Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila
FIFTEENTH CONGRESS
First Regular Session

2704

House Bill No.

Introduced by Hon. Karlo A. B. Nograles

EXPLANATORY NOTE

A Most Filipinos are directly or indirectly touched and possibly burdened by the impact
of mental illness at some point in their lives. They are equally affected by the adverse
effects on them and their families of extreme life experiences that have beset the country.
Yet there remains inadequate attention to and awareness of the problems regarding the
mental health of the population. This situation prevails despite the evidences found in
various studies dore locally that point to the urgency and extent of the problems of mental
health in the country.

Mental health is the state of well-being in which an individual is able to fulfill his
potential in every stage of his development at work and in his relationships, copes with day
to day and extraordinary stresses of life and contributes to his community. This definition
points to the importance of promoting the mental health of Filipinos while at the same time,
programs to combat mental illness are to be provided.

Mental illness refers to mental or psychiatric disorder characterized by the existence

“of recognizable changes in the thoughts, feelings and general behavior of an individual

brought about by neurobiological causes manifested by genetic biochemical abnormalities

and associated medical conditions and psychosocial factors in the environment which

impacts on the individual. In most cases these are experienced as distress and manifesting as

severe interference with personal functions in life. Hence, those affected by mental
disorders can be disabled and a burden to their families and community.

One out of five adult patients and one out of ten children of ages 5 to 15 years old
have diagnosable psychiatric disorders, according to a World Health Organization (WHO)
study. A population survey, conducted in the Western Visayas Region in 1994, showed that
thirty two (32%) of adult Filipinos and twenty two (22%) of children were diagnosed to
have psychiatric syndromes. This translates to 1 out of 3 Filipino adults and 1 out of 5
children to have a psychiatric disorder. Another study (L.L. Ignacio et al) conducted in three
primary health centers in Manila showed that one out of 5 adults and one out of 10 children
ages 5-15 years old consulting these health centers have mental disorders. A similar study



conducted in rural health centers in three municipalities in Bulacan showed that 34% of
adults consulting these clinics have psychological symptoms and the same study showed the
high prevalence of psychiatric disorders such as depression, anxiety. alcoholism and chronic
psychosis. However only 5% of these consultees in general health clinics were recognized
by the physicians, midwives and barangay health workers in these areas. This low
recognition among physicians and health workers has therefore rendered them incapable to
recognize the need to treat these disorders as part of their daily health care activities.

A study in 2005 on mental disorders among employees in several government offices

in the National Capital Region, found that one out of three employees have identifiable

psychiatric problems. The same study found that one out of four households has members
who suffer from mental nealth problems.

‘The geological and geographical characteristics of the Philippines make it highly
vulnerable to natural disasters. In addition it is a country with long-standing socio-economic
problems and unstable political situation. Hence, the mental health of Filipinos has been of
much concern, because many Filipinos have had to deal with the tremendous psychosocial
consequences of these adverse life experiences. The high unemployment rate and the
increasing loss of jobs, the increasing number of overseas Filipino workers and its impact
on the family, the continuing occurence of domestic violence and child abuse, are among the
current conditions that have major mental health concerns for the country, These are
recognized as important factors that lead to problems in the mental health of Filipinos. With
the prevailing global crisis, it can be expected that more Filipinos will suffer mentally. All

. the situations mentioned above point to the fact that, there are and will be, many citizens
who are unable to be fully productive, a fact that our country can not afford.

