Luis Miguel L.

Tirador October 22, 2019

Legal Research – 1F Atty. Kchyrziahshayne Dyñelle V. Dinopol

The Philippine Mental Health Act

Ever since the dawn of time, humanity has developed systems that sought to
comprehensively provide solutions—and preventive measures—to society’s problems. From
innovative farming systems designed to curb the population’s hunger needs to the powerful rule
of law and governance, people always find ways to deal with the most pressing of problems.

Some of the most common problems that have literally plagued humanity are health-
related problems.1 In spite of all the ‘biological warfare’ history has shown us, humanity has
continued to thrive and prevail against disease. Through the humble beginnings of herbal
remedies to the modern solutions provided by research and technology, the health sector—
together with public health specialists, epidemiologists, and researchers—works hand-in-hand
with the government and all other sectors of our society to ensure the ideal realization that is
public health.2

Today, world governments and international organizations tackle various public health
problems including Noncommunicable Diseases3 and even providing National Health Insurance.4
More recently, however, countries have begun to shift their attention towards another health
problem—one that takes the life of a person every 40 seconds5—that has the potential to be a
global pandemic—Mental Health.

As a response, 38 countries have already come up with national suicide prevention

strategies, most of which have been ratified in the last five years.6 This includes the Philippines
who, in June 20, 2018, signed into law Republic Act No. 11036 (R.A. No. 11036), otherwise
known as the Mental Health Act.

This paper will revolve entirely on the Mental Health Act providing relevant data,
impacts, as well as its origins including related cases. This paper is further supplemented by
interviews from representatives of various sectors.

Mental Health overview

Mental Health is defined as "a state of well-being in which every individual realizes his or
her own potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his community."7

At the onset, the phrase “a state of well-being” can be easily interpreted by the layman
as a mere subjective matter that may easily be declared by an individual. This interpretation
alone of an obviously complex issue has lead to the stigmatization and discrimination of mental
health and ultimately delayed the systematic solutions it sought.

In fact, a Forbes article highlighted that “mental health” is the most neglected health
problem in the developing world.8 It stems such outcome from varying problems—the difficulty
of separating the illness from the person and mental health being perceived as a luxury good.

                                                                                                               
1
History Editors 2019
2
Canadian Public Health Association 2017
3
WHO 2019
4
DOH 2016
5
WHO 2019
6
Ibid.
7
WHO 2016
8
Banis, D. 2019
 However, the definition of mental health is more than “a state of well-being”; it is also
defined as the absence or presence of the problems, disorders, or illnesses it’s attached with.
These mental health problems impact your thinking, mood, and behavior. Many factors
contribute to mental health problems, including biological factors (genes or brain chemistry), life
experiences, (trauma or abuse), and family history of mental health problems.9

Examples of these mental health problems include mental disorders such as depressive
disorders, schizophrenia and other psychotic disorders, trauma-related disorders, and substance
use disorders. Among these, common disorders include depression, anxiety, and post traumatic
stress disorder.

Numbers surrounding Mental Health

Globally, the World Health Organization (WHO) reports that around 450 million people
currently suffer from mental disorders, and that one in four people will be affected by mental or
neurological disorders at some point in their lives.10 Furthermore, they stated that around 20%
of the world’s children and adolescents are diagnosed with mental disorders.11

Locally, the ratio isn’t too far. In the Philippines, one out of five adult Filipinos suffer
from mental or psychiatric disorders, or 88 cases of mental illness for every 100,000 Filipinos.12
More specifically, the Philippine Health Information System on Mental Health reports that
schizophrenia—a mental illness that interferes with a person’s ability to think clearly, manage
emotions, make decisions, and relate to others—is the most common mental disorder for
Filipinos.13

Suicide rates rising (trigger warning: sensitive content)

Depression, on the other hand, would be considered as the most preventable disorder
and arguably the most impactful towards the community. At its worst, depression could lead to
suicide. During the World Suicide Prevention Day, WHO Director-General Dr. Tedros Adhanom
Ghebreyesus said, “Every death is a tragedy for family, friends and colleagues. Yet suicides are
preventable. We call on all countries to incorporate proven suicide prevention strategies into
national health and education programmes in a sustainable way.”

Annually, suicide takes the life of over 800,000 persons and is globally considered as the
second leading cause of death among 15-29 year olds.14 Furthermore, for every person who
died of suicide, there may have been more than 20 others who attempted suicide.15

The global age-standardized suicide rate for 2016 was 10.5 per 100,000.16
Comparatively, the Philippines’ suicide rate in 2015 is much lower at only 3.8 per 100,000, with
1.9 for females and 5.8 for males per 100,000.17 Accordingly, that statistic afforded the
Philippines rank 159th out of 183 countries.18

                                                                                                               
9
MentalHealth.gov 2019
10
WHO. 2019
11
WHO.
12
Octaviano, R. 2017
13
Ibid.
14
WHO.
15
Ibid.
16
WHO 2018
17
Global Burden of Disease Study 2015
18
WHO 2018
 19

