Community-Based Mental/Psychosocial Health Management
In the aftermath of the flash floods that claimed hundreds of lives in Infanta and General Nakar in November 2004, mental distress afflicted the survivors. Psychosocial intervention was provided so they could move on. This intervention led to the partnership between the Infanta Integrated Community Development Assistance, Inc. (ICDAI), the University of the Philippines-Philippine General Hospital (UP-PGH) and the World Association for Psychosocial Rehabilitation-Philippines (WAPRPhil). They developed the Community-Based Mental/Psychosocial Health Management Program which the Inter-Local Health Zone (ILHZ) II adopted in 2008.
The community-based mental/psychosocial health management program pools together resources from various sectors to address and fill in the gaps in mental/ psychosocial health care and the shortage of mental health professionals in the ReINaPan (Real, Infanta, Gen. Nakar, and Panukulan) area. Over time, the program broadened its scope from psychosocial processing and stress debriefing to mental and psychosocial health consultation and treatment.
In 2006, a partnership with the Claro M. Recto Memorial District Hospital (CMRMDH) led to the establishment of a psychiatric clinic. The program is now managed by the ReINaPan local government units of the ILHZ II in partnership with ICDAI, CMRMDH and UP-PGHWAPR-Phil.
Several strategies were implemented, namely: establishment of a psychiatric clinic; conduct of psychiatric consultation and treatment; implementation of socialized rate of psychotropic medicines; telepsychiatry; mental and psychosocial health education and information dissemination; formation of family support groups; and, capability building on mental health service delivery.
After four years of implementation, the program increased the knowledge and skills of LGUs in mental health care. It improved delivery of general health care in the municipalities, with mental and psychosocial health now included in the LGU’s regular health care program and with municipal health officers and area-based physicians providing psychiatric consultation and treatment.
The Psychiatric Clinic in CMRMDH was established with the assistance of the Northern Quezon Medical Society in which the partner psychiatrists and trained general physicians in the locality hold consultations. Prior to the establishment of the clinic, visiting psychiatrists held consultations in barangay halls.
Since medications for mental disorders are available only in Metro Manila health institutions and pharmacies, the ILHZ II purchased medicines from the Philippine General Hospital (PGH) and National Mental Health Center (NMHC) for stockpiling and retail to patients. The availability of medicines in the ILHZ II Pharmacy bridged the physical distance of ReINaPan municipalities from PGH and NMHC. The ILHZ II also ensured that medicines would be more accessible to indigent patients. A socialized scheme was developed where indigents pay only 25% of the actual medicine cost, while those who could afford pay the full amount.
The psychiatric consultations, coupled with the administration of medicines, proved to be successful in addressing mental health problems in the area. From 2006 to 2010, additional cases were recorded each year albeit in a decreasing pattern—from 110 new cases in 2006; 59 additional cases in 2007; 55 new ones in 2008; 36 more in 2009; and another 28 cases in 2010. These figures indicate improved awareness about mental health care. In 2009, a radio program dubbed as “ILHZ II in Action” served as a medium for ILHZ II to reach a wide number of people and encourage more families to bring their patients for consultation and treatment. The program also convinced the community to show more compassion for mental patients. There is now a growing acceptance among families that this condition is not something to be ashamed of; that it is manageable and that mental patients deserve mental health care.
Many of those with mental disorders have been brought back to normalcy. Some of the schizophrenic patients who exhibited violent behavior, auditory hallucination, and unhygienic practice are now able to help in household chores and are doing productive work outside their homes.
The formation of family support groups also contributed to hastening the recuperation of patients. Dialogues and activities between the families strengthened their resolve to provide proper mental health care for their patients and gradually break the stigma of mental disorder.
What is notable is that the program is being successfully managed by medical personnel who are not mental health professionals. This suggests that any LGU can provide mental health care service and that the absence or lack of mental health professionals in the area is not at all a hindrance as there are external stakeholders that can be tapped to assist the LGUs in developing their capacity in the delivery of mental health care service.
Telepsychiatry in CMRMDH allows real-time communication between the remote site in CMRMDH and the hub site in the Department of Psychiatry/National Telehealth Center in UP-PGH. A teleconference among the stakeholders is now also possible through Skype. With this mechanism in place, the partner psychiatrists are able to remotely assist the trained municipal health officers and general physicians in diagnosing and formulating mental health care plans for the patients. In addition, the psychiatrists could also provide continuous capacity development/enhancement through telementoring.
Partnership building is the key factor that made the implementation of the program in the ReINaPan area successful. Funding and human resource limitations were addressed by the pooling of resources among the partners. UPPGH-WAPR-Phil provided their technical knowledge and professional expertise to the ILHZ II so it could identify those who needed care.
Meanwhile, ICDAI provided financial support and technical expertise, and took the lead in building family support groups. On the other hand, the LGUs together with the CMRMDH provided funding, human resources and created mechanisms to enhance the program.
The cooperation of the families of individuals with mental disorders was also crucial. Without their support, their patients would not have been referred for consultations and treatment.
Lastly, capacity development of the LGU’s health personnel and volunteer health workers, and general physicians in CMRMDH ensure sustainability in the provision of mental health care in the area.