HOUSE OF REPRESENTATIVES
RECEIVED

Republic of the Philippines
HOUSE OF REPRESENTATIVE
Quezon City, Metro Manila

SEVENTEENTH CONGRESS

First Regular Session RECISTRATON UNE

BILLS AND INDEX SERVI

40
House Bill No. 1054

Introduced by Representative Ron P. Salo

EXPLANATORY NOTE

Mental health is a fundamental component of a person's overall health and
well-being. As defined by World Health Organization (WHO), health is “a state of
complete physical, mental and social well-being and not merely the absence of
disease or infirmity.” The Filipino’s right to health is enshrined in Article Il, Section 15
of the Philippine Constitution

Perhaps because of social and cultural stigma attached to being afflicted with
mental disorder, mental health has not been given sufficient attention in the
Philippines despite studies highlighting the need for a more intensive mental health
service delivery system. The Department of Health reported more than 8,000 cases
of mental disorders in 2015, with schizophrenia comprising a large percentage at
3,457 making it on top of the 10 leading causes of morbidity (National Center for
Mental Health, 2016). There were more than 2,000 cases of bipolar affective
disorder, followed by psychotic disorder and depression. As early as 2004, a DOH-
commissioned Social Weather Stations survey found that almost one per 100
households (0.7%) has a family member who has a mental disorder. The WHO
reported 2,558 cases of suicide in the country in 2012. The WHO Global School-
Based Health Survey in 2011 showed that 16% of students between 13-15 years old
have seriously considered attempting suicide, while 13% have actually attempted
suicide at least once.

The State has limited resources to adequately address the large and growing
number of mental health problems. The 2011 WHO Mental Health Atlas
approximated that 5% of the total health budget goes to mental health services.
However, majority of primary health care doctors and nurses have not received
official in-service training on mental health within the last 5 years, and there are no
available officially approved manuals on the management and treatment of mental
disorders in most primary health care clinics

In addition to limited access to proper health care services, persons with
mental disorders are also vulnerable to abuse. In a Special Report in March 2015,
the United Nations (UN) Special Rapporteur on Torture and other Cruel, Inhuman or

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Degrading Treatment or Punishment cited incidents of ill-treatment of children with
mental disorders in so-called prayer camps (alternative residential facilities), such as
shackling to the walls, floors or trees and forced fasting. An earlier report in 2013
cited severe abuses, such as neglect, mental and physical abuse and sexual
violence, committed against people with psychosocial and intellectual disorders in
health-care settings. Certainly, in those instances, instead of getting cured, their
conditions get aggravated

Thus, responding to mental health issues with a “human rights-based”
approach has been highlighted by international bodies such as the UN and the
WHO. Very recently, on 29 June 2016, the UN General Assembly adopted @
Resolution affirming the need for States to integrate human rights perspective into
mental health services. WHO, in its 2003 Mental Health Legislation and Human
Rights document (WHO Document), stressed that “all people with mental disorders
have the right to receive high quality treatment and care delivered through
responsive health care services,” and that ‘they should be protected against any
form of inhuman treatment and discrimination.”

The WHO Document also underscored the need for mental health legislation
to protect the rights of people with mental disorders. The document states that
mental health legislation: (i) can provide a legal framework for addressing critical
issues such as community integration of persons with mental disorders, provision of
high quality care, protection of civil rights and the protection and promotion of rights
in other critical areas such as housing, education and employment; and (ii) can play
an important role in promoting mental health and preventing mental disorders

This proposed law aims to address the growing mental health needs of
Filipinos by formulating and institutionalizing a national mental health care delivery
system that will ensure available, accessible, affordable, equitable, responsive, and
high quality mental health care services, especially the marginalized and high-risk
population. This law also aims to promote mental health and well-being of all
Filipinos.

Hence, immediate passage of this bill is earnestly sought.

nch¥ Sato

KABAYAN Party List

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

SEVENTEENTH CONGRESS:
First Regular Session

1045

House Bill No.

Introduced by Representative Ron P. Salo

AN ACT PROMOTING MENTAL HEALTH,
PROVIDING FOR A NATIONAL MENTAL HEALTH CARE DELIVERY SYSTEM,
ESTABLISHING A PHILIPPINE MENTAL HEALTH COUNCIL,
APPROPRIATING FUNDS THEREFOR AND FOR OTHER PURPOSES

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 "Philippine Mental Health
Act of 2016."

