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THE MENTALLY DISABLED in PHILIPPINE SETTING: A Call for Equal Protection. A Critique on the Rights and Privileges Of Mentally Disabled Filipinos And Their Place in Philippine Health Laws
_____________________________________________________________________________________

Authored by:

Naomi Therese F. Corpuz University of the Philippines College of Law

ABSTRACT

The research paper is a critique on the rights and privileges of the mentally disabled Filipinos. The paper starts with an introduction on the history of mental illness, how it is connected to the brain and how it is correlated to other physical illnesses. The paper also discusses, in terms of ranking as to importance viz-a-vis other disabilities, the place of mentally disabled Filipinos on Philippine Health Laws such as Republic Act 7277 also known as the Magna Carta for Disabled Persons, legislative policies issued by the Department of Health and the pending House Bill 6679 otherwise known as, An Act for A National Mental Health Care Delivery System Establishing For The Purpose The Philippines Council for Mental Health And Appropriating Funds Therefore. The research was done by conducting a survey on more than 90 respondent-psychiatrists by random sampling nationwide. The paper also discusses the Philippine Health Insurance (PhilHealth) which is the first and only social- based insurance in the country that is found, however, to be limited and unjust for the mentally disabled. This research also delves into the passive role of psychiatrists in legislative policies affecting their patients. It culminates with a conclusion and recommendations such as provisions of laws that can be amended and what the Department Health, private sectors and mental health professionals can do in furthering the rights and privileges of the mentally disabled Filipinos of the Philippines.

THE MENTALLY DISABLED in PHILIPPINE Setting: A Call for Equal Protection. A Critique on the Rights and Privileges Of Mentally Disabled Filipinos And Their Place in Philippine Health Laws

I. II. III.

Introduction.4 History of Mental Illness.5 Mental Illness Defined ......8 a. Common Mental Illnesses....10 b. Connection to the Brain, Risk Factors and Correlation to Physical Illnesses..................12

IV.

Laws Affecting the Mentally Disabled.....14 A. Republic Act 7277, otherwise known as Magna Carta for Disabled Persons..14 B. DOH AdministrativeOrder No. 8 Series of 2001 and DOH Administrative Order No. 9 Series of 2007....21 C. Amendment of Republic Act 7277 otherwise known as Magna Carta for Disabled Persons by Republic Act 9422 and DOH AdministrativeOrder No. 11 Series of 2009..22 D. Pending House Bill No. 6679...25

V. VI. VII.

Philippine Health Insurance Coverage of the Mentally Disabled.26 Conclusion & Recommendations33 Bibliography..35

ANNEX A Survey Form For Psychiatrists..39 ANNEX B Answers to Survey Form By Psychiatrists.42 ANNEX C Republic Act No. 7277, Magna Carta for Disabled Persons..59 ANNEX D Republic Act No. 9244, An Act Amending Magna Carta for Disabled Persons73

THE MENTALLY DISABLED in PHILIPPINE Setting: A Call for Equal Protection. A Critique on the Rights and Privileges Of Mentally Disabled Filipinos And Their Place in Philippine Health Laws*
Naomi Therese F. Corpuz**

I. INTRODUCTION If you will not give me a valid reason why you skipped the exam, I will give you a failing grade, said a law professor to Maricar Estrella, a law student from one of the prestigious law schools in the country. Maricar Estrella responded, I have clinical depression and anxiety disorder Sir. I had anxiety attacks. I skipped the exam because I did not want to take the risk. I have prescriptions, medical receipts and a medical certificate to prove it, to which the professor replied, You mean to tell me, you can skip an exam anytime you want?1 With the professors response, it can be assumed that the latter was in doubt or did not understand what depression and anxiety disorder means. Even with pertinent documents that Maricar was willing to show as evidence to prove her mental illness, the professor brushed it aside and instead made a sarcastic remark implying that she can skip an exam or class anytime she wants because of her mental illness. What is mental illness in the first place? Why is it that the above-mentioned law professor did not believe it actually exists and that it adversely affects the studies of a student suffering from it? In an interview with Maricar Estrella, she said she already had a failing mark in an examination previously under a different law professor due to symptoms of the same illness. When she experienced the same symptoms of her mental illness during the examination under a different law professor she did not want to take the same risk of failing another subject, hence she decided to skip the exam. Though it can be argued by professors that there is what they call academic freedom - that even illnesses cannot be excused where then and how is the state policy found in our Philippine Constitution which states, the State shall protect and promote the right to health of the people and instill health consciousness among them2, put into place? Do not educators such as the law professor of Maricar violate this state policy of our basic law which is the supreme law of the land? Another question would be, if Maricar had another type of illness other than mental illness, would she have been given consideration by her law professor? Maricar said in her interview that it is highly likely that she can be excused due to sore eyes or high fever as what happened to her other schoolmates but not due to a mental disorder. If other illnesses are given consideration, why not a mental illness?

*Cite as Naomi Therese F. Corpuz, THE MENTALLY DISABLED in PHILIPPINE Setting: A Call for Equal
Protection. A Critique on the Rights and Privileges Of The Mentally Disabled Filipinos And Their Place in Philippine Health Laws (2013) **J.D., University of the Philippines College of Law (2015 expected);A.B. Psychology, cum laude, University of the Philippines (2003) 1 Interview with Maricar Estrella, lawstudent of one of the lawschools at the Univeristy Belt, Manila (May 30, 2012). 2 CONST. Art. II, 15

Patients with mental disorders have symptoms that only they themselves could feel, hence, such disorders are difficult to understand by those who dont suffer from it because it cannot be perceived or seen by the naked eye. Few appreciate that mental health is, in fact, the matrix on which all health is built.3 People with mental illnesses are discriminated against in various forms not only in education. There is also unequal treatment when it comes to other rights and privileges i.e., persons afflicted with other illnesses are given more benefits even in legislative policies. The aim of this paper is to provide suggestions and recommendations and make known to all and sundry that persons with mental disabilities, have become highly prevalent and that they are real. Considering the diseases debilitating effects viz-a-vis other forms of illnesses, it must be given at least the same or even more, in terms of economic and insurance benefits under our health laws and aspects of education and labor. This research is also in consonance with the mission of the Philippine Psychiatric Association (PPA), among others, to be committed to the welfare of its members and to the advancement of mental health care, education, advocacy and research in the Philippines and the global community.

II. HISTORY OF MENTAL ILLNESS The Crucible is a play written by well-known playwright Arthur Miller. It is a story based on true to life accounts in 1602 at Salem, Massachusetts, where nineteen men and women and two dogs were convicted and hanged4. They were put to death based on the accusation of young women in Salem who were allegedly possessed, claiming that these nineteen people with two dogs were engaged in witchcraft and bewitched them. Three hundred ninety years later5 this wrongful judgment was rectified in a resolution of the court where families of those who died were paid civil damages. Salem was a community ruled by theocracy, where the rule of the Church was also the rule of law in the 16th Century. This is no different from the Philippines during the Spanish Era when Christianity was ingrained in the mindset of Filipinos for more than three hundred years. Historically, it is reported that the Philippines embraced two great religions, Islam and Christianity, five out of six of which are Catholics.6 The Christian bible accounts describe possession involved evil spirits. Those who were possessed were defiled and discriminated against. In Mark 5: 1-13, Jesus was reportedly to have cured a man with an unclean spirit by transferring the devils that plagued him to a herd of swine, who, in turn, became possessed and ran violently down a steep place in the sea.7 Similarly, in Matthew 10:1

MA. LUZ CASIMIRO QUERUBIN & SONIA CASTRO RODRIGUEZ, FINANCING HEALTH CARE: THE NATIONAL HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002). 4 ARTHUR MILLER, THE CRUCIBLE vii (1995). 5 Id at vii. 6 WHO and Department of Health-Manila, Report on Mental Health System in the Philippines, 7 in WHOAIMS (2007) 7 Robert Carson et.al., ABNORMAL PSYCHOLOGY AND MODERN LIFE 33 (2000).

6 He called his twelve disciples to him and gave them authority to drive out evil spirits and to heal every disease and sickness, that included mental diseases. In the Middle Ages, there have been reports that many mentally disturbed people were accused of being witches and thus were punished and have been killed.8 In Europe during the Middle Ages, apart from witchcraft, mass madness and exorcism relate to abnormal behavior. Mass madness was a widespread occurrence of group behavior disorders that were apparently cases of hysteria. Whole groups of people were affected simultaneously while in rural areas were outbreaks of lycanthropy a condition in which people believed themselves to be possessed by wolves and imitated their behavior.9 Management of the mentally-disturbed was left to the clergy during this Era where humane treatment was practiced. Treatment consisted of prayer, holy water, sanctified ointments, the breath or spittle of the priests, the touching of the relics, visits to holy places, and mild forms of exorcism,10 which is still practiced not only in other countries but also the Philippines up to this day11. The question here though, especially to the Catholic Church which practices exorcism if these prayers, holy waters and the like are not used to treat the mentally disabled, does it mean to say they can never be treated without the intervention of medical psychiatry? Skepticism not only among Catholics but Filipinos in general abounds when it comes to medical science of psychiatry. This is due to our socio-cultural influences12. In the Philippines, the evolution of treatment closely follows the path taken in Europe and America.13 In the pre-Spanish Era, Filipinos believed in spirits and if they defiled and violated the spiritual world, they would be punished thru some misfortune or illness in the material world, while in the Spanish Era they believed in act of sorcery, mangkukulam (witches) and manggagaway (devilmen)14. To cure the mental illnesses they go to herbolarios (herbmen) or the church for exorcism and some patients who suffered in hysteria were even taken in boatrides only to be thrown to the river and if they escaped drowning, patients illness is believed to be relieved.15 In the early nineteenth century, the first institution for the mentally-ill built in the Philippines was Hospicio de San Jose.16 When the patients increased in number, some patients, particularly the violent ones and those who committed crimes were kept at the Carcel de Bilibid.17
Id at 39. Id at 37. 10 Id at 38. 11 Fr. JOSE FRANCISCO SYQUIA, EXORCISM: ENCOUNTERS WITH THE PARANORMAL AND THE OCCULT 1207 (2006) 12 BALTAZAR REYES & CONSTANTINE DELLA, TREATMENT OF MENTAL ILLNESS IN THE PHILIPPINES: A HISTORICAL PERSPECTIVE (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002). 13 Id at 2. 14 See Querubin Supra at 49. 15 Id. 16 Id at 50.
9 8

There is no narrative account how the patients were treated in Carcel De Bilibid, however as the term de bilibid which means the prison implies it is not farfetched that the patients were treated like prisoners. Since the Philippines closely followed the history of Europe and America in treating mental illnesses, it can be similar or at least close to Western asylums that grew in number starting in the sixteenth century. The monastery of St. Mary of Bethlehem in London was officially made into an asylum by Henry VIII18 but it became widely known for its inhumane treatment. The more violent patients were exhibited to the public for one penny a look, and the more harmless inmates were forced to seek charity on the streets of London in the manner described by Shakespeare: Bedlam beggars, who, with roaring voices Sometime with lunatic bans, sometime with prayers, enforce their charity (King Lear, II, iii).19 In La Bicetre Hospital in Paris, the chronically insane were treated like beasts, The patients were ordinarily shackled on the walls of their dark, unlighted cells by iron collars which held them flat against the wall and permitted little movement. Oftimes there were also iron hoops around the waist of the patients and both their hands and feet were chained. Although these chains usually permitted enough movement that the patient themselves could feed themselves enough with their bowls, they often kept them from being able to lie down at night. Since little was known about nutrition, and the patients were presumed to be animals anyway, little attention was paid whether they were adequately fed or to whether the food was good or bad. The cells were furnished only with straw and never swept cleaned; the patient remained in the midst of all the accumulated odor. No one visited the cells except at feeding time, no provision was made warmth, and even the most elementary gestures of humanity were lacking.20 (Emphasis Supplied) Even today, there have been reports that some mentally disabled Filipinos are incarcerated in their own homes.21 However due to the intervention of community-based mental health care,22there have been a fortunate few who have been saved from these incarcerations and have been given the proper treatment since then.

Id . Carson, Supra Note 7, at 41. 19 Id. 20 Id. 21 nd Dr. Lourdes Ladrigo-Ignacio, speech delivered at, the 2 Asia Pacific Conference on Psychosocial nd th Rehabilitation in connection with the 22 Mid-year Convention and 27 Post graduate Court of the Philippine Psychiatric Association (PPA), Dusit Thani Manila, Makati last July 28, 2011. 22 Id.
18

17

8 The end of inhumane treatment to mentally disabled patients was not far from impossible. In the late 18th century, hospitals in Europe and America were reformed and humanitarian treatment received great impetus from the work of Philippe Pinel in France.23 As chains were removed and patients were allowed to go outdoors and treated with human kindness, start of scientific knowledge of mental illnesses burgeoned in the Philippines in 1892 1942, which covers the period of American rule. Treatment centers started to flourish in the 1900s such as the NPH (National Psychopathic Hospital) which is now the National Mental Health in Mandaluyong City.24 These treatment centers provided scientific and mechanistic approach, and therapies for the mentally-ill.25 During the Japanese Occupation, psychiatric treatment did not improve, but rather was even on a stalemate, but this ended after World War II and Japanese domination. There was an upsurge of different forms of treatment and the first prefrontal and transorbital lobotomy were conducted in the country.26 Lobotomy is the surgical treatment which involved severance of nerve fibers connecting the frontal lobes to the thalamus for the relief of some mental disorders.27 All these happened in the 1940s but the most radical change that paved the way to many successful treatments was in 195328 when psychopharmacology29, the science of determining which drugs alleviate which disorders and why they do so, was then introduced. Today, Philippine Psychiatry has paved a long way since the early age. Psychiatrists and clinical psychologists have increased through the years and even undergo further training abroad. However, compared to other countries, the Philippines mental health still lag behind and way below the list of the governments priorities. The mentally disabled patients in regard to access to maintenance treatment are still highly marginalized especially when it comes to insurance, health services and legislative policies which this paper aims to demonstrate. III. MENTAL ILLNESS DEFINED People refer to the mentally ill who are sirang-ulo or insane. Dr. Lourders Ignacio30 on the other hand explains It is not just for the sirang-ulo or insane. Ignacio clarifies that to have a mental health problem may simply mean that ones thoughts, feelings and behavior show disturbances which threaten the balance and stability of a person in his daily life. Many of these disturbances can be called reactions by those rendered vulnerable to extreme life experiences like disasters, and individual and

Carson, Supra Note 3, at 42. Querubin Supraat 51. 25 Id. 26 Querubin Supra at 53. 27 Westers Dictionary at http://www.merriam-webster.com/medical/lobotomy (last visited May 16, 2012) 28 Querubin Supra at 54. 29 Carson, Supra Note 3, at G-17. 30 Rina Jimenez David, At Large Not just for the sirang ulo at http://opinion.inquirer.net/8977/not-just-forthe-%E2%80%98sirang-ulo%E2%80%99 (last visited November 22, 2012).
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9 community violence, but others can be traced to difficulties and anxiety triggered by changing life circumstances.31 Mental illness is not always about insanity. Depression for instance, though a normal emotion of human beings, can be a mental illness if it becomes very severe until clinical. Major depression which is not tantamount to insanity or psychosis, can still be considered a mental illness if it is characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities32. Coupled with symptoms of irritablity, agitation, restlessness, dramatic change in appetite, often with weight gain or loss, fatigue and lack of energy, feelings of hopelessness and helplessness, feelings of worthlessness, self-hate, and guilt, becoming withdrawn or isolated, loss of interest or pleasure in activities that were once enjoyed33 are all indicators of major depression. Clinical major depression is a common mental illness that affects about 121 million people across the globe according to Dr. Lou Querubin, an attending psychiatrist at the Medical City in Manila, Philippines.34 According to a Disability Manual of the Government of Australia,35 mental illness refers to those causing a major disruption to a person's behaviour, emotions or thinking which lasts a period of time from a few weeks or months to years. These episodes can come and go in a person's life. Several contributing factors mentioned in the manual include the following: Chemical imbalances in the brain Family history of mental illness Stress Drug and alcohol abuse Psychosocial factors such as poor physical health, trauma and abuses.36

In dictionary meaning, mental disorder on the other hand is used synoymously with mental illness.37 The recently published Diagnostic Statistical Manual-V (DSM-V) which will be published in 2013

Id. Major Depressive Disorder, available at http://en.wikipedia.org/wiki/Major_depressive_disorder (Last visited: January 18, 2013). 33 Major Depression, available at http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm (Last visited: January 18, 2013). 34 Cara. Davis, 7 Ways to Ward off Clinical Depression, Jun 20, 2011, 3, at http://halogentv.com/articles/7-ways-to-ward-off-clinical-depression/ 35 Source: Government of Sourth Australia, Department for families and communities. Intellectual Disability and Mental Illness (Dual Disability) available at http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Information%20sheets%20%20Disability%20SA/Intellectual%20disability%20-%20mental%20illnessdual%20disability%20%28PDF%20140kb%29.pdf (Last visited: June 9, 2012). 36 Id. 37 The Free Dictionary, available at http://medical-dictionary.thefreedictionary.com/mental+illness and Wikipedia, available at http://en.wikipedia.org/wiki/Mental_disorder (Last visited: November 26, 2012).
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31

10 defines mental disorder38as a health condition characterized by significant dysfunction in an individuals cognitions, emotions, or behaviors that reflects a disturbance in the psychological, biological, or developmental processes underlying mental functioning. Some disorders may not be diagnosable until they have caused clinically significant distress or impairment of performance. A mental disorder is not merely an expectable or culturally sanctioned response to a specific event such as the death of a loved one. Neither culturally deviant behavior (e.g., political, religious, or sexual) nor a conflict that is primarily between the individual and society is a mental disorder unless the deviance or conflict results from a dysfunction in the individual. (Emphasis Supplied). The rationale why the terms psychological and biological are used is to emphasize the inextricable links between the biological and the behavioral and psychological.39

Common Mental Illnesses In a recent survey conducted among ninety-five psychiatrists, the top five most common cases of mental disorders are Schizophrenia, Bipolar, Major Depression, Anxiety Disorder and Addiction40

Figure 1.41
700 600 500 400 300 200 100 0 Psychiatric Disorders 653 587
Schizophrenia

613

571 555 460 482 510 400 423 386

Bipolar Major Depression Anxiety Disorder Addiction Dementia Personality Disorder Eating Disorder Somatoform Disorder Sleep Disorder Sexual Disorder

Schizophrenia is the most persistent and disabling of the major mental illnesses. It usually attacks people between the ages of 16 and 30, as they are beginning to realize their potential. It affects approximately one in 100 people worldwide, (one per cent of the population), affecting men and
38

DSM5.org, available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465 (Last visited: October 22, 2011). 39 Id 40 Survey conducted by Naomi Therese F. Corpuz on Psychiatrist-Respondents of Philippine Psychiatric Association, Inc. (PPA), at Dusit Thani Manila, Makati City (July 28-30, 2011). 41 Id.

