Republic of the Philippines
HOUSE OF REPRESENATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

House ait No. 4184

Introduced by AKBAYAN Representative Tomasito S. Villarin

EXPLANATORY NOTE

In the 2010 National Census, the Philippine Statistics Authority (PSA)
reported that 1 out 5 adult Filipinos suffer from mental or psychiatric
disorders. This translates to an average of 88 reported cases of
mental illness per 100,000 Filipinos. Half of adults who trooped to
rural health centers in remote areas were also diagnosed to be
suffering from psychological illness.

Of the 1.4 million Filipinos diagnosed with disabilities, the 2010
Census revealed that over 200,000 people were found to have a
mental disability or disorder. This figure that clearly illustrates the
frequency of mental, psychological and neurologic disorders is further
compounded by the fact that there were 490 licensed psychiatrists
practicing in the country during the survey period. The same
shortage is also manifest in hospital beds devoted for persons with
mental disorders nationwide. Only 4,200 beds are allocated for
mental health patients and most of these are in the National Center
for Mental Health.

This situation must be remedied. Otherwise, persons with mental
disorders will continue to be defamed and discriminated on account of
their mental condition. ‘The stigma associated with mental disorders
has forced families to hide from the public family members who are
afflicted with some form of mental disorder, ‘This is further
compounded by the lack of mental health framework that would
address the medical needs of patients found to be suffering from some
form mental health condition,

As a result, aside from being left untreated, mental health patients are
subjected unhygienic conditions, physical and sexual abuse, and


other forms of inhuman treatment.

This situation has been noted by the World Health Organization
(WHO) in other regions of the world, This global phenomenon is what
the United Nations Convention on the Rights of Persons with
Disabilities seeks to address. Under Section 4 of the Convention the
Philippines, as a party to the Convention, has “to ensure and promote
the full realization of all human rights and fundamental freedoms for
all persons with disabilities without discrimination of any kind on the
basis of disability.”

On 17 December 1991, the United Nations (U.N.) General Assembly
Resolution 46/119 was adopted. It enumerates the Principles for the
Protection of Persons with Mental Illness and the Improvement of
Mental Health Care.

The State, under Seo.11, Article XIIl of the 1987 Philippine
Constitution is mandated to ‘adopt an integrated and comprehensive
approach to health development which shall endeavor to make
essential goods, health and other social services available to all the
people at affordable cost.”

With ‘the foregoing, now is the time that the State should address the

long neglected area of mental health. Thus, the immediate passage of
this bill is earnestly sought.

ot

TOMASITO S, VILLARIN


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS:
First Regular Session

Win no, 4484 _

House Bill No.

Introduced by AKBAYAN Representative Tomasito §, Villarin

AN ACT
ESTABLISHING A NATIONAL MENTAL HEALTH POLICY FOR THE
PURPOSE OF ENHANCING THE DELIVERY OF INTEGRATED MENTAL
HEALTH SERVICES, PROMOTING AND PROTECTING PERSONS
UTILIZING PSYCHIATRIC, NEUROLOGIC AND PSYCHOSOCIAL HEALTH
SERVICES, APPROPRIATING FUNDS THEREFOR AND FOR OTHER
PURPOSES

Be it enacted by the Senate and the House of Representatives of the
Philippines in Congress assembled:

ARTICLE I
Policy, Objectives, and Definitions

Section 1. Short Title. This Act shall be known as the “Mental Health Act
of 2016.”

Section 2. Declaration of Policy. It is hereby declared the policy of the
State to uphold the basic right of all Filipinos to mental health and to
respect the fundamental rights of people who require mental health services.

‘The State thus commits itself to promoting the well-being of its people by,
among others, ensuring that mental health is valued, promoted and
protected; mental disorders are prevented; and persons affected by these
disorders are able to access high quality, culturally-appropriate health and
social care in a timely way to, exercise the full range of human rights, and
participate fully in society and at work free from stigmatization and
discrimination.