There are presently major barriers to a more eff
in the Philippines. These include: low awareness among decision makers and the public of
mental health issues as well as low prioritization of mental health care by the government;
non-integration of mental health care services with regular health services; difficulties in
shifting from hospital-based to community-based mental health care, low allocations for
mental health care programs; inadequate policy framework (absence of mental health law),
inadequate facilities and resources, low public awareness and recognition of mental health
issues, and inadequate facilities and shortage of resources.

tive delivery of mental health care

In most areas of the country, the management of patients with mental or psychiatric
disorders is centralized in mental hospitals. which remain overcrowded isolated and

_ undermanned. These hospitals are genrally not easily accessible and available. nor do they
have the necessary supply of medications to treat their patients. They are therefore unable to
provide effective treatment. Their overcrowding vis-d-vis shortage of manpower, seriously
create a dehumanizing effect on hospital staff and their patients. compromising therefore the
quality of their care for these patients.

There is now world-wide recognition of the fact taht community based mental health
care would offer the best effective strategy to reach the high number in the population who
needs mental health care. However. community-based mental health care, especially at the
primary health care level is widely unavailable. In many communities, there are many cases
of chronic untreated mentally ill patients who are simply ignored even by. their families. or



confined in cells in their homes or even tied to posts in their house. Many of these patients
roam the streets unkempt and are abused and ridiculed by people. This has perpetuated their
isolation and has strengthened the stigma which their mental illness has given them

There are also no coordination programs for those in the community for those who
suffer from the psychosocial and mental health consequences as a result if prevailing
adverse life experiences that beset the Philippines

These problems are manifestations of the glaringly low priority which is given by the
government to the provision of mental health care.

Although a national mental health policy has been formulated in 2001, there has not
been much progress in implementing its stated structural framework. The country has no
mental health law, no adequate funding support for mental health programs and projects,
and no balanced system of hospital-based and community-based mental health service. This,
despite the fact that the Philippines is a signatory to a 1991 United Nation General
Assembly Resolution which sets principles for the protection of persons with mental illness
and the improvement of mental health.

In this light, this bill aims to define a national mental health policy and to develop an
effective national mental health care delivery system in the Philippines.

ARLO A. B. NOGRALES


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila
FIFTEENTH CONGRESS,

First Regular Session

BONA.
House Bill No.2 204

Introduced by Hon. Karlo A. B. Nograles

AN ACT
TAL HEALTH CARE DELIVERY SYSTEM,
COUNCIL FOR

PROVIDING FOR A NATIONAL M
ESTABLISHING FOR THE PURPOSE THE PHILIPPI
MENTAL HEALTH AND APPROPRIATING FUNDS THEREFOR

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

SECTION 1. Short Title. - This Act shall be known as the "National Mental Health
Act of 2009."

SEC. 2. Declaration of Policy. -\t is hereby declared the policy of the State to uphold

_the right of the people to mental health and instill mental health consciousness among them.

Towards this end, the State shall adopt an integrated and comprehensive approach to the
development of the National Mental Health Care Delivery System to deliver appropriate
services and interventions including provision of mental health protection, care treatment
and other essential services to those with mental illness or disability

SEC, 3. Objectives. - The objectives of this Act are as follows:

a) Promote a shifi from a hospital based system to a strengthened community
based mental health care delivery system:

b) Reorient and modernize the existing mental health facilities or institutions:


¢) Integrate mental health care in the general health care delivery system:

d) Prevent, treat and control mental illness at all levels and rehabilitate persons
with mental disability:

e) Provide access to comprehensive health care and treatment which ensure a
well-balanced mental health program of community based and hospital care and treatment:

fy Establish a nationwide _ multi-sectoral collaborative network for the
identification and prevention of mental illness or disability and the management of mental
health problems among vulnerable groups in the population which include those affected by
overseas employment, children, adolescents, elderly and those who are in need of special

protection like survivors of extreme life experience

and violence, among others; and

2) Protect and promote the mental health of the people through a multi-
disciplinary approach that encompasses health, education, labor and employment, justice,
and social welfare.

