinaldo College of Medi-
cine; Far Eastern University – Dr. Nicanor Reyes Medical Foundation; University of Per-
petual Help Rizal Jonelta Foundation School of Medicine; Manila Central University-File-
mon D. Tanchoco Sr. Medical Foundation; Manila Theological College of Medicine;
Metropolitan Medical Center College of Arts Sciences and Technology College of Medi-
cine; New Era University College of Medicine; Our Lady of Fatima University; Pamantasan
ng Lungsod ng Maynila; San Beda College of Medicine; St. Luke’s College of Medicine
William H. Quasha Memorial; UERM Memorial Medical Center College of Medicine; Uni-
versity of Santo Tomas Faculty of Medicine & Surgery; University of the
Cordillera Saint Louis University
Region (1)
Region 1 (3) Lyceum-Northwestern University Dr. Francisco Q. Duque Medical Foundation; Mariano
Marcos State University College of Medicine; University of Northern-Philippines; Virgen
Milagrosa University Foundation
Region 2 (2) Cagayan State University; St. Paul University Philippines School of Medicine
Region 3 (1) Angeles University Foundation School of Medicine
Region 4-A (3) Adventist University of the Philippines; De La Salle Health Sciences Institute; University of
Perpetual Help - Dr. Jose G. Tamayo Medical University
Region 5 (1) Bicol Christian College of Medicine
Region 6 (4) Central Philippines University; Iloilo Doctors College of Medicine; University of Saint. La
Salle; West Visayas State University
Region 7 (6) Cebu Doctors University; Cebu Institute of Medicine; Southwestern University Matias H.
Aznar Memorial College of Medicine, Inc.; Southwestern University, Inc. College of Medi-
cine; Gullas College of Medicine; University of the Visayas; University of Cebu College of
Medicine Foundation, Inc.
Negros Island Silliman University Medical School
Region (1)
Region 8 (2) Remedios Trinidad Romualdez Medical School Foundation; University of the Philippines
School of Health Sciences
Region 9 (1) Ateneo de Zamboanga University School of Medicine
Region 10 (2) Mindanao State University; Xavier University-Dr. Jose P. Rizal School of Medicine Ateneo
de Cagayan
Region 11 (2) Davao Medical School Foundation; Brokenshire College of Medicine
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coordinator and subject expert who manages the Such numbers include those with and without for-
psychiatry module. The typical duration of a psy- mal titles in the department. Formal titles include
chiatry module is two weeks. Such involves lec- the department head or section chief, training of-
tures, patient-encounter activities in a psychiatric ficer, assistant training officer, and year level
facility, demonstration on patient interview, film coordinators.
showing, and rôle-play. Direct contact and actual The post-graduate residency training in the
work with patients are usually conducted during Philippines generally covers a three- or four-year
the third and fourth years of medical school as program, depending on the institution. The
well as during the post-graduate internship. Committee on Accreditation and Standardization
Depending on the medical school, other activities of Residency Training Program of the PPA evalu-
incorporated in the training may involve work- ates and certifies the program as necessitated. The
shops, seminars, and focused-group discussions. said program also follows the code of discipline
The fourth and final year in medical school is and policies set by the institution’s Medical
referred to as the medical clerkship, which entails Education and Research Division. The core com-
a full year of clinical exposure to the various med- petencies of each year-level trainee are patterned
ical specialties. Upon graduating from medical according to international requisites. As a rule, the
school, the trainee goes into one year of post- trainee is required to attend didactic sessions as
graduate internship which once more involves ro- prescribed for the respective year level. Each
tating in the different medical specialty depart- trainee is also assigned a consultant supervisor
ments. Subsequently, the trainee prepares for the who guides and oversees the trainee’s clinical per-
medical board examination and upon qualifying formance. Along the way, rotations and exposures
for the said assessment the trainee then decides to in non-psychiatric departments are timetabled,
either go into general medical practice or further specifically three months in Neurology service
pursue training in their specialty of choice. and two months in Internal Medicine service. The
number and type of cases seen by each resident
Post-graduate training follows the minimum requirement as set by the
The Philippines has a total of 13 institutions Accreditation Committee of the PPA. The PPA
that offer post-graduate training in psychiatry prescribes as well a list of recommended reference
(Table 2), all of which are accredited by the materials per year level. Throughout the course of
Philippine Psychiatric Association (PPA). Eight of training, all institutions conduct both written and
the 13 institutions are based in Metro Manila, oral examinations as based on the Objective
while the remaining 5 are based in the various re- Structured Clinical Examination (OSCE).
gions. Most post-graduate training programs are Upon completion of the residency training, a
instituted in a tertiary hospital whereas there is Diplomate Board Examination is conducted by
one that is solely based in the country’s national the Committee on Board Certification of the PPA.
mental institution, the National Center for Mental The said assessment is effected in two steps, the
Health. written and the oral examinations, respectively,
Depending on the expanse of the institution, both also based on the OSCE. The title, Diplomate
the number of psychiatrists formally involved in of the Specialty Board of Philippine Psychiatry
post-graduate training may vary from 12 to 35. (DSBPP), is given to the examinee who qualifies
• 110 • Psychiatric Care in the Philippines