Policies, plans and laws for mental health shall comply with obligations
under the United Nations Convention on the Rights of Persons with
Disabilities and other international and regional human rights conventions.
‘Thus, the State expressly recognizes the applicability of Republic Act (R.A.)
No. 7277, as amended, otherwise known as the “Magna Carta for Disabled
Persons”, to persons with mental disorders, as defined herein

1


Section 3. Objectives. The objectives of this Act a

(a)

(b)

Strengthen effective leadership and governance for mental health by,
among others, formulating, developing, and implementing national
policies, strategies, programs, and regulations relating to mental
healt

Develop and establish a comprehensive, integrated, effective, and
efficient national mental health care system responsive to the
psychiatric, neurologic, and psychosocial needs of the Filipino people;

Protect the rights and freedoms of persons with psychiatric,
neurologic, and psychosocial health needs; and

Strengthen information systems, evidence and research for mental
health.

Section 4. Definitions. For the purposes of this Act, the following
definitions shall apply:

(a)

(b)

(d)

(e)

“Confidentiality”. means ensuring that the personal and health
information related to persons with psychiatric, neurologic, and
psychosocial health needs is kept private, safe from access or use by
or disclosure to persons or entities who are not authorized to access,
use, or possess such information.

“Discrimination” means any distinction, exclusion or restriction which
has the purpose or effect of impairing or nullifying the recognition or
exercise, on an equal basis with others, of all human rights and
fundamental freedoms

“Informed Consent” refers to the voluntary acceptance of a plan for
treatment by a service user who is not mentally incapacitated, after
full disclosure by the attending mental health professional of
information regarding the plan of treatment, its risks, benefits, and
available alternativ:

“Legal Representative” refers to a person who is designated by the
service user or appointed by a court of competent jurisdiction, to act
as a supported or substitute decision maker.

“Mental Disorder” refers to a neurologic or psychiatric condition
characterized by the existence of a recognizable, clinically-significant
disturbance in an individual's cognition, emotional regulation, or
behavior that reflects a genetic or acquired dysfunction in the
neurobiological, psychosocial, or developmental processes underlying
mental functioning, The determination of psychiatric and neurologic

2


(8)

(h)

a

()

disorders shall be based on __ scientifically-accepted medical
nomenclature.

“Mental Health” refers to a state of psychosocial well-being in which
the individual realizes his or her own abilities, copes adequately with
the normal stresses of life, displays resilience in the face of extreme
life events, works productively and fruitfully, and is able to make a
positive contribution to the community.

“Mental Health Facility” refers to any establishment, or any unit of an
establishment, which has, as its primary function the provision of
mental health care or services.

“Mental Health Professional” refers to a medical doctor, clinical
psychologist, nurse, social worker or any other appropriately-trained
and qualified person with specific skills relevant to the provision of
mental health services.

“Mental Health Services” refer to psychosocial, psychiatric or
neurologic activities and programs along the whole range of the
mental health support spectrum including enhancement, prevention,
treatment, and aftercare.

“Mental Health Workers” refer to trained personnel, volunteers or
advocates engaged in mental health promotion, providing services
under the supervision of a mental health professional.

“Mental Incapacity” refers to medically-determined, temporary or
permanent inability on the part of a service user or any other person
affected by a mental disorder, to:

() Understand information given concerning the nature of a mental
disorder;

(ii) Understand the consequences of one’s decisions and actions on
one’s life or health, or the life or health of others;

Understand information about the nature of the treatment
proposed, including methodology, direct effects, and possible
side-effects; and

(iv) Effectively communicate consent to treatment or hospitalization,
or information regarding one’s own condition.

