The Philippine Mental Health Crisis: From the Economic Perspective

By: Andre Louis C. Gaviola

Published: June 18, 2023

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The Philippines is in a mental health crisis as mental health illnesses are the third most common disability in the country wherein six million Filipinos live with anxiety and depression (Martinez et al., 2020). Due to our colonial history, the country is home to 85 million Roman Catholics, or 78.8 percent of the 108 million population (PSA, 2020; Lally et al., 2019), and that unique and deep connection to religion has resulted in one of the most popular beliefs that mental health illnesses are non-existent and are something to be ashamed of (Maravilla & Tan, 2021) and has affected the people and the economy in the human, social, and economic aspect. In a study conducted by Tanaka et al. (2018), it showed that the mental health stigma (e.g. familial problems, unrealistic pessimism and optimism, oversimplified chronic course, etc.) in the Philippines is the primary reason why mental health care is currently being given little attention (Maravilla & Tan, 2021). 

In response, the Philippine government passed Republic Act No. 11036 or commonly known as the Philippine Mental Health Act. But contrarily, as Eshun and Gurung (2009) stated that culture can affect the inner linings of the mind which can heavily affect how people perceive different symptoms and how they deal with psychological problems. Even after passing the mental health act only five percent is allocated to mental health expenditure (World Health Organization—Assessment Instrument for Mental Health Systems, 2007; Department of Health, 2018; Tanaka et al., 2018; Martinez et al., 2020) and a report by the World Health Organization—Assessment Instrument for Mental Health Systems (2007) said that there were only 7.76 hospital beds and 0.41 psychiatrists per 100, 000 people (Department of Health, 2018) and when compared to other Western Pacific countries with similar economic conditions the ratio was known to be lower (Lally at al., 2019). But as the World Bank Group (2021) reiterated and emphasized that giving solutions to mental health-related problems, could lead disadvantaged economies to improve.

From an economic perspective, it was discovered by Hakulinen et al. (2020) that individuals with severe mental health disorders were reported to have lesser chances for employment before diagnosis and more especially after the diagnosis and thus could greatly affect employment and the level of education. The majority of Filipinos dislike their current living conditions because of the poor economic conditions (unemployment, low salary, etc.) resulting in the shortages of health workers in the country (Palaganas et al. (2017). Arguably, increasing the wages of low-wage earners will not positively affect their mental health (Kronenberg, Jacobs, & Zucchelli, 2017); Filipinos overseas enjoy high salaries and alleviated living conditions but mental health issues still exist among them (Martinez et al., 2020). Easterlin et al. (2010) reiterated that

“happiness does not increase when a country’s income increases”, and as stated by Maravilla and Tan (2021), “the effect of mental health on the economy, is probably equally as important.”

Diener’s (2009) Subjective Well-being (SWB) shows individuals who have high results tend to live longer, have healthier social relationships, and work more productively (Montagnoli, 2019). As the economy has a bi-directional relationship with mental health (Knapp & Wong, 2020); mental health issues can also contribute to a notable decrease in economic activity due to reduced productivity and insufficient resources allocated for treatment (Maravilla & Tan, 2021). In comparison, Northwestern European countries, provide a system that provides “security, education, and a reasonable balance of work and personal time” (Andreasson & Birkjaer, 2018) and as shown by the Happiness World Report (2020) the five Nordic countries-Finland, Denmark, Norway, Sweden, and Iceland have placed in the top with a high level of happiness and satisfaction in life because of high levels of SWB.

A healthy economy makes people happy but happy people make a strong country. In the advent of Covid-19, happier people were more compliant with following rules and regulations compared to the opposite spectrum (Krekel et al., 2020). Arguably, does a happy society make happy people which leads to a better economy? It is stated that mental health is associated with either happiness or unhappiness (Maravilla & Tan, 2021) however socioeconomic factors in the Philippines (e.g. poverty, poor education, unemployment, etc.) are highly experienced by Filipinos thus affecting happiness. The rise and fall of economies produce secondary mental health effects that lead to depression and anxiety (World Health Organization–European Region, 2020). As the Philippines experienced multiple economic crises in the 1980s and 1990s it resulted in a sharp decline in Filipinos trusting the country’s banking system–it was called the lost decade for the Philippine economy. However, due to economic, financial, and financial reforms in the 2000s, trust in the banking system gradually increased. In a study conducted by Montagnoli and Mirko Moro (2019), showed that economic crises have affected micro and macroeconomic changes in countries that lead to long-lasting psychological losses. Especially distrust and disapproval of financial and political institutions negatively affect the psychological process in the human decision-making capacity. In the end, if the Philippine government would address issues in the mental health sector (e.g. mental health stigmas) it would fix a lot of problems (e.g. economic recession) the country is currently facing–a loss in mental health is a loss in the economy.