However, such ranking can never be a reason for celebration. On its own, the statistic is
the Philippines’ highest ever suicide rate and is projected to rise higher. In 2012, the age-
standardized suicide rate was at 3.7 per 100,00020, in 2005 it was at 2.25, while way back in
1984 it was only at a mere 0.17 per 100,000.21

Philippines age-standardized Suicide Rate per

100,000 (1985-2016)
8

6 5.8
5.2 Philippines
4 3.7 3.8
3.5
Male
2.25 2.3
2 1.9
Female
1

0 0.17

1984 2005 2012 2016

In an interview with Inquirer, Dr. Dinah Nadera, a Psychologist of the University of the
Philippines’ Open University, provided additional information regarding suicide in the Philippines.
She said that suicides usually occurr during Summer and Lenten Season at April, between
8:01am and 12:00pm on weekdays, inferring that such is done when other people are not
present in their homes.22

Furthermore, Nadera adds that the most common methods of suicide were done by
hanging, strangulation, suffocation, poisoning, and exposure to chemicals and noxious
substances.23 Additionally, the most common causes of suicide were depression, low income,
unemployment, separation from spouses, and conditions such as heart diseases and cancer.24

Barriers to accessing Mental Health Services

In spite of the harrowing statistics, efforts to deter such numbers are not as effective as
expected. Other than the main problem of mental illness, the presence of other problems only

                                                                                                               
19
WHO. 2018
20
WHO. 2016
21
Dacanay, B. 2012
22
Ibid.
23
Ibid.
24
Ibid.
contributes to its proliferation. These problems include stigma, lack of health professionals, lack
of information towards services, and the expenses towards availing services and support.

1. Stigma towards the illness, person, solution

Stigma has long been a public health problem even for other diseases due to its effects
in health-seeking behavior.25 For mental health illnesses, stigma is arguably the most common
factor barricading at-risk populations from seeking and availing health services, or even at the
very least, acknowledging their condition as such.26

This manifestation is concurred by many individuals in the ‘frontlines’ including mental

health professionals and practitioners, and mental health advocates.

In an e-mail exchange with Ms. Tazjana Lebrilla27, her experience as a Psychologist

working with the Ateneo Bulatao Center for Psychological Services, Office of Guidance and
Counseling at the Ateneo de Manila University, and Human Dynamic-Philippines, has led to her
understanding of the detrimental effects of stigma towards worsening the problem and
ultimately hindering their initiative to seek mental health services:

The main and longstanding problem that is most prevalent in the Philippines with
regards to mental health is the stigma. The stigma ranges from denying its actual
existence to labeling it as something else. From downplaying words such as ‘stressed’ all
the way to extreme labels such as ‘crazy’. The general public is not only lacking in
knowledge regarding the matter, they are quick to dismiss anything that gives it
meaning or relevance. This makes it difficult for people who are going through mental
health problems to open up about their struggles. They effectively choose to conceal
these, thus creating a far bigger and more detrimental mental health problem. Further
complicating this, because it has been stigmatized, people tend to not seek any form of
mental health service. Thus, access to these services are either not known or not given
enough priority that they stay in the shadows. (Lebrilla, 2019)

Moreover, Mr. Roy Dahildahil—Executive Director and co-founder of #MentalHealthPH, a

non-governmental organization advocating for mental health—adds to the perception of the
general public towards mental health, even quipping the influence celebrities have towards such
perception. In a phone interview with Mr. Dahildahil28, he said:

Hindi pa ganoon ka norm for Filipinos to take care of their mental health. They think na
it’s not yet a priority or they do not know na dapat alagaan dahil nakapag-apekto with
physical health. They don’t see the connection of their mental health to their day-to-day.
Malaki pa rin yung stigma about mental health and especially mental illnesses. Stigma in
terms of not believing mental illnesses exist. They think that you can just ‘think postive’
and mawawala na yun. I believe most mental health professionals will also agree na
hindi yun ganoon ka simple na maaayos ang mental illness. A lot of myths surrounding
Mental health. For example before, that time na sinabi ni Joey Deleon na ‘yung ganoon
sakit na isip lang and minsan dahil sa mga ganoon na celebrities more na
pinapaniwalaan ng mga tao and nagtratransmit ang self-stigma. (Dahildahil, 2019)

                                                                                                               
25
Agoncillo et al. 2016
26
Zartaloudi et al.
27
Ms. Tazjana Lebrilla, Associate Psychologist for the Ateneo Bulatao Center for Psychological Services,
Part-Time Psychologist for the Office of Guidance and Counseling at the Ateneo de Manila University, and
Affiliate Psychologist at Human Dynamic-Philippines. E-mail, 6 October 2019
28
Mr. Roy Dahildahil, Executive Director and co-founder of #MentalHealthPH. Phone interview, 7 October
2019
 On the other hand, staunch mental health advocate and student of the University of San
Agustin, Mr. Juan Manuel C. Dela Cena in an e-mail exchange29 cited ‘victim blaming’ as a
perpetrator for the stigmatization of mental health.