Table 2. List of hospitals offering postgraduate training in psychiatry

Duration of
Name of Hospital Region Fellowship training
Training (Years)
Baguio General Hospital Cordillera Administrative 3 None
Makati Medical Center National Capital Region 3 None
National Center for Mental National Capital Region 4 None
Southern Philippines 11 3 None
Medical Center
The Medical City National Capital Region 4 Child and adolescent psychiatry;
Consultation-liaison psychiatry;
Addiction psychiatry
University of the East- National Capital Region 3 None
Ramon Magsaysay
Memorial Medical
University of the Philip- National Capital Region 3 Child and adolescent psychiatry;
pines-Philippine Gen- Consultation-liaison psychiatry;
eral Hospital Community psychiatry
Veterans Memorial Medi- National Capital Region 3 None
cal Center
Vicente Sotto Memorial 7 4 None
Medical Center
West Visayas State Univer- 6 4 None
sity Medical Center

for the said assessment. Three years thereafter, an number as most are based in Metro Manila and the
invitation for consideration and evaluation to be a other key cities whereas several remote provinces
fellow of the association is extended to an eligible have no locally practicing psychiatrists at all.
member after which the title, Fellow of the
Philippine Psychiatric Association (FPPA), is The Philippine
accorded. Mental Health Act
A number of institutions also offer two-year
Fellowships on psychiatric sub-specialties as Despite the international recognition of men-
Child and Adolescent Psychiatry, Consultation- tal health as an integral and essential component
Liaison Psychiatry, and Addiction Psychiatry. of health, not all countries have enacted a legisla-
Up to the present time, there are a little over tion to comprehensively address such issues.
500 PPA-accredited psychiatrists in the country. The Philippines is one of the remaining mi-
There is a disproportionate distribution of the said nority countries without a national mental health
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law which, as estimated by the World Health substantiating a challenge in ensuring adequate
Organization is comprised by 31% of the world’s provision of mental health services to the
population [9-11]. This is despite the 1987 community.
Constitution which specifically mandates that the The Mental Health Act makes it a duty on the
“State shall protect and promote the right to health part of all relevant government agencies such as
of the people...” [12]. While no such law is yet in the DOH, Commission on Human Rights (CHR),
place, the current administration through and Local Government Units (LGUs), to ensure
Department of Health (DOH) has publicly con- that “basic mental health services shall be made
veyed to make mental health a top priority. available at all local government units down to the
Measures that have been executed thus far in- barangay level.” The bill also expressly provides
cludes the establishment of a national suicide pre- for the psychiatric, psychosocial, and neurological
vention line called Hopeline, the signing of an services to be provided by regional, provincial,
administrative order rolling out mental health on and tertiary hospitals nationwide.
the local levels, and the proposed increase of the
mental health budget program for 2017 from The Philippine Mental Health Act protects
PhP36 million to Php220 million. the rights of patients and concerned
More importantly, the Philippines is current- individuals
ly in the thick of advocating and working towards The proposed bill expressly stipulates and
the passage of the first ever Mental Health Law upholds the following patient rights as follows:
which is in keeping with the existing administra- right to freedom from discrimination; right to pro-
tion’s aim of having mental health in the forefront tection from torture, cruel, inhumane, and degrad-
of its health agenda. Thus, the Philippine ing treatment; right to aftercare and rehabilitation;
Psychiatric Association and its allied mental right to be adequately informed about psychoso-
health affiliates are in full espousal of the Senate cial and clinical assessments; right to participate
Bill known as the Mental Health Act of 2017, and in the treatment plan to be implemented; right to
House Bill known as the Comprehensive Mental evidence-based or informed consent; right to con-
Health Act, as founded on four important grounds: fidentiality; and right to counsel, among others.
The bill proposes to protect not only the
The Philippine Mental Health Act ac- rights of the patients but also endorses certain
knowledges and responds to a critical rights in favor of concerned individuals such as
national issue the patient’s family members as well as the mental
The Philippine Statistical Authority has re- health professionals. For instance, it acknowledg-
ported that 1 in 5 Filipinos suffer from a mental or es the requisite of the family members to psycho-
psychiatric disorder. Furthermore, the incidence social support and participation in in the treatment
of suicide in males has also spiked upwards from plan of the patient. Likewise, it highlights the
0.23 to 3.59 per 100,000 between 1984 and 2005 mental health professionals claim to a safe work-
while rates rose from 0.12 to 1.09 per 100,000 in ing environment, continuous education, control of
females [13]. As it stands, the ratio of the coun- his/her practice excepting emergency situations,
try’s mental and allied mental health workforce to and opportunity to participate in mental health
the current population is a negligible 3 to 100,000, planning and development, among others.
• 112 • Psychiatric Care in the Philippines