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References:

Andreasson, U., and Birkjaer, M. (2018). In the Shadow of Happiness. Copenhagen: Nordic Council of Ministers. doi: 10.6027/ANP2018-799

Department of Health (2018). Mental Health Program. Available online at: https://doh.gov.ph/national-mental-health-program 

Department of Health (2020). Your Mind Matters: DOH Calls for Unified Response to Mental Health. Available online at: https://doh.gov.ph/press-release/YOUR-MIND-MATTERS-DOH-CALLS-FOR-UNIFIED-RESPONSE-TO-MENTAL-HEALTH 

Diener, E. (2009). The science of well-being: the collected works of Ed Diener. Soc. Indic. Res. Ser. 37, 1–10. doi: 10.1007/978-90-481-2350-6_1

Easterlin, R.A., McVey, L.A., Switek, M., Sawangfa, O., and Zweig, J.S. (2010). The happiness—income paradox revisited. Proc. Natl. Acad. Sci. U.S.A. 107 22463–22468. doi: 10.1073/pnas.1015962107

Eshun, S., and Gurung, A.R. (2009). Culture and Mental Health: Sociocultural Influences, Theory, and Practice. Hoboken: Blackwell Publishing. doi: 10.1002/9781444305807

Hakulinen, C., Elovainio, M., Arffman, M., Lumme, S., Pirkola, S., Keskimaki, I., et al. (2020). Employment status and personal income before and after onset of a severe mental disorder: a case-control study. Psychiatric Serv. 71:3. doi: 10.1176/appi.ps.201900239.ps.psychiatryonline.org

Knapp, M., and Wong, G. (2020). Economics and mental health: the current scenario. World Psychiatry 19, 3–14. doi: 10.1002/wps.20692

Krekel, C., Swanke, S., De Neve, J., & Fancourt, D. (2020, September 15). Are happier people more compliant? global evidence from three large-scale surveys during covid-19 Lockdowns. SSRN. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3691403

Kronenberg, C., Jacobs, R., and Zucchelli, E. (2017). The impact of the UK National Minimum Wage on mental health. SSM Popul. Health 3, 749–755. doi: 10.1016/j.ssmph.2017.08.007

Lally, J., Tully, J., and Samaniego, R. (2019). Mental health services in the Philippines. BJPsych Int. 16, 62–64. doi: 10.1192/bji.2018.34

Maravilla, N. M. A. T., & Tan, M. J. T. (2021). Philippine Mental Health Act: Just an act? A call to look into the bi-directionality of mental health and economy. Frontiers. https://doi.org/10.3389/fpsyg.2021.706483

Martela, F., Greve, B., Rothstein, B., & Saari, J. (2020). The Nordic exceptionalism: What explains why the Nordic countries are constantly among the happiest in the world. The World Happiness Report. https://worldhappiness.report/ed/2020/the-nordic-exceptionalism-what-explains-why-the-nordic-countries-are-constantly-among-the-happiest-in-the-world/ 

Martinez, A., Co, M., Lau, J., and Brown, J. (2020). Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Soc. Psychiatry Psychiatric Epidemiol. 55, 1397–1413 doi: 10.1007/s00127-020-01937-2

Montagnoli, A, and Mirko Moro, M. (2019). The cost of banking crises: new evidence from life satisfaction data. Kyklos 71, 279–309. doi: 10.1111/kykl.12170

Palaganas, E., Spitzer, D., Kabamalan, M., Sanchez, M., Caricativo, R., Runnels, V., et al. (2017). An examination of the causes,consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving—a mixed method study. Human Resour. Health 15:25. doi: 10.1186/s12960-017-0198-z

Philippine Statistics Authority. (2023, February 22). https://psa.gov.ph/content/religious-affiliation-philippines-2020-census-population-and-housing 

Republic act no. 11036: Govph. Official Gazette of the Republic of the Philippines. (2018, June 20). https://www.officialgazette.gov.ph/2018/06/20/republic-act-no-11036/ 

Tanaka, C., Tuliao, M., Tanaka, E., Yamashita, T., and Matsuo, H. (2018). A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines. BMC Psychiatry 18:325. doi: 10.1186/s12888-018-1902-9

World Bank Group (2021). Data, Digitalization, and Governance. Europe and Central Asia Economic Update (Spring). Washington, DC: World Bank. doi: 10.1596/978-1-4648-1698-7

World Health Organization—Assessment Instrument for Mental Health Systems (2007). WHO-AIMS Report on Mental Health Systems in the Philippines. Available online at: https://www.who.int/mental_health/evidence/philippines_who_aims_report.pdf (accessed April 30, 2021).

World Health Organization—European Region (2020). Mental Health: Fact Sheet. Available online at: https://www.euro.who.int/__data/assets/pdf_file/0004/404851/MNH_FactSheet_ENG.pdf (accessed June 8, 2021).