With the alarming increase of suicide cases, I hear and see a lot of side comments from
people putting all the blame to suicide victims. These people simply do not understand.
The fact that students are hesitant about going to the Guidance Office because of the
notion that only “problematic” people need consultation from the office [is also another
problem]. (Dela Cena, 2019)

Finally, Mrs. Kirstin Leigh Lopez-Pareja—founder of Postpartum Heroes, an organization

advocating for mental health—adds a cultural and historic dynamic behind the definition of this
stigma. In an e-mail exchange with Mrs. Lopez-Pareja30, she said:

[The] stigma around mental health issues, especially depression and suicide, [is shown
when persons with mental health conditions are] labeled as 'buang'. Mostly in the
provinces, mental health issues are treated as 'bughat' or given paranormal explanations
thus treated by albularyos, which do not really help. (Lopez-Pareja, 2019)

Stigma is a set of negative and often unfair beliefs that a society or group have towards
something.31 As a factor affecting health-seeking behavior among at-risk populations, stigma is
simply an umbrella term that encapsulates the socio-cultural, religious, and even historic beliefs
the Philippine population has towards mental health.

There are several factors that contribute to the stigmatization of mental health in the
Philippines.32 These include ‘stereotypical’ portrayal in media, religious condemnation and/or
problem-solving (‘praying the sadness away’), and lack of education towards mental health.33

2. Lack of health professionals

On the other side of the problem is the shortage of response from the health provider—
a lack of health professionals and a lack of awareness and information towards mental health
services and facilities.

Even if stigma were to disappear, the current number of mental health professionals is
unable to accommodate the number of persons with mental health conditions. This is not
because there would simply be too many persons needing such service (although expectedly
there ought to be), but because there are simply too few personnel available.

In an interview with Dr. Lisa Gayoles34, the resident Psychologist at the University of San
Agustin’s Office of Guidance and Counseling, she shared her problems regarding the lack of
psychologists:

As a mental health professional, one of the problems I have encountered is the lack of
psychologists doing counseling and psychotherapy. Most of the psychologists in Iloilo
City as well as in Bacolod City do psychological assessment mostly for annulment and
adoption, and sometimes when asked by the courts for VAWC and other cases.
(Gayoles, 2019)

                                                                                                               
29
Mr. Juan Manuel Dela Cena, Project Head of Project CathARTsis, E-mail, 6 October 2019
30
Mrs. Kirstin Leigh Lopez-Pareja, Founder of Postpartum Heroes. E-mail, 9 October 2019
31
Merriam-Webster Dictionary.
32
Coronel, R. 2019
33
Ibid.
34
Dr. Lisa Gayoles, Psychologist of the University of San Agustin Office of Guidance and Counseling. E-
mail, 7 October 2019
 As of 2014, there are only 490 psychiatrists for 100 million Filipinos.35 In general, the
ratio of mental health workers is at 2-3 per 100,000 Filipinos.36 This is lower than other
countries with a similar economic status like Malaysia (4.9 per 100,000) and Indonesia (3.1 per
100,000).37 Other data regarding the number of mental health workers in the Philippines is that
there are 0.52 psychiatrists, 0.07 psychologists, and 0.49 mental health nurses per 100,000
inhabitants.38

Mr. Dahildahil also weighs in on the matter saying that other than the lack of personnel,
the number of hospitals and the referral system in the Philippines should also improve. He says
that:

Wala pa masyadong hospitals and referral systems in the Philippines. Hindi pa ganoon
karami. There’s [also] a lack of psychologists and psychiatrists. Hindi ganoon kadami.
Hindi pa ganoon kadami ang mga clinics and hospitals. (Dahildahil, 2019)

Furthermore, Mr. Dahildahil emphasizes on the importance of such services because the
presence of which is only one-half of the solution; the other half is for people to be aware of
the availability of such services:

Siguro hindi pa alam ng mga tao saan banda doon ang mga services. For
example…would you know ano ba yung mga facilities [for mental health], if you want to
refer a friend, who wants to commit suicide or to kill themselves? If people na mayroong
educational attainment hindi alam, how much more the people na high school or
elementary lang ang pinag-aralan? (Dahildahil, 2019)

3. Expense towards availing services and support

Prior to the full implementation of R.A. No. 11036, persons with mental health
conditions or those who seek to avail of mental health services are burdened with high
expenses for such services.

According to the same email exchange with Mrs. Lopez-Pareja, she states that the cost
of psychiatric consultations in Iloilo would range from P500.00 to P1,000.00, amounts that are
considered expensive for the simple Filipino.

In Metro Manila, however, a session with a private psychiatrist would cost between
P2,000.00 to P3,000.00.39 Moreover, prices of medicine are also expensive with anti-
depressants and anti-psychotic drugs costing around P300.00 per tablet.40

Programs and efforts prior to the Mental Health Act

In spite of all these problems, however, there are efforts still being made to close the
gap. These efforts and programs—whether executed as an institution, clinic, organization, or
even personal initiative—have been happening prior to the Mental Health Act. The examples
listed below are the programs and initiatives of those interviewed.