SEC. 2. Declaration of Policy. — It is hereby declared the policy of the State to
protect, promote, and fulfill the right of all Filipinos to mental health. It shall promote
mental health and well-being of the people, respect the rights of the people who
require mental health services, and protect the rights of all people with mental
disabilities. The State shall provide mental health care services appropriate to their
needs and based on nationally and internationally-accepted standards.

The state recognizes that people with mental disorders are a vulnerable section of
society. Because of the nature and/or severity of their illness, people with mental
disorders may face discrimination, marginalization, and other vulnerabilities that
increase the likelihood of violation of their human rights. Hence, the State shall
endeavor to develop plans, policies, programs, mechanisms and measures to
address these discrimination, marginalization and vulnerabilities

The State reaffirms its commitment as a State-Party to the UN Convention on the
Rights of Persons with Disabilities, to undertake measures to “ensure and promote
the full realization of all human rights and fundamental freedoms for all persons with
disorders without discrimination of any kind on the basis of disability,” and to promote
respect for their inherent dignity. In line with this, the State guarantees its obligation
under the UN General Assembly Resolution 46/119, which adopts the principles for
the protection of persons with mental illness and for the improvement of mental
health care, to implement the said principles through appropriate legislative, judicial,
administrative, educational and other measures.

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SEC. 3. Objectives. — The following are the objectives of this Act:

a)

b)

f)

Ensure a community of Filipinos who are mentally healthy, able to contribute
to the development of the country and attain a better quality of life;

Promote mental health and well-being of all Filipinos through access to an
integrated, well-planned, effectively organized and efficiently delivered mental
health care delivery system that provides affordable, equitable, and high
quality mental health care services, and that responds to their mental health
needs in equity with their physical health needs;

Ensure the protection of the fundamental rights and freedoms of persons with
mental health needs, and the reduction of the burden and consequences of
mental ill - health, mental and brain disorders and disabilities,

Provide the direction for a coherent, rational, and unified response to the
nation's psychosocial and mental health problems, concerns and efforts;

Integrate mental health care in the general health delivery system; and

Promote a strengthened community based mental health care delivery
system.

SEC. 4. Definitions. — For the purpose of this Act, the following terms shall be
defined as follows:

a)

b)

d)

Mental health refers to a state of well-being in which an individual fulfills his
or her own potential in every stage of human development, 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.

Mental Disorder refers to impairments, activity limitations, and individual and
participatory restrictions denoting dysfunctional aspects of interaction between
an individual and his/her environment

Mental Iliness refers to neurologic or psychiatric disorder characterized by
the existence of recognizable, clinically significant disturbance in an
individual's cognition, emotion regulation, or behavior that reflects a
dysfunction in the neurobiological, psychosocial, or developmental processes
underlying mental functioning

Mental Incapacity refers to the: (i) absence of mental capacity resulting to
the inability to carry on the everyday affairs of life or to care for one's person
or property with reasonable discretion; or (ii) inability to understand the
consequences that his/her decisions and actions have for his/her own life or
health and for the life and health of others, which may be serious and
irreversible

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e) Psychosocial Problem refers to a condition that indicates the existence of
disturbances in the individual's behavior, thoughts and feelings brought about
by sudden, extreme or prolonged stressors in the physical or social
environment.

f) Psychiatric emergencies are conditions which may present a serious threat
to the person’s wellbeing, and/or that of others requiring immediate psychiatric
interventions such as in cases of attempted suicide, acute intoxication, severe
depression, acute psychosis or violent behavior.

g) Mental Health Facility refers to any establishment, or any unit of an
establishment, which has, as its primary function, mental health care or
services

h) Mental Health Professional refers to a medical doctor, clinical psychologist,
nurse, social worker or other appropriately trained and qualified person with
specific skills relevant to mental health care.

i) 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 which
are provided by mental health facilities and mental health professionals.

j) Mental Health Workers refer to trained volunteers or advocates engaged in
mental health promotion and services under the supervision of mental health
professionals.

k) Multidisciplinary care plan refers to a comprehensive and holistic
careltreatment plan which includes a range of interventions to address not just
the psychological concerns of the service user but other factors in his/her
social environment, through varied expertise of a range of mental health
professionals including doctors, nurses, psychologists, social workers,
‘occupational therapists and other therapists.

