Professional Documents
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INTRODUCTION
state of well-being in which every individual realizes his or her own potential, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to make
a contribution to her or his community. Mental illness refers to a wide range of mental
health conditions — disorders that affect your mood, thinking and behaviour (Mayo
Clinic, 2015).
The World Health Organization (2017) estimated that between 35 percent and 50
percent of people with severe mental health problems in developed countries, and 76 – 85
sheet for 2017, suicide is the second leading cause of death among 15 to 29-year-olds,
and 78 percent of global suicides occur in low and middle-income countries. WHO
(2013) mentioned that the 66th World Health Assembly adopted the WHO’s
5.8 for male, 1.9 for females, and 3.8 for both sexes. The rate is based from the number of
cases affected per sample size of 100,000 people. The Department of Health (2007)
issued an administrative order on mental health program. The objective of this mental
health program is to provide general guidelines for stakeholders in the government and
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 1
private sector on the development and implementation of the National Policy on Mental
Health through plans and programs, in order to protect the rights and freedom of persons
with mental disease, thereby reducing the burden of mental and neurological disorders in
the country.
As a lone psychiatrist in the Cotabato City, Dr. Apostol (2017) claimed that she
encounters patients suffering from mental health problems every day. She further said
that the mental health illnesses are alarming in Cotabato City due to the increase of
patients that she encounters every day. An interview done to one of the nurses in Office
of City Health in Cotabato City, accordingly they had a training last 2016 about Mental
Health Gap Action Programme (mhGAP), and it was started last 2017, however it was
this program was initiated by the Department of Health (DOH) which has the primary goal
of quality mental health care. But the question is, is the program properly disseminated to
the public? Are they aware of its existence? Are they availing on these service? Grounded
on these premises, merit the need to conduct the study. It will shed light to all these queries
This chapter contains relevant literature and concepts providing insights and
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 2
Mental Health
his or her own potential, can cope with the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution to her or his community (WHO, 2014).
contained in its constitution: "Health is a state of complete physical, mental and social
Therefore, WHO (2016) agreed that mental health and well-being are
fundamental to our collective and individual ability as humans to think, emote, interact
with each other, earn a living and enjoy life. Hence, on this basis, the promotion,
and emotional wellbeing - it is all about how we think, feel, and behave. The term 'mental
that mental health can affect daily life, relationships, and even physical health. Mental
health also includes a person's ability to enjoy life - to attain a balance between life
Mayo Clinic (2015) discussed that mental illness refers to a wide range of mental
health conditions — disorders that affect the mood, thinking and behavior. Examples of
mental illness include depression, anxiety disorders, schizophrenia, eating disorders and
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 3
addictive behaviors. Many people have mental health concerns from time to time. But a
mental health concern becomes a mental illness when ongoing signs and symptoms cause
frequent stress and affect your ability to function (Mayo Clinic, 2015).
According to Center for Disease Control and Prevention (CDC), mental illnesses
behavior, as recognized by the Diagnostic and Statistical Manual, 4th edition, of the
American Psychiatric Association (DSM-IV). Mood disorders are among the most
pervasive of all mental disorders and include major depression, in which the individual
commonly reports feeling, for a time period of two weeks or more, sad or blue,
increased or decreased appetite since the depressive episode ensued (CDC, 2016).
WHO (2014) stated in its report “Health for the World’s Adolescents"
that depression is the predominant cause of illness and disability for both boys and girls
aged 10 to 19 years old. Further, Mayo Clinic (2016) pointed out that women are nearly
twice as likely as men to be diagnosed with depression. Some mood changes and
depressed feelings occur with normal hormonal changes. But hormonal changes alone do
not cause depression. Other biological factors, inherited traits, and personal life
one or more symptoms of depression. This startling statistic shows that hits depression
faced by nearly half of all college students could lead to more complex mental health
issues without the proper counseling to help them identify the source of their depression.
