This document discusses mental health and counseling in the Philippines. It begins by defining mental health and noting that maintaining mental health involves daily activities, relationships, and coping with stress and change. It then provides definitions of mental health from medical sources. The document notes that mental health has received little attention from the Philippine government. Only 5% of healthcare spending is on mental health and there are very few psychiatrists and hospital beds. Mental illness is common but also stigmatized in the country. The top barriers to seeking help are financial constraints, self-stigma, and social stigma. The passage discusses counseling in the Philippines and notes it has been influenced by multiple disciplines and acknowledges the societal context. It emphasizes

1. ISSUES ABOUT MENTAL HEALTH AND THE GUIDANCE AND
COUNSELING FIELD IN THE PHILIPPINES

2. MENTAL HEALTH
Mental health refers to the maintenance of successful mental activity.
This includes maintaining productive daily activities and maintaining
fulfilling relationships with others .
It also includes maintaining the abilities to adapt to change and to
cope with stresses

3. MENTAL HEALTH
Mental health is: "Emotional, behavioral, and social maturity or normality; the absence of a
mental or behavioral disorder; a state of psychological well-being in which one has achieved a
satisfactory integration of one's instinctual drives acceptable to both oneself and one's social
milieu; an appropriate balance of love, work, and leisure pursuits.“ - Medilexicon's medical
dictionary
Mental health is: "... a state of well-being in which the individual realizes his or her own abilities,
can cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community." The WHO stresses that mental health "is not just
the absence of mental disorder.“ - WHO

4. THE STATE OF THE MENTAL HEALTH IN THE PHILIPPINES
 The Philippines is an archipelago of over 7000 islands, with over 120 languages, and
numerous religions. The country has been occupied and colonized by many foreign powers
since 1545 and it only gained full independence in 1946.
 The cultural beliefs of Filipinos vary in almost every respect. One of the popular beliefs is that
depression and anxiety are non-existent, and that mental illnesses are something to be
ashamed of.
 A qualitative study conducted by Tanaka et al. (2018) showed that this stigma is considered to
be an effect of the public belief about mental disorders which consist of three themes: Familial
problems, Unrealistic pessimism and optimism, Oversimplified chronic course.

5. THE STATE OF THE MENTAL HEALTH IN THE PHILIPPINES
 Mental health has been given very little attention by the Philippine government and public sectors. Even
after the country has recently passed its first Mental Health Act and Universal Health Care Law, only 5%
of the healthcare expenditure is directed toward mental health. Also, there are only 7.76 hospital beds
and 0.41 psychiatrists per 100,000 people (World Health Organization—Assessment Instrument for
Mental Health Systems, 2007; Department of Health, 2018).
 Mental illness is the third most common disability in the Philippines (Martinez, 2020). According to
the Philippine World Health Organization (WHO), Special Initiative for Mental Health conducted in the
early part of 2020, at least 3.6 million Filipinos suffer from one kind of mental, neurological, and
substance use disorder (DOH, 2020).
 Filipinos are generally unhappy not only because of poor economic conditions (unemployment, low
salary, etc.), but also because of pressures arising from high expectations from family and society.

6. THE STATE OF THE MENTAL HEALTH IN THE PHILIPPINES
 On a larger scale, mental and behavioral disorders account for about 14% of
the global burden of disease, which means that as many as 450 million people
suffer from these illnesses worldwide (DOH, 2020).
 And with a pandemic suddenly taking the whole world by storm, the mental
health of groups especially the older adults, health care providers, and people
with underlying health conditions have suffered further and even more
gravely (DOH, 2020).

7. MENTAL HEALTH AND POLICY SUPPORT
 With the passage of RA No. 11036, otherwise known as the Mental Health Act, in June of 2018,
after a long policy campaign, there was considerable hope that the said law will promote the
importance of Mental Health to educational institutions, workplaces, and communities, and
protect the rights of those who are experiencing mental health illness against discrimination. The
law was also expected to guarantee access to comprehensive and integrated mental health services,
particularly for the marginalized and the most vulnerable (WHO, 2018).
 Before these laws, the move to professionalize the Guidance & Counseling, and Psychology practice
in the country has also been vigorously undertaken. The Guidance and Counseling Act of 2004
(R.A. No. 9258), and the Philippine Psychology Act of 2009 (R.A. No. 10029) recognized the
important role of guidance and counselors, and psychologists in nation-building and development.

8. MENTAL HEALTH AND POLICY SUPPORT
 RA 10029 further acknowledged the diverse specializations of psychologists
and the diverse functions specific to the varied specializations. It also
recognized the significance of the psychological services that practicing
psychologists provide to diverse types of clients. The act highlighted the need
to protect the public by preventing inexperienced or untrained individuals
from offering psychological services (Psychology, 2010).
 With all of these laws in place, what and where are the gaps that are reflected
in data from quantitative community studies? Said data showed that the rates
of formal help-seeking behaviors among the Filipino general population only
ranged from 2.2% to 17.5%. This was supported by reports from qualitative
studies where participants did not seek help at all (Martinez, 2020).