“Psychiatric Emergencies” refer to conditions presenting a serious and
immediate threat to the health and well-being of a service user or any


other person affected by a mental disorder, or to the health and well-
being of others, such as, but not limited to, threatened or attempted

suicide, acute intoxication, severe depression, acute psychosis, or
violent behavior, requiring immediate psychiatric intervention.
(m) “Psychosocial Problem” refers to a condition that indicates the

existence of dysfunctions in a person’s behavior, thoughts and feelings
brought about by sudden, extreme, prolonged or cumulative stressors
in the physical or social environment.

(n) “Service User” refers to a person receiving psychiatric, neurologic, or
psychosocial services or care.

(o) “Substituted Decision Making” ” is the act of making decisions on
behalf of a service user in situations where the latter has been
assessed by a mental health professional to be mentally incapacitated,
consistent with the service user’s written directives, if available.

(p) “Supported Decision Making’ is the act of assisting a service user who
retains decision-making ability, or who is not otherwise mentally
incapacitated as defined herein, in coherently expressing a mental
health-related preference, intention or decision.

ARTICLE II
Rights of Persons with Mental Health Needs, their Families & Legal
Representatives, and Mental Health Professionals

Section 5. Rights of Persons with Mental Health Needs. Without
prejudice to the provisions of this Act or any other applicable law, a service
user or any other person with mental health needs shall have the right to’

(a) Freedom from social, economic, and political discrimination and
stigmatization, whether committed by public or private actors;

(b) Exercise all their inherent civil, political, economic, social, religious,
educational, “and cultural rights respecting individual qualities,
abilities, and diversity of background, without discrimination on the
basis of physical disability, age, gender, sexual orientation, race, color,
language, religion or national, ethnic, or social origin of the service
user concerned;

(c) Receive evidence-based or informed treatment of the same standard
and quality as that of other persons similarly situated, regardless of
age, sex, socioeconomic status, race, ethnicity or sexual
orientation;


(d)

(e)
()

(8)

(h)

(i)

0)

(h)

(i)

Access essential health and social services that enable them to recover
and achieve the highest attainable standard of mental health without
risk of impoverishing themselves or their families;

Receive mental health services at all levels of the health care system;

Receive comprehensive and coordinated treatment that integrates
holistic prevention, promotion, rehabilitation, care and support
aimed at addressing mental and physical health care needs and
facilitating recovery, through a multi-disciplinary, user-driven
treatment and recovery plan;

Psychosocial care and clinical treatment in the least restrictive

environment and manner;

Humane treatment free from solitary confinement, torture, and cruel,
inhumane, harmful or degrading treatment;

Aftercare and rehabilitation within the community whenever pos
for the purpose of facilitating social reintegration;

sible,

Adequate information regarding psychosocial and clinical assessments
and available multidisciplinary health services;

Participate in mental health advocacy, policy, _ planning,
legislation, service provision, monitoring, research and evaluation;

Confidentiality of all information, communications, and records, in
whatever form or medium stored, regarding the service user, any
aspect of the service user’s mental health, or any treatment or care
received by the service user, which information, communications, and
records shall not be disclosed to third parties without the written
consent of the service user concerned or the service user’s legal
representative, unless

(i) Such disclosure is required by law or pursuant to an order
issued by a court of competent jurisdiction;

(ii) A life-threatening emergency exists and such disclosure is
necessary to prevent harm or injury to the service user or to
other persons;

(iii) ‘The service user is a minor and the attending mental health
professional reasonably believes that the service user is a victim
of child abuse;



Gi)

(ky

()

or

(m)

(n)

(iv) Such disclosure is required in connection with an
administrative, civil, or criminal case against a mental health
professional or worker for negligence or a breach of professional
ethics, to the extent necessary to completely adjudicate, settle,
or resolve any issue or controversy involved therein; or

(v) Such disclosure is in the interest of public safety or national
security.