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 4
According to Goldberg (2012), the causes of mental illnesses include heredity or
genetics. He also mentioned biology as another reason since some mental illnesses have
mental illnesses may be triggered by another factor, the psychological trauma suffered as
morbidity associated with mental illness has received substantially more attention than
the gender specific determinants and mechanisms that promote and protect mental health
and foster resilience to stress and adversity. WHO further added that gender determines
the differential power and control men and women have over the socioeconomic
determinants of their mental health and lives, their social position, status and treatment in
society and their susceptibility and exposure to specific mental health risks (WHO, 2014).
In most parts of the world, unfortunately, mental health and mental disorders are not
regarded with anything like the same importance as physical health. Indeed, they have
mental ill health are widespread. Despite the existence of effective treatments for mental
disorders, there is a belief that they are untreatable or mentally-ill people are
dysfunctional to the community. This stigma can lead to abuse, rejection and isolation
and exclude people from health care or support. In the Philippines, Francisco (2017)
addressed the concern regarding mental health issue which still remains a misunderstood
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 5
topic for some Filipinos. Ferrolino (2017) added that people with mental illness are often
discriminated. Likewise, this stigma in the local setting only shows that a lot of Filipinos
lack proper information about mental health. Thus, the social distance between the public
and mentally ill people is getting farther. He claimed that in the Philippines, access to
mental health facilities and institutions remains uneven throughout the country. Within
the health system, people are too often treated in institutions which resemble human
warehouses rather than places of healing. In addition, they claimed that human rights
violations of people with mental and psychosocial disability are routinely reported in
most countries. These include physical restraint, seclusion and denial of basic needs and
privacy. Few countries have a legal framework that adequately protects the rights of
According to Cabrido (2017), with the sudden increase in suicide rates in South
Cotabato, the Integrated Provincial Health Office capacitates its health workers to create
strategies, benefitting those suffering from mental illness. The Mental Health Program
Coordinator, Jade Javellana said a private partner collaborates with the Lake Sebu
Municipal Health Officer Dr. Jospehine Bayquin to capacitate health workers and build
up efforts for potential medical actions. South Cotabato recorded 21 incidents of suicide,
Hopeline, a 24/7 suicide prevention hotline was launched last 2016. Online,
concerned citizens pass around hotlines and resources to refer psychiatrists and mental
health resources to each other both an indication of how much of a problem it is in the
Philippines, and how Filipinos are now starting to openly seek help (Francisco, 2017).
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 6
Mental Health Program
program. The objective of this mental health program is to provide general guidelines for
implementation of the National Policy on Mental Health through plans and programs, in
order to protect the rights and freedom of persons with mental disease, thereby reducing
The program which the DOH has implemented has general guidelines which
composes of 3 areas. First is the National Objectives for Health and F1 encompasses
mental health and applies to the promotion of mental health. The goals of the mental
health program as follow: reduce mental health prevalence; reduce mortality from suicide
and intentional harm, and reduce the risk for mental disorder. This area also comprises
the service delivery which summarizes the enhancement of the mental health services and
the program in school and workplace. In terms of financing, it primarily focused on the
benefit package and funding for resources. As for the regulation, there will a coordination
with the Bureau of Health Facilities Services. For the governance, it tackles more on their
goals on the sustainability and enhancement of the program. Next area is the National
Mental Health Program focuses on four sub-programs. First is the Wellness of Daily
Living which is done by promoting the healthy lifestyle giving emphasis on coping with
stress and other psychological issues. Second is the Extreme Life Experience that focuses
on addressing the mental health needs of the people who experience catastrophes. Third
is the Substance Abuse and Other Forms of Addiction. Fourth is the mental disorder
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 7
which focuses on the promotion of mental health and prevention of mental illness (DOH,
2007).
administrative order (AO) on the implementation of the agency’s mental health program.
framework of how the mental health program will be implemented at all levels of the
health system, like health rural unit, the barangay health station, and even in the
community.