11 women almost equally. While it is treatable with proper medication and therapy, there is as yet no cure for schizophrenia.42People stricken with this disease may hear voices, see objects that arent really there, or assume that others are reading and controlling their minds.43 Bipolar Disorder is illustrated by severe mood swings that impair patients daily life and negatively affect their relationship; these mood swings include highs (mania), when individuals feel either on top of the world or on edge, and lows (depression), when they feel sad and hopeless. 44 Suicide attempts are common in bipolar disorder, especially during depressive episodes.45 Major Depression46is a mental health disorder which causes prolonged feelings of despair, worthlessness, irritability, and fatigue (see a more complete set of depression symptoms below). It can strike at any age, although it is most common in young adulthood. Both men and women can experience major depression, however the disorder is more common in women.47 Depression is sometimes called the "common cold" of mental health, because it is so common--nearly 10% of the population suffers from a depressive illness in any given year, according to National Institute of Mental Health.48 It is the leading cause of disability in the US and worldwide, according to the World Health Organnization.49 Its symptoms50 are:

Despair and hopelessness Little motivation to complete even simple tasks Thoughts or attempts of suicide Low self-esteem and self-confidence Low energy levels, tired and run-down Trouble falling asleep, nightmares, waking and can't fall back asleep Daily life is severely affected Loss of sex drive Loss of appetite Loss of interest in formerly pleasurable activities Symptoms last longer than two months

Anxiety Disorder is a blanket term covering several different forms of a type of common psychiatric disorders characterized by excessive rumination, worrying, uneasiness, apprehension and fear about future uncertainties either based on real or imagined events, which may affect both physical

World Fellowship for Schizophrenia and Allied Disorders, available at http://www.worldschizophrenia.org/disorders/schizophrenia.html(Last visited: November 26, 2012). 43 Meeting of Minds, available at http://www.medobserver.com/article.php?ArticleID=440(last visited May 17, 2012). 44 Margarita Tartakovsky M.S., The Bipolar Fact Sheet, available at http://psychcentral.com/lib/2009/bipolar-disorder-fact-sheet/Last visited: November 26, 2012). 45 Id. 46 Major Depression, available at http://www.depressedtest.com/major_depression.html(Last visited: November 26, 2012). 47 Id. 48 Id. 49 Id. 50 Id.

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12 and psychological health.51 It has many types which include panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder. Though anxiety is a normal human emotion that everyone experiences at times, anxiety disorders, however, are different. They can cause such distress that it interferes with a person's ability to lead a normal life. An anxiety disorder is a serious mental illness. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling.52 Addiction is the continued use of a mood altering substance or behavior despite adverse dependency consequences, or a neurological impairment leading to such behaviors.53 Addiction is a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health. Users may not be aware that their behavior is out of control and causing problems for themselves and others.54

Connection to the Brain, Risk Factors and Correlation to Physical Illnesses Mental Disorders do exist with scientific basis. According to studies, scientists have largely attributed it to the brains functioning. Most scientists believe that mental illnesses result from problems with the communication between neurons in the brain called neurotransmission55 and chemical compounds called neurotransmitters. For instance the neurotransmitter serotonin levels of those with depression are lower than normal individuals. Apart from serotonin there could also be other changes in other neurotransmitters in the brain.56 In schizophrenia, studies show that there are disruptions in neurotransmitters dopamine, glutamate and norepinephrine.57 Scientists have also identified the risk factors that make one mentally ill. Some of these are environmental, genetic and social factors.58 These factors may also combine and interact that lead to mental illness. Environmental factors such as head injury, poor nutrition, and exposure to toxins (including lead and tobacco smoke) can increase the likelihood of developing a mental illness.59 Illnesses which most likely have a genetic component are autism, ADHD or attention deficit disorder, bipolar disorder and schizophrenia.60
51

Anxiety Disoder, available at http://en.wikipedia.org/wiki/Anxiety_disorder (Last visited: November 26,

2012).

Anxiety and Panic Disorders Health Center, available at http://www.webmd.com/anxietypanic/guide/mental-health-anxiety-disorders(Last visited: November 26, 2012). 53 Addiction, available at http://en.wikipedia.org/wiki/Addiction(Last visited: November 26, 2012). 54 What is Addicition?, available at http://www.psychologytoday.com/basics/addiction(Last visited: November 26, 2012). 55 Information about Mental Illness and the Brain, available at http://science.education.nih.gov/supplements/nih5/mental/guide/info-mental-b.htm (Last visited: November 26, 2012). 56 Id. 57 Id. 58 Id. 59 Id. 60 Id.

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Mental Disorders can also be psychosomatic. Psychosomatic pertains to physical ailments that are caused by or notably influenced by emotional factors,61 such factors that can be attributed to mental disorders. Dr. Jercyl Leilani Demeterio says that mental disorders are as debilitating as any form of illness affecting the persons ordinary daily activities, even relationships and even results to, if not correlated with, physical illnesses such as heart diseases, thyroidism, stroke, cancer and many others.62 Psychopharmacology on the other hand only proves further that mental disorders have a connection with the brain. Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior; this field studies a wide range of substances with various types of psychoactive properties, focusing primarily on the chemical interactions with the brain.63 It is also defined as, the study of drug-induced changes in mood, thinking, and behavior. These drugs may originate from natural sources such as plants and animals, or from artificial sources such as chemical syntheses in the laboratory. These drugs interact with particular target sites or receptors found in the nervous system to induce widespread changes in physiological or psychological functions.64 However, as aptly explained by Dr. Jercyl Leilani Demetetrio65, it is a sad state that despite studies and evidence that mental disorders are attributed to brain function there are still many who do not believe that there is a connection of emotions and feelings to the brain. Mental Illness is a disability like any other form of disability. However, as emphasized by Dr. Constantine Della, the term disability, is associated with other forms of disabilities, such as physical handicap, blindness, and deafness among others but rarely is such term associated with mental illness.66 This is a sad truth despite the fact that psychiatry is a specialty and a subject in the school of medicine. This is also an undesirable result and can be greatly attributed to our belief systems largely influenced by religion, culture and traditions.

Dictionary.com, available at http://dictionary.reference.com/browse/psychosomatic (Last visited: November 26, 2012). 62 Interview with Dr. Jercyl Leilani-Demeterio, Past-PPA President, former Professor of Psychiatry of U.P. College of Medicine and current private practioner at Cardinal Medical Santos Center, Mandaluyong City (August 6, 2011). 63 Psychopharmacology From Wikipedia, the free encyclopedia at http://en.wikipedia.org/wiki/Psychopharmacology (last visited May 17, 2012). 64 Psychopharmacology, available at http://www.sciencedaily.com/articles/p/psychopharmacology.htm (Last visited: November 26, 2012). 65 Interview with Dr. Jercyl Leilani Demeterio, past Philippine Psychiatric Association president, former professor of U.P. College of Medicine and current psychiatrist at Cardinal Santos Medical Center, Quezon City (May 15, 2012). 66 Interview with Dr. Constantine Della, President, Philippine Psychiatric Association, Inc. (PPA), at the 2nd Asia-Pacific Conference on Psychosocial Rehabilitation in connection with the 22nd Mid-Year Convention and 27th Post Graduate Course of the PPA, Dusit Thani Manila, Makati City (July 28, 2011).

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14 IV. LAWS AFFECTING THE MENTALLY DISABLED

The two provisions of the Constitution which mention the term disabled are in Article XIII entitled Social Justice and Human Rights. Its Section 11 and Section 13 state: Section 11. The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers.(Emphases supplied) Section 13. The State shall establish a special agency for disabled persons for their rehabilitation, self-development, and self-reliance, and their integration into the mainstream of society. (Emphases supplied) What does social justice mean in the first place? According to Matthew Robinson, in conditions of social justice, people are "not be discriminated against, nor their welfare and well-being constrained or prejudiced on the basis of gender, sexuality, religion, political affiliations, age, race, belief, disability, location, social class, socioeconomic circumstances, or other characteristic of background or group membership."67 Social justice is generally equated with the notion of equality or equal opportunity in society.68 Social justice then is equal opportunity. However though Section 13 emphasizes priority for the needs of the disabled, it is a provision which does not clearly pertain to mental disability or even to include mental disability among all forms of disabilities. According to WHO (World Health Organization), the laws that govern the provision of mental health services are contained in various parts of promulgated laws such as the Penal Code, Magna Carta for Disabled Person, Family Code and Dangerous Drug Act,69 however there is no single mental health legislation but only mental health policies such as Administrative orders issued by the Department of Health and a single Republict Act which is R.A. 7277, also known as the Magna Carta for Disabled persons that is not even specific to mental disabilities. A. Critique on Republic Act 7277, otherwise known as Magna Carta for Disabled Persons

Republic Act 7277 was approved on March 24, 1992 entitled, An Act Providing for the Rehabilitation, Self-Development and Self Reliance of Disabled Persons And Their Integration Into The Mainstream Of Society And For Other Purposes. This is otherwise known as the Magna Carta for Disabled Persons which provides rights and privileges of disabled persons under its Title II which are
Matthew Robinson, What is Social http://www.pscj.appstate.edu/socialjustice/whatissocialjustice.html (Last visited January 14, 2012). 68 Id. 69 WHO and Department of Health-Manila, Supra Note 6.
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Justice?,

15 Equal Opportunity for Employment, Access to Quality Education, National Health Program, Auxiliary Social Services, Telecommunications and Accesibility. Although these six are listed in the law with comprehensive descriptions and how they are adopted, people with mental disability are marginalized in the real scenario and other people with illnesses are given more benefits, though not apparent. Section 5 of Title II states: Section 5. Equal opportunity for employment. No disabled person shall be denied access to opportunities for suitable employment. A qualified disabled employee shall be subject to the same terms and conditions of employment and the same compensation, privileges, benefits, fringe benefits, incentives or allowances as a qualified able bodied person. Five per cent of all casual, emergency and contractual positions in the Departments of Social Welfare and Development, Health, Education, Culture and Sports, and other government agencies, offices or corporations engaged in social development shall be reserved for disabled persons.(Emphases Supplied). As mentioned above, A qualified disabled employee shall be subject to the same terms and conditions of employment and the same compensation, privileges, benefits, fringe benefits, incentives or allowances as a qualified able bodied person. Persons with physical disabilities could easily fit the term qualified disabled employee but not for the mentally disabled. In Chapter VI of Title II of R.A. 7277 Section 25, it implements Batasang Pambansa 344, which states: Sec. 25. Barrier-Free Environment. The State shall ensure the attainment of a barrier-free environment that will enable disabled persons to have access in public and private buildings and establishments and such other places mentioned in Batas Pambansa Bilang 344, otherwise known as the "Accessibility Law. The national and local governments shall allocate funds for the provision of architectural facilities or structural features for disabled persons in government buildings and facilities.(Emphases Supplied). Batasang Pambansa 344, Section 1 states:

Section 1. In order to promote the realization of the rights of disabled persons to participate fully in the social life and the development of the societies in which they live and the enjoyment of the opportunities available to other citizens, no license or permit for the construction, repair or renovation of public and private buildings for public use. Educational institutions, airports, sports and recreation centers and complexes, shopping centers or establishments, public parking places, work-places, public utilities, shall be granted or issued unless the owner or operator thereof shall install and incorporate in such building, establishment, institution or public utility, such architectural facilities or structural features as shall reasonably enhance the

16 mobility of disabled persons such as sidewalks, ramps, railings and the like. If feasible, all such existing buildings, institutions, establishments, or public utilities to be constructed or established for which licenses or permits had already been issued may comply with the requirements of this law: Provided, further, That in case of government buildings, street and highways, the Ministry of Public Works and Highways shall see to it that the same shall be provided with architectural facilities or structural features for disabled persons. In the case of the parking place of any of the above institutions, buildings, or establishment, or public utilities, the owner or operator shall reserve sufficient and suitable space for the use of disabled persons. (Emphases Supplied) Again, notice the term disabled persons is used in the above-quoted provision but the cited law only benefits the physically disabled but not persons afflicted with mental illnesses. Apart from this there are still discriminations against mentally disabled particulary in employment and education. Overseas contract workers for instance, prior to departure, must undergo neuropsychiatric screening and those found with symptoms of mental distress and symptoms are not certified to leave for overseas employment.70 Any reapplication must be accompanied by psychiatric clearance, according to a noted psychiatrist Dr. Bernardo Conde of University of Santo Tomas.71 This regulation of the Department of Labor and Employment (DOLE) is unfair and a total violation of social justice. With this regulation those who are afflicted with mental disorders have no opportunity of having greener pastures abroad to help their families but those with physical disabilities do since the latter do not have the same kind of regulation. Yet, according to Dr. Jercyl Leilani Demeterio, with proper treatment or psychotherapy and medication, workers with mental illnesses can function as normal individuals.72 If this is the case why does the DOLE not accept them with the same regulation as normal individuals? One reason for this is poverty. Although the Magna Carta For Disabled Persons in its policy, states that: Sec. 2. Declaration of Policy The grant of the rights and privileges for disabled persons shall be guided by the following principles: (a) Disabled persons are part of Philippine society, thus the State shall give full support to the improvement of the total well-being of disabled persons and their integration into the mainstream of society. Toward this end, the State shall adopt policies ensuring the rehabilitation, selfdevelopment and self-reliance of disabled persons. It shall develop their
70

Dr. Bernardo Conde, Philippines mental health country profile, International Review of Psychiatry, 166 Id. Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65.

(2004).

71 72

17 skills and potentials to enable them to compete favorably for available opportunities. (b) Disabled persons have the same rights as other people to take their proper place in society. They should be able to live freely and as independently as possible. This must be the concern of everyone the family, community and all government and nongovernment organizations. Disabled persons' rights must never be perceived as welfare services by the Government. (c) The rehabilitation of the disabled persons shall be the concern of the Government in order to foster their capacity to attain a more meaningful, productive and satisfying life. To reach out to a greater number of disabled persons, the rehabilitation services and benefits shall be expanded beyond the traditional urban-based centers to community based Programs, that will ensure full participation of different sectors as supported by national and local government agencies. xxx (Emphases Supplied). Not all Filipinos afflicted with mental disabilities can afford to have the maintainance treatment and medication. In the Philippines alone, a disability survey done in 2000 by the National Statistics Office (NSO) found out that mental illness was the third most common form of disability.73 Prevalence rate of mental disorders were 88 per 100,000 populations and was highest among the elderly group. This finding was supported by a more recent data from the social weather survey commissioned by the Department of Health(DOH) in 2004. 74It revealed that 0.7% of the total household have a family member afflicted with mental disability.75 The policy of the Magna Carta cited above which states that (a) the State shall give full support to the total well-being of the disabled, (b) Disabled persons have the same rights as other people to take their proper place in society, (c) The rehabilitation of the disabled persons shall be the concern of the Government in order to foster their capacity to attain a more meaningful, productive and satisfying life, are not fully enforced because of the miniscule budget alloted by the Government to mental health.

Interview with Mr. Nelson Mendoza, National Program Coordinator, National Mental Health Program and Degenerative Disease Office, Department of Health, Philippines (March 30, 2012). 74 Id. 75 Id.

