Psychiatric Nursing

1. Historical Perspective of Mental Illnesses in the Philippines
Pre-Spanish Regime

During this period the Filipinos believed in a world that was equally material and spiritual. The concept of illness was based on the belief in such material and spiritual worlds, thus the treatment of both physical and mental illness depended heavily on the valid and authentic rituals and ceremonies aimed at converting the punishment and at the same time maintaining and protecting the psychological well-being and survival of the people involved. The Filipinos also relied on healers called babaylan (shaman) and sorcerer healing, through which the spirits communicated with people or healed the sick individual. This cause of healing involved the temporary possession of the medium’s body.

Spanish Rule

Under the Spanish era, the Filipinos accepted that mental illness was caused by an act of sorcery. As it was written, the mangkukulam (witches) pricked the heads of their magic dolls with their magic pins while the mangaaaway (devil men) solicited satanic powers that can cause individuals to become mentally-ill (Santiago, 1995).
Herbolarios (herbsmen) intervene for treatment or “victims” are brought to the church for exorcism or ritual cleaning. Herbolarios are said to have an understanding of the mentally-ill persons. Through their own ability to get rid of the individual’s malady or ailment, they may have been using psychotherapy in a much different and ancient form. Therefore, it goes without saying that the procedures or religious rites have represented the means for the patient’s healing.

Early Nineteenth Century
The organized care and treatment for individuals with mental illness was established at the Hospicio de San Jose in the early 19th century. This historical event was made possible when the Spanish naval authorities requested for a place of confinement for their mentally-ill sailors. Medical doctors and nuns from the hospicio composed the treatment staff. Carcel de Bilibid served as the place for patients who committed criminal acts and those who are dangerous ones.

The American Era

In 1904, The Insane Department was opened at San Lazaro Hospital for use by mentally ill patients who were transferred from the Hospicio de San Jose. Dr. Elias Domingo who headed the unit was the first physician to obtain formal training in psychiatry in the U.S. He was assisted by Filipino and American nurses who were also trained in psychiatric nursing care.
In 1918, the city sanitarium was constructed to provide a place for treatment solely for patients residing in Manila. Consequently, the insane department in San Lazaro Hospital provided services for patients residing outside Manila.

Japanese Occupation
The WWII broke out on 8 December 1941 and the Japanese occupation began. Meanwhile the National Psychopathic Hospital continued to operate without regard of the danger and fear that the war was bringing. Many of the patients were fetched by their families while those left in the hospital died due to starvation and lack of medicine. The remaining patients and employees were executed for alleged anti-Japanese activities.
The Japanese Imperial Army donated and electroshock apparatus to the hospital. It was a big help to the patients and represented a breakthrough in the treatment of hospital patients. Since then, the electroshock therapy became the principal and famous treatment modality of the time due to the scarcity of medicine. The war was definitely an unprecedented obstacle in the progress of psychiatry and psychiatric treatment.

The Liberation Period and the Era of the Republic

At the end of WWII and the Japanese Rule, the hospital was liberated by the American Army of Liberation in 1945. With the return of the American to the Philippines, the development and growth in the treatment of mentally-ill patients began. Rehabilitation and expansion of facilities, training of medical staff and improvement in the management of hospitalized patients were immediate. This cooperative effort was in keeping with the general adoption of the concept of “mental health” in the U.S. It was during this period when the National Psychopathic Hospital was renamed National Mental Hospital, with Dr. Jose Fernandez designated as officer-in-charge from October 1946 to April 1961. Additional infirmary buildings for non-paying and paying patients, additional infrastructures and the improvement of basic services were accomplished.

In the Philippines, the emphasis of the treatment of mentally-ill patients was psychotherapy and chemotherapy, which were usually based on the development and progress in the U.S.

The end of WWII marked the continued interest and expansion of psychoanalysis abroad. Because of its popularity, psychoanalysis was equated often with psychiatry by the general public. However, despite this seeming dominance of the psychoanalytic treatment during this period, the biological orientation as demonstrated by the use of insulin coma in schizophrenia and electric shock in depression were still commonly used.

In 1953, this situation was radically changed with the dramatic discoveries in psychopharmacology. Consequently, these developments proved favorable and were largely responsible for the changes in the practice of psychiatry in the country. Soon drugs known to be helpful and beneficial with schizophrenia, depression, and anxiety disorders were being used. In the Philippines the use of chlorpromazine has apparently shortened the hospital stay of psychotic patients. Most importantly, its use facilitated the early discharge of these patients and early reintegration into the community.

Present-day Psychiatry
In the Philippines, the use of somatic therapies became most popular in this period. In the early 1960s the following drugs were introduced:
Lithium- used specifically for the treatment of mania
Benzodiazepines- usually prescribed for non-psychotic anxiety
Imipramine-like drugs and MAOIs0 commonly prescribed for the treatment of depression and for patients with severe state of anxiety.
Serotonin specific reupateke inhibitors and serotonin-norephineophrine reupatake inhibitors were included in the treatment of depression during the last decades on the 20th century.
Atypical antispsychotics were also introduced in the treatment of mental disorders and they have the advantage of causing few side effects.
Some somatic therapies become obsolete except for ECT.
Collaboration among different professionals- psychologists, social workers, nurses and occupational therapists further enhanced the delivery of care.
Hospitalizations were apparently shortened.
The thrust in the psychiatry movement and attention has now focused on interventions for people who are not necessarily suffering from mental illness.
The growing interest is geared towards assisting individuals who are vulnerable to develop mental health disturbances- these people are who are victims of either domestic or non-domestic violence, victims of disaster, abandoned children, overseas workers, and others.