For Ms. Lebrilla, her involvement in the promotion of mental health services was in
touch in three different sectors—institutional-professional, academe, and private. She
elaborates on these programs:

                                                                                                               
35
Francisco, K. 2014
36
Lally, J., Tully J., Samaniego, R. 2019
37
Ibid.
38
Ibid.
39
Gonzales, M. 2019
40
Ibid.
 Firstly, what the Ateneo Bulatao Center does to be of service to high-risk populations is
to create workshop programs. These workshops are the most cost-effective
psychological interventions…on a large-scale level. We have conducted workshops to
children, mothers in urban-poor communities, corporate employees, elementary
children, …and non-government organizations. These are free programs…in exchange
for data we could use for…better psychological interventions. With every workshop, we
impart more knowledge regarding mental health in hopes to close the gap.

Secondly, my work with the Office of Guidance and Counseling…only caters to the
students and professionals within the Ateneo community. However, there are many
outreach programs that the students are involved in yearly. Before they are able to join
these programs, the office makes sure they are mentally fit. We conduct interviews,
focus group discussions, and follow-ups to ascertain their readiness. This would put
them in a sound mind and body to interact with people in other communities.

Lastly, as a consultant in Human Dynamic, a corporate company, we provide mental

health services that are included in the employees’ insurance. The employees are
afforded a total of 25 therapy sessions for them or for anyone in their immediate family.
This gives them direct access to a psychologist anytime they deem it necessary. It is
pleasing to know that…corporate companies put more value on their employees’ mental
health. This helps reduce the stigma especially in the corporate sector. (Lebrilla, 2019)

Meanwhile, organizations that advocate for mental health are also creating impact within
their community. Mrs. Lopez-Pareja explains how the organization she founded, Postpartum
Heroes, has provided support to mothers, and how through Global Shapers Iloilo she
contributed to the awareness of mental health:

We do awareness campaign thru our FB page, Postpartum Heroes. We also have

monthly/quarterly Mommy Circles, which aims to provide a safe space for mothers to
talk about day-to-day motherhood life. We also offer emotional support to mothers
online and thru personal one-on-one meet-ups. [Through] Global Shapers, we led a
roundtable discussion wherein various sectors have been invited to talk about mental
health issues among the youth. We also do awareness campaigns through FB pages,
Global Shapers Iloilo and Agubayani, and talks every October for Wold Mental health
day. (Lopez-Pareja, 2019)

Mr. Dela Cena, being a student and mental health advocate, continues to lead programs
in his school that raise awareness on mental health. Being crowned as Mr. USA 2018, he used
his platform to launch his advocacy, Project CathARTsis to promote mental health. However, he
reminisces his humble beginnings:

I started advocating mental health when I was in Grade 10…by the simplest acts of
sharing relevant posts on my social media accounts. I created content that didn’t only
raise awareness but more importantly inspired those who came across them. I also
frequently tell my friends, and …that I am with them, and their emotional burdens.
Though I still am young and not a professional at this field, I lend them my ears, and
encourage them to talk more about their problems, and listen more to the problems of
others. (Dela Cena, 2019)

While the efforts of these mental health advocates and practitioners are certainly
laudable, such measures simply cannot handle the magnitude of the timeless and boundless
public health predicament that is Mental Health.
The Case of Liam Madamba

On February 6, 2015, 18-year old Liam Madamba (Liam) jumped off of the sixth floor of
the Dela Rosa carpark building of Legazpi Village, Makati City. This instantly led to his death.
Upon tracing the events that led to her child’s death, mother Trixie Madamba (Trixie)
discovered through her son’s suicide note that Liam had been involved in a cheating
controversy and was forced by a teacher to apologize in public. The apology, which was done
through a letter addressed to the entire school body, traumatized Liam prompting him to
commit suicide shortly after.41

The death of Liam led to his mother blaming the officials of the school for the death of
her son. Trixie specifically points at Natalie Mann, the teacher who forced Liam to apologize, as
the “proximate cause” of Liam’s suicide.42 British School Manila denied any involvement in the
death of Madamba and defended Mann’s actions. The case is currently under Senate inquiry
being used as a means of foreclosing the school.43

In spite of the case steering away from the subject matter of mental health, it
nevertheless remained influential in the campaign for the legislation of the Mental Health Act.
The impact of Liam Madamba’s death at the time may have provided the domino effect that led
to the filing of bill that eventually be enacted as R.A. No. 11036.

During the escalation of the issue, then Secretary General of the Philippine National
Commission of UNESCO, Lila Ramos-Shahani wrote about the death of Liam Madamba in the
light of lacking mental health awareness and a culture pervasive towards its stigmatization.44

The death of Liam Madamba was reported by several news outlets and gained a lot of
traction in social media at the time. This incident led to the increase in conversation towards
mental health, especially since it was only a few months apart from the deaths by suicide of
over notable celebrities like Filipina model Helena Belmonte45 and American comedian Robin
Williams in 2014.46

The passage of the Mental Health Act

Prior to the enactment of R.A. No. 11036, reliance on public health systems regarding
Mental Health rested on the National Mental Health Policy (Administrative Order #8 s.2001),
signed by then Secretary of Health Manuel M. Dayrit.47 Moreover, laws that governed the
provision of mental health services had varied sources such as the Penal Code, Magna Carta for
Disabled Persons, Family Code, and even the Dangerous Drug Act.48 Today, however, spells a
different sense of optimism towards mental health legislation.