73

18 Figure 2.76

The Philippine Government only gave 5% of its DOH budget to the National Mental Health Program where only 5% of which are for health care expenditures by the government health department directed towards mental health. Of all expenditures on mental health, 95% are spent on the operation, maintenance and salary of the personnel of mental hospitals. The percentage of the population that has free access to psychotropic medication is unknown.77 For those that pay out of pocket, the cost of antipsychotic medication is 0.46% and antidepressant medication is 11.4% of the minimum daily wage.78 There is also a scarce resource of Mental Health Workers. In a study conducted by World Health Organization in 2007: Figure 3. # of Mental Health Workersper 100,000 pop Psychiatrists* Nurses Psychologists Social Workers Occupational Therapists Others 412 769 119 74 72 1,372 0.42 0.91 0.14 0.08 0.08 1.62

*237 (58%) of the Psychiatrists practice in the NCR

76 77

Id. Id. 78 Id.

19 Out of 412 Psychiatrists in the Philippines, a majority of 237 of them are based in the National Capital Region, making medical treatment from health therapists our of reach to patients from provinces and far-flung barrios. Apart from this, The majority of mental health facilities are still located in the National Capital Region.79 Hence, access to mental healthfacilities is uneven across the country, favoring those living near the main cities.80 In education on the other hand, the introduction of this paper is an example of what a student with mental disability ordinarily experiences in school. As any other mentally disabled patient, a student also suffers from schizophrenia, ADHD (Attention Deficit Disorder), bipolar disorder, clinical depression and anxiety disorders among others.81 A mentally disabled student must be given considerations similar to students with physical disabilities. If railings and ramps are built for students with physical handicap, is there no special treatment that can be given to mentally disabled students? Some authorities, particularly professors and instructors find this questionable since most have the impression that mentally disabilities are not life-threatening, but as previously discussed in this paper mental disabilities are as debilititating as any form of illness that can even lead to death. In a World Health Organization Report of 2007, more than 150 million people suffer from depression at any point in time and nearly 1 million commit suicide every year.82 Special considerations though are given to disabled students that are categorically stated in Section 12 of Title II of R.A. 7277:

Sec. 12. Access to Quality Education. xxx The State shall take into consideration the special requirements of disabled persons in the formulation of educational policies and Programs. It shall encourage learning institutions to take into account the special needs of disabled persons with respect to the use of school facilities, class schedules, physical education requirements, and other pertinent consideration. The State shall also promote the provision by learning institutions, especially higher learning institutions of auxiliary services that will facilitate the learning process for disabled persons. (Emphases Supplied). What this pertinent consideration of the above-cited provision means though is not specific. Legislators must specify the meaning of pertinent consideration or at least the National Mental Health Program of the Department of Health must make a separate Implementing Rule and Regulation
79 80

Interview with Mr. Nelson Mendoza, Supra Note 40 Id. 81 Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65. 82 Department of Health Administrative Order No. 9 (2007).

20 for Schools with mentally disabled patients that will specifically describe these pertinent considerations and mandate such schools to implement such rules. Although Chapter II on Education of R.A. 7277 has a specific provision on Special Education which states: Section. 14. Special Education. The State shall establish, maintain and support complete, adequate and integrated system of special education for the visually impaired, hearing impaired, mentally retarded persons and other types of exceptional children in all regions of the country. Toward this end, the Department of Education, Culture and Sports shall establish, special education classes in public schools in cities, or municipalities. It shall also establish, where viable, Braille and Record Libraries in provinces, cities or municipalities. Xxx (Emphases Supplied). and Section 17 for State Universities and Colleges: Sec. 17. State Universities and Colleges. If viable and needed, the State University or State College in each region or province shall be responsible for (a) the development of material appliances and technical aids for disabled persons; (b) the development of training materials for vocational rehabilitation and special education instructions; (c) the research on special problems, particularly of the visually-impaired, hearing-impaired, speech-impaired, and orthopedically-impaired students, mentally retarded, and multi-handicapped and others, and the elimination of social barriers and discrimination against disabled persons; and (d) inclusion of the Special Education for Disabled (SPED) course in the curriculum. xxx (Emphases Supplied). The provision makes use of the term mentally retarded which only includes those pupils and students with subaverage intelligence and impaired adaptive functioning.83 However mental retardation is not synonymous to mental disability. Mental Retardation is only one ofthe kinds of mental disabilities. In fact there are persons with mental disabilities with superior intelligence which is the total opposite of mentally retarded persons.84 Section 12 and Section 17 of Title II of Magna Carta for Disabled Persons are discriminatory as it only provides privileges to the visually-impaired, hearing-impaired, speech-impaired, orthopedicallyimpaired students, mentally retarded, and multi-handicapped but there is no mention of mentally disabled persons. A sound suggestion was made by Carla Laforteza, a bipolar patient and a physical therapist student of University of Santo Tomas with superior intelligence. She said that the Government must

83

Mental Retardation, http://emedicine.medscape.com/article/1180709-overview (Last visited: January Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65.

14, 2013).

84

21 create special schools for the mentally disabled85 those suffering not only of mental retartdation but all types of mental disorders, such as the common major illness of clinical depression. Though it is difficult to establish special schools for courses such as medicine and law, a special class that is segregated can be created solely for them.The schools can hire certified psychiatirists and clinical psychologists. These schools and/or special classes can be regulated and monitored by these certified psychiatrists and clinical psychologists to determine the veracity and gravity of the illness of the student-patient from time to time and assess their capacity to learn. From these assessments, school rules and regulations can be adjusted accordingly and not prevent a student from becoming a doctor, lawyer or inhibit them from finishing other courses they want to pursue. To emphasize, social justice as mentioned earlier is equal opportunity - a policy of the Constitution that our State must uphold. B. DOH AdministrativeOrder No. 8 Seriesof 2001 and DOH AdministrativeOrder No. 9 Series of 2007 AdministrativeOrder No. 8 entitiled theNational Mental Health Policy(AO 08-01) was signed on April 5, 2001 by former Department of Health (DOH) Secretary Manuel Dayrit. DOH formulated AO 08-01 which prescribed the national policy framework towards the attainment of a good state of health for all Filipinos. The mental health strategy of the policy is to improve mental health and integrate services for people with mental disorders. In its objective, it states that the National Mental Health Policy shall be pursued through a National Program strategy prioritizing the promotion of mental health, protection of the rights and freedoms of persons with mental diseases and the reduction of the burden of the consequences of mental ill- health, mental and brain disorders and disabilities. To implement this strategy, the policy identifies twelve policy statements which are Leadership, Collaboration and Partnership, Empowerment and Participation, Equity, Standards for Quality Mental Health Services, Human Resource Development, Health Service Delivery System, Mental Health Care, Stability and Sustainability, Information System, Legislation and Monitoring and Evaluation. Although AO 08-01 have valuable goals and objectives there is a problem in the implementation of its planned mental health strategy since there are no specific and designated agencies, NGOs or groups that can help such goals and objectives to materialize. When this was realized by the Department of Health, it took though 6 years to adopt another Administrative Order which is Administrative Order No. 9 Series of 2007(AO 09-07)entitled Operational Framework for the Sustainable Establishment of a Mental Health Program, designed to provide policy guidelines and procedures for establishing mental health program at the national and local levels. Its objective is to provide guidelines for stakeholders in the government and private sector on the development and implementation on the National Policy on Mental Health through plans and programs. The beauty of this AO 09-07 is that it covers the Department of Health including its attached agencies, the local government units, non-government organizations and other devolved health services. It also includes public and private sectors such as national agencies, including governmentowned and controlled corporations, faith-based organizations, academe, media, professional associations, civil society and international development agencies whose activities contribute to the improvement of the state of mental health of the Filipino people. One of the implementing mechanisms of AO 09-07 is a management structure. Such structure necessitates institutionalization of a functional management structure that sets mental health stakeholders into committees and teams: the National Program Management Committee (NPMC), the
85

Interview with Carla Laforteza, Physical Therapist Student of University of Santo Tomas (November 13,

2012).

22 Program Development and Management Teams (PDMT), the Regional Mental Health Teams ((RMHT), and the Local Government Units for Mental Health (LGUTMH). Although the beauty of this management structure is the devolution of responsibilities from the national level to the ground level, it does not mean it does not have loose ends. Once one of the committees or teams will not perform its designated job, the mechanism of the management structure becomes futile considering for instance that not all Local Government Units (LGUs), which is the group nearest to the people, are actively involved in Department of Healths Mental Health Programs. In fact, the LGUs are not mandated to follow this mechanism of management structure of AO 09-07. If such LGUs do not follow the flow of the mechanism then the goals and objectives of AO 09-07 is put to naught.

C. Amendment of Republic Act 7277 otherwise known as Magna Carta for Disabled Persons by Republic Act 9422 and DOH AdministrativeOrder No. 11 Series of 2009

During the term of former President Gloria Macapagal Arroyo, Republic Act No. 9422 was enacted entitled as, An Act Amending Republic Act No. 7277, Otherwise known as the Magna Carta for Persons with Disability as Amended, and For Other Purposes Granting Additional Privileges and Incentives and Prohibitions on Verbal, Non-Verbal Ridicule and Vilification Against Persons with Disability. It is the objective of Republic Act No. 9442 to provide persons with disability, the opportunity to participate fully into the mainstream of society by granting them at least twenty percent (20%) discount in all basic services. Section 1 of R.A. 9422 states:

SECTION 1. A new chapter, to be denominated as "Chapter 8. Other Privileges and Incentives" is hereby added to Title Two of Republic Act No. 7277, otherwise known as the "Magna Carta for Disabled Persons", with new Sections 32 and 33, to read as follows: "CHAPTER 8. Other Privileges and Incentives "SEC. 32. Persons with disability shall be entitled to the following: (a) At least twenty percent (20%) discount from all establishments relative to the utilization of all services in hotels and similar lodging establishments; restaurants and recreation centers for the exclusive use or enjoyment of persons with disability; (b) A minimum of twenty percent (20%) discount on admission fees charged by the theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture, leisure and amusement for the exclusive use or enjoyment of persons with disability;

23 (c) At least twenty percent (20%) discount for the purchase of medicines in all drugstores for the exclusive use or enjoyment of persons with disability; (d) At least twenty percent (20%) discount on medical and dental services including diagnostic and laboratory fees such as, but not limited to x-rays, computerized tomography scans and blood tests, in all government facilities, subject to guidelines to be issued by the Department of Health (DOH), in coordination with the Philippine Health Insurance Corporation (PHILHEALTH); (e) At least twenty percent (20%) discount on medical and dental services including diagnostic and laboratory fees, and professional fees of attending doctors in all private hospitals and medical facilities, in accordance with the rules and regulations to be issued by the DOH, in coordination with the PHILHEALTH; (f) At least twenty percent (20%) discount on fare for domestic air and sea travel for the exclusive use or enjoyment of persons with disability; (g) At least twenty percent (20%) discount in public Railways, skyways and bus fare for the exclusive use and enjoyment of persons with disability; Xxx(Emphases Supplied). Under the law, there are seven (7) types of basic services cited above where persons with disability can avail of atleast twenty percent (20%) discount. The Department of Health adopted Administrative Order No. 9 Series of 2011 (AO 09-11) entitled, Guidelines to Implement the Provisions of Republic Act 9422 , Otherwise Known as An Act Amending Republic Act 7277, otherwise known as Magna Carta for Persons, and for other Purposes, for the provision of medical and related discounts and special privileges, which is an order issued to support the Implementing Rules and Regulations of R.A. 9422. Under this Order, the objective is to prescribe procedures and guidelines for the implementation of the 20% discount in all health related services of Persons with Disabilities (PWDs). Although Republict Act 9422 is a big step in alleviating the financial burden of PWDs, it is not without any disadvantage to persons with mental disability. In relation to Republic Act 9422, to avail of the discount, a person with disability must present his//her identification card issued by the National Council on Disability Affairs (NCDA) or by the Local Government Units (LGUs) where he/she resides.86 In addition, a purchase booklet issued by the LGUs to persons with disabilities for free shall be presented every time a purchase of medicine is made.87 Hence, although a mentally disabled can avail of a discount in in public railways, skyways and bus fare or in purchasing medicines there is an undeniable fact that there is a stigma attached to persons with mental disablity while there is none to those who
86 87

National Council for Disability Affairs, Administrative Order No. 1, Series of 2008. Id.

24 are suffering from other illnesses. If an illness of a patient is not apparent, it is inevitable that one of the assumptions of the persons seeing a PWD identification card is that the patient who owns the card has a mental disability which he can possibly identify as sirang ulo. Infact a mother of an autistic child said that she does not want to avail of the PWD identfication card because she doesnt want anybody to identify that her daughter is, sirang ulo,88 though a mentally disabled patient with a PWD identification card is not insane or sirang ulo per se. It is best if the legislators of R.A. 9422 and NCDA have thought of a different term instead of Person With Disability (PWD) that will not identify the patient, with non- apparent illness, in any way to be suffering from mental disability. Persons With Discounts, or Persons With Special Discounts are terms that can be used for instance that will not identify the patient to be suffering with any form of mental disability. Also, in the experience of Perlas Reodica, when she bought the generic medicine Clonazepam, a sedative for her anxiety disorder with her PWD identification card in a known drugstore in Sta. Mesa, Manila, three of the pharmacists told her, Drug addict ka ano? (You are a drug addict arent you?).89 This experience only shows the discrimination and ridicule that the PWD identification card can cause to a mentally disabled patient. This also shows that there is a need for a wider dissemination of information of R.A. 9422 particularly Prohibitions on Verbal, Non-verbal Ridicule and Vilification Against Persons With Disability90 and its penal clause91. Another problem caused due to poor dissemination of information of R.A. 9422 is the discounted professional fees in private health facilities for in-patient and outpatient medical, dental, and other health care professional services where the corresponding physician or dentist must issue a corresponding official receipt. Figure 4. Survey on 95 Psychiatrist-Respondents92 Have you heard of R.A. 7277 Magna Carta for Disabled Persons as amended by R.A. 9422? YES 58 NO 37

Do you think you need to know more about the Magna Carta for Disabled Persons? 90 5

In a recent survey, although 58 out of 95 psychiatrist-respondents have heard of the Magna Carta for Disabled Persons, 90 of the 95 respondents are ignorant of the contents of the said law. If this is the case, how can the patient avail of its twenty percent discount from her doctor if her own physician is not aware of the said law? This is also shows the passive role of psychiatrists in legislation who must keep themselves abreast not only of the latest in medicine but also of laws affecting their patients.
Interview with Mrs. Gene Lesaca, mother of a a 10 year old autistic child (October 7, 2012). Interview with Perlas Reodica, patient with anxiety disorder (November 12, 2012). 90 Rep. Act. No. 9244 2 (2007). This is known as the Amendment to R.A. 7277 otherwise known as the Magna Carta for Disabled Persons of 2007 (hereinafter R.A. No. 9422) 91 3. 92 Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
89 88

25

The downside however, if psychiatrists will learn of the twenty percent discount that can be availled under R.A. 9422, since there is no ceiling price in their professional fees, they would be inclined to jack up their prices.

D. Pending House Bill No. 6679 During the 15th Congress of 2009, House Bill 6679 entitled , An Act for A National Mental Health Care Delivery System Establishing For The Purpose The Philippines Council for Mental Health And Appropriating Funds Therefore, was introduced by Representatives Prospero C. Nograles and Arthur Y. Pingoy. Since 2009, the bill has remained pending. Representive Nograles and Pingoy introduced the bill since mental health programs, facilities, projects and services are not evenly distributed in the country.93 This bill will also establish a "National Mental Health Care Delivery System" and the "Philippine Council for Mental Health.94" It also aims to enact a national mental health policy and to establish a national mental health care delivery system in the Philippines that is effectivethat will deliver appropriate services and interventions, treatments and other essential services to every Filipino with mental illness and or disability.95 The salient feature of this bill is the establishment of the National Management Committee for Mental Health to provide for a coherent, rational and unified response to mental health problems, concerns and efforts through the formulation and implementation of the National Mental Health Care Delivery System stated in Section 5 of the bill. However, the probability of passing the bill into a Republic Act is nil since our very own Department of Health (DOH) is not supportive of the idea of creating a National Management Committee for Mental Health. In the Department of Healths position paper on this bill, it said that it cannot support the establishment of the Philippine Council for Mental Health (which refers to the National Management Committee for Mental Health) since there is already an existing National Program Management Committee (NMPC) in the DOH as per Administrative Order No. 9 Series of 2007. The Department of Health though seems to forget that the National Program Management Committee (NMPC) that they created is not only focused on mental health but also other areas of health.96 We need a committee that will solely focus on mental health which is one of the objectives of House Bill 6679. Also though the DOH position paper boasts that NMPC is to be chaired by the Undersecretary of Health of the policy and standards Development Team for Service Delivery, cochaired by the Director IV of the National Center for Disease prevention and Control and composed of mental health advocates from central regional DOH units; hospital, medical and other attached agencies; other public agencies; the academe, local government units, donor organizations, media,
Adrian Jeric G. Pena, Mental Health and Mental Illness in the Philippines at http:// http://mentalhealthph.wikispaces.com/5.+Salient+Points+of+House+Bill+6679(last visited January 17, 2012). 94 Id. 95 Id. 96 Interview with Mr. Nelson Mendoza, Supra Note 73.
93

26 professional associations, civil society and international development agencies the magnititude of their responsibilities are wide since it is not only mental health that they focus on but also other illnesses.97 There is also a dearth of participation of psychiatrists in supporting and pushing this bill into law. Infact, many of them are ignorant what this bill is about. Figure 5. Survey on 93 Psychiatrist-Respondents98 Have you heard of the Do you think you pending National need to know more Mental Health Bill (HB about the contents of 6679) in Congress? the Bill? YES 50 90 NO 43 3 In a recent survey of 93 psychiatrist-respondents, almost half (48 out of 93) have not heard of House Bill 6679 and 90 out of 93 of them need to know more about the contents of the bill. If these psychiatrists are informed of the bill, then they can assist and support in fighting for the passage of House Bill 6679 into law. It appears though that our Filipino psychiatrists are active in their own medical professions but passive when it comes to legislative policies that will greatly advance the rights and privileges of their patients which they must keep in mind to be one of their major responsibilities.

