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A CRY FOR HELP:

Mental illness, suicide cases

rising among youth

Rappler speaks to psychiatrists, psychologists, and life coaches who say mental illnesses and suicide
cases among the youth have drastically increased

BY SOFIA TOMACRUZ | SEPTEMBER 11, 2018

Published 9:00 PM, September 11, 2018

Updated 12:20 PM, January 24, 2019

AT A GLANCE:

Experts say the number of suicide cases and students with mental illnesses has risen drastically in the
last two years with at least one suicide referral made each day

Increased risk factors such as breakdown of relationships coupled with a decrease in protective factors
such as health lifestyles and rest can leave children increasingly exposed to mental health issues and
vulnerable to suicide

Urgent attention is needed to address the rise in mental illnesses and suicide cases among the youth

Part 1 of 2
MANILA, Philippines – “I would feel suffocated, then I felt like ants were crawling on my skin and on to
my head, then I wouldn’t be able to stop crying. I resorted to pinching my arms just to distract myself
from what was going on in my head,” recalled 22-year-old Bettina Jose.

“It was the only thing that reminded me that I was still breathing because I could still feel the pain in my
forearms,” she added.

Bettina was just 20 when she first attempted suicide. When the thought first entered her head, it was as
though something had snapped. No weapons involved, she said, but the compulsion to commit suicide
was intense.

That first time, she had come from an 8 am class presentation. Her mother found her 9 hours after she
left home for school, lying in the university chapel.

Nearly two years later, after much prodding and convincing from her family, Bettina sought treatment for
anxiety and post-traumatic stress disorder. For almost two years, she battled with the anxiety attacks on
her own. They only became worse over time.

"I was really convinced I was managing them and handling them well enough but my attacks never really
went away and I would get so stuck in my head it would be much harder to do things I normally had no
problems with in the past," Bettina said.

Sometimes the attacks would have triggers, other times they would not. But each time she ended up
with the same kind of anxiety attack.

Even with treatment, Bettina admitted having entertained suicidal thoughts since that first attempt.
Oftentimes, it was masked as having a grave and intense need to disappear.

“In the times I’ve experienced that, I’m usually pushed by an intense feeling of isolation and
desperation,” she said.
To this day, Bettina said dealing with her mental illness remains a struggle. But creating her own mental
health group, which she called Spring, gave her the courage and the community she needs.

"I'm not sure if it's also the looming fear that it could go back to the way things were," she said.

CRY FOR HELP. Writings from students express feeling a lack of options. Photo by Sofia Tomacruz/Rappler

CRY FOR HELP. Writings from students express feeling a lack of options. Photo by Sofia Tomacruz/Rappler

Like Bettina, many students struggle with mental illness. Often, they can come as unknown desperate
cries for help.

Over the last 4 years, psychiatrist Dr Dinah Nadera, would receive urgent calls and messages from
students asking to meet. Not holding regular clinic, Nadera had no idea how students got hold of her
number. But one thing she knew: they needed help and had no one else to turn to.

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For the students, it was worth a chance: a message to an unknown number could lead them to someone
who could listen and maybe guide them.

Nadera recalled some who contacted her felt pressured with school or had scholarships on the line.
Other times, they had been referred to psychiatrists but with appointments scheduled months away.
(READ: Student's wish: More guidance counselors in school)

More often than not, students felt as though they were reaching a point where they had run out of
options. So as long as they were at least 18 years old, Nadera would meet them – be it at a Jollibee
branch or somewhere on campus.
It was enough to prompt Nadera to move on from her work in public health and research to take on a
new role as a psychiatrist at the University of the Philippines Diliman.

“(That’s) the reason why I wanted to be here even if I would leave my other work. It’s because there is
really a felt need,” she said.

Nadera’s experience does not stand alone. It’s one echoed across the field of mental health practitioners
in the Philippines.

Psychiatrists, psychologists, and life coaches Rappler spoke to attested to the fact that in the last few
years, suicide cases and mental illnesses among the youth have drastically increased.