SEC. 4. Definition od Terms.- As used in this Act:

a. Mental health refers to a state of well-being in which an individual fulfills
his/her own potential in every stage of human development, at work and in relationships, in
order to cope with the day to day stresses of life and make a positive contribution to the
community:

b Mental iliness refers to mental or psychiatric disorder characterized by the
existence of recognizable changes in the thoughts, feelings and general bahaviour of an
individual brought about by neurobiological causes manifested by genetic or biochemical

abnormalities and

ssociated medical conditions which include distress. personality

disorder, sub:

ince use dependence and mental retardation:

e Psychosocial problem refers to a condition that indicates the existence of


recognizable changes in the individual's baheviour. thoughts and feelings brought about and
closely related to sudden, extreme and prolonged stressors in the physical or social
environment;
d. Mental disability refers to impairments, activity limitations and individual and
participatory restrictions denoting the negative aspects of interaction between an individual
“GRAINS SNOUREL MIGRANT SEANG FRAT B WEHATRATNTT
acquired lesions of the central nervous system, dementia and psychotic and non-psychotic

disorders;

ee Patient refers to a person receiving mental health care and treatment or
psychosocial intervention from a mental health care facility or clinic:

f. Legal repr

sentative refers to a person charged by law with the duty of
representing a patient in any specified undertaking or of exercising specified rights on the

patient's behalf:

8. Mental health professionals refer to those persons with formal education and
training in mental health and bahavioural sciences, such as, but not limited to, psychiatrist,
psychologist, psychiatric nurse or psychiatric social worker;

h. Mental health workers refer to trained volunteers and advocates engaged in

mental health promotion and services under the supervision of mental health professionals;

and

Allied professionals refer to any trained or certified non-psychiatric physician,
social worker, nurse, occupational therapist. recreational therapist, counselor, priest.

minister, pastor, nun, trained or certified non-psychiatric individual or non-physician.

SEC. 5. Philippine Council for Mental Health.- The Philippine Council for Mental

Health, hereinafter referred to as the Counc’

. is hereby established as an attached ageney


under the Department of Health (DOH), to provide for a coherent, rational and unified
response to mental health problems, concerns and efforts through the formulation and
implementation of the National Mental Health Care Delivery System.

For purposes of this Act. the National Mental Health Care Delivery System shall
constitute a quality mental health care program, through the development of efficient and
effective structures, systems and mechanisms, that will ensure cquitable, accessible,

_ affordable, appropriate, efficient and efefctive delivery of mental health care to all its
stakeholders by qualified, competent, compassionate and ethical mental health professionals
and mental health workers.

SEC. 6. Duties and Functions.- The Council shall exercise the following duties and

a, Review and formulate policies and guidelines on mental health issues and
concerns;

b. Develop a comprehensive and integrated national plan and program on mental
health;

c. Conduct regular monitoring and evaluation in support of policy formulation

and planning on mental health:

d Promote and faci

tate collaboration among sectors and disciplines for the
development and implementation of mental health related programs within these sectors;

©. Provide over-all technical supervision and ensure compliance with policies,
programs, and projects within the comprehensive framework of the National Mental Health
Care Delivery System and other such activities related to the implementation of this Act.
through the review of mental health services and the adoption of legal and other remedies

provided by law; *


f. Plan and implement the necessary and urgent capacity building, reorientation
and training programs for all mental health professionals, mental health workers and allied
professionals as articulated in this Act;

g. Review all existing laws related to mental health and recommend legislation
which will sustain and strengthen programs, services and other mental health initiatives;

he Conduct or cause to be conducted studies and researches on mental health,
with special emphasis on studies that would serve as basis for developing appropriate and
culturally relevant mental health services in the community:

i, Create such inter-agency committees. project task forces, and other groups

necessary to implement the policy and program framework of this Act; and

j. Perform such other duties and functions necessary to carry out the purposes of

fhe Council shall be composed of the following:

a) The Secretary of Health, as ex officio chairman;
b) The Executive Director, as vice chairman;
©) Three (3) representatives from the government health sector;

d) Two (2) representatives from the private health sector;

©) One (1) representative from the academe; and

f) One (1) representative from the nongovernment organizations involved in
mental health issues, as members.