V. PHILIPPINE HEALTH INSURANCE COVERAGE OF THE MENTALLY DISABLED Insurance as defined in the Insurance Code of the Philippines is an agreement whereby one undertakes for a consideration to indemnify another against loss, damage, or liability arising from an unknown or contingent event.99 Although this definition may sound business for some, which objectively is for private insurance companies and corporations, it is legitimate for it serves as protection where the risk insured against by the insured is compensated by the insurer when this contingent event arises. One of the risks highly insured is health. Health insurance in the Philippines started with Philippine Medical Care Act of 1969 (RA 6111) which was organized and implemented by the Government Service Insurance System (GSIS) and Social Service Security (SSS).100 To target the lower income and non-salaried populations, it later tied-up with Local Government Units (LGUs) and Health Maintenance Organizations (HMOs).101 In the early 1990s studies were made for the need of social based insurance. Hence in 1995 under President Fidel
Id. Survey conducted by Naomi Therese F. Corpuz, Supra Note 40. 99 Pres. Dec. No. 1460, 2 (1978). This is the Insurance Code of the Philippines. 100 MARIA OFELIA ALCANTARA, FINANCING HEALTH CARE: THE NATIONAL HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002). 101 Id at 43.
98 97

27 Ramoss leadership, the National Health Insurance of the Philippines was made into effect known as RA 7875. RA 7875 gave birth to Philhealth which became the driver in implementing the first and only social based insurance in the Philippines. In a benefit package of R.A. 7875 of 1995 which states: SEC. 10.Benefit Package. - Subject to the limitations specified in this Act and as may be determined by the Corporation, the following categories of personal health services granted to the member or his dependents as medically necessary or appropriate, shall include: a) Inpatient hospital care: 1) room and board; 2) services of health care professionals; 3) diagnostic, laboratory, and other medical examination services; 4) use of surgical or medical equipment and facilities; 5) prescription drugs and biologicals; subject to the limitations stated in Section 37 of this Act; 6) inpatient education packages; b) Outpatient care: 1) services of health care professionals; 2) diagnostic, laboratory, and other medical examination services; 3) personal preventive services; and 4) prescription drugs and biologicals, subject to the limitations described in Section 37 of this Act; c) Emergency and transfer services; and d) Such other health care services that the Corporation shall determine to be appropriate and cost-effective: Provided, That the Program, during its initial phase of implementation, which shall not be more than five (5) years, shall provide a basic minimum package of benefits xxx. (Emphasis Supplied) There has been no mandate of insurance given to the mentally-ill. Since the first health insurance was created in 1969, there has been no insurance given to any mental disability only until a circular was issued in 2010. Figure 6. RA 7875 National Health Insurance Act 1995

RA 7875 National Health Insurance Act 1995 (as amended by RA 9241) 11. Excluded

PhilHealth Circular No. 09-2010

SEC.

11.

Excluded

Personal SEC.

Personal Coverage Rules of Psychiatric

28 Health Services The benefits granted under this Act shall not cover expenses for the services enumerated hereunder except when the Corporation, after actuarial studies, recommends their inclusion subject to the approval of the Board: Health Services The benefits granted under this Act shall not cover expenses for the services enumErated hereunder except when the Corporation, after actuarial studies, recommends their inclusion subject to the approval of the Board: Conditions Requiring Admission In order to facilitate reimbursement of claims on confinements for psychiatric conditions, the following rules are hereby issued: 1. Claims for mental and behavioral disorder shall be compensable only for patients with acute attacks or episodes admitted for any of the following reasons: a. When aggressive of assaultive behavior presents danger to self or others; b. When the patient is suicidal; c. When the patient becomes manic or depressed and there is gross impairment in judgement and reality testing; d. When medication side effects became disabling or potentially life threatening (e.g. severe parkinsonism, severe tardive dyskinesia, neuroleptic malignant syndrome); e. For special medical procedures such as electric convulsive

a) non-prescription drugs and a) non-prescription drugs devices; and devices; b) out-patient psychotherapy and counselling for mental b) alcohol abuse or dependency treatment; disorders; c) drug and alcohol abuse or d) cosmetic surgery; dependency treatment; e) optometric services; d) cosmetic surgery; e) home services; and f) fifth and subsequent normal rehabilitation obstetrical deliveries; and g) cost-ineffective procedures which shall be defined by the Corporation.

f) optometric services; g) normal obstetrical delivery; and h) cost-ineffective procedures which shall be defined by the Corporation. xxx (emphasis supplied)

29 therapy. xxx (emphasis supplied)

Above are the provisions and the circular implemented and issued respectively by the PhilHealth affecting mental illness in chronological order. The lack of insurance coverage prior PhilHealth Circular No. 09-2010was made categorical under sec. 11 of the National Health Insurance Act of 1995 (RA 7875): SEC. 11. Excluded Personal Health Services The benefits granted under this Act shall not cover expenses for the services enumErated hereunder except when the Corporation, after actuarial studies, recommends their inclusion subject to the approval of the Board: xxx b) out-patient psychotherapy and counselling for mental disorders; RA 9241, The Act Amending the National Health Insurance in 2003 amended RA 7875, particularly the benefit b) out-patient psychotherapy and counselling for mental disorders of section 11 as shown in the first column of Figure 6 above. This benefit was removed (as shown in the second column of Figure 6) as one of those excluded for personal benefits thus making it vague if mental disorders are now covered by PhilHealth. Although the present psychiatric conditions covered was made clear after 8 years when PhilHealth Circular No. 09-2010 was issued ,102 it is surprising to know that out of 94 respondentpsychiatrists in a survey done by random sampling nationwide, 51 of them (54.26% of the respondents) did not know that such health insurance coverage for their patients exists.103 This only goes to show that there is poor dissemination of informationby the PhilHealth to the people, especially psychiatrists the most important health provider for the mentally disabled. Although some of the guiding principle and policies of National Health Insurance of 1995 are health for all especially the poor, universality and equity as provided in section 2: SEC. 2. Declaration of Principles and Policies. Section II, Article XIII of the 1987 Constitution of the Republic of the Philippines declares that the State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. Priority of the needs of the underprivileged, sick, elderly, disabled, women, and children shall be recognized. Likewise, it shall be the policy of the State to provide free medical care to paupers.
Philhealth Circ. No. 09-2010. This is the Coverage Rules of Psychiatric Conditions Requiring Admission (hereinafter PH Circular 09-10). 103 Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
102

30

In the pursuit of a National Health Insurance Program, this Act shall adopt the following guiding principles: xxx b) Universality The Program shall provide all citizens with the mechanism to gain financial access to health services, in combination with other government health programs. The National Health Insurance Program shall give the highest priority to achieving covErage of the entire population with at least a basic minimum package of health insurance benefits; c) Equity The Program shall provide for uniform basic benefits. Access to care must be a function of a persons health needs rather than his ability to pay;xxx (emphasis supplied) it can be gleaned that the PhilHealth insurance coverage for mental disorders as issued in its PH Circular 09-10 is limited only to acute inpatient care(as shown in the third column of Figure 6 above).104 Apart from being limited, PhilHealth did not operationally define what acute is and how different it is from chronic. Thus, it can only be assumed that the terms acute and chronic are understood in their laymans terms: acute for short period attacks105 and chronic for persistent and long-lasting attacks.106
104

Phil Health Circular No. 09-2010 states: CovErage Rules of Psychiatric Conditions Requiring Admission In order to facilitate reimbursement of claims on confinements for psychiatric conditions, the following rules are hereby issued: 1. Claims for mental and behavioral disorder shall be compensable only for patients with acute attacks or episodes admitted for any of the following reasons: a) When aggressive of assaultive behavior presents danger to self or others; b) When the patient is suicidal; c) When the patient becomes manic or depressed and there is gross impairment in judgement and reality testing; d) When medication side effects became disabling or potentially life threatening (e.g. severe parkinsonism, severe tardive dyskinesia, neuroleptic malignant syndrome);

e) For special medical procedures such as electric convulsive therapy.xxx

(Emphasis Supplied) Acute (medicine), available at http://en.wikipedia.org/wiki/Acute_%28medicine%29 (Last visited: January 18, 2013). 106 Chronic (medicine), available athttp://en.wikipedia.org/wiki/Chronic_%28medicine%29 (Last visited: January 18, 2013).
105

31

It is important to distinguish the two because it is only inpatients with acute attacks or episodes are covered in the PH Circular 09-10. The Circular merely gave five reasons where this acute inpatient care is limited to, which are: (a) when aggressive of assaultive behavior presents danger to self or others; (b) when the patient is suicidal; (c) when the patient becomes manic or depressed and there is gross impairment in judgement and reality testing; (d) when medication side effects became disabling or potentially life threatening (e.g. severe parkinsonism, severe tardive dyskinesia, neuroleptic malignant syndrome); (e) for special medical procedures such as electric convulsive therapy.(Emphases Supplied) This means that even if a mentally-ill patient is confined for acute (short period) attacks, but for reasons that do not fall under the five conditions above, he or she will not be covered by PhilHealth insurance. According to Dr. Israel Francis Pargas107, patients confined with chronic (long-lasting) physical illnesses such as leukemia or in need of dialysis for kidney failureare covered by Philhealth when they are confined, same with mentally-ill inpatients also confined falling under the acute attacksor episodeslimited to the five conditions enumerated. This also means, persons with chronic physical illnesses confined are covered by PhilHealth but not persons with chronic mental illnesses. What is questionable then iswhy only confine insurance with inpatient acute episodes limited to only 5 conditions but not mental illnesses that can also be chronic?By this fact alone there is already a unfair and unjust treatment of PhilHealth giving insurance coverage to other chronic ailments subject to confinement that are not mental. Unfortunately these chronic mental illnesses are not in equal footing with other chronic physical illnesses under PhilHealth Insurance. This then could lead to more deleterious effects if inpatient chronic mental illnesses are not covered by insurance while other forms of inpatient illnesses are, may they be chronic or acute. Evidence shows that delays in treatments for mental disorders can lead to increased morbidity and mortality and one of the determinants for this delay is income and lack of health insurance coverage.108 Less well known is the fact that those with severe mental illness (SMI) are less likely to have health insurance coverage of any kind.109 There have been reports that chronic illnesses such as
Interview with Dr. Israel Francis Pargas, Senior Manager for Benefits Development and Research of PhilHealth, Pasig City (July 22, 2011). 108 Catherine Mclaughlin, Delays in Treatment in Mental Disorders and Health Insurance Coverage, 39 Health Serv. Res. 221-224 (2004). 109 Id.
107

32 mental health problems, including depression and schizophrenia, are among the 10 leading causes of disability worldwide.110 According to a World Bank study, depression will become the second leading cause of disability in 2010.111Clinical depression is a common mental disorder that affects about 121 million people across the globe.112 It is estimated that by 2020, clinical depression will be the second most leading cause of disability worldwide second only to cardiovascular illness.113 If these are the cases, and at the same time confinement of such chronic mental illnesses are not covered by Philhealth, mentally-ill adults are more likely to be unemployed relative to other adults.114 Multivariate studies of labor force outcomes have generally found unemployment levels to be lower among persons with mental illness.115 If they are unemployed, this would also result to non-eligibility for employer sponsored insurance, the primary source of health care for elderly adults.116 They also become ineligible to insurance disability benefits from GSIS or SSS if they stop working for the government or a private employer respectively. Although the basis of Philhealth in all its insurance coverage are actuarial studies, it can be of help to widen the scope given to mentally-ill patients if there are psychiatrists who can explain that early intervention in treatment of mental illness lessens its reccurrence or even with greater probability to be completely cured. Onset of mental illness occurs during late adolescence or young adulthood especially the aged 25-34 years.117 This is the same age group that has the highest level of uninsurance; in part because mental illness often begins during late adolescence or young adulthood, it is more likely to have greater impact on educational attainment and income than many other chronic conditions.118 Philhealth is not the only insurance corporation which limits its insurance coverage to the mentally ill but also private insurance companies such as HMOs (Health Maintenance Organizations). Although under the National Insurance Code of the Philippines (RA 7875) these HMOs can be accredited, to date, there has been no accredited HMO by PhilHealth.119 HMOs also do not provide any form of insurance, inpatient or out-patient, for the mentally disabled for the belief that mental disorders are chronic and will consume too much of their funds. HMOs and other entities must however be educated and informed that mental illnesses that are not treated early can lead to worse conditions. If there is early intervention and compliance to treatment for mental disorders, which can be done through the support of an insurance coverage, there is shorter
Sol Jose Vanzi, Mental Health Problems: Psychiatrists Tap Social Science, available athttp://www.newsflash.org/2004/02/si/si001922.htm (last visited October 25, 2004). 111 Id. 112 Cara Davis, 7 Ways to Ward off Clinical Depression, 3, at http://halogentv.com/articles/7-ways-toward-off-clinical-depression/ (last visited: June 20, 2011). 113 Id. 114 Maclughlin, Supra Note 104. 115 Id. 116 Id. 117 Id. 118 Id. 119 Interview with Dr. Israel Francis Pargas, supra note 103.
110

33 duration for the improvement, and lesser dosages and treatment needed120. If there is decrease in dosages and maintenance treatment, then this will lead to decrease in expenses, decrease in hospitalization and decrease for the need for insurance benefits. There is also a possibility of completely not using such insurance if the patient is completely cured. Early treatment of disorders like depression, anxiety and drug and alcohol dependence can cut the risk that the problem will persist past young adulthood, noted by the researchers, led by Dr. Carlos Blanco of the New York State Psychiatric Institute at Columbia University.121

VI. Conclusion with Recommendations According to the World Health Organization, there is at least one percent of the global population that may be suffering from mental health problems. Worldwide, endogenous or major depression is set to become second only to cardiovascular disease as the most diagnosed condition by year 2020. It is already the fourth most common diagnosis as of 1998,122 and the Philippines is no exception from these statistics.123Unfortunately, Filipinos with mental illness are dicriminated against in various forms where there is unequal treament when it comes to rights and privileges that persons afflicted with other forms of illnesses that are not mental are given more benefits and privileges in legislative policies. In R.A. 7277 also known as the Magna Carta for Disabled Persons alone, there are provisions that are questionable, thus need to be modified inorder for mentally disabled Filipinos can be given fair treatment vis a vis other people afflicted with non-mental disabilities. In education for instance, there are no considerations given to mentally disabled people. The term mentally retarded is used in Section 14 and 17 of the Act together with persons afflicted with other illnesses who are given considerations in education. However mental retardation is not the same as mental disability for it does not cover schizophrenia, major depression, bipolar, anxiety disorder, addiction the top five most common mental illnesses124 and other mental illnesses. To give special
Interview with Dr. Jercyl Leilani Demeterio, supra note 62. Reuters, Mental health disorders common in young adults: survey, at http://www.abscbnnews.com/lifestyle/12/14/08/mental-health-disorders-common-young-adults-survey (last visted May 19, 2012). 122 Medical Observer, Mental State, http://www.medobserver.com/article.php?ArticleID=437 (last visited July 23, 2011). 123 Supra note 2. In the Philippines today, a WHO document on Mental Health and Development (2010) reports that one of every four households worldwide have members with mental health problems. A Population Survey for Mental Disorders conducted in four provinces in Western Visayas (Iloilo, Capiz, Antique, Negros Occidental) showed that one out of three households have members with mental health problems. Another WHO study conducted among patients in seven developing countries (the Philippines included) showed 17-25% of patients consulting at health care centers have diagnosable psychiatric disorders that, however, are not recognized by the general physician, midwife, and community health workers in these areas. Mental health problems are predominantly treated in psychiatric clinics and mental hospitals located in urban centers, thus mental health services are inaccessible to the majority of Filipinos in rural areas. www.bworld.com.ph, A mental health care advocate, at http://www.bworld.com.ph/content.php?section=Opinion&title=A-mental-health-careadvocate&id=34287 (last visited July 23, 2011) 124 Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
121
120