The Philippine Mental Health Act Honors various public and private sector stakeholders, in-
International Treaties and Conventions cluding those representing mental health patients
The Philippines is a signatory in various in- and their family members, mental health institu-
ternational covenants, including the United tions, youth groups, civil society organizations,
Nations General Assembly Resolution 46/119 the media, the Department of Health, the
otherwise known as The Principles for the Commission on Human Rights, the World Health
Protection of Persons with Mental Illness and for Organization, the Philippine Psychiatric
the Improvement of Mental Health Care. The Association, the Philippine League Against
principles cover the following areas: definition of Epilepsy, the Philippine Mental Health
mental illness; protection of confidentiality; stan- Association, the Philippine Neurological
dards of care and treatment including involuntary Association, the Psychological Association of the
admission and consent to treatment; rights of per- Philippines, and civil society organizations.
sons with mental disorders in mental health facili- There were two major conferences in addi-
ties; protection of minors; provision of resources tion to numerous smaller meetings where issues
for mental health facilities; rôle of community and involving mental health legislation were dis-
culture; review mechanisms providing for the pro- cussed. Such efforts were steered through the ini-
tection of the rights of offenders with mental dis- tiative of the Philippine Psychiatric Association in
orders; and procedural safeguards protecting the coordination with the Department of Health.
rights of persons with mental disorders. Such ar-
eas have been specifically addressed in the provi- The objectives and highlights of the Phil-
sions of the Philippine Mental Health Act. ippine Mental Health Act
Numerous other international documents The Philippine Mental Health Act has the
supporting the protection of mental health to following general four objectives:
which the Philippines is also a signatory include: • to strengthen effective leadership and gover-
The Declaration of Caracas, 1990; The Declaration nance for mental health by, among others, for-
of Madrid, 1996; The Mental Health Care Law: mulating, developing, and implementing na-
Ten Basic Principles, 1996; International tional policies, strategies, programs, and
Covenant on Economic, Social and Cultural regulations relating to mental health;
Rights (ICESCR), 1974; International Covenant • to develop and establish a comprehensive, inte-
on Civil & Political Rights (ICCPR), 1986; grated, effective, and efficient national mental
International Convention on the Rights of Persons health care system responsive to the psychiat-
with Disabilities (ICRPD), 2008; and World ric, neurologic, and psychosocial needs of the
Psychiatric Association (WPA)-Philippine Filipino people;
Psychiatric Association (PPA) Manila Declaration • to protect the rights and freedoms of persons
on The Promotion of Mental Health, 2016. with psychiatric, neurologic, and psychosocial
health needs; and
The Philippine Mental Health Act is a • to strengthen information systems, evidence,
Broad Multi-sectoral Initiative and research for mental health [14].
The original Philippine Mental Health Act is On the other hand, the highlights of the
the outcome of consultations with and drafting by Philippine Mental Health Act are:
Samaniego RM • 113 •