Reference: CURRENT TRENDS & ISSUES IN PSYCHIATRIC AND MENTAL HEALTH NURSING by CHRISTIAN LUTHER FABIA, R.N.
Reaction:
Philippines has similar historical perspective on mental illnesses like on other countries. Science really brought a great impact that from rituals and ceremonies to a mentally ill patient we are now treating patients with proper interventions by using drugs, rehabilitations, etc. Moreover, unlike before, spreading of information is difficult and would take a lot of time to disseminate, with the use of media and networking sites new trends and/or information are now easier to distribute.

2. Community Mental Health Care in the Philippines
According to the World Health Organization, the Philippines currently has a National Mental Health Policy, sometimes known as the National Mental Health Program. The Philippines also has an authorized body that oversees mental health care facilities, which is the National Program Management Committee of the Department of Health (DOH).

Mental health legislation
The Philippines does not yet have any independent legislation regarding mental health. The Philippines only have, at present, laws regarding the governance of the provision of mental health services. Such laws are contained in other laws, including the Penal Code, the Magna Carta for Disabled Persons, the Family Code, and the Dangerous Drug Act, among others.

Government expenditure
The government of the Philippines sets aside and spends around 5% of its "total health budget" on the "operation and maintenance of mental hospitals". There is an insurance plan coverage program that covers only patients with mental disorders that are categorized as being in "acute in-patient care". Mental health facilities are the providers of psychotropic medications

Government focus
Among the focus of mental health care professionals from both national and international agencies at present include the integration of provision mental health care for displaced civilian population who experienced violence during the still ongoing conflict in Mindanao (such as the mental health program that was integrated into the primary health care program by the Medecins Sans Frontieres or Doctors Without Borders in 2008; the conflict between the Bangsamoro rebel forces and the Armed Forces of the Philippines in Mindanao began during the 1960s), and the provision of psychological counseling to the victims of typhoon Haiyan (known in the Philippines as typhoon Yolanda) in 2013.
Reference: http://en.wikipedia.org/wiki/Mental_health_care_in_the_Philippines

Reaction: As we can see our country has limited resources. We need some upgrading in course of mental health. There’s a lot of years passed by and yet there’s only few improvements done.

3. Department of Health program/s on Mental Health

National Mental Health Program
The National Mental Health Program (NMHP) now, under the Degenerative Disease Office of the National Center for Disease Prevention and Control (NCDPC), Department of Health. It aims at integrating mental health within the total health system, initially within the DOH system, and the local health system. Within the DOH, it has initiated and sustained the integration process within the hospital and public health systems, both at the central and regional level. Furthermore, it aims at ensuring equity in the availability, accessibility, appropriateness and affordability of mental health and psychiatric services in the country.

Vision: Full integration of Mental Health in the national system
Mission: To make available, accessible, affordable and equitable quality mental health care/services to the Filipinos especially the poor, the underserved and high risk populations.
Mandate: To provide the Department of Health with necessary services related to planning, programmming and project development in mental health.

Functions
1. Advisory body to the Secretary of Health regarding mental health concerns.
2. Acts as a policy making body regarding mental health concerns
3. Involves itself in training, research, supervision and, monitoring of mental health resources/programs services.
4. Mobilizes mental health resources for advocacy, planning, implementation and service delivery.
Reference: http://mentalhealth-ph.wikispaces.com/Existing+Government+Programs+on+Mental+Health

Reaction: At least the Department of Health has a program. They also have mission and vision. But is this enough? Can this program satisfy our mentally ill patients ? Does the program meet the needs of the clients?

4. Statistics of Mental Health Illness in the Philippines and trend of the statistics

Up to one in five adult Filipinos have “psychiatric disorders" and more people are developing mental disorders due to “extreme life experiences", doctors said Thursday.

Dr Lourdes Ladrido-Ignacio, a former president of the Philippine Psychiatric Association, said between 17 to 20 percent of the country’s adult population have psychiatric disorders.

About 10 to 15 percent of children aged 5 to 15 are believed to have mental problems.

Ladrido-Ignacio also noted that in remote barrios without doctors, 50 percent of adults who consult at rural health centers were diagnosed to have some form of psychological illness.

The National Statistics Office’s 2000 disability ranked mental illness as the third most common form of morbidity, or type of disease, after visual and hearing impairments among Filipinos.

The same survey showed that 88 Filipinos out of every 100,000 population with mental problems.

In 2004, a DOH-commissioned Social Weather Stations survey found that 0.7 percent of total Filipino households have a family member who has a psychological disorder such as depression, schizophrenia, epilepsy, and substance abuse.
Reference: http://www.gmanetwork.com/news/story/52861/lifestyle/1-in-5-adult-pinoys-have-psychiatric-disorders

Reaction: This information was from 10 years ago. There were no updates up to this time. It only mirrors there are unrevealed information or it might only mirror that the service for Mental Health here in the Philippines is poor.

5. My Life’s Meaning
Each one of us was created uniquely from each other. Therefore, I could say that each one of us has his or her own meaning of life. I believe that my life’s meaning will come from I, myself alone. No one could ever dictate the meaning of my existence in the world. I am alone will make my own decisions, in what will I be and in who will I be. Therefore, the answer to the question “What is my life’s meaning?” is I, myself.