34 considerations to mentally disabled students, the Government can create a pilot study where schools and/or special classes can be regulated and monitored by certified psychiatrists and clinical psychologists to determine the veracity and gravity of the illness of the student-patient from time to time and assess their capacity to learn. These assessments of a pilot case study can be used to determine special considerations that can be made that are not provided by R.A. 7277. In labor, a provision must be added to R.A. 7277 where it should categorically state that though people are diagnosed with mental illnesses it should not be a reason for them to be not accepted from work. No single provision is stated as such in the Act. Infact, mentally disabled overseas contract workers are not allowed by the Department of Labor and Employment (DOLE) to leave for overseas contract employment although it is a fact that with therapy and medication such workers can function as normal individuals do. A difficult problem to solve in relation to above is poverty and this is aggravated by the miniscule budget given to mental health by the DOH. A meager 5% are directed for mental health while 95% are spent on operation, maintenance and salary of the personnel of mental hospitals. The DOH and other private sectors such as the Philippine Psychiatric Association must think of ways to compensate the miniscule budget. Such private sectors must lobby for larger budget but sadly the country has psychiatrists who are passive when it comes to the advancement of their patients rights particularly in legislative policies. R.A. 7277 which gives atleast twenty percent discounts to disabled persons for basic health services is not well-known among the Filipino Psychiatrists in the country. In a survey of 95 respondentpsychiatrists across the Philippines, 90 out of 95 are ignorant of the contents of the Act. Also the pending House Bill 6679 which pushes for the establishment of a National Mental Health Care Delivery System and the Philippine Council for Mental Health, is not known to these psychiatrists where 90 out of 93 of them are not also aware of the substance of the law. If the main health professionals such as psychiatrists are ignorant of the pending bill, how can they start to support and lobby for the enactment of House Bill 6799? The Congress must create campaign materials to strengthen advocacy and public information campaign on mental health. They can also mandate each and every psychiatrist of the Philippines to attend seminars on the laws and bills affecting the mentally disabled. Campaign materials are not also meant for psychiatrists but also for Local Government Units where every region down to the barangays which is the smallest political unit are made aware of the laws and bills affecting mentally disabled patients. There is also a poor dissemination of information of the benefits and privileges given to mentally disabled patients covered by the Philippine Health Insurance (PhilHealth). PhilHealth Insurance coverage for the mentally ill is limited only to acute inpatient care which must fall under 5 conditions enumerated by PH Circular 09-10. While PhilHealth covers chronic illnesses that are not mental subject to confinement, it does not cover chronic mental illnesses subject also to confinement which only shows the unjust treatment to mentally disabled patients. This PH Circular 09-10 must be amended by making known by the DOH, private sectors, mental health professionals such as psychiatrists that mentally disabled patients with chronic illnesses subject to confinement must be covered by insurance of PhilHealth as evidence shows that delays in treatments for mental disorders can lead to increased morbidity and mortality and one of the determinants of this delay is income and lack of health insurance coverage.

35 VI. BIBLIOGRAPHY Laws 1987 Philippine Constitution Batasang Pambansa 344. AN ACT TO ENHANCE THE MOBILITY OF DISABLED PERSONS BY REQUIRING CERTAIN BUILDINGS, INSTITUTIONS, ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL FACILITIES AND OTHER DEVICES Rep. Act No. 7277, The Magna Carta for Disabled Persons Rep. Act. No. 9244. This is known as the Amendment to R.A. 7277 otherwise known as the Magna Carta for Disabled Persons of 2007 DOH AdministrativeOrder No. 8 Series of 2001 DOH AdministrativeOrder No. 9 Series of 2007 National Council for Disability Affairs Administrative Order No. 1, Series of 2008 Pres. Dec. No. 1460, 2 (1978) Insurance Code of the Philippines RA 7875 National Health Insurance Act 1995 RA 7875 National Health Insurance Act 1995 (as amended by RA 9241) PhilHealth Circular No. 09-2010 House Bill 6679 entitled An Act for A National Mental Health Care Delivery System Establishing For The Purpose The Philippines Council for Mental Health And Appropriating Funds Therefore

Books ARTHUR MILLER, THE CRUCIBLE vii (1995). BALTAZAR REYES & CONSTANTINE DELLA, TREATMENT OF MENTAL ILLNESS IN THE PHILIPPINES: A HISTORICAL PERSPECTIVE (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002). Fr. JOSE FRANCISCO SYQUIA, EXORCISM: ENCOUNTERS WITH THE PARANORMAL AND THE OCCULT 1-207 (2006) MA. LUZ CASIMIRO QUERUBIN & SONIA CASTRO RODRIGUEZ, FINANCING HEALTH CARE: THE NATIONAL HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002).

36

MARIA OFELIA ALCANTARA, FINANCING HELATH CARE: THE NATIONAL HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002). Robert Carson et.al., ABNORMAL PSYCHOLOGY AND MODERN LIFE 33 (2000).

Papers Dr. Bernardo Conde, Philippines mental health country profile, International Review of Psychiatry, 166 (2004). WHO and Department of Health-Manila, Report on Mental Health System in the Philippines, 7 in WHO-AIMS (2007) Catherine Mclaughlin, Delays in Treatment in Mental Disorders and Health Insurance Coverage, 39 Health Serv. Res. 221-224 (2004).

Websites Major Depressive Disorder, available http://en.wikipedia.org/wiki/Major_depressive_disorder (Last visited: January 18, 2013). at

Major Depression, available at http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm (Last visited: January 18, 2013). Cara Davis, 7 Ways to Ward off Clinical Depression, Jun 20, 2011, 3, http://halogentv.com/articles/7-ways-to-ward-off-clinical-depression/ at

Source: Government of Sourth Australia, Department for families and communities. Intellectual Disability and Mental Illness (Dual Disability) available at http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Information%20sheets%20%20Disability%20SA/Intellectual%20disability%20-%20mental%20illnessdual%20disability%20%28PDF%20140kb%29.pdf (Last visited: June 9, 2012). The Free Dictionary, available at http://medical-dictionary.thefreedictionary.com/mental+illness and Wikipedia, available at http://en.wikipedia.org/wiki/Mental_disorder (Last visited: November 26, 2012). DSM5.org, available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465 (Last visited: October 22, 2011). Rina Jimenez David, At Large Not just for the sirang ulo at http://opinion.inquirer.net/8977/notjust-for-the-%E2%80%98sirang-ulo%E2%80%99(last visited November 22, 2012).

37 Westers Dictionary at http://www.merriam-webster.com/medical/lobotomy (last visited May 16, 2012) World Fellowship for Schizophrenia and Allied Disorders, available at http://www.worldschizophrenia.org/disorders/schizophrenia.html(Last visited: November 26, 2012). Meeting of Minds, available at http://www.medobserver.com/article.php?ArticleID=440(last visited May 17, 2012). Margarita Tartakovsky M.S., The Bipolar Fact Sheet, available http://psychcentral.com/lib/2009/bipolar-disorder-fact-sheet/ Last visited: November 26, 2012). at

Major Depression, available at http://www.depressedtest.com/major_depression.html(Last visited: November 26, 2012). Anxiety Disoder, available at http://en.wikipedia.org/wiki/Anxiety_disorder (Last visited: November 26, 2012). Anxiety and Panic Disorders Health Center, available at http://www.webmd.com/anxietypanic/guide/mental-health-anxiety-disorders (Last visited: November 26, 2012). Addiction, available at http://en.wikipedia.org/wiki/Addiction (Last visited: November 26, 2012). What is Addicition?, available at http://www.psychologytoday.com/basics/addiction (Last visited: November 26, 2012). Information about Mental Illness and the Brain, http://science.education.nih.gov/supplements/nih5/mental/guide/info-mental-b.htm November 26, 2012). available at (Last visited:

Dictionary.com, available at http://dictionary.reference.com/browse/psychosomatic (Last visited: November 26, 2012). Psychopharmacology From Wikipedia, the free http://en.wikipedia.org/wiki/Psychopharmacology (last visited May 17, 2012). encyclopedia at

Psychopharmacology, available at http://www.sciencedaily.com/articles/p/psychopharmacology.htm (Last visited: November 26, 2012). Mental Retardation, http://emedicine.medscape.com/article/1180709-overview (Last visited: January 14, 2013). Adrian Jeric G. Pena, Mental Health and Mental Illness in the Philippines at http:// http://mentalhealth-ph.wikispaces.com/5.+Salient+Points+of+House+Bill+6679 (last visited January 17, 2012). Acute (medicine), available at http://en.wikipedia.org/wiki/Acute_%28medicine%29 (Last visited: January 18, 2013).

38

Chronic (medicine), available athttp://en.wikipedia.org/wiki/Chronic_%28medicine%29 (Last visited: January 18, 2013). Sol Jose Vanzi, Mental Health Problems: Psychiatrists Tap Social Science, available athttp://www.newsflash.org/2004/02/si/si001922.htm (last visited October 25, 2004). Cara Davis, 7 Ways to Ward off Clinical Depression, 3, at http://halogentv.com/articles/7ways-to-ward-off-clinical-depression/ (last visited: Jun 20, 2011). Reuters, Mental health disorders common in young adults: survey, at http://www.abscbnnews.com/lifestyle/12/14/08/mental-health-disorders-common-young-adults-survey (last visted May 19, 2012). Medical Observer, Mental State, http://www.medobserver.com/article.php?ArticleID=437 (last visited July 23, 2011).

39 ANNEX A SURVEY FORM FOR PSYCHIATRISTS Please take time to answer the following questions. The information you will provide will be treated with UTMOST CONFIDENTIALITY. 1) Hospitals/Institutions: Check as many as applicable Private Hospital: ( ) Specialized ( ) General Government: ( ) Specialized Institution ( ) Genera.l Hospital ( ) Own Clinic ( ) Others, pls specify _______________ 2) Services: ( ) Outpatient care ( ) Home visits ( ) Inpatient care ( ) Group Sessions ( ) Others, pls specify ____________________ 3) Location of Institutions associated with: ( ) NCR ( ) North Luzon ( ) South Luzon ( ) Central Luzon ( ) Visayas ( ) Mindanao 4) Years of Practice: ( ) Less than 1 yr( )11-20 yrs( ) 31-40 yrs ( )1-5 yrs( ) 21-30 yrs( ) Above 50 yrs ( )6-10 yrs ( ) 41-50 yrs 5) Estimated number of outpatient consults in a week: ( ) 1-5 ( )11-20 ( ) 31-40 ( ) 51-60 ( ) 6-10 ( ) 21-30 ( ) 41-50 ( ) Above 60 6) Estimated number of in-patients in a month: ( ) at least 5 / month ( ) around 10 / month ( ) approximately 20 / month ( ) others, ____________________ 7)Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by Republic Act 9244)? ( ) Yes ( ) No Comments: ___________________________________ 8) Do you think you need to know more about it? ( ) Yes ( ) No Comments: ___________________________________ 9) Is there a present Health Insurance Coveragefor psychiatric illnesses that you know of?

40 ( ) Yes ( ) None Comments: ___________________________________ 10) What are your insights regarding health Insurancefor psychiatric patients? _____________________________________________ _____________________________________________ 11) Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of psychiatric disorder in your medical practice: _______ schizophrenia _______ bipolar _______ majordepression ________ anxiety disorder ________ addiction (substance-use disorder) ________ dementia ________ personality disorder ________ eating disorder ________ somatoform disorder ________ sleep disorder ________ sexual disorder Comments: ___________________________________ _____________________________________________ 12)Are there other psychiatric disorders that you commonly encounter apart from those listed above? If Yes, please specify ___________________________ 13) Estimated number of consults patient would need before adequate recovery is perceived: (in terms of the top 5 common disorders you Ranked in no. 11) ( ) 1 consult is enough ( ) 11-15 ( ) 2-3 consults ( ) 16-20 ( ) 4-5 consults ( ) 21-25 ( ) 6-10 ( ) 26-30 ( ) Above 30 Comments: ___________________________________

14)Yourestimated cost for consultations before some adequate recovery is perceived per patient:(in terms of the top 5 common disorders you ranked in no. 11) OUTPATIENT IN-PATIENT If Private Setting: If Private Setting: ____________ ____________ weekly ____________ bi- weekly ____________ biweekly weekly ____________ ____________ monthly monthly ____________ ____________ quarterly ____________ quarterly ____________ yearly yearly

41 If Setting: Government If Government

Setting: ____________ ____________ weekly ____________ bi- weekly ____________ biweekly weekly ____________ ____________ monthly monthly ____________ ____________ quarterly ____________ quarterly ____________ yearly yearly Comments: ___________________________________ 15) Your estimated cost of medications per patient would need to spend on a monthly basis: (in terms of the top 5 common disorders you ranked in no. 11) ( ) P100 P500 ( ) P3000 P4, 500 ( ) P600 P 1000 ( ) P5000 P8,000 ( ) P1, 500 P 2, 500 ( ) P8000 P10,000 () Above P10,000 Comments: ___________________________________ 16) Have you heard of the pending National Mental Health Bill in Congress? ( ) Yes ( ) No Comments: __________________________________________________ 17) Do you think you need to know more about it? ( ) Yes ( ) No Comments: __________________________________________________ IMPORTANT REMINDER: We want to ensure retrieval of this survey form, hence submission of each psychiatrist-participant will be checked after it is completely filled-out. Kindly return after answering the form to the registration site for the checking of your submission of such form. Thank you very much.

42 ANNEX B ANSWERS TO SURVEY BY PSYCHIATRISTS 1. Table 1 Hospital/ Institutions: Check as many as applicable

a.) Specialized 25

Private Hospital GenEral 41

Government Hospital Specialized Institute 27 GenEral Hospital 37

Table 2 Own Clinic Others, pls. Specify (if there is no. it mins. The number of person with the same answers) 1. Psychologist 2. Home care =3 3. Multispecialty Clinic 4. Academe 5. Shelter for street children 6. Multispecialty private clinic 7. San Bernabe Med. Clinic, 8. NGO=2 9. Visiting.

b.)

51

2. Services: Table 3

Outpatient Care

91

Inpatient Care 88 Home Visit 22 Group Session 22 Others, pls. specify 1. E.R. Patient=2 (if there is no. it means. 2. Psychiatric Education The number of person 3.Detoxification

43 with the same answers)

3. Location of institutions associated with: Table 4 NCR North Luzon South Luzon Central Luzon Visayas Mindanao 4. Years of Practice: Table 5 52 8 10 3 21 10

Less than 1 yr. 1-5 yrs. 6-10 yrs. 11-20 yrs 21-30 yrs. 31- 40yrs. 41-50 yrs. Above 50 yrs.

8 20 25 22 12 8

5. Estimated number of outpatient consults in a week. Table 6 1-5 6-10 11-20 21-30 31- 40 41-50 51-Above

7 25 13 14 10 5 21

44 6. Estimated number of in- patient in a month: Table 7

Less than 5/month Less than 5/month At least 5/month Around 10/month Approximately 20/month 51-100/month 200/month 20-50/month 500/month Others, (if there is no. it means. The number of person with the same answers)

10 10 39 12 10 4 3 5 1 1. Variable or one / 3 months 2. Once a month 3. None-All patients are Outpatients 4. 20/month 5. None/ n.a. (OPD) 6. 5X / year 7. Seldom 8. More than 20/ month 9. 500/month 10. 1-3/month 11.Less than 5/month 12. more than 20/month 13. 50 inpatients, at present 14. 500 inpatients of the whole hospital 15. 50/month-in govt. hospital 16. 100 17. 5 18. 1-2 patients 19. 100/month 20. 5/month 21. 100/month or more 22. 150-200/month=2 23. more than 50 in a month 24. occasional only

45 25. 3 patients/month=2 26. 5000 27.Approximately 200/month 30. 5/month

7. Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by Republic Act 9244)? Table 8 YES NO COMMENTS: 58 37 1. Needs copy of R.A. 7277. 2. I know there is one but I havent read it 3. Given emphasis for the physically disabled including the mental. 4. Not totally though 5. Not aware of this Act

8. Do you think you need to know more about it ? Table 9 YES NO COMMENTS: 90 5

9 .Is there a present Health Insurance CovEragefor psychiatric illnesses that you know of? Table 10 YES NONE COMMENTS: 44 51 1. Phil health for acute cases only=3

46 2. Phil health= 8 3. It is limited 4. Psychiatric patients should be covered by Insurance 5. very limited only for admitted patients 6. SSS/GSIS disability claim 7. Phil health for inpatients 8. Phil health very selective cases only 9. Sources only acute cases 10. Their limited to certain illness 11. Phil health but still not implemented for hospitals w/o psychiatric wards.

