UPD mental health services suffer from lack of resident psychiatrist, professionals

Content warning: This article contains mentions of suicide, suicidal ideations and self-harm.

Upon arriving at the university’s emergency room (ER) due to her suicidal ideations, journalism student Iana was greeted by a scrambling staff and a form to be filled out, all while her hands were shaking.

She asked if the ER of the University Health Service (UHS) had a suicide watch but did not receive any immediate response from the staff.

For more than two years now, the UHS has not filled the position of a resident psychiatrist, whose tasks include assisting in psychiatric emergencies. 

Without the aid of a psychiatrist to deal with cases like hers, Iana found the staff to be unprepared to assist her.

Iana was instructed to rest and calm herself while the UHS staff asked her questions — one of which was why she thought of suicide. It also took a while before she was accommodated by a resident doctor.

[S]ana they know what they are doing kasi naramdaman kong nagkakagulo sila that night,” she said.

Under the implementing rules and regulations of Republic Act No. 11036 or the Mental Health Law, educational institutions should “facilitate access, including referral mechanisms of individuals with mental health conditions to treatment and psychosocial support.” 

This means that the UHS, as part of a university, is not necessarily required to have a resident psychiatrist on campus as they are only tasked to facilitate access and referrals. However, former UHS resident psychiatrist Dr. Dinah Nadera believed that the University of the Philippines (UP) “must have felt the need” to still hire a psychiatrist.

“The way that UP tried to address the law was to hire a psychiatrist para easy access,” Nadera said.

Even though she only worked part-time after being hired in August 2018, Nadera said she accommodated twice as many consultations, ranging from 25 to 30 overtime a week.

When asked why the UHS has yet to find a replacement for Nadera, UHS director Dr. Myrissa Alip stressed that the UHS is an infirmary so subspecialized services are “not part” of their mandate.

Inside the UHS

According to the outpatient data obtained from the UHS, the number of mental health cases increased by nearly twice in just five months during the Academic Year 2022-23.

From only a total of 28 cases during the blended learning setup in the first semester, the number jumped to 83 when UP returned to in-person classes in the second semester.

Despite this recorded spike, pre-pandemic times still had a higher number of mental health consultations with 93 cases in January 2020 alone.

Nadera noted that the UP constituents’ “high awareness” of mental health is a “two-edged sword,” as it leads to a high demand for mental health services.

“[S]a UP, … hindi siya kasing-taboo katulad ng sa ibang institutions. … It’s because it’s openly spoken about, mas marami kang expected na consultations,” Nadera said.

While Nadera described her time in UP as rewarding, she found the workload to be demanding, considering that she also had other commitments.

Although officially not affiliated with the university anymore, she still sees around 30 patients from UP through teleconsultations, including graduating students, faculty, staff and previous clients who are unable to find a psychiatrist elsewhere.

Current UHS medical officer Dr. Genevieve Sadaya said most mental health concerns she accommodated, many of which are panic attacks, stem from issues in school and work environments.

“People usually wait until things are unbearable before they seek consultation,” Sadaya added.

Meanwhile, UHS medical specialist Dr. Feliz Tagle also observed that the mental health of UP constituents seemed “more vulnerable nowadays,” as failing grades and family disputes fuel anxiety issues, especially among students.

Tagle mentioned that the UHS has policies in place to handle ER patients with urgent mental health concerns. This includes closely watching those with suicidal ideations, taking their medical history and having them undergo a physical examination to establish rapport.

Patients with suicidal tendencies are then referred to the UP Diliman Psychosocial Services (UPD PsycServ) or the UPD Office of Counseling and Guidance (OCG) if they are an existing client. The UHS also informs their parents or guardians regarding their situation.

Established in 2017 as a special project under the Office of the Chancellor, UPD PsycServ is tasked to address urgent concerns and emergencies on a case-to-case basis by “providing support and interventions up until risk has been mitigated and continuing support has been secured” for the patients. 

Since the pandemic in 2020, PsycServ data showed it has received an average of 87 monthly sign-ups, peaking in 2021 with 131.

After 24 hours of close monitoring, patients are referred to the nearest hospital and are advised admission if they still experience suicidal ideations.

However, the experience of Iana is different from the protocol explained by Tagle, who affirmed that the preparedness of the UHS in handling urgent mental health concerns “needs to be enhanced.” 

After their slow response to Iana’s case, the UHS contacted her dorm managers and parents to fetch her. She was not allowed to return to campus and attend her classes until she got clearance from a psychiatrist.

It was a different experience for broadcast media arts student Maria, who had her self-harm wound treated also in the UHS ER. According to her, the staff were nice and she did not feel a sense of stigma from them.

After the UHS staff cleaned her wound, Maria was quickly out of the ER. While the UHS offered to provide more assistance, which Maria refused, she noted that they needed to be “more persistent” in making her seek further help.

When she got back to her college, Maria inflicted self-harm again. For her, it could have been avoided if the UHS had better protocols in place to monitor those with urgent mental health concerns.

“Maybe if they were a bit more attuned to what I was going through, they would have taken the tool, the self-harm tool, from me. Kasi ‘yun nga nag-cut ulit ako pagdating ng college. … You never know what would happen once the student steps out of the UHS,” she said.

Inaccessible alternatives

With the lack of psychiatric services in the UHS, students are forced to look for a psychiatrist outside the university and pay thousands per session.