In May 2013, the WHO’s Comprehensive Mental Health Action Plan 2013-2020
was initiated. The Action Plan recognizes the essential role of mental health in achieving
health for all people (WHO, 2015). It indicates, as one of its principles that mental health
strategies and interventions for treatment, prevention and promotion need to be based on
scientific evidence and/or best practice, taking cultural considerations into account. As a
consequence, the WHO launched Mental Health Gap Action Programme (mhGAP) in
2008 with the primary goal of increasing the services for mental, neurological and
substance use (MNS) disorders for countries with low- and middle- income (WHO,
2015). Its implementation is based on mhGAP products, including the evidence based
guideline for MNS disorders, Mental Health Gap Action Programme Intervention Guide
These are the objectives of mhGAP guideline: (1) to provide latest WHO guidance to
facilitate delivery of interventions; (2) to assist with the increasing of care for MNS
disorders identified with high priority in Low- and Middle-Income Countries (LAMICs);
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 8
(3) to provide latest WHO guidance that will ease the implementation of WHO
According to WHO (2010), the mhGAP-IG is a model guide wherein the users
may select a subset of the priority conditions or interventions to adapt and implement,
and behavioural disorders in children and adolescents, dementia, alcohol use disorders,
drug use disorders, self-harm / suicide and other significant emotional or medically
unexplained complaints. The mhGAP-IG contains modules that serve as toll for clinical
presentations of the suspected condition, from which there are a series of clinical
assessment questions one should move down answering yes or no, which directs the user
to move on for further instructions to reach a final clinical assessment. Next, the
manage the specific conditions that have been assessed. Lastly, the Follow-up section
provides detailed information on how to continue the clinical relationship and detailed
collaborated between the World Health Organization, the Department of Health, and
local government units to strengthen the mental health services in local communities in
the Philippines. Furthermore, over a few years, non-specialized health workers in all 18
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 9
regions in the country have participated in the training, empowering them to make
decisions and manage mental health patients close to where it is most needed.
effectiveness. Itulid (2017) discussed in his article that the Chairman of the Department
of Psychiatry and Behavioral Medicine of the Philippine General Hospital, Dr. Anselmo
Tronco presented the six principles of an effective mental health program: (1) Address
stigma for it has negative effects to the patients as it deteriorates self-esteem, disrupts
family relationships and limits patient’s function in his community. (2) Create
relationship with the stakeholders for mental health since they have important roles in
can share difficulties, identify common reactions, validate good stories of coping, and
facilitate plans for action. (4) Involve the family in the program since services such as
family education and training, support, and counseling on mental health should be
available and accessible to them. (5) Harness Community Resilience on Mental Health,
and it requires human resource that can effectively mobilize community services and
infrastructure for mental health. Lastly, (6) Grab opportunities from crisis and disasters in
order to highlight emotional and social needs since disasters creates a context of shared
and Henderson (2016) enlisted the known effectiveness of the program which include: (1)
integrating mental health promotion strategies (e.g. stress reduction and awareness of
alcohol and drug misuse) into occupational health and safety policies; (2) universal and
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 10
targeted socio‐emotional learning school programs for vulnerable children; (3) mental
health awareness school programs; (4) methods for the identification and case detection
educational programs; (6) parenting programs for children aged 2‐14 years; (7) gender
equity and/or economic empowerment programs for vulnerable groups; and (8) training
Secondly is the availability of the mental health program. In the study of Jagodic,
Rokavec, Aguis, and Pregelj (2013), they obtained a data from the Institute of Public
Health of the Republic of Slovenia that mental health service availability data including
services, and the availability of primary care doctors. However, Sahu (2014) stated that
there is a huge gap between mental health service availability and needs of people in the
community. Likewise, in the study of Thornicroft, et al. (2016), they enumerated some
health system as follow: (1) lack of a feasible mental health program or non-
implementation of mental health program; (2) Need to include non-medical services; (3)
health care crisis because the country does not have enough psychologists or funding to
support mentally disabled citizens, and stigma is still rampant in the country.
