Mental Health Care in the Philippines

This is Nicole blogging today.  This morning’s visits were clearly all designed with me in mind as they focused on the mental health systems of Cebu in particular and the mental health resources available to Filipinos in general.


Led by Marybeth Chan, the president, and members of the Rotary Club of Cebu Gloria Maris, the first stop was the Vicente Sotto Memorial Medical Center for Behavioral Sciences, an inpatient and outpatient mental health facility that serves mainly indigent individuals in both areas.  The facility was in a gated compound in a central part of Cebu and included two one-story buildings. A number of people sat on benches apparently waiting for resources.  Many of them seemed uncomfortable about making eye contact and we tried to respect their privacy. We toured the main building, viewing the testing area, the counseling rooms, and administrative area. The facility was very well maintained and orderly. 

Dr. Ann Clara P. Alvez, DODT met with us and toured us around. In the outpatient offices they mainly conduct evaluations of children (primarily learning, developmental, and behavior concerns) and adults (people going to work abroad, or seeking positions in government or private companies that require assessments). Most often presenting concerns for teens are behavioral (in trouble with the law, involved in gangs) and most children are referred for behavioral concerns in school, like ADHD and disruptive behaviors. Most of the work they do is assessment and recommendation, though some therapy services are offered. In our discussion, we learn that the Center for Behavioral Sciences was named this in an effort to avoid the stigma associated with seeking psych or mental health services. John had a long conversation with Lemuel F. Sagaral, one of the staff counselors. He confirmed the difficulty of creating the safety that allows Filipinos to reach for the honesty that effective therapy requires. The level of shame attached to common issues (e.g., addictions, domestic violence) complicates the therapeutic relationship.

Nicole with Ann Clara P. Alvez

Next we toured the inpatient hospital that is part of the center (no photos were allowed for this part of the visit).  It first opened in 1965 in a building initially used as a hospital for people quarantined for tuberculosis and was then abandoned for a decade or more before it was repurposed. The staff has tried to make the facility work, but it is clearly not ideal. Patients are first held for 3 days in observation in a front area. After three days, if they are better, they are released, if not, they are admitted to the unit. the hospital currently houses 138 patients (have the capacity for 91 men and 55 women) on two stories: the first level is for the men; the second for the women. When we arrived, the men were outside in a large outdoor area about the size of a football field.  In one corner some men were playing basketball.  In another, the staff were working with a small group of patients. Most of the men were either sitting, lying on the ground, or walking around.  A number of patients expressed curiosity and approached John. All of them were friendly and a few could track a conversation.  Introductions were made. They were impressed we came to visit them from the U.S.

In the living quarters, there are multiple beds to a ward (the one we saw had 12 beds consisting of metal grate supports and pads that are removed daily for safety). There are also isolation rooms for patients in need of being separated from the population.  Theses consist of a square cell with a grated door that locks and when needed, patients are placed in there without clothing so they are not able to hurt themselves with anything. The walls of all the units are bare except for the marker and pen graffiti that is everywhere. Student nurses are in charge of developing and providing daily OT, Recreational Therapy and Music Therapy (they were singing in the yard to the patients today), and group therapy.

We then visited the women on the second level. When we arrived there was a recreational group in process. About 50 women were seated on benches and staff in starched white uniforms were performing skits, holding up signs with words to describe the actions and concepts they were acting out. Almost all the staff was female. The conditions of women seemed more orderly and socialized than it was for the men.
We learn that mental health services (assessment, therapy and medication) are NOT covered by insurance in the Philippines, so individuals either need to have the means to pay out of pocket or be declared indigent by the Department of Social Welfare and Development. There are also private facilities (this was government run) but we were not granted access to these. 


Before leaving, the GSE team had a supply of candy and treats that we were pleased to donate to the hospital for the patients. We wished we could do more.

Ann Clara P. Alvez, Mental Psychology Section, Center for Behavioral  Sciences, briefs the GSE team on the work of the Vicente Sotto facility. Bernie Lumapas, member RCCGM stands to the left of Ann Clara.

We next went to Intelliprime, Educational Consultancy and Human Development Center, a clinic established two years ago and the first in Cebu city that mainly does assessments for children and adults; most clients are teens or adults who are referred for job related testing (e.g. teachers). We met with Dr. Russell Velasquez-Makilling, PhD, a licensed guidance counselor and clinical psychologist (psychologists are not yet licensed in the Philippines) to discuss mental health care and the state of psychology in the Philippines. She reported the main concerns that children present with to her are ADHD, Autism, and other developmental concerns. We discussed the stigma related to mental health care, the lack of insurance coverage that keeps children and adults from receiving the care they need (including ADHD medications), and the cultural issues related to emotional and behavioral expressions of distress. We also learned that as there has been in increase in Call Center work here, there has been an increase of problems related to stress and working conditions for these workers, which has required more services to assist them. Currently, there are very few clinical psychologists in the Philippines, and Russell is the only one in Cebu. There is a movement to professionalize psychology and require licensure, but that is still only a movement. My teammates were quite gracious in allowing me the time to sit and talk with Dr. Velasquez-Makilling, who was likewise gracious in giving of her professional time. Overall, I was very appreciative of the whole morning as I learned so much.


Nicole with Dr. Russell Velasquez-Makilling



Marybeth Chan, president, RCCGM, with Bernie Lumapas, member RCCGM

Following our morning vocational visits, the ladies of RCCGM took Stacey and Nicole to the local shopping area for a wonderful lunch of fellowship, while John met with a PDG and journalist for a lunch time discussion.  After lunch, the ladies gave Stacey and I some time at the Ayala mall while we waited for John.  This was a cultural experience in itself.  Although on the surface it seems like an American mall (albeit a very big one, and somewhat high end) when you go in and shop around, you see the difference.  First, there are the security guards at every entrance to the mall and to each store.  They look in your bag briefly, and it is unclear what, if anything, they are looking for or even if they are paying attention.  In fact, when Grace and I pulled into the parking garage the previous night, there was a security guard that opened up the rear doors to Grace’s car to look in.  Again, for what?  Grace responded that they (the guards) likely don't even know what they are looking for but have been told to look anyway.  I don’t think this would be tolerated in the US.  The other thing that was notable, was that the sales staff in the malls are intensely pushy and not unlike the women that were swarming us selling their wares on the beach in Bohol. They keep asking, and more come, and they hold things up and shove them at you.  When we finally did make a purchase and are ready to leave, the sales staff took our bags, asked us where we are going next and escort us out. Apparently, shoplifting is a big concern and they appear to take security seriously as we were led not just to the store entrance, but to our next destination in the mall.  Who knew that a short shopping trip would be a cultural journey?


Our evening was filled with fellowship at a birthday dinner for John's home stay host, Joe Soberano, and attended by all of us (plus others). There was much food and singing (by us included), and a good time was had by all.