Following advice from the UHS, Iana has been consulting with her psychiatrist from a community clinic every two months, which costs her P2,000 for the first session and P1,000 for the succeeding ones.

While Iana was fortunate enough to find a psychiatrist with relatively inexpensive fees, some are not lucky.

Consultation fees proved to be a deterrent for sociology student Marion Cruz in seeking psychiatric services. In her research, she found out that consultation rates for psychiatrists can go as high as P3,360 per session.

“I do not want to cause any burden on my family members, as consultation fees are very expensive and are not covered by health insurance,” said Cruz, who needs psychiatric services to treat her symptoms of depression and anxiety.

At present, Cruz has yet to consult with a psychiatrist but is currently on the waiting list for one. 

Meanwhile, journalism student Edelweiss Nazal has also been looking for a psychiatrist since she was in Grade 9 but found the inaccessibility of psychiatric services to be the biggest hurdle.

“Sobrang [kaunti] nila, ang haba ng pila lagi, at mahal. … Sobrang hirap humanap ng psychiatrist at nakakaubos siya ng energy kaya ayan madalas pinipilit kong ‘wag na lang,” she said.

Nazal said that UP Diliman should provide a resident psychiatrist as health services are a “human right,” especially given the rise in mental health concerns.

The UHS is transparent and aware of its lack of a resident psychiatrist. The facility instead referred to the Department of Psychiatry at the Philippine General Hospital for psychiatric services and to PsycServ and the OCG for psychotherapy and counseling.

PsycServ only recorded around 50 to 54 average monthly sign-ups from 2017 to 2019. During the pandemic, it recorded at least 87 monthly sign-ups. Moreover, online sign-ups since the pandemic were temporarily closed from time to time due to the high number of people on the waiting list.

While PsycServ had 15 psychosocial support specialists serving as part-timers and 11 as full-timers in 2023, it still has struggled with a weeks-long waitlist.

The long waiting time prevented Nazal from availing of psychosocial services, while others like Iana endured the long wait and constant monitoring of the sign-up form to secure a slot.

Even with these difficulties, Iana, Maria and Cruz said the psychotherapy sessions provided by PsycServ have helped manage their mental health concerns. 

According to PsycServ, the “ever-increasing demand” for their services amplifies the need for an established office for mental health and psychosocial services. To date, PsycServ is yet to be institutionalized despite calls from the student body.

Another option for students is the OCG, which has served more than 359 clients per month for initial and follow-up counseling sessions since August to September 2023.

Like PsycServ and the UHS, it also grapples with understaffing, as its nine guidance services specialists (GSSs) serve 24,845 students as of the first semester of the A.Y. 2023-24. This is equivalent to one GSS for around every 2,760 students.

This guidance counselor-to-student population ratio exceeds the recommended ratio of 1:1000 by the Commission on Higher Education.

What needs to be done

Apart from requesting more plantilla items for psychiatrist and psychologist positions, Tagle said there is a need to provide more lay forums on mental health and maintain compassion in treating patients with mental health concerns.

Medical officer Sadaya also emphasized the need to provide training opportunities in handling mental health cases, so non-mental health professionals can handle less complicated cases and provide psychological first aid— a practice currently being conducted by the UHS.

Apart from the low number of psychiatrists in the country, Nadera said some of them might prefer to be consultants instead of holding plantilla positions in the university.

When Nadera went on leave for three months during her stay as the resident psychiatrist of the UHS, she hired two substitute psychiatrists, who found her workload to be difficult.

“[N]apagod ‘yung dalawa. … They will probably not want to be engaged [in that situation]. So maybe it is really a handful na work,” Nadera said. 

However, what is missing from the university, according to Nadera, is the prevention of mental health problems and promotion of mental health.

“Puro case management. So paano ‘yon, you wait for them to break down then sasaluhin mo? … [W]e are quick to respond to those who are already suffering but there is not much effort or investment to prevent ‘yung pag-trigger,” she added.

Nadera said this could be done by ensuring the protection of mental health in student organizations, providing safe spaces against harassment and isolation, and promoting physical activities.

Meanwhile, Nazal shared that mental health should also be approached as how physical health is treated.

“Kunwari kapag may lagnat, may nakahandang gamot and other treatments kahit hindi siya diagnosed na malalang sakit. Sana ganoon din maging pagtingin ng UP pagdating sa mental health at sana mag-reflect siya sa services,” she said.

Iana said a bigger budget and more trained professionals and personnel are needed for the university to meet the mental health needs of its constituents.

“Kasi if we cannot address the systemic problems at hand that deteriorate our mental health, at least provide the help we need to cope with it,” she added.

The Office of the Chancellor and the Office of the Vice Chancellor for Community Affairs have not responded to requests for comment as of press time.

If you or someone you know needs to seek help, please reach out to the National Center for Mental Health’s crisis hotline at 1553, 1800-1888-1553, 0917-899-8727, or 0908-639-2672.

Alternatively, Hopeline is a 24/7 suicide prevention and crisis support helpline that may be reached at 8804-4673, 0918-873-4673, or 0917-558-4673.

Editor’s Note: An earlier version of this story was submitted as a final requirement to J197 (Special Projects in Journalism) class under Assistant Professor Adelle Chua. Iana and Maria’s true names are withheld upon their request for privacy.