The members of the Council shall be appointed by the President from among the
nominees of their respective organizations.

SEC. 8. Term of Office.- The members of the Council shall serve for three (3) years

In case a vacancy occurs in the Council, any person chosen to fill the vacancy shall serve


only for the unexpired term of the member whom he succeeds.

SEC. 9. Per Diem. - The members of the Council shall receive reasonable per diems
and transportation allowance as may be fixed by the Council for any meeting actually
attended.

SEC. 10 . Quorum.- The presence of a majority of the members of the Council shall

constitute a quorum.

2C. 11. Meetings. - The Council shall meet at least once a month or as frequently as
necessary to discharge its duties and functions. The Council shall be convoked by the
Chairman or upon written request of at least three (3) of its members.

SEC. 12. Executive Director. - The Council shall appoint an Executive Director who
shall serve for a term of six (6) years. The Executive Director shall be eligible for
reappointment and shall not be removed from office except in accordance with existing

laws.

SEC. 13. Duties and Functions. - The

executive Director shall exercise the
following duties and functions:
a) Act as chief executive officer of the Council and assume full responsibility in

implementing its purposes and objectives:

b) Maintain a close and functional relationship with the Department of Health
and other government and private entities concerning mental health care:

c) Formulate, develop, and implement, subject to the approval of the Council,
measures that will effectively carry out the policies laid down by the Council:

d) Execute and administer all approved policies, programs and measures, and
allocate appropriate resources for their implementation:

e) Recommend to the Secretary of Health the appointment of personnel of the


Couneil including supervisory. technical. clerical and other personnel in accordance to the
staffing patterns and organizational structure approved by the Council; and
£) Represent the Council in all of its official transactions or dealings and

authorize legal contracts, annual reports. financial statements, correspondence and other

_ documents.

SEC. 14. Salary. - The Executive Director shall receive a salary to be fixed by the
Council in accordance with the Salary Standardization Law.

SEC, 15. Appointment of Members. - Within thirty (30) days from the date of the
effectivity of this Act, the President of the Philippines shall appoint the members of the
Council.

SEC. 16. Community Based Mental Health Care. - The Mental Health Care

_ Delivery System shall evolve from a predominantly hospital based mental health care

system to a comprehensive community based mental health care system which shall consist

of: a) mental health service development; b) capacity building, reorientation and training
and c) research and development.
A. Mental Health Service Development. - Mental health service shall, within the

general health care system in the community

include the following:

a Development and integration of mental health care at the primary health
care in the community.

b. Continuation of programs for capacity building among existing local
mental health workers so that they can undertake mental health care in the
community “and undertake training and capacity building programs in close
coordination with mental or psychiatric hospitals or departments of psychiatry in

general or university hospitals:


Continuous support services and intervention for families and co-

workers; -

Advocacy and promotion of mental health awareness among the
general population.
B. Capacity Building, Reorientation and Training. - Capacity building.

reorientation and training shall, in close coordination with departments of psychiatry in

general hospitals. university hospitals or mental facilities, be required for those who are

mental health professionals or workers whose previous education and training had not
emphasized community mental health perspective.

C.— Research and Development. - Research and development shall be undertaken,
in collaboration with academic institutions. mental health associations and non-government
organizations. to develop appropriate and culturally relevant mental health services in the

community.

SEC. 17. Promotion of Mental Helath.

To protect the right for dignity. respect and
justice of those who are suffering from mental health problems. the Council shall promote
an integrated approach to mental health care to prevent mental disorders through programs
that strengthen the basic coping mechanism of individuals in relation to stress and advocacy
to raise the value of mental health consciousness among the people.

SEC

18. Access to Effective and High Quality Mental Health Care. - Any person
shall have the right to receive mental health care appropriate to his needs and shall be
. entitled to care and treatment in accordance to the same standards and accessibility as other

sick individuals,
An improved, effective and easy access to mental health care shall be made possible

and a shift from a predominantly hospital based mental health care to community based care


shall be provided.