10. What are your insights regarding health Insurancefor psychiatric patients? Table 11 1.) Should also include chronic cases 2.) Coverage should include OP's medicators 3.) It is a necessity 4.) Health Insuranceshould be instituted for care for mental health patients 5.) Needs to be given fair assistance from Insuranceco. 6.) Long term to have one 7.) Took time to have one 8.) Very less of a privilege & opportunity 9.) Health Insuranceco. seems reluctant to cover psychiatric conditions 10.) They needed it badly esp. for indigent patients 11.) Most health Insurancedo not recognize psychiatric illness 12.) It is necessary since most mental illness is chronic 13.) None 14.) I think it will help those who are not economically -privileged to avail services 15.) limited coverage due & high cost of medicines & hospitalization. 16.) It is needed but none is available 17.) It will be very helpful if approved 18.) They deserve to have an Insurancetoo for humanizations reason 19.) It is highly recommended since psychiatric care is costly 20.) This should be a must for voluntary consultations & regular treatment 21.) Psychiatric patients should be covered by Phil Health 22.) It does not sum to realize that psychiatric conditions are chronic & patients are mostly a lifetime maintain treatment 23.) Health Insuranceco. just make money for themselves. They dont pay current consultations/professional fees for doctors pay even up to several years late.

47

24.) Too difficult to be specific depends on patients recovery & response too 25.) Necessary 26.) They should benefit from Insurancesince treatment is usually long term 27.)There should be expansion of the coverage for psychiatric patients 28.) Psychiatric admissions should be included in health insurance 29.) It is a must 30.) Government needs to come up with a nahomel mental health Program to create awareness, politics & employer respond to wellness Programs, price control on medicines . 31.) It should also outpatient services 32.) It is necessary esp. with the cost of medications and hospitalization during relapse. 33.)Theres a need 34.) neglected by private Insuranceco. & ignored by gov't. but a basic need and right for the mentally disabled 35.) Badly needed 36.) we need more health Insurancebenefits for both psychotic & non psychotic admission an OPD consult 37.) There is a definite need for it but it will all fall down to financial liability 38.) Health Insuranceshould include all illnesses including psychiatric conditions except for substance we abuse /dependence 39.) About time we have a comprehensive one 40.) Psychiatric disorders are also medical conditions and should share equal benefits together with all other illnesses 41.) This should be a must for voluntary consultations & reg. treatment 42.) There should be good somewhere for it if there was one 43.) It would entail to much cost 44.)When will it be available 45.) Most psychiatric patients are claiming for Insurance-they need to be provided for 46.) It is important 47.) Inadequate 48.) Should have 49.) Should be included in the Health Insurance CovErageof Phil Health 50.) Needs to cover non psychiatric cases/doctors 51.) It is limited and some disorders /mental disorders are allegedly not covered private health insurances dont cover it 52.) Unfair & lacking 53.) It should have adequate coverage like medical illnesses 54.) It is needed 55.) Need ,it is acknowledge that it is a chronic conditions and will really go through government resources. 56.)Good & helpful 57.)Mental illnesses should be covered by health Insurance 58.) Insurancecompanies (private coverage of psychiatric patients as well as

48 government should accept all of them 59.) Health Insuranceshould also be made available for psychiatric patients 60.) It is important 61.) Wanting 62.) They need it 63.) It would be a help of both in the caregivers & patient, it will make them prompt /OPD for consult 64.) Its non-existent 65.) It should cover up to 3-6 months 66.) Needs to be reinforced 67.) There should be HMO provider 68.) Still needs to be more extensive covering more illness 69.) It would be a great help for our patients 70.) Limited to some illness, & this is unfair knowing that mental illness are recurrent & treatment serve longer time 71.) Health Insurancefor psychiatric patients should have a broader coverage 72.) Public is not aware and extensive review of coverage should be done because usually mental problems is excluded in health coveR.A.ge 73.) Need so much because of relapses(financial problems) 74.) Needs wider coverage 75.) Will take a long 76.) Imperfect, but at least its a start. 77.) I think psychiatric patient

11. Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of psychiatric disorder in your medical practice: Table 12 SCHIZOPHRENIA 653 BIPOLAR 587 MAJOR DEPRESSION 613 ANXIETY DISORDER 571 ADDICTION (Substance-use disorder) 555 DEMENTIA 460 PERSONALITY DISORDER 482 EATING DISORDER 400 SOMATOFORM DISORDER 423 SLEEP DISORDER 510 SEXUAL DISORDER 386 COMMENTS: 1. Adjustment disordering have anxiety or depressive symptoms 2. Other patient has dual diagnose

49 3. at times they exist co-morbidly

12. Are there other psychiatric disorder you commonly encounter apart from those listed above? If yes Pls, Specify Table 13 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. ADHD=3 No Marital problems Suicide Adjustment disorder, physical abuse, sexual abuse School phonic , ADHD, Mental retardation, conduct disorder Panic disorder, post traumatic stress disorder ADHD & learning disorder , mental retardation Schzo affective disorder PTSD Relationship disorder/problem none except co-morbid conditions additional developmental disorder like ADHD; MR; Conduct disorder Marital problems & work related problems mixed anxiety depression disorder delusional disorder Dismpture disorder ADHD; Autism

13. Estimated number of consults patient would need before adequate recovery is perceived: (in terms of the top 5 common disorders you Rankin no. 11) Table 14

24 1 -5 CONSULTS 38 6--15 20 16--30 30 Above COMMENTS: 13 (answer of NEW QUESTIONNAIRE included) 1. I practice psychotherapy. The approach in psychiatry 2. Several factors should be considered here like financial support and patients insight

50 3. It really depends on the severity of each illness ,the social support available for the patient & mental capacity of the patient 4. recovery also depends on patient/family compliance with medication and advice given by the doctor 5. Continues psychiatric care is recommended 6. Some patients do not recover completely 7.Patients needs also continuous monitoring & follow up there after 8. Lifetime 9. Treatments for each disorder is too varied in terms of approaches & pharmacology , psychotherapy consults 10. Case to case basis 11. Per need-it varies 12. Follow up consults still needed even if patients is asymptomatic already 13. If seen at once (acute)given treatment improvements is seen 14. Mental illness is lifetime disease 15. I cant answer this as the top 5 Mental illness is the recurrent & recovering is not possible disorder to the nature or cause of thinking.

CORRECT ANSWERS

51 Table 15 OUTPATIENT If Private(Pesos) WKLY BIWKLY MNTLY QTRLY YRLY WKLY 1,000/ Day 600 3,000 20k 20,000 6,000 5,000 2,500 Room rate 7,000 1,500 6,000 1520k 1-2k 7,000 30,000 1,000 1,000 1,000 15,000 5,000 20k BIWKLY 1,000/ Day If Private(pesos) MNTLY QTRLY 1,000/ Day 72,000 105,000 YRLY 1000/ day 60,000 72,000 420,00 IN-PATIENT

1,000 600 400 1,500 20,000 1,000 20,000

500 1,200 2,500 6,000 2,500 1,200 3,000

600 1,200 12k 1,200 1-2k 2,000 5,000

600 36,000 1,8000 1,500 2,500

600 36k 7,200 1012k

16,000 1,000/ 12,000 Day 18,000 24,000 5,000 35,000 20,000 10-15k 3,000

2,000 2,000 1,500 600 500 At least 1,000 500 500 600 800/ Session 4,000 1-2k 1,000 1,500-2k 6,000 1,000 500 If Government WEEKLY

1,500 700

1,000 800 1,500700 2k 2,000 1,000 4,000 20k 2k

OUTPATIENT BI-WEEKLY MONTHLY

IN-PATIENT If Government QUARTERLY YEARLY

52 300 500 1,ooo Free Free 50 100 600 200 200 0 Others: 8-10,000 COMMENTS: 200 free 0 0 1-3k 1,500-3k Free charity 0 0

Table 16 1.) Cant be measured 2.) In government setting no PF so consultation cost will be in terms of medicine & laboratory work-up 3.) Cant be measured 4.) Depends 5.) Socialized 6.) Not very clear question & what we are being asked too 7.) Just voluntarily/part of the duty 8.) Not possible knowing that recovery is not possible. 9.) Hospitalization can be avoided if patient regularly follow up our out patient basis.

15. . Your estimated cost of medications per patient would need to spend on a monthly Basis : (in terms of the top 5 common disorders you ranked in no.11).

53

Table 17 P100-P500 P600-P1000 P1, 500-P2, 500 P3000-P4, 500 P5000-P8, 000 Above P8,000 COMMENTS: using a typical antipsychotics 2. Assuming we use the best medications available 3. Range in terms of generic medicines 4. the disorder ranked 1-5 are too varied to describe by the above choices 5. Depends 6. No idea, not discussed with patient 7. Esp. if branded/innovator drugs will be used 8. Varies on patients capacity to buy 9. Mightly meds P26-7/month 10. Depending on the medications prescribed 4 4 15 27 17 20 1. For treatment resistant psychotic patients

16. Have you heard of the pending National Mental Health Bill in Congress Table 18 YES NO COMMENT: 50 43 1. It was remained to be pending for the past 12 yers 2. Needs to push 3. Long been pending 4. Not apperceived because there were more important one.

17. Do you think you need to know more about it? Table 19 YES 89

54 NO COMMENT: 3 1. More involved about it, involvement & multi sectoral group 2. to nosy 3. Just pass it they just say , medicines are costly 4. One has to know somebody intensive follow up 5. it would be good if there is .

GRAPHS 3. Location of institutions associated with: Figure 1

60 50 40 30 21 20 10 0 Locations 8 10 3
Mindanao Central Luzon

52
NCR North Luzon South Luzon

10

Visayas

4. Years of Practice. Figure 2

25 25 20 20 15 10 5 0 No. of psychistrist answered 8
1-5 yrs. 6-10 yrs.

22

Less than 1 yr.

12 8

11-20 yrs. 21-30 yrs. 31-40 yrs. 41-50 yrs. Above 50 yrs.

TOTAL=95

5. Estimated number of outpatient consults in a week. Figure 3

25 25 21 20
6-10 1-5

15 10 5

13

14 10

11-20 21-30

7 5

31-40 41-50

55

TOTAL=95 6. Estimated number of in- patient in a month: Figure 4

40 35 30 25 20 15 10 5 0 4 3 10 12 10 5 1 39
Less than 5/month At least 5/month Around 10/month Approximately 20/month 51-100/month 200/month 20-50/month 500/month

TOTAL = 84

No. of psychiatrist answered

7. Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by Republic Act 9244)? Figure 5

58 37
YES NO

TOTAL = 95

56 9 .Is there a present Health Insurance CovErage for psychiatric illnesses that you know of? Figure 6

51 44
YES NO

TOTAL 95

10. Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of psychiatric disorder in your medical practice

Figure 7
Schizophrenia

700 600 500 400 300 200 100 0

653 587

613

Bipolar

571 555 460 482 400 510 423 386

Major Depression Anxiety Disorder Addiction Dementia Personality Disorder Eating Disorder Somatoform Disorder

Psychiatric Disorders

Sleep Disorder Sexual Disorder

57

13. Estimated number of consults patient would need before adequate recovery is perceived: (in terms of the top 5 common disorders you Rank in no. 11)

Figure 8
40 35 30 25 20 15 10 5 0 No. of Consults needed by a patient 13 24 20
1-5 6-15 16-30 30 above

38

TOTAL = 95 15. Your estimated cost of medications per patient would need to spend on a monthly basis: (in terms of the top 5 common disorders you ranked in no.11).

Figure 9

30 25

27
P100-P500 P600-P1000 P1,500-P2,500 P3,000-4,500 P5,000-P8,000

20 20 15 15 10 5 0 Estimated cost of medication/ patient 4 4 17

Above P8,000

58 16. Have you heard of the pending National Mental Health Bill in Congress? Figure 10

50

43

YES NO

TOTAL = 93

17. Do you think you need to know more about it? Figure
90

11
YES NO

TOTAL = 93

59 ANNEX C Republic Act No. 9277 March 24, 1992

AN ACT PROVIDING FOR THE REHABILITATION, SELF-DEVELOPMENT AND SELF-RELIANCE OF DISABLED PERSONS AND THEIR INTEGRATION INTO THE MAINSTREAM OF SOCIETY AND FOR OTHER PURPOSES.

TITLE I GENERAL PROVISIONS CHAPTER I BASIC PRINCIPLE Section 1. Title. This Act shall be known and cited as the "Magna Carta for Disabled Persons." Sec. 2. Declaration of Policy The grant of the rights and privileges for disabled persons shall be guided by the following principles: (a) Disabled persons are part of Philippine society, thus the State shall give full support to the improvement of the total well-being of disabled persons and their integration into the mainstream of society. Toward this end, the State shall adopt policies ensuring the rehabilitation, self-development and selfreliance of disabled persons. It shall develop their skills and potentials to enable them to compete favorably for available opportunities. (b) Disabled persons have the same rights as other people to take their proper place in society. They should be able to live freely and as independently as possible. This must be the concern of everyone the family, community and all government and nongovernment organizations. Disabled persons' rights must never be perceived as welfare services by the Government.

(c) The rehabilitation of the disabled persons shall be the concern of the Government in order to foster their capacity to attain a more meaningful, productive and satisfying life. To reach out to a greater number of disabled persons, the rehabilitation services and benefits shall be expanded beyond the traditional urbanbased centers to community based programs, that will ensure full participation of different sectors as supported by national and local government agencies. (d) The State also recognizes the role of the private sector in promoting the welfare of disabled persons and shall encourage partnership in programs that address their needs and concerns. (e) To facilitate integration of disabled persons into the mainstream of society, the State shall advocate for and encourage respect for disabled persons. The State shall exert all efforts to remove all social, cultural, economic, environmental and attitudinal barriers that are prejudicial to disabled persons.

Sec. 3. Coverage. This Act shall cover all disabled persons and, to the extent herein provided, departments, offices and agencies of the National Government or nongovernment organizations involved in the attainment of the objectives of this Act.chanrobles virtual law library

60 (1) qualified interpreters or other effective methods of delivering materials to individuals with hearing impairments; (2) qualified readers, taped tests, or other effective methods of delivering materials to individuals with visual impairments; (3) acquisition or modification of equipment or devices; and (4) other similar services and actions or all types of aids and services that facilitate the learning process of people with mental disability. (h) Reasonable Accommodation include 1) improvement of existing facilities used by employees in order to render these readily accessible to and usable by disabled persons; and 2) modification of work schedules, reassignment to a vacant position, acquisition or modification of equipment or devices, appropriate adjustments or modifications of examinations, training materials or company policies, rules and regulations, the provision of auxiliary aids and services, and other similar accommodations for disabled persons; (i) Sheltered Employment refers to the provision of productive work for disabled persons through workshops providing special facilities, income-producing projects or homework schemes with a view to giving them the opportunity to earn a living thus enabling them to acquire a working capacity required in open industry; (j) Auxiliary Social Services are the supportive activities in the delivery of social services to the marginalized sectors of society; (k) Marginalized Disabled Persons refer to disabled persons who lack access to rehabilitative services and opportunities to be able to participate fully in socioeconomic activities and who have no means of livelihood and whose incomes fall below the poverty threshold;

Sec. 4. Definition of Terms. For purposes of this Act, these terms are defined as follows:chanroblesvirtualawlibrary (a) Disabled persons are those suffering from restriction or different abilities, as a result of a mental, physical or sensory impairment, to perform an activity in the manner or within the range considered normal for a human being; (b) Impairment is any loss, diminution or aberration of psychological, physiological, or anatomical structure or function; (c) Disability shall mean 1) a physical or mental impairment that substantially limits one or more psychological, physiological or anatomical function of an individual or activities of such individual; 2) a record of such an impairment; or 3) being regarded as having such an impairment; (d) Handicap refers to a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the function or activity, that is considered normal given the age and sex of the individual; (e) Rehabilitation is an integrated approach to physical, social, cultural, spiritual, educational and vocational measures that create conditions for the individual to attain the highest possible level of functional ability; (f) Social Barriers refer to the characteristics of institutions, whether legal, economic, cultural, recreational or other, any human group, community, or society which limit the fullest possible participation of disabled persons in the life of the group. Social barriers include negative attitudes which tend to single out and exclude disabled persons and which distort roles and inter-personal relationships; (g) Auxiliary Aids and Services include:

61 (l) Qualified Individual with a Disability shall mean an individual with a disability who, with or without reasonable accommodations, can perform the essential functions of the employment position that such individual holds or desires. However, consideration shall be given to the employer's judgment as to what functions of a job are essential, and if an employer has prepared a written description before advertising or interviewing applicants for the job, this description shall be considered evidence of the essential functions of the job; (m) Readily Achievable means a goal can be easily attained and carried out without much difficulty or expense. In determining whether an action is readily achievable, factors to be considered include (1) the nature and cost of the action; (2) the overall financial resources of the facility or facilities involved in the action; the number of persons employed at such facility; the effect on expenses and resources, or the impact otherwise of such action upon the operation of the facility; (3) the overall financial resources of the covered entity with respect to the number of its employees; the number, type and location of its facilities; and (4) the type of operation or operations of the covered entity, including the composition, structure and functions of the work force of such entity; the geographic separateness, administrative or fiscal relationship of the facility or facilities in question to the covered entity. (n) Public Transportation means transportation by air, land and sea that provides the public with general or special service on a regular and continuing basis; (o) Covered Entity means an employer, employment agency, labor organization or jointlabor management committee; and (p) Commerce shall be taken to mean as travel, trade, traffic, commerce, transportation, or communication among the provinces or between any foreign country or any territory or possession and any province. TITLE II RIGHTS AND PRIVILEGES OF DISABLED PERSONS CHAPTER I EMPLOYMENT

Sec. 5. Equal Opportunity for Employment. No disable person shall be denied access to opportunities for suitable employment. A qualified disabled employee shall be subject to the same terms and conditions of employment and the same compensation, privileges, benefits, fringe benefits, incentives or allowances as a qualified able bodied person. chan robles virtual law library Five percent (5%) of all casual emergency and contractual positions in the Departments of Social Welfare and Development; Health; Education, Culture and Sports; and other government agencies, offices or corporations engaged in social development shall be reserved for disabled persons. Sec. 6. Sheltered Employment If suitable employment for disabled persons cannot be found through open employment as provided in the immediately preceding Section, the State shall endeavor to provide it by means of sheltered employment. In the placement of disabled persons in sheltered employment, it shall accord due regard to the individual qualities, vocational goals and inclinations to ensure a good working atmosphere and efficient production.