The Philippine Mental Health Act’s (Senate Bill No. 1354, 2017) passage into law was
influenced by the rising cases of suicides and rising numbers on mental health disorders49. And
while controversial suicides such as that of Liam Madamba and of celebrities50 strengthened the
public’s clamour for mental health legislation, it was the totality of the hair-raising cases that
mental health disorders brought into our reality.

                                                                                                               
41
Cepeda, M. 2018
42
Merueñas, M. 2016
43
Felongco, G. 2015
44
Shahani, L. 2015
45
GMA News Online. 2014.
46
BBC 2014
47
WHO and Department of Health. 2006
48
Ibid.
49
Lally, J. et al. 2019
50
James, S. 2014
 Dr. Joseph Anthony Lachica of the Policy and Legislation Unit of the Office of Senator
Risa Hontiveros—through an e-mail correspondence51—lays insight on what prompted the
legislation:

There was no single or particular case, but there were a lot of cases that highlighted
further the need to pass mental health legislation. There were stories of people with
mental health conditions being abused by their relatives. There were stories of people
being tied so they cannot roam around. Some were being caged because their family
didn’t know what to do with them. There were also stories of people with mental health
conditions being confined in hospitals against their will. The collection of anecdotes of
how people suffered from these injustices emphasized the need for policies that would
protect them.

Dr. Lachica adds that the reason why Senator Hontiveros passed the Bill in 2016 was
due to a public health necessity, warranting the safeguards afforded to the stakeholders
involved and systems to address its barriers such as stigma:

The main reason [for passing the Bill] was that there was a need for this legislation.
Mental Health is a significant public health concern in the country…. Mental health was
not merely about mental illness but more of mental health promotion and the
attainment of this positive state of mental health… There was a need to raise the level
of awareness through education and advocacy. The stigma associated with MH had to
be addressed because it was a barrier towards attaining these objectives. It was also
important that a stronger set of regulations to protect the human rights of individuals
with mental health conditions, their caregivers, and the health professionals / workers
involved in service provision were put in place. Furthermore, it was also critical that to
improve the capacity of both the government and the private sector to provide mental
health services to respond to these rising challenges.

Involvement of stakeholders, actors, and lobbyists

Meanwhile, Mr. Dahildahil has a another perspective towards the development of such
Act. Being in the forefront of mental health advocacy in this country, Mr. Dahildahil recounts the
events that, for him, led to the passage of the Bill:

Nung 2016 na sinamulan namin [ang #MentalHealthPH], napag-usapan [ang Mental

Health] at binigyan ng atensyon ng mga politicians and other political parties at
inadvocate nalang kasi nila at nagtayo din sila ng kanilang sariling organization para ma
push forward pa ang mental health.

Dati, prinopromote na rin ang mental health act ng Philippine Mental Health Association
(PMHA) and the [Psychological Association of the Philippines] PAP. Pero nung 2016,
umingay. May something na umingay sa 2016. Not sure kung ano yung root na yan.
Pero nung 2016, mas lalo sya umingay and parang all eyes on the law na.

I don’t want to claim naman na parang kami talaga yung nagsimula ng dialogue na yun
pero I just want to point out that in 2016, nung nilaunch namin na paghahanap ng mga
volunteers for mental health advocates, sinupport kami ni Doc Gia Sison sa Twitter and
Dr. Iris Isip-Tan and Dr. Herbosa, the undersecretary before. And then in some of the
forums na meet ko yung mga…secretary-general…of Risa Hontiveros and I told them of
my advocacy on mental health and they were pretty supportive of it and then we all
acted as an organization to lobby for the law.

                                                                                                               
51
Dr. Joseph Anthony Lachica, respondent from the Policy and Legislation Unit, Office of Senator Risa
Hontiveros, author of the Mental Health Act. E-mail, 22 October 2019.
 Mr. Dahildahil further adds that the presence of such actors advocating for the Bill was
timed perfectly:

I think nagalign lang, naging serendipitous lang. Kasi…ang dating secretary na si

[Paulyn Rosell-] Ubial ay advocacy niya for health is mental health.
So, umingay sa social media tapos nagkakaroon ng legislation to promote mental health
and then we have a DOH secretary na mental health ang pina-push. So almost lahat na
national [actors] na priority ay mental health. So, na-establish sya na maging bill and
then all eyes on the law na.

