Mental health services ‘not enough’, suicide count highest in 14 years

Content warning: This article mentions self-harm and suicide.

An average of 13 people died every day from January to December 2020, latest data from the Philippine Statistics Authority (PSA) show.

The report recorded 4,418 suicide deaths during a full year of the COVID-19 pandemic, a 57.3% spike from the 2,808 cases tallied in 2019.

Psychiatrist Dinah Nadera said that while suicide deaths have been predicted to increase since 2010, distress due to the pandemic worsened cases of self-harm.

“We are expecting the increase for several reasons. Reporting is better now and awareness is higher,” Nadera told TNP. “When the pandemic struck, we expected that mental health [problems will be] on the rise because COVID is bringing psychosocial harm.”

Despite the soaring number of lives lost to suicide, data point to a huge gap in the country’s declining mental health services.

One psychiatrist for every 180,000 Filipinos 

The World Health Organization recommends 10 psychiatrists for every 100,000 people. In the Philippines, however, those 100,000 people will share 0.55 of a psychiatrist.

As of January, there are only 602 psychiatrists registered in the Philippine Psychiatric Association. Each one of them caters to 180,000 Filipinos.

“There were never enough mental health services and professionals even before the pandemic, and the more they’re not enough now,” Nadera said.

Aside from psychiatrists who diagnose patients and manage treatment, psychologists providing firsthand mental health services are also thin in numbers.

As of May, there are 1,458 registered psychologists in the country, based on data from the Professional Regulation Commission.

As the lone resident psychiatrist in UP Diliman, Nadera said that limited slots, unstable internet connection, inaccessibility to medicine and the loss of boundaries from work exacerbate her already heavy workload. 

“I have more new cases and emails where patients ask questions any time. This actually blurs the boundary of clinical work,”  she added. “My email became a hotline.”

READ: UP mental health providers stretched thin as students grow anxious over remote learning

Second-year college student Angel, who requested to hide her identity, is one of the new patients under Nadera’s wing. Angel sought therapy consultation in May with UPD PsycServ, the university’s free tele-psychotherapy program, after facing difficulties with her family’s health and finances.

“My Lolo was positive of COVID-19 and had to be hospitalized. I can’t help but think of the worst-case scenario,” said Angel. “Not only was I bothered by the heavy workload of my classes, but I was also constantly terrified for my family.”

READ: As COVID-19 hits UP students and faculty, learning now ‘survival of the fittest’

Nadera said she handles many new cases directly related to the pandemic due to social isolation and increased situational triggers.

“If you look at the cases, patients already have predispositions to developing mental health illnesses and it was actually the pandemic that triggered everything,” Nadera added. 

Angel was diagnosed with major depressive disorder and anxiety distress. While the eight free sessions from PsycServ helped her better cope with the situation, she said it would have been better in a face-to-face setting.

“You don’t feel as connected as you should with your specialist,” Angel added. “Whenever I am in session […] I become more cautious of what I say as if I’m being recorded […] I also share a room with my sister, so there were times when I wasn’t able to say everything I wanted and needed to say.”

Shortage in facilities

On top of the limited number of mental health professionals, the country also lacks mental health facilities.

The 2016 list of Health Facilities and Regulatory Bureau tallies only two state-owned psychiatric care facilities out of 60 nationwide. Both facilities are based in Luzon, specifically in Bataan and Cavite. 

Yet to be added to the list is the National Center for Mental Health in Mandaluyong, which has an authorized 4,200 inhouse bed capacity.

Nadera, also the Vice-Chairperson of the Mental Health Science Academe and Research Task Force, said the lack of in-house care facilities is only one part of the problem.

“What we lack is community-based mental health facilities,” Nadera said. “If we really want to prevent complications, we need to create community-based mental health treatments. The Mental Health Law is actually advocating for [this].”