62 Sec. 7. Apprenticeship. Subject to the provisions of the Labor Code as amended, disabled persons shall be eligible as apprentices or learners: Provided, That their handicap is not as much as to effectively impede the performance of job operations in the particular occupation for which they are hired; Provided, further, That after the lapse of the period of apprenticeship, if found satisfactory in the job performance, they shall be eligible for employment. Sec. 8. Incentives for Employers. (a) To encourage the active participation of the private sector in promoting the welfare of disabled persons and to ensure gainful employment for qualified disabled persons, adequate incentives shall be provided to private entities which employ disabled persons. (b) Private entities that employ disabled persons who meet the required skills or qualifications, either as regular employee, apprentice or learner, shall be entitled to an additional deduction, from their gross income, equivalent to twenty-five percent (25%) of the total amount paid as salaries and wages to disabled persons: Provided, however, That such entities present proof as certified by the Department of Labor and Employment that disabled persons are under their employ: Provided, further, That the disabled employee is accredited with the Department of Labor and Employment and the Department of Health as to his disability, skills and qualifications. (c) Private entities that improve or modify their physical facilities in order to provide reasonable accommodation for disabled persons shall also be entitled to an additional deduction from their net taxable income, equivalent to fifty percent (50%) of the direct costs of the improvements or modifications. This Section, however, does not apply to improvements or modifications of facilities required under Batas Pambansa Bilang 344. Sec. 9. Vocational Rehabilitation. Consistent with the principle of equal opportunity for disabled workers and workers in general, the State shall take appropriate vocational rehabilitation measures that shall serve to develop the skills and potentials of disabled persons and enable them to compete favorably for available productive and remunerative employment opportunities in the labor market. The State shall also take measures to ensure the provision of vocational rehabilitation and livelihood services for disabled persons in the rural areas. In addition, it shall promote cooperation and coordination between the government and nongovernmental organizations and other private entities engaged in vocational rehabilitation activities. The Department of Social Welfare and Development shall design and implement training programs that will provide disabled persons with vocational skills to enable them to engage in livelihood activities or obtain gainful employment. The Department of Labor and Employment shall likewise design and conduct training programs geared towards providing disabled persons with skills for livelihood. Sec. 10. Vocational Guidance and Counseling. The Department of Social and Welfare and Development, shall implement measures providing and evaluating vocational guidance and counseling to enable disabled persons to secure, retain and advance in employment. It shall ensure the availability and training of counselors and other suitably qualified staff responsible for the vocational guidance and counseling of disabled persons. Sec. 11. Implementing Rules and Regulations. The Department of Labor and Employment shall in coordination with the Department of Social Welfare and Development (DSWD) and National Council for the Welfare of the Disabled Persons (NCWDP) shall promulgate the rules and regulations necessary to implement the provisions under this Chapter.

63 CHAPTER II EDUCATION adequate and integrated system of special education for the visually impaired, hearing impaired, mentally retarded persons and other types of exceptional children in all regions of the country. Toward this end, the Department of Education, Culture and Sports shall establish, special education classes in public schools in cities, or municipalities. It shall also establish, where viable, Braille and Record Libraries in provinces, cities or municipalities. The National Government shall allocate funds necessary for the effective implementation of the special education program nationwide. Local government units may likewise appropriate counterpart funds to supplement national funds. Sec. 15. Vocational or Technical and Other Training Programs. The State shall provide disabled persons with training in civics, vocational efficiency, sports and physical fitness, and other skills. The Department of Education, Culture and Sports shall establish in at least one government-owned vocational and technical school in every province a special vocational and technical training program for disabled persons. It shall develop and implement sports and physical fitness programs specifically designed for disabled persons taking into consideration the nature of their handicap. Sec. 16. Non-Formal Education. The State shall develop non-formal education programs intended for the total human development of disabled persons. It shall provide adequate resources for non-formal education programs and projects that cater to the special needs of disabled persons. Sec. 17. State Universities and Colleges. If viable and needed, the State University or State College in each region or province shall be responsible for (a) the development of material appliances and technical aids for disabled persons; (b) the development of training materials for vocational rehabilitation and special education instructions; (c) the research

Sec. 12. Access to Quality Education. The State shall ensure that disabled persons are provided with access to quality education and ample opportunities to develop their skills. It shall take appropriate steps to make such education accessible to all disabled persons. It shall be unlawful for any learning institution to deny a disabled person admission to any course it offers by reason of handicap or disability.chanrobles virtual law library The State shall take into consideration the special requirements of disabled persons in the formulation of educational policies and programs. It shall encourage learning institutions to take into account the special needs of disabled persons with respect to the use of school facilities, class schedules, physical education requirements, and other pertinent consideration.chanrobles virtual law library The State shall also promote the provision by learning institutions, especially higher learning institutions of auxiliary services that will facilitate the learning process for disabled persons. Sec. 13. Assistance to Disabled Students. The State shall provide financial assistance to economically marginalized but deserving disabled students pursuing post secondary or tertiary education. Such assistance may be in the form of scholarship grants, student loan programs, subsidies, and other incentives to qualified disabled students in both public and private schools. At least five percent (5%) of the allocation for the Private Education Student Financial Assistance Program created by virtue of R.A. 6725 shall be set aside for disabled students pursuing vocational or technical and degree courses. Sec. 14. Special Education. The State shall establish, maintain and support complete,

64 on special problems, particularly of the visuallyimpaired, hearing-impaired, speech-impaired, and orthopedically-impaired students, mentally retarded, and multi-handicapped and others, and the elimination of social barriers and discrimination against disabled persons; and (d) inclusion of the Special Education for Disabled (SPED) course in the curriculum. The National Government shall provide these state universities and colleges with necessary special facilities for visually-impaired, hearingimpaired, speech-impaired, and orthopedicallyimpaired students. It shall likewise allocate the necessary funds in support of the above. CHAPTER III HEALTH Sec. 20. Health Services. The State shall protect and promote the right to health of disabled persons and shall adopt an integrated and comprehensive approach to their health development which shall make essential health services available to them at affordable cost. The National Government shall provide an integrated health service for disabled persons which shall include, but not limited to, the following: (a) prevention of disability through immunization, nutrition, environmental protection and preservation, and genetic counseling; and early detection of disability and timely intervention to arrest disabling condition; and (b) medical treatment and rehabilitation. Sec. 18. National Health Program. The Department of Health in coordination with the National Council for the Welfare of Disabled Persons, shall institute a national health program which shall aim to attain the following:chanroblesvirtualawlibrary (a) prevention of disability, whether occurring prenatally or postnatally; (b) recognition and early diagnosis of disability; and (c) early rehabilitation of the disabled. CHAPTER IV AUXILIARY SOCIAL SERVICES The Department of Health shall field medical personnel specializing in the treatment and rehabilitation of disabled persons to provincial hospitals and, when viable, to municipal health centers. It shall also train its field health personnel in the provision of medical attention to disabled persons. It shall further ensure that its field health units have the necessary capabilities to fit prosthetic and orthotic appliances on disabled persons.chanrobles virtual law library

Sec. 19. Rehabilitation Centers. The Department of Health shall establish medical rehabilitation centers in government provincial hospitals, and shall include in its annual appropriation the necessary funds for the operation of such centers. chan robles virtual law library The Department of Health shall formulate and implement a program to enable marginalized disabled persons to avail of free rehabilitation services in government hospitals.

Sec. 21. Auxiliary Social Services. The State shall ensure that marginalized persons are provided with the necessary auxiliary services that will restore their social functioning and participation in community affairs. Towards this end, the Department of Social Welfare and Development shall develop and implement programs on auxiliary social services that respond to the needs of marginalized disabled

65 persons. The components of such a program shall be as follows: (a) assistance in the acquisition of prosthetic devices and medical intervention of specialty services; (b) provision of specialized training activities designed to improve functional limitations of disabled persons related to communication skills; (c) development among disabled persons of a positive self-image through the provision of counseling, orientation and mobility and strengthening daily living capability; (d) provision of family care services geared towards developing the capability of families to respond to the needs of the disabled members of the family; (e) provision of substitute family care services and the facilities therefor for abandoned, neglected, abused and unattached disabled persons who need custodial care; (f) provision of after care and follow-up services for the continued rehabilitation in a community-based setting of disabled persons who were released from residential care or rehabilitation centers; and (g) provision of day care services for disabled children of pre-school age. CHAPTER V TELECOMMUNICATIONS Sec. 23. Telephone Services. All telephone companies shall be encouraged to install special telephone devices or units for the hearingimpaired and ensure that they are commercially available to enable them to communicate through the telephone system.chanrobles virtual law library Sec. 24. Free Postal Charges for the Disabled. Postal charges shall be free on the following: (a) articles and literatures like books and periodicals, orthopedic and other devices, and teaching aids for the use of the disabled sent by mail within the Philippines and abroad; and (b) aids and orthopedic devices for the disabled sent by abroad by mail for repair: Provided, That the aforesaid items are for personal purposes only: Provided, further, That the disabled person is a marginalized disabled as certified by the Social Welfare and Development Office of the local government unit concerned or the Department of Social Welfare and Development.chanrobles virtual law library

CHAPTER VI ACCESSIBILITY

Sec. 22. Broadcast Media. Television stations shall be encouraged to provide a sign language inset or subtitles in at least one (1) newscast program a day and special programs covering events of national significance.chanrobles virtual law library

Sec. 25. Barrier-Free Environment. The State shall ensure the attainment of a barrier-free environment that will enable disabled persons to have access in public and private buildings and establishments and such other places mentioned in Batas Pambansa Bilang 344, otherwise known as the "Accessibility Law".

The national and local governments shall allocate funds for the provision of architectural

66 facilities or structural features for disabled persons in government buildings and facilities. Sec. 26. Mobility. The State shall promote the mobility of disabled persons. Disabled persons shall be allowed to drive motor vehicles, subject to the rules and regulations issued by the Land Transportation Office pertinent to the nature of their disability and the appropriate adaptations or modifications made on such vehicles. Sec. 27. Access to Public Transport Facilities. The Department of Social Welfare and Development shall develop a program to assist marginalized disabled persons gain access in the use of public transport facilities. Such assistance may be in the form of subsidized transportation fare. The said department shall also allocate such funds as may be necessary for the effective implementation of the public transport program for the disabled persons. The "Accessibility Law", as amended, shall be made suppletory to this Act. Sec. 28. Implementing Rules and Regulations. The Department of Transportation and Communications shall formulate the rules and regulations necessary to implement the provisions of this Chapter. contents of the ballot prepared by him. Violation of this provision shall constitute an election offense. Polling places should be made accessible to disabled persons during national or local elections.chanrobles virtual law library Sec. 30. Right to Assemble. Consistent with the provisions of the Constitution, the State shall recognize the right of disabled persons to participate in processions, rallies, parades, demonstrations, public meetings, and assemblages or other forms of mass or concerned action held in public. Sec. 31. Right to Organize. The State recognizes the right of disabled persons to form organizations or associations that promote their welfare and advance or safeguard their interests. The National Government, through its agencies, instrumentalities and subdivisions, shall assist disabled persons in establishing selfhelp organizations by providing them with necessary technical and financial assistance. Concerned government agencies and offices shall establish close linkages with organizations of the disabled persons in order to respond expeditiously to the needs of disabled persons. National line agencies and local government units shall assist disabled persons in setting up specific projects that will be managed like business propositions. To ensure the active participation of disabled persons in the social and economic development of the country, their organizations shall be encouraged to participate in the planning, organization and management of government programs and projects for disabled persons. Organizations of disabled persons shall participate in the identification and preparation of programs that shall serve to develop employment opportunities for the disabled persons.

CHAPTER VII POLITICAL AND CIVIL RIGHTS

Sec. 29. System of Voting. Disabled persons shall be allowed to be assisted by a person of his choice in voting in the national or local elections. The person thus chosen shall prepare the ballot for the disabled voter inside the voting booth. The person assisting shall bind himself in a formal document under oath to fill out the ballot strictly in accordance with the instructions of the voter and not to reveal the

67 TITLE III PROHIBITION ON DISCRIMINATION AGAINST DISABLED PERSONS CHAPTER I DISCRIMINATION ON EMPLOYMENT (e) Favoring a non-disabled employee over a qualified disabled employee with respect to promotion, training opportunities, study and scholarship grants, solely on account of the latter's disability; (f) Re-assigning or transferring a disabled employee to a job or position he cannot perform by reason of his disability; Sec. 32. Discrimination on Employment. No entity, whether public or private, shall discriminate against a qualified disabled person by reason of disability in regard to job application procedures, the hiring, promotion, or discharge of employees, employee compensation, job training, and other terms, conditions, and privileges of employment. The following constitute acts of discrimination: (a) Limiting, segregating or classifying a disabled job applicant in such a manner that adversely affects his work opportunities; (b) Using qualification standards, employment tests or other selection criteria that screen out or tend to screen out a disabled person unless such standards, tests or other selection criteria are shown to be job-related for the position in question and are consistent with business necessity; (c) Utilizing standards, criteria, or methods of administration that: (1) have the effect of discrimination on the basis of disability; or (2) perpetuate the discrimination of others who are subject to common administrative control. (d) Providing less compensation, such as salary, wage or other forms of remuneration and fringe benefits, to a qualified disabled employee, by reason of his disability, than the amount to which a non-disabled person performing the same work is entitled; (g) Dismissing or terminating the services of a disabled employee by reason of his disability unless the employer can prove that he impairs the satisfactory performance of the work involved to the prejudice of the business entity: Provided, however, That the employer first sought to provide reasonable accommodations for disabled persons; (h) Failing to select or administer in the most effective manner employment tests which accurately reflect the skills, aptitude or other factor of the disabled applicant or employee that such tests purports to measure, rather than the impaired sensory, manual or speaking skills of such applicant or employee, if any; and (i) Excluding disabled persons from membership in labor unions or similar organizations.

Sec. 33. Employment Entrance Examination. Upon an offer of employment, a disabled applicant may be subjected to medical examination, on the following occasions: (a) all entering employees are subjected to such an examination regardless of disability; (b) information obtained during the medical condition or history of the applicant is collected and maintained on separate forms and in separate medical files and is treated as a confidential medical record; Provided, however, That:chanroblesvirtualawlibrary (1) supervisors and managers may be informed regarding necessary restrictions on the work or

68 duties of the employees and necessary accommodations;chan robles virtual law library (2) first aid and safety personnel may be informed, when appropriate, if the disability may require emergency treatment; (3) government officials investigating compliance with this Act shall be provided relevant information on request; and (4) the results of such examination are used only in accordance with this Act. CHAPTER II DISCRIMINATION ON TRANSPORTATION (c) a motion picture, theater, concert hall, stadium, or other place of exhibition or entertainment; (d) an auditorium, convention center, lecture hall, or other place of public gathering; (e) a bakery, grocery store, hardware store, shopping center, or other sales or rental establishment; (f) a bank, barber shop, beauty shop, travel service, funeral parlor, gas station, office of a lawyer, pharmacy, insurance office, professional office of a health care provider, hospital or other service establishment; (g) a terminal, depot, or other station used for specified public transportation; (h) a museum, gallery, library or other place of public display or collection; (i) a park, zoo, amusement park, or other place of recreation; (j) a nursery, elementary, secondary, undergraduate, or post-graduate private school, or other place of education; (k) a gymnasium, health spa, bowling alley, golf course; or (l) other place of exercise or recreation.

Sec. 34. Public Transportation. It shall be considered discrimination for the franchisees or operators and personnel of sea, land, and air transportation facilities to charge higher fare or to refuse to convey a passenger, his orthopedic devices, personal effects, and merchandise by reason of his disability.