Among 8,761 students from Grades 7-9, Year 4 in the Philippines:

11.6% among 13 to 17 year olds considered suicide

16.8% among 13 to 17 year olds attempted suicide

- 2015 World Health Organization Global school-based survey

“At least one per day would come in the emergency room for a suicide attempt, one young person,” said
Dr Constantine Chua, chief resident of the Philippine General Hospital (PGH) Department of Psychiatry
and Behavioral Medicine in an interview with Rappler.

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Child psychiatrist Dr Norieta Balderrama from the PGH Child Protection Unit also said that she and
roughly 80 child psychiatrists in the country have shared anecdotes from their practice indicating an
increase in young patients who have suicidal thoughts or have attempted suicide.

Many of them, she said, experienced depression.

Balderrama and other child psychiatrists noticed this as several schools would refer students who
admitted to dealing with mental health issues.

“We have a lot of this….One consultant said in one clinic day he has 5 children who are suicidal… in one
clinic day, so it can go as high as (5), 2 to 3…one every day,” she said, adding that the past two years have
been the busiest in her more than 20-year practice.

For life coach Myke Celis, this turnaround was apparent in those who have sought his help – from those
aged 25 or older, Celis said the majority of those he coaches are now aged 13 to 25 years old.

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Many of them experienced depression and anxiety, with some having entertained suicidal thoughts.
Behind the rise

In the Philippines, the rise in the number of suicide cases and youth with mental health issues is brought
about by a mix of social and biological factors. (READ: How does the PH fare in mental health?)

However, a common theme stands out: disconnectedness and deterioration of relationships brought
about by social media and technology. Experts said young people today tend to be more disconnected
despite the internet supposedly opening up the world to everyone.

“With all the social media, there’s just too many things to do; too many things to prove….Young people
today tend to be very pressured, very stressed, live very complicated lives, and tend to be socially
disconnected,” Chua said.

DISCONNECT. Experts argue social media and the Internet have given way to lack of genuine connection
among the youth.

DISCONNECT. Experts argue social media and the Internet have given way to lack of genuine connection
among the youth.

The lack of connectedness can often lead to a breakdown in relationships, which are crucial in fostering
good mental health. A recent 2017 study published in the Association for Psychological Science also
found that adolescents who spent more time online – such as social media – were more likely to report
mental health issues.

“That sense of lack of social connectedness is very, very prevalent….They’re connected but they can’t
seem to have a trusted person,” Nadera said.

This was echoed by Celis who observed that children nowadays do not always understand the difference
between “true friendship” and belonging. “There’s a need to fit in and there’s a need to stand out and
you tend to forget what really matters,” he said.
The breakdown in connectedness is often seen in high school and college students but Balderrama said it
had already been observed even among elementary students.

Meanwhile, relationships at home may not always be better either. Experts said many Filipino children
also have parents who work abroad. Some of them experience increased busyness themselves, too.

In addition, experts said children nowadays are also often exposed to events and information that older
generations might have encountered at a later stage. For instance, Nadera highlighted the case of
children who have gone through traumatic events such as armed conflict, sexual abuse, and even
exposure to a more “chaotic” world.

Coupled with high levels of stress from increased competition and school, these can have an impact on
how children learn to cope as brain development may not be at a stage where one would know how to
deal with changes and heightened expectations.

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Experts also observed this has often led to children with low self-esteem and high self-expectations.

PRESSURE. Writings from students speak of difficulty coping with increased pressure and stress. Photo by
Sofia Tomacruz/Rappler

PRESSURE. Writings from students speak of difficulty coping with increased pressure and stress. Photo by
Sofia Tomacruz/Rappler

High risk
While there is no one factor that causes these, the rise in mental illnesses and suicide cases can also be
explained by what Chua described as a simultaneous increase in “risk factors” like social disconnection
and weakened “protective factors” such as genuine relationships and healthy lifestyles.

“If that happens for a long time then the mental health tends to be not so good, leading to different
kinds of mental health conditions, which, of course, would predispose to suicide,” he said.