Republic Act 11036 or the Mental Health Law enabled the Community-Based Mental Health Program, which has been going on for more than a year. The program showed significant progress in treating schizophrenic patients from Laguna and Rizal.

The same is yet to be said of provinces like Cebu that have high cases of suicide, as they are yet to have their own community-based mental care facilities.

A look at the 14-year data 

Cebu has met the most number of suicide deaths accumulated from 2006 to 2019, TNP’s look into PSA data shows. An average of nine people die of suicide every month in the province alone.

“The high suicide rates in Cebu [weren’t] surprising to me,” said Nicole Milca, a volunteer in UP Cebu’s Peer Facilitator Program. “As much as Cebu is advancing, the stigma is still there that mental health is not a big issue.”  

Cebu has topped the list of provinces with the highest suicide deaths since 2013. Nadera attributed this to better reporting of cases in the province and common factors associated with suicide such as drug abuse, alcoholism and trauma.

Next to Cebu, Bulacan and Batangas have the highest cases of suicide, with no less than five cases every month from 2006 to 2019.

As a peer facilitator, Milca connects students to mental health professionals. She told TNP that a call from a then-suicidal 20-year-old friend inspired her to join the program.

“He said he might have HIV. He feels it, that's why he’s really scared,” Milca said. “He told me, ‘if I have HIV I would really [attempt] suicide because everything would end for me.

Related: Immunocompromised, afraid: HIV treatment tails off amid COVID-19

PSA reports show that men are four times likelier to attempt suicide than women. Throughout the 14-year period between 2006 and 2019, men make up an average of 79% of all suicide deaths.

“It has always been the case that suicide deaths are higher among males, but suicide attempts are almost equal,” according to Nadera. “[This is because men] postpone seeking help and when the suicidal thought has crystallized it's probably too late to seek help or maybe they don't even try to seek help at all.”

PSA data adds that suicide deaths are highest among young adults from 20 to 24 years old, making up 16% of total cases. This is followed by age groups 15-19 and 25-29, which comprise 14% and 13% of suicide deaths, respectively.

"What happens with regard to any mental health problem is that when you see them in adults, [they] most likely would have had it at the age of 14 and nobody would have noticed,” said Nadera. 

On government response 

With the growing number of suicide cases due to the pandemic, the government called on the religious sector to help ‘guide’ members who experience difficulty due to the health crisis.

Justice Secretary Menardo Guevarra requested spiritual leaders to bring messages of hope to Filipinos “in order to stave off more incidents of self-destruction.” But mental health advocates and organizations criticized this call.

In a joint statement, COPE UP, a student-led mental health organization said that mental health should be addressed holistically as a social issue.

“It is a must that we do away with crisis as the primary impetus of dialogue and properly foster a safe and inclusive community educated about mental health,” COPE UP said. “We envision a world where it is normal to discuss mental health [...] and where mental health services are sufficiently funded and made accessible to everyone.”

For Angel, the eight free therapy sessions that spanned for over three months helped her manage her emotions but it’s not enough.

“It felt very anticlimactic, although my specialist was able to wrap up everything properly I didn’t feel I'm ready to end [the consultations],” said Angel. “I requested if I can continue at least once a month with my specialist instead of weekly and she told me she'll consult with the admin about it.

To help prevent more mental illnesses and suicide deaths, Nadera said there should be institutionalized and concerted efforts from different stakeholders.

“If you have a general education on mental health you'll be preventing a lot of suicides. Building regulations will actually help prevention,” Nadera said.

For immediate psychological assistance, you may call the National Center for Mental Health crisis hotline at 0917 899 8727 or 0917 989 8727; or Hopeline Philippines at 8804-4673, 09175584673, and 2919 (toll-free for Globe and TM).

For those in Cebu, the numbers to call are Tawag Paglaum-Centro Bisaya at 0939 937 5433 and 0939 936 5433.

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This article is a submission for Journalism 116 (Data Journalism) class under Prof. Yvonne Chua.