Perhaps the passage of the Bill was indeed serendipitous. While the previous
Department of Health (DOH) secretaries Francisco Duque (2005-2009) and Enrique Ona (2010-
2014) focused more on health financing52 and providing universal coverage for PhilHealth53,
respectively, the DOH Secretary in 2016, Paulyn Jean Rosell-Ubial (Ubial) included mental
health as one of her primary health concerns.54 Accordingly, she signed an administrative order
on October 2016 increasing the budget for mental health from P36 million to P220 million.55

On the other side of the table is Risa Hontiveros (Hontiveros), a health advocate herself
who authored other health-related Bills such as the Expanded Maternity Leave Law, the Safe
Spaces Act, and the HIV Policy Act.56 And with Hontiveros’s Senatorial win in 2016, and with the
lobbying of groups such as #MentalHealthPH and SilakboPH57, the timing seemed ripe for the
passage of a Mental Health Bill. After all, the Ubial-Hontiveros tandem is strong, having worked
together on the DOH Plan of 2016-2022.58

Moreover, it wasn’t only the collaboration of Ubial and Hontiveros that led to the Bill, but
also the infusion of a diverse set of actors that influenced its inception. According to Dr.
Lachica, “there were several stakeholders that participated in the legislative process” before and
even after the law was passed. He enumerates them:

a. The Service users – Service users is a term used to refer to people with mental
health conditions who access mental health services. This stakeholder block includes
patient groups, family memebrs of service users, among others. The voice they offer is
unique as it is guided by previous experiences dealing with stigma, dealing with a
broken, inaccessible, and sometimes abusive, system.
b. The Mental Health Service Providers: This refers to all providers of mental health
services. Their interest was mainly in the awareness that any improvement in the
system will not only benefit service users but will invariably lead to the advancement of
the profession and craft in terms of prestige and incentives. The group of health service
providers is one big block which includes psychiatrists, neurologist, substance abuse
specialists, psychologists, guidance counsellers, peer counsellers, among others. Each of
these service providers is a separate stakeholder group pushing for a bigger role for
themselves in the system.
c. Non governmental organizations and civil society – This is a big group that
includes even some service providers, service users, patient’s groups among others.
These individuals and organizations who have been actively working for the
advancement of mental health in the country even with out the law. They are present in
the communities and have experience in working on mental health programs in these
settings.

                                                                                                               
52
DOH. 2018
53
SunStar. 2010
54
Octaviano, R. 2017
55
Ibid.
56
Senate of the Philippines. 2019
57
de Guzman, L. 2018
58
Inquirer.net. 2016
 d. Private sector – This includes industry and private entities who are possibly looking
for economic opportunities and possibilities for colloboration along the lines of mental
health.
e. The Government particularly the Department of Health and other pertinent
agencies is also an important stakeholder as the lead agency that will implement the
law. Their concerns are mostly operational and are mostly based on the understanding
of existing constraints.
f. The youth is as big block of stakeholders. They are the ones who pushed the
advocacy further several notches higher by taking to social media express their support.

All-in-all, the collaboration of many parties bore fruit to an Act that puts on a pedestal
the mental health of every Filipino.

For Senator Villanueva, too, he cites rising cases of suicide among the youth as the
reason for filing the bill.59 As one of the co-authors, he cited a report from the National Poison
Management and Control Center showed that 46% of all suicide cases since 2010 are from the
youth. Thirty percent are from ages 20-35, while remaining 16% are from ages 10-19.
Incidence is highest among young adults ages 15-24 years old, according to the PAP.60 Aside
from co-authoring the Mental Health Act, he also filed Senate Bill No. 1163 or the Youth Suicide
Prevention Act.

Republic Act No. 11036 – the Mental Health Act

On October 6, 2016, Senator Hontiveros, as Chair of the Senate Committee on Health,

and Senator Villanueva filed the Mental Health Act of 2016. Almost two years later, the Bill was
signed into law by President Rodrigo Duterte on June 20, 2018.61

R.A. No. 11036 or the Mental Health Act establishes a National Mental Health Policy that
seeks to empower the stakeholders involved by protecting their rights, ensure the delivery of
Mental Health services, promote and educate the public on Mental Health, and integrate other
departments of the government to work together for the successful implementation of the said
policy. Listed below are the Act’s highlights. For the full text of R.A. No. 11036, visit
https://www.officialgazette.gov.ph/2018/06/20/republic-act-no-11036/

1. Protection of the rights of the stakeholders involved

Under the provisions of the law, the rights of the service users as well as other
stakeholders are held. Chapters 2 and 3 of the law focus on providing protection to service
users from stigma and discrimination, ensuring their access to services and treatment.
Moreover, the law highlights on the confidentiality of the information and upholding the consent
required in all stages of availing the service, including a provision of legal services for the user.

Ms. Lebrilla concurs with these provisions, being affected personally by them. As a
licensed psychologist, she wholeheartedly approves of the protection of the rights of the
medical professionals involved:

These [provisions] make it easier for us professionals to move forward with our jobs
knowing that we have rights that would protect us. At the same time, the act solidifies
everything we already provide in our institutions such as access to all forms of mental
health services, humane treatment, access to rehabilitation, and aftercare. It would push
more professionals or institutions to provide these services as well. Thus, giving the
people more options and opportunities to seek help. Personally, we have noticed a

                                                                                                               
59
Ager, M. 2016
60
Ibid.
61
de Guzman, L. 2018
 growing amount of people who seek services- both in the clinical and corporate setting.
(Lebrilla, 2019)

2. Provision of Mental Health services

The Act also provides the objective of providing mental health services that are
responsive and appropriate, ensuring that such services be available not only in hospitals and
other health facilities, but also in the community or barangay levels. Such far-reaching service
will be beneficial especially for those who already have difficulty in accessing health services, in
general. In concurrence with such provisions, Dr. Gayoles said:

The act aims to provide mental health services to the barangay level, which makes it
more accessible to a diverse group of people who may be in need of such services. Not
only will health services be available for sustaining physical health, but for mental health
as well. (Gayoles, 2019)

Moreover, Chapter 4 of the Mental Health Act puts priority on suicide prevention in such
health services. This includes the maintenance of a 24/7 suicide prevention hotline as well as
launching nationwide campaigns for public awareness. All-in-all, the Act enshrines human rights
to be the center in terms of providing these services.