Additionally, studies suggest over half of South Africans who live with mental illness
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 11
consult a faith or traditional healer as a form of counseling, despite healers' lack of
Lastly is the accessibility of the mental health program. Walker, Cummings, and
Druss (2015) concluded in their study that the challenges experienced in mental health
care include structural barriers, such as cost and uninsurance, as well as attitudinal
barriers, such as mental health stigma and misconceptions about the effectiveness of
treatments. They added that changing attitudes toward mental health care will need to
target multiple sectors of the population and involve a variety of approaches, such as
public education and awareness of mental disorders and effective treatments, addressing
social norms and cultural factors, and empowering people with mental disorders to
overcome barriers to treatment. On the study of Knaak, Mantler, and Szeto (2017),
mental illness-related stigma, including that which exists in the healthcare system and
among healthcare providers, creates serious barriers to access and quality care. They
identified the key ingredients for effective stigma reduction in healthcare contexts. These
include teaching skills that help healthcare providers know “what to say” and “what to
do,” ensuring program facilitators are modelling person-first behaviours and making
ample use of social contact. Other ingredients namely providing interventions that
include myth busting or a transformative learning focus to target unconscious biases and
correct false beliefs that may be negatively impacting care. The second is
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 12
Theoretical Framework
Relations Theory”.
interactions between an individual who is sick or in need of health services, and a nurse
especially educated to recognize, respond to the need for help”. The theory explains the
purpose of nursing is to help others identify their felt difficulties and that nurses should
apply principles of human relations to the problems that arise at all levels of experience.
Likewise, Peplau saw a major goal of nursing as helping patients reduce their anxiety and
convert it to constructive action. This theory has significant connection to this study
because there are people who are suffering or experiencing mental health illness. They
are fighting in an invisible war wherein the people around them are not aware of. They
One of the roles of nurses is being advocate. Given the theory of Peplau, upon the
Cotabato City, this will describe the status and extent of the program.
Being member of health care team, nurses are constantly exposed to people
experiencing problem –listening attentively, showing genuine concern, and respecting the
preference of how these people express themselves. People are secretly fighting for
invisible wars. They are overthinking problems which can greatly affect their mental
health. This theory points out that as healthcare workers, nurses have to provide
appropriate and essential plans, and interventions which are based on their unique
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 13
experiences. Nurses should never judge them by their stories. Instead, help them as much
as we could.
a. effectiveness;
b. availability; and
c. accessibility?
The useful and relevant information that will be acquired from the study will
Barangay. They will see the benefits and advantages of mental health program in
implementation of mental health program, thus this will gain knowledge to the DOH to
Nursing Education. The academe will gain additional knowledge and updates on
the extent and status of mental health program in the community especially that the
Nursing Practice. The nurses will gain additional knowledge and updates on the
extent and status of mental health program in the community especially that the barangay
is using mhGAP.
Nursing Research. The findings of the study shall serve as baseline data
health programs in the selected barangays in Cotabato City. In the preliminary census, all
barangays in Cotabato City shall be included in the study which involves two (2)
participants: one (1) barangay official and one (1) barangay healthcare worker. On the
actual data gathering, the five (5) mother barangays of Cotabato City will be involved
namely Mother Bagua, Mother Poblacion, Mother Rosary Heights, Mother Tamontaka,
and Mother Kalanganan. The participants shall be fifteen (15): two (2) barangay
healthcare workers, three (3) barangay officials, and ten (10) residents of the barangay.
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 15
The study will be limited to the mental health program which the Department of
Health (DOH) implemented in the barangay, and the assessment of the participants in the
health program, and recommendations for its enhancement will also be considered in the
study.
Definition of Terms
The following terms are defined as they are used in the study:
Accessibility. This refers to the extent of the mental health program of which
Assessment. This refers to the appraisal or analysis of the mental health program
accessibility.
Availability. This refers to the extent of mental health program in terms of the
availability of services in the barangay wherein there is the presence of the staff to render
the services.
Challenges. This refers to the obstacles or struggles that the participants observed
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 16
Effectiveness. This refers to the extent of the mental health program in which the
intervention, regimen, and service done have beneficial effect to the barangay and its
people.
Mental Health Program. This refers to the program that the DOH initiated
which has a primary goal of Quality Mental Health Care by addressing the needs of the
Mental Health. This refers to the wellness of mental state of the barangay
officials, barangay health workers and residents of selected barangay in Cotabato City,
wherein they are free from alterations of mental status for they have the capability to
anxiety disorder, addictive behaviors, mood disorders and others regardless of the
severity.
Assessment of the Implementation of Mental Health Programs in the Selected Barangays in Cotabato City 17