Give informed consent before treatment or care is provided, inchiding
the right to withdraw such consent. Such consent shall be recorded in
the service user’s clinical record;

Participate in the development and formulation of the psychosocial
care or clinical treatment plan to be implemented;

Unless the service user has been determined or declared to be
mentally incapacitated, designate or appoint a person of legal age to
act as his or her legal representative through a notarized document
executed for that purpose. If the service user has been determined or
declared to be mentally incapacitated, or otherwise fails to designate
or appoint a legal representative, the following persons shall act as the
service user’s legal representative, in order of preference:

(i) ‘The spouse, if any, unless permanently separated from the
service user by a decree issued by a court of competent
jurisdiction, or unless such spouse has abandoned or been
abandoned by the service user for any period which has not yet
come to an end;

(ii) Non-Minor Children;

(iii) Bither parent by mutual consent, if the service user is a minor;

(iv) A person appointed by the court.

Legal representation, through competent counsel of the service user
choice. In case the service user cannot afford the services of counsel,
the Public Attorney’s Office, or a legal aid institution of the service
user or representative’s choice, shall assist the service user;

Access to their clinical records unless, in the opinion of the attending
mental health professional, revealing such information would cause
harm to the service user’s health or put the safety of others at risk.
When any such clinical records are withheld, the service user or his or
her legal representative may contest such decision with the internal


review body created pursuant to this Act authorized to investigate and
resolve disputes, or with the Commission on Human Rights; and

Information, within twenty-four (24) of admission to a mental health
facility, of the rights enumerated in this section in a form and
language understood by the service user;

Section 6. Rights of Family Members and Legal Representatives. ‘The
family members and duly-designated or appointed legal representative of the
service user shall have the right to

{a)

(b)

()

(a)

Receive appropriate psychosocial support from the relevant
government agencies;

With the consent of the concerned service user, participate in the
formulation, development, and implementation of the service user’s
individualized treatment plan;

Apply for release and transfer of the service user to an appropriate
mental health facility; and

Participate in mental health advocacy, policy, _ planning,
legislation, service provision, monitoring, research and evaluation.

Section 7. Rights of Mental Health Professionals. Mental health
professionals shall have the right to:

(a)
(b)

()

(d)

(e)

()

A safe and supportive work environment;
Continuous education and training;

Participate in the planning, development, and management of mental
health services;

Contribute to the development and regular review of standards for
evaluating mental health services provided to service users;

ticipate in the development of mental health policy and service
delivery guidelines;

Except in emergency situations, manage and control all aspects of his
or her practice, including whether or not to accept or decline a service
user for treatment; and



(2)

Advocate for the rights of a service user, in cases where the service
user’s wishes are at odds with those of his family or legal
representative,

ARTICLE I
Duties & Responsibilities of Government Agencies

Section 8. Duties and Responsibilities of the Department of Health

(DOH). To achieve the policy and obje

(a)

(b)

(ce)

(dj

(e)

ves of this Act, the DOH shall:

Formulate, develop, and implement a national mental health program;

Ensure that a safe, therapeutic, and hygienic environment with
sulficient privacy exists in all mental health facilities and, for this
purpose, shall be responsible for the regulation, licensing, monitoring,
and assessment of all mental health facilitie

Integrate. mental health into the routine health information
system and identify, collate, routinely report and use core
mental health data disaggregated by sex and age, and health
outcomes, including data on completed and attempted suicides,
in order to improve mental health service delivery, promotion
and prevention strategies;

Improve research capacity and academic collaboration on
national priorities for research in mental health, particularly
operational research with direct relevance to service development
and implementation and the exercise of human rights — by
persons with mental disorders, including the establishment of
centers of excellence;

fnsure that all public and private mental health institutions uphold
the right of patients to be protected against torture or cruel,
inhumane, and degrading treatment;

Coordinate with the Philippine Health Insurance Corporation to
ensure that insurance packages equivalent to those covering physical
disorders of comparable impact to the patient, as measured by
Disability Adjusted Life Year or other methodologies, are available to
patients affected by mental disorders;