• protection of the rights of the mentally ill, their richness and depth of the Philippine history of
families, and mental health professionals; psychiatry reaches one of its summits as it comes
• defining the mental health services from the re- closer to the critical aspiration of having its very
gional hospitals to the community; first mental health law, hopefully a substantiation
• integration of mental health into the education- that the country’s more genuine understanding of
al system including age appropriate content; its history is commencing to pave the way for the
and brighter future in mental health that it merits.
• its budget to be sourced from 5% allocation of
sin tax on alcohol and tobacco products [14]. Acknowledgements

A promise of hope of the Philippine The opinions expressed in this overview are
Mental Health Act author’s own personal opinions, and are unneces-
On April 27, 2017, in a historic vote, the sarily reflect those of either his institution or the
Senate of the Philippines conducted its third and Philippine Psychiatric Association, of which he is
final reading and subsequently the passage of the currently the president. The author declares that
Senate Bill 1354, otherwise known as the he does not have any competing conflicts of inter-
Philippine Mental Health Act of 2017. This most est in writing this invited overview.
recent watermark brings the Philippines one step
closer to the realization of its first ever mental References
health law, carrying with it the promise of com-
prehensively addressing at the national level the 1. National Mapping and Resource Information
Filipinos’ mental health needs and ensuring that Authority (NAMRIA). Manila: Department of
the rights of such individuals are protected and se- Environment and Natural Resources, February 12,
cured. All of its exponents and advocates are now 2016.
2. Stock Estimates of Filipinos Overseas as of December
looking ahead to put forth as much effort in effect-
2013. Manila: Philippine Overseas Employment
ing the passage of its counterpart bill in the Lower
Administration. September 19, 2015.
House of Representatives, known as the
3. Constantino R: The Philippines: A Past Revisited.
Comprehensive Mental Health Act.
Manila: 3: 32-9; 15: 250-3 (Tala Publishing Services)
Conclusion 4. Santiago AS: The original people power revolution.
Quartet February 28, 2008.
A nation providing itself with a better under- 5. Santiago LP: Rizal, and the beginnings of Philippine
standing of its history translates to a capacity to psychiatry, with a translation of Rizal’s “La Curacion
change and improve its present reality. de los Hechizados”. Acta Med Philipp 1965; 2:
Furthermore, it provides an opportunity to create a 65-7.
more distinct and defined vision of ones future. 6. Manguigad LC: Psychiatry in the Philippines. Am J
Thus, history should not merely be known but Psychiatry 1964; 121: 21-5.
rather understood sincerely. It is only when one 7. Catindig CT: Psychiatry in the Philippines. Philippine
Medical Association Journal (Manila) 1966; 4 (12):
adopts this perspective can history become rele-
vant and lead to a clearer goal. At this moment, the
• 114 • Psychiatric Care in the Philippines

8. Reyes BV: History of the Department of Psychiatry 12. Philippine Constitution Section 15, Article II. 1987.
in the College of Medicine, University of the 13. Redaniel MT, Lebanan-Dalida MA, Gunnell D:
Philippines. Manual of the Structural and Functional Suicide in the Philippines: time trend analysis (1974-
Organization of the Department of Psychiatry. 2005) and literature review. BMC Public Health
Manila: UP-PGH Medical Center, 1968. 2011; 11: 536.
9. World Health Organization Constitution, Preamble. 14. Senate Bill No. 1354. An Act Establishing a National
Geneva: WHO, 1948. Mental Health Policy for the Purpose of Enhancing
10. WHO Mental Health Policy and Service Guidance the Delivery of Integrated Mental Health Services,
Package. Geneva: WHO, 2003. Promoting and Protecting Persons Utilizing
11. World Health Organization. WHO-AIMS Report on Psychiatric, Neurologic and Psychosocial Health
Mental Health System in the Philippines. Manila: Services, Appropriating Funds Therefore and for
WHO Office, 2007. Other Purposes. February 2017.