SEC. 19. Person with Mental Iiness or Disbility. - The determination that a person
has a mental illness or disability shall be made according to internationally accepted
medical classificattons and standards.

SEC.20, Confidentiality. - All patients or clients with mental illness or disability
shall enjoy the right to confidentiality

SEC. 21. Patient's Treatment. - A patient with mental illness or disability shall have
the right to treatment in the least restrictive environment suited to the patients’ mental health
needs,

SEC. 22. Consent to Care, Treatment or Rehabilitation. - The consent of the patient
to be treated or admitted in a mental health facility shall be obtained freely, without threats
or improper inducements, and with pertinent disclosure to the patient of adequate and
understandable information in a form or language that is understood by the patient, When
the patient, at the relevant time, lacks the capacity to give or withhold consent, his next of
kin or legal representative shall give consent.

SEC. 23. Mental Health Facility. - A mental health facility shall have adequate
number of mental health professionals, workers and allied professionals which shall include
ample space to provide each patient with privacy and appropriate diagnostic and therapeutic
apparatus. regular and comprehensive treatment and medications. Every mental health
facility shall be inspected frequently by competent authorities to guarantee that the
treatment conditions and care of patients comply with these existing regulations.

SEC. 24. Voluntary Admission. - Every patient admitted voluntarily shall have the

right to leave the facility upon the recommendation of his attending psychiatrist: Provided,

That the patient may be retained for further treatment and care in case of following


observations:
a. There exisis a serious likelihood of danger of harming himself or others:
b. The severity of the paticnt’s mental illness is likely to lead a serious

deterioration in his condition; and

e The appropriate treatment can only be done by admission to a mental health
facility.
SEC. 25. Psychiatric Service in Regional and Provincial Hospitals. - A psychiatric

service shall be established in every regional and provincial hospital which shall provide the

following:

a. Short term in-patient hospital care for those with acute psychiatric symptoms
in a small psychiatric ward:

b. Partial hospital care for those with psychiatric symptoms or undergoing
difficult personal and family circumstances:

A Out-patient clinic in close collaboration with the mental health program at the
primary health centers in the area;

d. Linkage and possibel supervision of home care services for those with special

needs as a consequence of long-term hospitalization, unavailable families, inadequate or
: non-compliance to treatment:

e Coordination with drug rehabilitation centers on the care, treatment and
rehabilitation of persons suffering from drug or alcohol induced mental, emotional and

bahavioural disorder: and

f. Referral system with other health and social welfare programs. both
government and non-government. for programs in the prevention of mental illness, the

management of those at risk for mental health and psychosocial problems and mental illness


or disability.

SEC. 26. Access to Information. - Only patients or former patients shall be entitled
to have access to their personal mental health records. For justifiable reason, such
confidential information may not be given to the patient but instead be given to the patient's
representative or counsel.

SEC. 27. Implementing Rules and Regulations. - Within ninety (90) days from the
effectivity of this Act, the Secretary of Health shall. in coordination with the Council,

formulate the rules and regulations necessary for the effective implementation of this Act.

SEC. 28. Appropriation. - The initial amount of seventy Million (Php 70.000,000.00)

Pesos is hereby appropriated for the initial implementation of this Act. Thereafier, any
amount as may be necessary to carry out the provisions of this Act shall be included in the
General Appropriations Act.

SEC. 29. Repeating Clause. - All laws. decrees, executive orders, proclamations,
rules and regulations, and issuances. or parts thereof, which are inconsistent with the
provistonsePinis acuate hereby repealed or amended accordingly.

SEC. 30. Effeetivity. - This Act shall take effect fifteen (15) days after publication in

the Official Gazette or in two (2) national newspapers of general circulation.

Approved.