Prohibit forced or inadequately remunerated labor within mental
health facilities, unless such labor is justified as part of an accepted
therapeutic treatment program; and


(h) Develop alternatives to institutionalization, particularly community-
based approaches to treatment aimed at receiving patients discharged
from hospitals, meeting the needs expressed by persons with mental
health disorders, and respecting their autonomy, decisions, dignity,
and privacy

Section 9. Duties and Responsibilities of the Commission on Human
Rights (CHR). The CHR shall:

(a) Establish mechanisms to investigate, address, and act upon
impropriety and abuse in the treatment and care received by service
users, particularly when such treatment or care is administered or
implemented involuntarily;

(b) Inspect mental health facilities to ensure that service users therein are
not being subjected to cruel, inhumane, or degrading conditions or
treatment;

(c) Investigate all cases involving involuntary treatment, confinement, or
care of service users, for the purpose of ensuring strict compliance
with domestic and international standards respecting the legality,
quality, and appropriateness of such treatment, confinement, or care;
and

(a) Appoint a focal commissioner for mental health tasked with protecting
and promoting the rights of service users and other persons utilizing
mental health services or confined in mental health facilities, as well
as the rights of mental health professionals and workers. The focal
commissioner shall, upon a finding that a mental health facility,
mental health professional, or mental health worker has violated any
of the rights provided for in this Act, take all necessary action to
rectify or remedy such violation, including recommending that an
administrative, civil, or criminal case be filed by the appropriate
government agency.

Section 10, Dutiés and Responsibilities of Mental Health Facilities.
Mental health facilities shall:

(a) Establish policies, guidelines, and protocols for minimizing the use of
restrictive care and involuntary treatment;

(b) Inform service users of their rights under this Act and all other
pertinent laws and regulations;

(c) Provide every service user, whether admitted for voluntary or
involuntary treatment, with complete information regarding the plan
of treatment to be implemented;

9


(a)

(e)

()

Ensure that informed consent is obtained from service users prior to
the implementation of any medical procedure or plan of treatment or
care, except when the service user concerned is mentally
incapacitated, as defined herein;

Ensure that involuntarily treatment or restraint, whether physical or
chemical, is only administered or implemented pursuant to the
following safeguards and conditions, and only to the extent that such
treatment or restraint is necessary:

() During psychiatric or neurologic emergencies;

(ii) Upon the order of the service user’s attending physician, which
order must be reviewed by a board-certified psychiatrist within
one (1) month from date of issuance, or as soon as possible;

(ii) When all other means of treatment or restraint have proven
unsuccessful; and

(iv) That such involuntary medical treatment or restraint shall be: in
strict accordance with guidelines approved by the appropriate
authorities, which must contain clear criteria regulating the
application and termination of such medical intervention; used
for the shortest period of time possible, as assessed by a board-
certified psychiatrist or by the service user’s attending physician
under the supervision of a board-certified psychiatrist; and fully
documented and subject to regular external independent
monitoring and audit.

Maintain a register containing information on all medical treatments
and procedures involuntarily administered to service users;

Ensure that legal representatives are designated or appointed only
after the requirements of this Act and the procedures established for
the purpose have been observed, which procedures should respect the
autonomy and preferences of the patient as far as possible; and

Establish an internal review body to monitor and ensure compliance
with the provisions of this Act, as well as receive, investigate, resolve,
and act upon complaints brought by service users or their families
and legal representatives against the mental health facility or any
mental health professional or worker.

ARTICLE IV
Community Mental Health Services

10


Section 11. Community Mental Health Services, Within the general
health care system, the following mental health services shall be developed

and integrated into the primary health care system at the

(a)

(b)

(e)

ommunity level:

Basic mental health services, which shall be made available at all local
government units down to the barangay level;

Community resilience and psychosocial well-being training in all
barangays, including the availability of mental health and
psychosocial support servi during and after natural disasters and
other calamities;

Training and capacity-building programs for local mental health
workers in coordination with mental health facilities and departments
of psychiatry in general or university hospitals;

Support services for families and co-workers of service users, mental
health professionals, and mental health workers; and

Dissemination of mental health information and promotion of mental
health awareness among the general population.