CHAPTER III DISCRIMINATION ON THE USE OF PUBLIC ACCOMMODATIONS AND SERVICES

Sec. 35. Public Accommodations and Services. For purposes of this Chapter, public accommodations and services shall include the following:chanroblesvirtualawlibrary (a) an inn, hotel, motel, or other place of lodging, except for an establishment located within a building that contains not more than five (5) rooms for rent or hire and that is actually occupied by the proprietor of such establishment as the residence of such proprietor; (b) a restaurant, bar, or other establishment serving food or drink;

Sec. 36. Discrimination on the Use of Public Accommodations. (a) No disabled person shall be discriminated on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages or accommodations of any place of public accommodation by any person who owns, leases, or operates a place of public accommodation. The following constitute acts of discrimination:

69 (1) denying a disabled person, directly or through contractual, licensing, or other arrangement, the opportunity to participate in or benefit from the goods, services, facilities, privileges, advantages, or accommodations of an entity by reason of his disability; (2) affording a disabled person, on the basis of his disability, directly or through contractual, licensing, or other arrangement, with the opportunity to participate in or benefit from a good service, facility, privilege, advantage, or accommodation that is not equal to that afforded to other able-bodied persons; and (3) providing a disabled person, on the basis of his disability, directly or through contractual, licensing, or other arrangement, with a good, service, facility, advantage, privilege, or accommodation that is different or separate form that provided to other able-bodied persons unless such action is necessary to provide the disabled person with a good, service, facility, advantage, privilege, or accommodation, or other opportunity that is as effective as that provided to others; to participate in such programs or activities that are not separate or different. (d) Association It shall be discriminatory to exclude or otherwise deny equal goods, services, facilities, advantages, privileges, accommodations or other opportunities to an individual or entity because of the known disability of an individual with whom the individual or entity is known to have a relationship or association. (e) Prohibitions For purposes of this Section, the following shall be considered as discriminatory: (1) the imposition or application of eligibility criteria that screen out or tend to screen out an individual with a disability or any class or individuals with disabilities from fully and equally enjoying any goods, services, facilities, privileges, advantages, or accommodations, unless such criteria can be shown to be necessary for the provision of the goods, services, facilities, privileges, or accommodations being offered; (2) a failure to make reasonable modifications in policies, practices, or procedures, when such modifications are necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities, unless the entity can demonstrate that making such modifications would fundamentally alter the nature of the goods, facilities, services, privileges, advantages, or accommodations; (3) failure to take such steps as may be necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services, unless the entity can demonstrate that taking such steps would fundamentally alter the nature of the good, service, facility, privilege, advantage or

For purposes of this Section, the term "individuals or class of individuals" refers to the clients or customers of the covered public accommodation that enters into the contractual, licensing or other arrangement.

(b) Integrated Settings Goods, services, facilities, privileges, advantages, and accommodations shall be afforded to individual with a disability in the most integrated setting appropriate to the needs of the individual. (c) Opportunity to Participate Notwithstanding the existence of separate or different programs or activities provided in accordance with this Section, an individual with a disability shall not be denied the opportunity

70 accommodation being offered or would result in undue burden; (4) a failure to remove architectural barriers, and communication barriers that are structural in nature, in existing facilities, where such removal is readily achievable; and (5) where an entity can demonstrate that the removal of a barrier under clause (4) is not readily achievable, a failure to make such goods, services, facilities, privileges, advantages, or accommodations available through alternative methods if such methods are readily achievable.chan robles virtual law library agencies and local government units may enter into joint ventures with organizations or associations of disabled persons to explore livelihood opportunities and other undertakings that shall enhance the health, physical fitness and the economic and social well-being of disabled persons.chanrobles virtual law library Sec. 41. Support From Nongovernment Organizations. Nongovernment organizations or private volunteer organizations dedicated to the purpose of promoting and enhancing the welfare of disabled persons shall, as they, are hereby encouraged, become partners of the Government in the implementation of vocational rehabilitation measures and other related programs and projects. Accordingly, their participation in the implementation of said measures, programs and projects is to be extended all possible support by the Government. The Government shall sponsor a volunteer service program which shall harness the involvement of private individuals in the provision of assistance to disabled persons. Sec. 42. Tax Incentives. (a) Any donation, bequest, subsidy or financial aid which may be made to government agencies engaged in the rehabilitation of disabled persons and organizations of disabled persons shall be exempt from the donor's tax subject to the provisions of Section 94 of the National Internal Revenue Code (NIRC), as amended and shall be allowed as deductions from the donor's gross income for purposes of computing the taxable income subject to the provisions of Section 29 (h) of the Code. (b) Donations from foreign countries shall be exempt from taxes and duties on importation subject to the provisions of Section 105 of the Tariff and Customs Code of the Philippines, as amended, Section 103 of the NIRC, as amended and other relevant laws and international agreements.

Sec. 37. Use of Government Recreational or Sports Centers Free of Charge. Recreational or sports centers owned or operated by the Government shall be used, free of charge, by marginalized disabled persons during their social, sports or recreational activities.

Sec. 38. Implementing Rules and Regulations. The Department of Public Works and Highways shall formulate the rules and regulations necessary to implement the provisions of this Chapter.chanrobles virtual law library

TITLE IV FINAL PROVISIONS

Sec. 39. Housing Program. The National Government shall take into consideration in its national shelter program the special housing requirements of disabled persons. Sec. 40. Role of National Agencies and Local Government Units. Local government units shall promote the establishment of organizations of disabled persons in their respective territorial jurisdictions. National

71 (c) Local manufacturing or technical aids and appliances used by disabled persons shall be considered as a preferred area of investment subject to the provisions of Executive Order No. 226 otherwise known as the "Omnibus Investments Code of 1987" and, as such, shall enjoy the rights, privileges and incentives as provided in said Code such as, but not limited, to the following: (1) repatriation of investments; (2) remittance of earnings; (3) remittance contracts; of payments on foreign (a) In case of abolition, the department or agency established to replace the abolished department or agency shall take-over the functions under this Act of the abolished department or agency. (b) In case the department or agency tasked with the enforcement or formulation of rules, regulations and guidelines for implementation of this Act is merged with another department or agency, the former shall continue the functions under this Act of the merged department or agency.chanrobles virtual law library (c) In case of modification, the department or agency modified shall continue the functions under this Act of the department or agency that has undergone the modification. (17) exemption from wharfage dues and any export tax, duty, impost and fee.

Sec. 43. Continuity Clause. Should any department or agency tasked with the enforcement or formulation of rules and regulations and guidelines for implementation of any provision of this Act is abolished, merged with another department or agency or modified, such shall not affect the enforcement or formulation of rules, regulations and guidelines for implementation of this Act to the effect that

(4) freedom from expropriations; (5) freedom from requisition of investment; (6) income tax holiday; (7) additional deduction for labor expense; (8) tax and duty exemption on imported capital equipment; (9) tax credit on domestic capital equipment; (10) exemption from contractor's tax; (11) simplification of customs procedures; (12) unrestricted use of consigned equipment; (13) employment of foreign nationals; (14) tax credit for taxes and duties on raw materials; (15) access to bonded manufacturing/traded warehouse system; (16) exemption from taxes and duties on imported spare parts; and

Sec. 44. Enforcement by the Secretary of Justice. (a) Denial of Right (1) Duty to Investigate the Secretary of Justice shall investigate alleged violations of this Act, and shall undertake periodic reviews of compliance of covered entities under this Act. (b) Potential Violations If the Secretary of Justice has reasonable cause to believe that

72 (1) any person or group of persons is engaged in a pattern or practice of discrimination under this Act; or (2) any person or group or persons has been discriminated against under this Act and such discrimination raises an issue of general public importance, the Secretary of Justice may commence a legal action in any appropriate court.chanrobles virtual law library Sec. 45. Authority of Court. The court may grant any equitable relief that such court considers to be appropriate, including, to the extent required by this Act: (a) granting temporary, permanent relief; preliminary or

(b) Any person who abuses the privileges granted herein shall be punished with imprisonment of not less than six (6) months or a fine of not less than Five thousand pesos (P5,000.00), but not more than Fifty thousand pesos (P50,000.00), or both, at the discretion of the court.

(c) If the violator is a corporation, organization or any similar entity, the officials thereof directly involved shall be liable therefor. (d) If the violator is an alien or a foreigner, he shall be deported immediately after service of sentence without further deportation proceedings. Sec. 47. Appropriations. The amount necessary to carry out the provisions of this Act shall be included in the General Appropriations Act of the year following its enactment into law and thereafter. Sec. 48. Separability Clause. Should any provisions of this Act be found unconstitutional by a court of law, such provisions shall be severed from the remainder of the Act, and such action shall not affect the enforceability of the remaining provisions of this Act. Sec. 49. Repealing Clause. All laws, presidential decrees, executive orders and rules and regulations inconsistent with the provisions of this Act are hereby repealed or modified accordingly. Sec. 50. Effectivity. This Act shall take effect fifteen (15) days after its publication in any two (2) newspapers of general circulation.

(b) providing an auxiliary aid or service, modification of policy, practice or procedure, or alternative method; and (c) making facilities readily accessible to and usable by individuals with disabilities.

Sec. 46. Penal Clause. (a) Any person who violates any provision of this Act shall suffer the following penalties:chanroblesvirtualawlibrary (1) for the first violation, a fine of not less than Fifty thousand pesos (P50,000.00) but not exceeding One hundred thousand pesos (P100,000.00) or imprisonment of not less than six (6) months but not more than two (2) years, or both at the discretion of the court; and (2) for any subsequent violation, a fine of not less than One hundred thousand pesos (P100,000.00) but not exceeding Two hundred thousand pesos (P200,000.00) or imprisonment for not less than two (2) years but not more than six (6) years, or both at the discretion of the court.chanrobles virtual law library

73 ANNEX D REPUBLIC ACT NO. 9442 April 30, 2007 AN ACT AMENDING REPUBLIC ACT NO. 7277, OTHERWISE KNOWN AS THE "MAGNA CARTA FOR DISABLED PERSONS, AND FOR OTHER PURPOSES" Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled: SECTION 1. A new chapter, to be denominated as "Chapter 8. Other Privileges and Incentives" is hereby added to Title Two of Republic Act No. 7277, otherwise known as the "Magna Carta for Disabled Persons", with new Sections 32 and 33, to read as follows: "CHAPTER 8. Other Privileges and Incentives "SEC. 32. Persons with disability shall be entitled to the following: (a) At least twenty percent (20%) discount from all establishments relative to the utilization of all services in hotels and similar lodging establishments; restaurants and recreation centers for the exclusive use or enjoyment of persons with disability; (b) A minimum of twenty percent (20%) discount on admission fees charged by the theaters, cinema houses, concert halls, circuses, carnivals and other similar places of culture, leisure and amusement for the exclusive use or enjoyment of persons with disability; (c) At least twenty percent (20%) discount for the purchase of medicines in all drugstores for the exclusive use or enjoyment of persons with disability; (d) At least twenty percent (20%) discount on medical and dental services including diagnostic and laboratory fees such as, but not limited to x-rays, computerized tomography scans and blood tests, in all government facilities, subject to guidelines to be issued by the Department of Health (DOH), in coordination with the Philippine Health Insurance Corporation (PHILHEALTH); (e) At least twenty percent (20%) discount on medical and dental services including diagnostic and laboratory fees, and professional fees of attending doctors in all private hospitals and medical facilities, in accordance with the rules and regulations to be issued by the DOH, in coordination with the PHILHEALTH; (f) At least twenty percent (20%) discount on fare for domestic air and sea travel for the exclusive use or enjoyment of persons with disability; (g) At least twenty percent (20%) discount in public railways, skyways and bus fare for the exclusive use and enjoyment of persons with disability; (h) Educational assistance to persons with disability, for them to pursue primary, secondary, tertiary, post tertiary, as well as vocational or technical education, In both public and private schools, through the provision of scholarships, grants, financial aids,

74 subsidies and other incentives to qualified persons with disability, including support for books, learning materials, and uniform allowance to the extent feasible: provided, that persons with disability shall meet minimum admission requirements; (i) To the extent practicable and feasible, the continuance of the same benefits and privileges given by the Government Service Insurance System (GSIS), Social Security System (SSS), and PAG-IBIG, as the case may be, as are enjoyed by those in actual service; (j) To the extent possible, the government may grant special discounts in special programs for persons with disability on purchase of basic commodities, subject to guidelines to be issued for the purpose by the Department of Trade and Industry (DTI) and the Department of Agriculture (DA); and (k) Provision of express lanes for persons with disability in all commercial and government establishments; in the absence thereof, priority shall be given to them. The abovementioned privileges are available only to persons with disability who are Filipino citizens upon submission of any of the following as proof of his/her entitlement thereto: (I) An identification card issued by the city or municipal mayor the barangay captain of the place where the person with disability resides; (II) The passport of the persons with disability concerned; or (III) Transportation discount fare Identification Card (ID) issued by the National Council for the Welfare of Disabled Persons (NCWDP). The privileges may not be claimed if the persons with disability claims a higher discount as may be granted by the commercial establishment and/or under other existing laws or in combination with other discount program/s. The establishments may claim the discounts granted in sub-sections (a), (b), (c), (e), (f) and (g) as tax deductions based on the net cost of the goods sold or services rendered: provided, however, That the cost of the discount shall be allowed as deduction from gross income for the same taxable year that the discount is granted: provided, further, That the total amount of the claimed tax deduction net of valueadded tax if applicable, shall be Included in their gross sales receipts for tax purposes and shall be subject to proper documentation and to the provisions of the National Internal Revenue Code (NIRC), as amended." "SEC. 33. Incentives. - Those caring for and living with a person with disability shall be granted the following incentives; (a) persons with disability shall be treated as dependents under Section 35(A) of the National Internal Revenue Code, as amended and as such, individual taxpayers caring for them shall be accorded the privileges granted by the code Insofar as having dependents under the same section are concerned; and

75 (b) Individuals or nongovernmental institutions establishing homes, residential communities or retirement villages solely to suit the needs and requirements of persons with disability shall be accorded the following: (i) Realty tax holiday for the first five years of operation; and (ii) Priority in the building and/or maintenance of provincial or municipal roads leading to the aforesaid home residential community or retirement village." SEC. 2. Republic Act No. 7277 is hereby amended by inserting a new title, chapter and section after Section 38 to be denominated as Title 4, chapters 1 and 2 and Sections 39, 40, 41 and 42 to read as follows: "Title Four Prohibitions on Verbal, Non-verbal Ridicule and VilificationAgainst Persons with Disability "CHAPTER 1. Deliverance from Public Ridicule. "SEC. 39. Public Ridicule . - For purposes of this Chapter, public ridicule shall be defined as an act of making fun or contemptuous initiating or making mockery of persons with disability whether in writing or in words, or in action due to their impairment/s. "SEC. 40. No individual, group or community shall execute any of these acts of ridicule against persons with disability in any time and place which could intimidate or result in loss of selfesteem of the latter. "CHAPTER 2. Deliverance from Vilification "SEC. 41. Vilification. - For purposes of this chapter, vilification shall be defined as: (a) the utterance of slanderous and abusive statements against a person with disability; and/or (b) An activity in public which incites hatred towards serious contempt for, or severe ridicule of persons with disability." "SEC. 42. Any individual, group or community is hereby prohibited from vilifying any person with disability which could result into loss of selfesteem of the latter." SEC. 3. Section 46 of Republic Act No. 7277 is hereby amended to read as follows: "SEC. 46. Penal Clause. (a) Any person who violates any provision of this Act shall suffer the following penalties: (1) For the first violation, a fine of not less than Fifty thousand pesos (P50,000.00) but not exceeding One hundred thousand pesos (P100,000.00) or imprisonment of not less than six months but not more than two years, or both at the discretion of the court; and (2) For any subsequent violation, a fine of not less than One hundred thousand pesos (P100,000.00) but not exceeding Two hundred thousand pesos (P200,000.00)

76 or imprisonment for not less than two years but not more than six years, or both at the discretion of the court. (b) Any person who abuses the privileges granted herein shall be punished with imprisonment of not less than six months or a fine of not less than Five thousand pesos (P5,000.00), but not more than Fifty thousand pesos (P50,000.00), or both, at the discretion of the court. (c) If the violator is a corporation organization or any similar entity, the officials thereof directly involved shall be liable therefore. (d) If the violator is an alien or a foreigner, he shall be deported immediately after service of sentence without further deportation proceedings. Upon filing of an appropriate complaint, and after notice and hearing the proper authorities may also cause the cancellation or revocation of the business permit, permit to operate, franchise and other similar privileges granted to any business entity that fails to abide by the provisions of this Act." Sec. 4. The title of Republic Act No. 7277 is hereby amended to read as the "Magna Carta for Persons with Disability", and all references on the said law to "disabled persons" shall likewise be amended to read as "persons with disability". SEC. 5. The Department of Social Welfare and Development, the National Council for the Welfare of Disabled Persons, and the Bureau of Internal Revenue, in consultation with the concerned Senate and House committees and other agencies, organizations, establishments shall formulate an agencies, organizations, establishments shall formulate an implementing rules and regulations pertinent to the provisions of this Act within six months after the effectivity of this Act. SEC. 6. This Act shall take effect fifteen (15) days after its publication in any two newspapers of general circulation.