Globally, the World Health Organization reported an average of 3,000 people who die by suicide daily –
this translates to one suicide every 40 seconds. Suicide is also listed as the second highest cause of death
among people between the ages of 15 and 29.

Locally, there is no one figure for mental health and suicide cases as data is often scattered in different
government agencies, and varies across years. Latest available data on the Philippines recorded by the
WHO, however, reported over 2,000 cases of suicide from 2000 to 2012 with majority of individuals
dying by suicide also aged between 15 to 29 years old.

But beyond the numbers, experts said paying attention to mental illnesses among the youth remains
urgent.

“You also know it’s on the rise if you feel and see one person suffering and that story isn’t very different
from others. You know it can happen to anyone,” Nadera said.

Experts added the problem is not hard to fathom, with majority of people knowing at least one person
who may be dealing with a mental health illness or even unstable mental health.

Balderamma added, “There’s always somebody we know. We communicate it as urgent because it cuts
all strata and it cuts all professions.” – Rappler.com

READ: Conclusion | Is the Philippines ready to address mental health?

In the Philippines, the Natasha Goulbourn Foundation has a depression and suicide prevention hotline to
help those secretly suffering from depression. The numbers to call are 804-4673 and 0917-558-4673.
Globe and TM subscribers may call the toll-free number 2919. More information is available on its
website.

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IN-DEPTH

Is the Philippines ready to address mental health?

With an increase in mental illnesses and suicide cases among the youth, experts say everyone has a
crucial role to play in fostering mental wellness

Sofia Tomacruz

Published 12:00 PM, September 12, 2018

Updated 12:21 PM, January 24, 2019

AT A GLANCE

From Part 1: Increasing mental illnesses and suicide cases among youth needs urgent attention
The World Health Organization predicts mental disorders will account for 13% of the global burden of
diseases

The Mental Health Act is crucial to addressing the rising number of youth with mental health issues but
everyone has a role to play in ensuring mental wellness

READ: Part 1 | A cry for help: Mental illness, suicide cases rising among youth

Conclusion

MANILA, Philippines – “No one is spared” from the possibility of suffering from mental illness.

This is the clear message mental health experts are sending to the public. Mental illnesses can cut across
all professions and ages, and affect even those who care for patients with mental health issues
themselves.

The problem is one that carries a heavy burden as the World Health Organization (WHO) predicted that
by 2030, mental disorders will account for 13% of the total global burden of diseases.

“Everyone is on alert,” said psychiatrist Dr Dinah Nadera of the University of the Philippines Diliman
Infirmary and president of non-governmental organization Foundation Awit in an interview with Rappler.

The risks apply to the Philippines as well. Experts told Rappler mental illnesses and suicide cases among
the youth have increased in the last few years.

In 2004, over 4.5 million cases of depression were reported in the Philippines, according to the
Department of Health (DOH). Suicide cases in the Philippines recorded by the WHO in 2012 also
reported over 2,000 cases from 2000 to 2012. Majority of those who died by suicide were between 15 to
29 years old.

Fast forward to the present, the numbers are most likely much higher since many who suffer from
depression often hesitate to seek help due to the stigma that surrounds mental disorders. The same can
also be said for those who attempt suicide.
This begs the question: is the Philippines ready to seriously address mental health?

RIGHTS. Experts say recognizing the fundamental right to mental health services will help to lessen
stigma around mental illnesses.

RIGHTS. Experts say recognizing the fundamental right to mental health services will help to lessen
stigma around mental illnesses.

Crucial mental health law

According to experts, whether or not the Philippines effectively addresses the growing health concern
will depend on how well the recently signed Mental Health Act will be implemented. The DOH, along
with health professionals and civic groups, are still finalizing the law’s implementing rules and
regulations.

Hailed by mental health advocates as a “major victory,” President Rodrigo Duterte signed into law the
landmark bill in June 2018. The Philippines was one of the last few countries in the world without a
mental health law, though several bills were proposed as early as the 1980s.