9. COUNSELING
According to the American Counseling Association, counseling is defined as a professional
relationship that empowers diverse individuals, families, and groups to
accomplish mental health, wellness, education, and career goals. Counseling is
usually done by a mental health professional to help and guide people during difficult situations,
such as the stress that comes from our daily lives (What is, n.d.).

10. COUNSELING IN THE PHILIPPINES
 “Much like its inherent multiculturalism, counseling in the Philippines has
evolved from multiple influences. Counseling encompasses a broad spectrum of
disciplines (e.g., guidance and counseling, counseling/clinical psychology), and
an acknowledgment of the societal context in which it occurs (e.g., poverty,
physical disasters, overseas working, graft and corruption, and economic and
political instability) (Tuason, 2012)”
 In this case, counselors must navigate societal stigmas regarding the need for
mental health assistance and widespread ignorance of the field; they also
advocate for mental health and resilience in difficult life circumstances (Tuason,
2012).

11. At present, there is a shortage of mental health professionals in the country. The ratio of
Mental health professionals is 2-3 per 100,000 population (WHO & Department of
Health, 2006) and more recent data indicate that there are 1.08 mental health beds in
general hospitals and 4.95 beds in psychiatric hospitals per 100 000 of the population
(WHO, 2014).

12. There are 46 outpatient facilities (0.05/100 000 population) and 4 community
residential facilities (0.02/100 000) (WHO, 2014). Also, there are only tertiary care
psychiatric hospitals here in the Philippines, some of which are the National Center
for Mental Health (NCMH) which is located in Mandaluyong City, and Mariveles
Mental Hospital in Bataan. The others are small satellites affiliated with the
National Center of Mental Health.

13. BARRIERS ON HELP-SEEKING BEHAVIORS

14. BARRIERS ON HELP=SEEKING BEHAVIORS
 Stigma regarding mental health illness, more specifically towards seeking professional help or
counseling, remains among the most cited reasons why people do not seek mental health
treatment (Corrigan, 2004). Stigmatic belief held by self and others may be due to a variety of
reasons such as lack of knowledge about mental health, and avoidance behavior towards
individuals who suffer from mental health problems. (Vogel, Wester, & Larson, 2007),
 Vogel, Wade, and Hackler (2007) suggest that the fear and anxiety of the undesirable label
placed on the individual who are experiencing mental health difficulties, and the strong stigma
about mental health illness in general, may be the reasons one will choose to be in denial
regarding their mental health issues. This in turn, prevents them from seeking professional
help.
 Vogel, Wade, and Hackler (2007) also state that public opinion and public stigma play a
powerful role in influencing someone about the stigma and the acceptance of mental health
illness in the society.

15. IN THE PHILIPPINES, THEMES ON BARRIERS AND FACILITATORS OF
FORMAL HELP-SEEKING HAVE BEEN IDENTIFIED AS:
1. psychosocial barriers/ facilitators, which include social support from family and friends, perceived
severity of mental illness, awareness of mental health issues, self-stigmatizing beliefs, treatment fears,
and other individual concerns;
2. socio-cultural barriers/facilitators, which include the perceived social norms and beliefs on
mental health, social stigma, the influence of religious beliefs, and language and acculturation factors;
and
3. systemic/structural and economic barriers/facilitators, which include financial or employment
status, the health care system and its accessibility, availability and affordability, and ethnicity, nativity,
or immigration status (Martinez, 2020).

16. SPECIFICALLY, THE MOST COMMONLY ENDORSED BARRIERS
WERE:
1. financial constraints due to high cost of service, lack of health insurance, or
precarious employment condition;
2. self-stigma, with associated fear of negative judgment, sense of shame,
embarrassment and being a disgrace, fear of being labeled as ‘crazy’, self-blame and
concern for the loss of face; and
3. social stigma that puts the family’s reputation at stake or places one’s cultural group
in bad light (Martinez, 2020).

17. BREAKING THE STIGMA ABOUT COUNSELING

18. BREAKING THE STIGMA ABOUT COUNSELING
 A most important point to emphasize is that advocacy should be directed
toward societal issues and include a social justice agenda given the
prevalent poverty, the intersection of poverty with crime and trauma, the necessity of
overseas working in families, the presence of street children, and child laborers.
These sectors have been worst hit by the current pandemic. These issues contribute
to the context of the Filipino’s environment, and importantly, set the parameters for
how change happens. Of these, the most significant are poverty, overseas working,
and unstable political and economic conditions (Tuason, 2012).
 Social issues become counseling issues at the individual level (CIA, 2011).
Hazards and disasters in the Philippines also exacerbate the impact of poverty as the
country is regularly affected by typhoons, volcanoes, landslides, earthquakes, and
tsunamis (Tuason, 2012).