3. Promotion and education on Mental Health

Perhaps the most sustainable part in this Act is its provision of integrating the education
of Mental Health in the Philippines’s educational system, as indicated in Chapter 5. It specifies
that age-appropriate content on Mental Health be integrated in all educational levels.

Other than the educational system, the act also calls for the promotion and education of
mental health in the workplace, providing capacity building opportunities for health workers to
be trained and oriented on the matters of Mental Health. At its core, education of mental health
in the educational system and also private institutions seeks to reduce the stigma and
discrimination surrounding mental health.

4. Integration of the government’s departments (Philippine Council for Mental

Health)

Lastly, to ensure the prioritization of mental health in terms of leadership and

governance, the provisions of the Act assembles various departments of the government to
work hand-in-hand to realize the Act’s objectives. For example, the Department of Health
spearheads the program, the Department of Education integrates the same into their
curriculum, the Department of Labor and Employment creates workplace guidelines, and the
Local Government Units implement effective mental health policies.

The Mental Health Act also establishes the Philippine Council for Mental Health (PCMH),
the body that will develop the mental health policies and come up with multi-sectoral strategic
plans for mental health.

The impact (so far) of the Mental Health Act

It was only last January 22, 2019 when the Implementing Rules and Regulations (IRR)
of R.A. No. 11036 was signed. The IRR specifies the rights of the user and the stakeholders it
seeks to protect, provides specific provisions on consent, upholds its promise in providing
quality mental health services from communities to tertiary hospitals, integrates mental health
in educational institutions within two years, mandates the PCMH, and creates the DOH Mental
Health Division, among others. For the full text of the IRR of R.A. No. 11036, you may access it
at https://www.doh.gov.ph/sites/default/files/health_advisory/IRR%20of%20RA%2011036.pdf
 While the effects of the Mental Health Act are yet to be felt by the majority, the same
nevertheless provides optimism and security for those involved in the front lines. For Mr.
Dahildahil, he and his organization will now have a better platform in fulfilling their advocacy:

Yes it impacted our organization kasi nga nung una sinimulan namin yung pagpapaingay
ng mental health organization and nakikita na kami ng mga Department of Health and
other agencies. Dahil sa Mental Health Law, mas ma reinforce yung involvement namin
in providing services. And yung #MentalHealthPH is with the technical working group of
the…Philippine Council for Mental Health. Because of the law, nagkaroon ng PCMH and
nakaupo kami doon sa technical working group kung saan…inaayos ang mental health
law. And also because of the law, naging maingay ang mental health and vis-à-vis na
apektohan rin yung demand ng organization. Nahahanap na rin at nakikita sa NGOs and
other websites yung org. (Dahildahil, 2019)

Relevance of the Mental Health Act today

For those who may not be personally afflicted by the trials of mental health disorders
and its unintended consequences, the passage of the Mental Health Act may simply be another
form of good news. In contrast, for those who experience all the problems of and attached to
mental health, the Mental Health Act may be considered as a form of validation that empowers
their work, a clog to the money drain, a sign of hope, or even as a literal ‘life saver’.

The relevance of the Mental Health Act cannot be measured yet with data since the Act
itself is merely one year old and its IRR having been recently passed. However, interviews with
mental health professionals and advocates present the underlying value R.A. 11036 presents to
them and to society.

For Ms. Lebrilla, the Mental Health Act is a sign of our country’s promise and obligation
in rendering support to those who need to be heard and taken care of. It is a step in the right
direction being inclusive to those who are in need of its services:

It is highly relevant because mere enactment of such an act deems it important enough
for the government to pay attention to. By bringing it to the forefront and showing that
it is pertinent enough to be talked about, it would eliminate some of the stigma
surrounding mental health. It would encourage people to seek help because they are
now provided with rights and freedoms, they would be free of discrimination, and there
would be provision of more accessible and cheaper mental health services. (Lebrilla,
2019)

Mr. Dahildahil further adds to the conversation specifying that the Act would trample
one of Mental Health’s biggest problems—expenses:

In terms of suicide, mahalaga ang Mental Health Act because suicide is preventable. And
so makakatulong ito para ma avoid ang irreversible act, which is yung pagpapakamatay.
Pagdating sa mental health act kasi, for people with mental health conditions sobrang
mahal ng services and sobrang mahal ng rate ng mental health providers. So having
mental health conditions in the Philippnes can become very costly. Because of the law,
mapapagapang niya at matutulungan niya i-subsidize yung mga ganoong klase na mga
expenses at mapapadali yung health-seeking behavior ng mga tao. (Dahildahil, 2019)