1) Allied Professionals refer to any formally educated and trained non-mental
health professionals, such as, but not limited to, physicians, social workers,
nurses, occupational therapists, recreational therapists, priests, ministers,
pastors, and nuns.

m) Carer refers to a person who may or may not be the patient's next of kin or
relative who maintains a close personal relationship with the patient and
manifests concer for his/her welfare

n) Discrimination on the basis of disorder means any distinction, exclusion or
restriction on the basis of disorder which has the purpose or effect of
impairing or nullifying the recognition, enjoyment or exercise on an equal
basis with other human beings, of all human rights and fundamental
freedoms in the political, economic, social, cultural, civil or any other field

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©) Legal Representative refers to a substitute decision-maker charged by law
with the duty of representing a patient in any specified undertaking or of
exercising specified rights on the patient's behalf. The legal representative
may also be a person appointed in writing by the patient to act on his/her
behalf, unless the patient lacks mental capacity, or otherwise fails to appoint a
legal representative in writing

p) Service user refers to a person receiving mental health care whether admitted to a
mental health facility or undergoing care or treatment outside a facility.

ARTICLE |
RIGHTS OF PERSONS WITH MENTAL HEALTH NEEDS

SEC. 5. Human rights of persons with mental health needs. ~ All rights in the
Constitution and those rights recognized under international instruments duly signed
and ratified by the Philippines, in consonance with Philippine law, shall be enjoyed
by persons with mental health needs without any discrimination.

Specifically, persons with mental health needs shall have the following rights:

a) To be treated with respect and dignity;

b) To be protected from discriminatory, degrading, and harmful treatment;
torture, sexual abuse, and any other form of cruel and inhumane treatment;

¢) To be adequately informed about their illness and the multidisciplinary

services available to cater to their needs and the treatment options available;

To give consent free from any threats or improper inducement, before being

admitted in a mental health facility, or being provided with any treatment or

care

e) To have a responsible legal representative to serve as a substitute decision-

maker and to represent the interests of the service user in case the severity of

the mental disorder or illness renders the service user unable to provide

consent;

To actively participate in the formulation of their multidisciplinary treatment

plan;

g) To receive treatment of the same quality and standard as other individuals in
a safe, conducive, environment, and in the least restrictive manner;

h) To receive treatment which addresses holistically their needs through a
multidisciplinary care plan approach;

i) To receive aftercare and rehabilitation and be supported for full integration
and inclusion in the community

j) To have access to their clinical records unless, in the opinion of their
attending mental health professional, revealing such information may cause
harm to the service user or put at risk the safety of others. Where an
information is unjustly withheld, the service user or his/her legal
representative may contest such decision with the appropriate body in the
hospital/mental health facility which is authorized to investigate and resolve
disputes, or to the Commission on Human Rights;

d)

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k) To have a competent counsel of his/her own choice where the service user
needs legal representation; and in cases where he/she cannot afford one,
he/she shall be assisted by the Public Attorney's Office;

1) To be secure in the confidentiality of all information, about themselves, their
illness and treatment in whatever form stored, which information shall not be
revealed to third parties without their consent unless:

i. Ordered by a competent court;

ii. There is sufficient reason to believe that disclosure of information is in
the interest of safety of the public, groups, or individuals; or conversely
that non-disclosure will place individuals, groups of individuals, or the
public in serious harm or prejudice; or

ili, Whoever is requesting information is entitled under the law to receive
such.

m) To be informed, within 24 hours of admission in a facility, of their rights under
this Act, in a language and form that they understand

ARTICLE Il
DUTIES AND RESPONSIBILITIES OF GOVERNMENT AGENCIES

SEC. 6. Duties and Responsibilities of the Department of Health (DOH). - Itis
the duty and responsibility of the DOH to

a) Develop, through the Philippine Mental Health Council, a comprehensive
community based mental health care system, with a view to providing an
alternative to institutionalization and hospital based mental health care;

b) Ensure conditions for a safe, therapeutic and hygienic environment with
sufficient privacy in mental health facilities and shall be responsible for the
licensing, monitoring and assessment of all mental health facilities,

c) Ensure that all public and private mental health facilities are protecting the
rights of service users against cruel, inhuman and degrading treatment and/or
torture; and

d) Prohibit forced or inadequately remunerated labor within mental health
institutions. This does not include activities justified as part of an accepted
therapeutic treatment.