19. BREAKING THE STIGMA ABOUT CONSELING
 Counseling practices, and research, training, and supervision of future counselors,
therefore, will need to focus on restructuring societal systems to be more reliable and
equitable. This is necessary to address the deep conflicts perpetrated by long-
standing graft and corruption, bribery, and injustices toward the citizens, the
protracted conflict between Christians and Muslims (Ebal, 2006), exacerbated by
intractable poverty. At the individual level, counselors will need to focus on
redefining themselves within the context of the system to be empowered and to be
able to create changes within their spheres of influence (Tuason, 2012).
 With the indigenization of theories that started with Filipino psychology by Enriquez
(1977) and phenomena of religion, consciousness, and culture by Bulatao (1992) the
thrust for counseling models and theories in the future will be for specifically
identifying, labeling, and using counseling models borne in Philippine society (e.g.,
Ramos, 2010; Tanalega, 2004).

20. KAPWA AND FILIPINO HELP-SEEKING BEHAVIORS

21. KAPWA AND FILIPINO HELP-SEEKING BEHAVIORS
 Most of the studies identified informal help through family and friends as the most widely
utilized source of support, while professional service providers were only used as a last resort (Martinez,
2020).
 This is very culturally true for Filipinos. Studies have shown that reliance on, and accessibility of
sympathetic, reliable and trusted family and friends may be a strong decision point in formal help-
seeking behavior since professional help is sought only in the absence of this social support (Martinez,
2020).
 This is consistent with the predominant cultural value that govern Filipino interpersonal relationships
called “kapwa” (or shared identity) in which trusted family and friends are considered as “hindi-ibang-
tao” (one-of-us/insider), while doctors or professionals are seen as “ibang-tao” (outsider) (Martinez,
2020).

22. KAPWA AND FILIPINO HELP-SEEKING BEHAVIORS
 Filipinos are apt to disclose and be more open and honest about their mental illness to those
whom they consider as “hindi-ibang-tao” (insider) as against those who are “ibang-tao”
(outsider), hence their preference for family members and close friends as a source of
informal help (Martinez, 2020).
 This may be a complexity in the Filipino help seeking behavior that we always need to keep in
mind. Especially as we aim for the indigenization of theories and professional practice, which
recognizes fully the phenomena of religion, consciousness, and culture (Martinez, 2020).

23. KAPWA AND FILIPINO HELP-SEEKING BEHAVIORS
 In addition, Sydney-Based Psychologist Aimee Santos, stated that some Filipino values we see
as positive traits can have a counter effect on one’s mental health, especially their help seeking
behavior.
 One of the Filipino traits Aimee discusses is “hiya”. Many Filipinos see “hiya” as a sign of
humility, but “hiya” can restrain individuals from expressing themselves and prevent them
from seeking professional help. The aphorism “mahiya ka naman” (shame on you) is used to
regulate behavior to become more acceptable to our family and community, which may also
prevent individuals from seeking help.

24. Active Listening Reminders
(Basic, 2019)
• Take time to listen carefully, concentrate on what
is being said
• Telling their story will often help people
understand, and eventually, accept the event.
• Do not hurry
• Ask questions to clarify
• Try not to interrupt until story ends
• Do ask questions to clarify
• Occasionally restate part of the story in your own
words to make sure you understand
• Avoid Why/Why not?
• Don’t judge
• Avoid “I know how you feel.”
• Avoid evaluation of their experience and their
reactions
• Silence is O.K.

25.  Helping Responsibly, Four Main Points:
(Basic, 2019)
1. Respect safety, dignity and rights
2. Adapt what you do to take account of the person’s
culture
3. Be aware of other emergency response measures
4. Look after yourself.
 What to avoid
(Basic, 2019)
• Force people to share their story with you
• Tell people what they should or should not feel or
think
• Minimize what they have gone through
• Automatically assume they share your religious belief
• Do not make assumptions about what survivors are
experiencing or what they have been through
• Do not assume that everyone exposed to a disaster
/experienced a crisis will be traumatized
• Do not pathologize
• Do not talk down or patronize
• Do not assume that all persons want to talk or need
to talk to you
• Do not give promises you cannot keep
• Do not preach
• Do not judge
• Avoid taking more responsibility for the situation than
seems appropriate

29. Myth: Mental health problems don't
affect me.
Fact: Mental health problems are
actually very common.
 The mental health situation in the
Philippines is something we should be
able to talk freely about. Approximately
1 in 5 Filipino adults suffers from a
mental disorder — this isn’t to mention
the 10 to 15 percent of children who
also have mental health conditions.
 The most common mental illnesses in
the country include schizophrenia,
substance abuse, post-traumatic stress
disorder (PTSD), and depression.

30. THANK YOU FOR LISTENING!