For Mrs. Lopez-Pareja, meanwhile, the Act is a hopeful solution towards a problem that
plagues our society, having garnered more attention with the latest cases of suicide and
depression. She also adds the importance of harmonizing various government agencies:
 Very relevant especially [since] the number of suicides and depression cases are
continuing to increase in the City. I think the most important part of the Act is activating
government agencies such as Deped, Ched, and DOLE to also create MH programs as
this is preventive in nature. (Lopez-Pareja, 2019)

Recently, the Province of Iloilo was haunted by the harrowing statistics of rising cases of
youth suicide (ages 9 to 21) numbering to 179 suicide cases from 2016 to 2019.62

A sign of hope for the Filipino’s state of Mental Health

The Mental Health Act is a validating sign of hope for the future of the Philippines’ state
of mental health. While mental health advocates may have already begun to see the tides (on
negative outlooks towards mental health) turn a few years ago, the Act still remains as a
reminder that so much more needs to be done. Nevertheless, there is a resounding amount of
hope surrounding the subject matter.

For Ms. Lebrilla, she is positive that more professionals will join her ranks in alleviating
this matter. The growing number of professionals in the industry would hopefully offset the
demand and that more people will see it as an in-demand job:

There has been a slow but steady stream of people who choose a career in Psychology.
These people, both professionals and advocates, continue to develop interventions and
create research that furthers the development of the mental health programs in the
country. They create awareness and advocate for better mental health programs that
would profit the whole Psychology community and its end users. (Lebrilla, 2019)

Furthermore, one of the ‘easiest’ solutions in countering the stigma that surrounds
mental health is to simply talk about it. After all, a topic that is considered as taboo will no
longer be considered as such if more people talk about it earnestly. Several of the advocates
are happy with the ‘noise’ that is being generated by the passage of the Act:

Some students are open to talk about their personal problems, with proper guidance,
and with an appropriate medium. In Project cathARTsis, some shared their emotional
baggage through pot-paintings and write-ups. Digital platforms of Mental Health
awareness increase more virtual advocates who eventually do their part on and offline.
More symposia and activities are being conducted by non-government organizations.
I can say that Mental Health-related issues are gaining talks within the country and I am
positive that Filipinos will become more open about it. I see the Mental Health Act
gradually attaining its goals of providing accessible mental health care and a
compassionate social understanding. (Dela Cena, 2019)

More awareness campaigns are available especially through social media which helps
people talk more about MH issues. [It also] seems that youth are more open now to talk
about mental health. However guardians/parents/teachers are not open thus youths find
it hard to talk to elders. (Lopez-Pareja, 2019)

I have seen an increase in people seeking counseling and psychotherapy, which

indicates acceptance of mental health services, thus an indication of decreasing stigma
attached to mental disorders. (Gayoles, 2019)

There is a lot of optimism, in general, towards the subject. For Ms. Lebrilla, the support
of the government would increase the magnitude of their services:

                                                                                                               
62
Momblan, G. 2019
 I’m very much optimistic that this will pave way for greater access to mental health
services. With the support of the government and health departments, we would be able
to allocate for research, develop psychological interventions, and provide more services
with a wider reach. If anything, more people are now talking about mental health and
advocating for it, especially the youth. Hopefully, this would encourage people to see
that mental health is just as important as your physical health and that there is no
shame in wanting to have yourself checked. At the core of it all, that is basically what
going to a therapist is. It is not something you should be ashamed of and it definitely
does not automatically mean something is wrong with you. Even then, there needs to be
separation of the person to the problem. The person is not the problem. The problem is
the problem. Once people start seeing it in this perspective, they would see that they as
humans are separate from whatever they are struggling with, and they can eliminate it.
It’s still very much an uphill battle, but I am hopeful. (Lebrilla, 2019)

For Mr. Dahildahil, the signing of the Act itself, constituting the government’s care
towards its people, would be enough to create ripples of change:

Makikita nila na dahil binigyan ng gobyerno ng importansya ang mental health,

binibigyan nila ng importansya yung ating mental health. So kahit hindi iimplement yung
act o hindi maiimplement nang maayos yung mental health, optimistic ako na
magkakaroon ng impact sa mga tao, sa mga educational systems, sa mga private
companies and NGOs. (Dahildahil, 2019)

Ultimately, the Act in itself would be a mere piece of paper. The implementation of such
Act would require the involvement of many parties for it to work fruitfully:

From the several meetings I have been to about the MHAct I am very hopeful. However,
government cannot do it alone. Therefore, its also crucial to involve other sectors to
take a part in implementing the MHAct. (Lopez-Pareja, 2019).

The Mental Health Act was passed and developed as a response towards a problem that
was not even initially considered as one. It was chosen in spite of being unprioritized, it was
believed in in spite of the stigma surrounding it, and yet it will champion the isolated and the
reclused. And while the passage of the act is a laudable feat, its implementation may be
another story. Nevertheless, we remain hopeful.
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