Section 12. Psychiatric, Psychosocial, and Neurologic Services in
Regional, Provincial, and Tertiary Hospitals. All regional, provincial, and
tertiary hospitals shall provide the following psychiatric, psychosocial, and

neurologic servic:

{a)

(b)

(c)

(d)

(e)

Short-term, in-patient hospital care in a small psychiatric ward for
service users exhibiting acute psychiatric symptom:

Partial hospital care for those exhibiting psychiatric symptoms or
experiencing difficulties vis-a-vis their personal and family
circumstances;

Out-patient services in close collaboration with existing mental health
programs at primary health centers in the same area;

Home care services for service users with special needs as a result of,
among others, long-term hospitalization, non-compliance with or
inadequacy of treatment, and absence of immediate family;

Coordination with drug rehabilitation centers vis-a-vis the care,
treatment, and rehabilitation of persons suffering from addiction and
other substance-induced mental disorders; and

u


() A referral system involving other public and private health and si
welfare service providers, for the purpose of expanding access
programs aimed at preventing mental illness and managing the
condition of persons at risk of developing mental, neurologic, and
psychosocial problems.

ARTICLE V
Education, Research, and Development

Section 13, Integration of Mental Health into the Educational System.
The State shall ensure the integration of the mental health into the
educational system, as follows:

(a) Age-appropriate content pertaining to mental health shall be
integrated into the curriculum at all educational levels; and

(b) Psychiatry and neurology shall be a required subjects in all medical

and allied health courses, including post-graduate courses in health

Section 14. Capacity-Building, Reorientation, and Training. In close
coordination with mental health facilities, and the departments of psychiatry
in general and university hospitals, mental health professionals and workers
shall undergo capacity-building, reorientation, and training to develop their
ability to deliver evidence-based, culturally-appropriate and human rights-
oriented mental health services, with an emphasis on the community and
public health aspects of mental health.

Section 15. Research and Development. Research and development shall
be undertaken, in collaboration with academic institutions, psychiatric,
neurologic, and related associations, and non-government organizations, to
produce the information, evidence, and research necessary to formulate and
develop a culturally-relevant national mental health program incorporating
indigenous concepts and practices related to mental health.

High ethical standards in mental health research shall be promoted to
ensure that: research is conducted only with the free and informed consent
of the persons involved; researchers do not receive any privileges,
compensation or remuneration in exchange for encouraging or recruiting
participants; potentially harmful or dangerous research is not undertaken;
and all research is approved by an independent ethics committee, in
accordance with applicable law.

ARTICLE VI
Miscellaneous Provisions

Section 16, Implementing Rules & Regulations. The Secretary of Health
shall issue the Implementing Rules & Regulations necessary for the effective

12


implementation of this Act within ninety (90) days from the effectivity
thereof.

Section 17. Appropriations. The amount necessary for the initial
implementation of the provisions of this Act shall be charged against the
current year’s appropriations of the Department of Health. Thereafter, five
percent (5%) of the annual excise tax on alcohol and tobacco products
collected by the government shall be earmarked for the implementation of
this Act.

Section 18, Separability Clause. If any provision of this Act is declared
unconstitutional or invalid by a court of competent jurisdiction, the
remaining provisions not affected thereby shall continue to be in full force
and effect.

Section 19. Repealing Clause. All laws, decrees, executive orders,
department or memorandum orders and other administrative issuances or
parts thereof which are inconsistent with the provisions of this Act are
hereby modified, superseded or repealed accordingly.

Section 20. Effectivity. This Act shall take effect fifteen (15) days after
publication in the Official Gazette or in at least two (2) newspapers of
general circulation.

Approved,

13