SEC. 7. Duties and Responsibilities of the Commission on Human Rights
(CHR). -It is the duty and responsibility of the CHR to

a) Establish mechanisms to investigate alleged improprieties and abuses in the
use of involuntary interventions and recommend appropriate charges against
the perpetrators;

b) Inspect all places where psychiatric service users are held for involuntary
treatment or otherwise, to ensure full compliance with domestic and
international standards governing the legal basis for treatment and detention,
quality of medical care, and living standards;

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°)

Appoint a Focal Commissioner for Mental Health under the CHR to ensure
that the rights of service users and their carers, as well as the rights of mental
health professionals and workers are protected in accordance with our
national laws and international obligations. The Focal Commissioner shall,
whenever necessary and if there are findings of human rights violations
committed by the mental health facility and/or any mental health professional
and mental health worker, recommend civil, administrative or penal actions to
appropriate agencies. The CHR will formulate the specific functions and
duties of the focal person

SEC. 8. Complaints. — The Department of Health, the Commission on Human
Rights and/or the Department of Justice shall receive all complaints of improprieties
and abuses in mental health care and shall, on their own or through coordination
with each other, initiate appropriate investigation and action against those who
authorized the confinement and committed the improprieties and abuses

SEC. 9. Duties and Responsibilities of the Heads of National and Local Mental
Health Facilities. — \t is the duty and responsibility of the heads of national and local
mental health facilities to:

1)

4)

5)

Inform service users of their rights. Every service user should be fully
informed about the treatment to be prescribed and the reason for
recommending such, and be given the opportunity to refuse treatment or any
other medical intervention. Informed consent must be sought from all service
users at all times, except where the service lacks the capacity to give or
withhold consent, in which case the legal representative shall make the
decision in the interest of the service user

Ensure that the decision on the need for a legal representative or substitute
decision-maker shall be made only for reasons of mental incapacity and shall
be made following established judicial procedures which should ensure that
the rights, will and preferences of the service users are respected as far as
possible;

Provide transparent and make accessible to the person affected and his/her
family the decision to apply involuntary treatment, as this is an essential factor
for building and maintaining mutual confidence;

Ensure that guidelines and protocols for minimizing restrictive care are
established; and

Keep a register on involuntary treatment and procedures.

ARTICLE Ill
MENTAL HEALTH CARE IN THE LOCAL GOVERNMENT UNITS

SEC. 10. Community Based Mental Health Care. — A comprehensive community
based mental health care delivery system shall be developed, which shall have the
following components

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a) Development and integration of mental health care in the community primary
health care. Basic mental health services, such as Mental Health and
Psychosocial Support Services (MHPSS), shall be made available at the
barangay health level. The MHPSS will ensure that mental health services are
available in times of natural disasters, development aggression, and
displacement.

b) Capacity building for local mental health workers. Continuing programs for
capacity building among local mental health workers shall be undertaken to
equip them to provide basic mental health care in the community.

c) Continuing support services and intervention for families and co-workers of
persons with mental disorders

d) 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.

) Advocacy and promotion of mental health awareness among the general
population. Training on community resilience and psychosocial well-being
shall be conducted in all barangays

SEC. 11. Psychiatric Service in Regional and Provincial Hospitals. — Psychiatric
service shall be established in every regional and provincial hospitals 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;

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

d) Linkage and possible supervision of home cares services for those with
special needs as a consequence of long-term hospitalization, unavailable
families, inadequate or non-compliance to treatment:

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

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ARTICLE IV
PHILIPPINE COUNCIL FOR MENTAL HEALTH

SEC. 12. Philippine Council for Mental Health. — The Philippine Council for Mental
Health, hereinafter referred to as the Council, is hereby established as an attached
agency under the Department of Health (DOH), to provide for a coherent, rational
and unified response to the 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 equitable
accessible, affordable, appropriate, efficient and effective mental health care to all its
stakeholders by qualified, competent, and ethical mental health professionals and
mental health workers.

