A visit to country's prime mental health institution, the National Center for Mental Health (NCMH) in Mandaluyong City. Essentially, the visit was intended to make us, students become familiar with NCMH set up, the delivery of health services provided and the condition of the patients who are confined in groups.
Background of NCMH
NCMH was established through Public Works Act 3258. It was formally opened on December 17, 1928 and was originally called the INSULAR PSYCHOPATIC HOSPITAL. It was later called the National Mental Hospital. On November 12, 1986, it was renamed NATIONAL CENTER FOR MENTAL HEALTH (NCMH) through Memorandum Circular No. 48 issued by the Office of the President. ¹
Today, NCMH has an authorized bed capacity of 4,200 and a daily average of around 3,000 in-patients. It has a total of 35 Pavilions and 52 Wards sprawling on a 46.7 hectare compound in Mauway, Mandaluyong City. The NCMH is a special training and research hospital mandated to render a comprehensive (preventive, promotive, curative and rehabilitative) range of quality mental health services nationwide. It also gives and creates venues for quality mental health education, training and research geared towards hospital and community mental health services nationwide.¹
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In 2001, the World Health Organization provided a new understanding of mental disorders that offers new hope to the mentally ill and their families in all countries and all societies. It entails a comprehensive review of the contributing factors of the current and future disorders. It concludes with recommendations that can be adapted by every country according to its needs and its resources.
Due to lack of studies here in the Philippines with regards to Mental Health, it is difficult to update the current situation in the delivery of services in the mental institutions especially in the government mental health facilitates. During our visit in the National Center for Mental Health, we are able to gather some information in terms of delivery of services, the process of admitting the mentally-ill patients and on how they generate funds to suffice the needs and provide services inside the institution.
Our country at present is in the early stage of developing a mental health system.² Due to limited legislative authority and no mental health law has been established, the allotted budget for mental health is only 0.02% of its total health budget, the latter being 3% of its GDP - this is below the World Health Organization's (WHO) recommendations for developing countries. Mental health policy, programs and legislation are necessary steps for significant and sustained action. These should be based on current knowledge and human rights considerations. Most countries need to increase their budgets for mental health programs from existing low levels.âµ
During the early part of our visit, Dr. Jose Loveria (Head of Pavilion 10-Chronic Improved Patients) accommodated us to gather some facts about the National Center for Mental Health. In NCMH, given the limited budget that they have, there are services inside the institution helping the institution to gain profit to allot for services and to sustain the existing these income generating strategies. Some of them are soap making, different accessories such as wallets made from zippers etc. These materials are located at Pavilion 14 and being sold by the nursing students and interns. A small hospital within the hospital, the Infirmary is equipped with X-ray and an ultrasound facility which is Philhealth accredited with 100 beds and classified it as medical center.¹ It caters not only the patients inside but also patients coming from other referrals outside NCMH.
The World Health Organization (WHO) in 2007 published a report on its assessment on the mental health system in the Philippines. In partnership with the Department of Health (DoH), WHO gathered baseline information using the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), for the purpose of enabling the country to develop mental health plans.
WHO-AIMS findings reported that the NCMH has all 400 beds for forensic inpatients committed by court order.â´ During our visit, in Pavilion 14 which is intended for patient with court cases, the patients there were overcrowding due to lack of beds. There is a huge number of patients with court cases inside. According to Dr. Edison Galindez (only forensic psychiatrist in the country), they have several tasks to do due to lack of resident doctors trained in forensic psychiatry. They have this high number of patient per doctor ratio. Based on the WHO-AIMS report, there are 0.41 psychiatrists in the public sector per 100,000 population, and a ratio of 3.21 psychiatrists per 100,000 population working in mental health facilities based in urban areas. The distribution of human resources for mental health is likewise lopsided, favoring the urban centers or Metro Manila in particular.
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Still, in our country has an inadequate number of mental health staff providing care; this has slowed its progress in carrying out its de-institutionalization policy. We only have minimal data on refresher training for mental health staff, as well as data on the number of organizations, associations or nongovernmental organizations (NGOs) involved in mental health policies, legislation or advocacy. Having data in these areas would help service planning and resource allocation. ³
Dr. Bernardo Conde noted in his article in the International Review of Psychiatry that the government's attempts to integrate mental health in general health services have failed. Large hospitals must cope with thousands of patients while community-based programs remained undeveloped. â´
Acute psychiatric wards in regional medical centers and provincial hospitals have never been set up. Government general hospitals have no acute psychiatric units because of lack of budget. The access to mental health facilities nationwide is therefore very much uneven across the country, especially as many of the facilities remain located in the National Capital Region.â´
Since the National Center for Mental Health and some private institutions with psychiatric wards are mostly located in NCR, in terms of mental health promotion, it is done primarily in these tertiary institutions and not reaching the grass-roots level according to Dr. Beverly Azucena (OIC, Chief Medical Staff-Hospital Service). There are also initiatives being done by the other sectors of the government in promoting mental health according to her. On the other hand, there are coordinating bodies that oversee public education and awareness campaigns on mental health and mental disorders. Sectors should be involved in improving the mental health of communities.âµ Government agencies, NGOs, professional associations, and private foundations have promoted public education and awareness campaigns, in their own capacity, in the last five years according to WHO-AIMS.
In terms of research, according to World Health Report of WHO in 2001, more research into biological and psychosocial aspects of mental health is needed in order to increase the understanding of mental disorders and to develop more effective interventions. In NCMH, according to Dr. Azucena, there are on-going research studies in the institution, but it is focused more on the clinical aspect of mental health. Research in our country is focused on non-epidemiological clinical/questionnaires assessments of mental disorders and services research. The research consists of monographs, theses, and publications in non-indexed journals. There are mental health research publications in indexed journals (e.g., Philippine Journal of Psychiatry is indexed in the Western Pacific Regional Index Medicus).â´
Challenges encountered by the Mental Health Care Providers
At present, we are in the stage of developing the status of mental health based on the recommendations of World Health Organization. The major resource in the Philippines is its highly literate population who also values education and professional development. Academic institutions and training centers have in the last 4 decades developed good programs to educate and develop the mental health human resources, specifically psychiatrists, psychologists, social workers, nurses and allied mental health professionals.âµ It contributed a lot in terms of the understanding on the management of mental health disorders and in the development of mental health programs in our country. I am agree with what WHO-AIMS mentioned in their report that the challenge is on how to motivate these professionals to stay here in the country and sustain their involvement, especially in the community setting, because our country is continuing to lose this valuable and crucial resource to overseas employment. Giving priority to this by the government nationally and locally would be a start of a new beginning in the development of mental health in our country.