But apart from the nearly 30 years it took to become law, Republic Act 11036 is praised for being the first
legislation to recognize the fundamental right of all Filipinos to mental health services.

“(The) Mental Health Law would aim to bring mental health closer to the everyday lives of the youth,”
said Dr Constantine Chua, chief resident of the Philippine General Hospital (PGH) Department of
Psychiatry and Behavioral Medicine.

Crucial parts of the law include the government’s responsibility in promoting the well-being of people,
which would be done by ensuring the value, promotion, and protection of mental health.
ACCESS. The Mental Health Act will ensure access and delivery to mental health services.

ACCESS. The Mental Health Act will ensure access and delivery to mental health services.

According to experts, this is important as it can lessen the stigma around mental health and ensure the
access and delivery of mental health services to every Filipino.

The law also aims to ensure that delivery of, and access to psychiatric, psychosocial, and neurologic
services happens in regional, provincial, and tertiary hospitals. Apart from this, the law also supports the
presence of mental health services embedded in school systems and the teaching of mental health in all
education levels.

Another salient feature of the law shifts focus of care to the community. For Nadera, this is crucial as this
is where “true recovery happens.”

Successful implementation

But how exactly will we be able to gauge the law's success once it is fully implemented?

Ideally, the offshoot would be the presence of mental health services at the primary health care setting
such as in barangay health stations and not just hospitals, Chua said.

Adequate training of teachers and officials in mental health knowledge as well as mental health
programs should also be required in schools and the workplace.

"Our general practitioners, doctors, nurses, teachers being taught the mental health dimensions of their
work adequately...those are measures or goals of the mental health law and when we achieve those
things, the mental health law is doing its purpose," Chua said.
Mental health advocates also hope that with the implementation of the mental health law, more people
would be enticed to become practicing psychiatrists. Currently there are roughly only 600 in the whole
country for a population of nearly 100 million.

According to Nadera, success would also mean less reports of violence or human rights violations against
persons with mental health problems. Mental heath policies and services should also be made available
to vulnerable sectors. These include Filipinos working abroad in maritime and service industries, as well
as those who are victims of disasters.

WELLNESS. Mental health also means having the best cognitive, emotional, behavioral, and social state.

WELLNESS. Mental health also means having the best cognitive, emotional, behavioral, and social state.

Not just doctors

With limited capacity to tackle mental health fully, experts said fighting the rise in mental illnesses and
suicide cases among the youth will need to be taken up by everyone. (READ: [OPINYON] Kasama tayo sa
laban para sa mental health)

The shared exposure to mental disorders puts everyone at risk. This will mean each will have a role to
play in trying to boost preventive efforts against developing mental illnesses.

“Mental health is not just the role of doctors or clinical psychologists…. The whole community will really
play a role”

- Dr Constantine Chua, chief resident of the PGH Department of Psychiatry and Behavioral Medicine

“When we say mental health, it’s not really just having or not having a psychiatric diagnosis but it’s
enjoying the best cognitive, emotional, behavioral, and social state in which you can have a fulfilling life
and a community,” Chua said.
For youth and adults alike, experts suggest fostering a healthy lifestyle that allots time for rest and
leisure. It also means having balanced self-expectations, learning how to ask for help, and making the
effort to stay connected with other people.

“Having healthy and meaningful relationships…where you are accepted by people, where you are
listened to is actually the best protective factor,” Chua said. Balderrama likewise agreed that having
healthy relationships is good as these provide crucial support systems for those with mental health
disorders.

Parents and teachers, for their part, should also focus on preventive efforts – such as being equipped
with knowledge about mental health – as this could strengthen children and prevent them from
developing full-blown mental disorders.

“Mental health is not just the role of doctors or clinical psychologists….The whole community will really
play a role – that includes the family, the teachers, the students themselves,” Chua said. – Rappler.com

In the Philippines, the Natasha Goulbourn Foundation has a depression and suicide prevention hotline to
help those secretly suffering from depression. The numbers to call are 804-4673 and 0917-558-4673.
Globe and TM subscribers may call the toll-free number 2919. More information is available on its
website.

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