SEC. 13. Duties and Functions. — The Council shall exercise the following duties
and functions:

a) Review and formulate policies and guidelines on mental health concerns;

b) Develop a comprehensive and integrated national plan and program on

mental health;

Conduct regular monitoring and evaluation in support of policy formulation

and planning on mental health:

d) Promote and facilitate collaboration among sectors and disciplines for the

development and implementation of mental health related program 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;

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;

Review all existing laws related to mental health and recommend legislation

which will sustain and strengthen programs, services and other mental health

initiatives;

Conduct or facilitate the implementation of 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 inter-agency committees, project task forces, and other groups
necessary to implement the policy and program framework of this Act;

j) Collaborate with relevant agencies as necessary to perform its functions; and

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

of this Act;

C)

e)

f)

g

hy

=

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SEC. 14. Composition. — The Council shall have eleven (110) members composed
of the following

a) The Secretary of Health, as ex officio chairman;

b) The Executive Director, as vice chairman and Chief Executive Officer:

c) Two (2) representatives from the government sector;

d) Two (2) representatives from the private health sector or consumer groups;
e) One (1) representative from the academe;

f) Two (2) representatives from the professional organization; and

g )

Two (2) representatives from non-government organizations involved in
mental health issues; as members

The members of the Council specified under par. (c) to (g) above shall be appointed
by the President of the Philippines

SEC. 15. Term of Office. - The appointive 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.16. Per Diem. — The members of the Council shall receive reasonable per diem
and transportation allowance subject to existing rules and regulations of the
Department of Budget and Management (DBM)

SEC. 17. Quorum. - The presence of a majority of the members of the Council shall
constitute a quorum.

SEC. 18. 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. 19. Executive Director. — The Council shall have an Executive Director to be
appointed by the President of the Philippines. He shall serve for a term of three (3)
years, and shall be eligible for one (1) reappointment. He shall not be removed from
office except in accordance with existing laws.

SEC. 20. Duties and Functions of the Executive Director — The Executive
Director shall have the following duties and functions:

(1) Act as chief executive officer of the Council and assume full
responsibility in implementing its purposes and objectives;

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

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

(4) Execute and administer all approved policies, programs and measures,
and allocate appropriate resources for their implementation;

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(5) Recommend to the Secretary of Health the appointment of personnel
of the Council including supervisory, technical, clerical and other
personnel in accordance with the staffing patterns and organizational
structure approved by the Council; and

(6) Represent the Council in all of its official transactions or dealings and
authorize legal contracts, annual reports, financial statements, and
other documents.

SEC. 21. Rank and Salary. - The Executive Director shall have a rank and salary
equivalent to an Assistant Secretary.

SEC. 22. Appointment of Members. — Within thirty (30) days from the issuance of
the Implementing Rules and Regulations (IRR) of this Act, the President of the
Philippines shall appoint the members of the Council

SEC. 23. Advisory Board. - The Philippine Mental Health Council shall create an
advisory board constituting of mental health care users, carers and professionals,
representatives of the DOH as well as visiting bodies under national and
international obligations of the State.

ARTICLE V
MISCELLANEOUS PROVISIONS

SEC. 24. Implementing Rules and Regulations (IRR). — Within (90) days from the
effectivity of this Act, the Secretary of Health shall in coordination with the Philippine
Mental Health Council, as created by Executive Order No. 470 series of 1998,
formulate the implementing rules and regulations necessary for the effective
implementation of this Act

SEC. 25. Appropriations. - The amount necessary to carry out the initial
implementation of this Act shall be charged against the current year’s appropriation
of the DOH. Thereafter, such amount as may be necessary for the continued
implementation of this Act shall be included in the Annual General Appropriations
Act.

SEC. 26. Separability Clause. — If any provision of this Act is held invalid or
unconstitutional, the remainder of the Act or the provision not otherwise affected
shall remain valid and subsisting.

SEC. 27. Repealing Clause. — Any law, presidential decree or issuance, executive
order, letter of instruction, administrative rule or regulation contrary to or inconsistent
with the provisions of this Act is hereby repealed, modified or amended accordingly.

SEC. 28. Effectivity. — This Act shall take effect fifteen (15) days upon its
publication in at least two (2) national newspapers of general circulation

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