Public mental health: A wish list
The World Health Organization (WHO) recently released the World Mental Health Report, a 20-year update to its previous incarnation. Essentially, it described the worsening mental health conditions where one in eight people in the world live with a mental disorder. While public interest in mental health has increased over the last few years, investment in mental health programs and services remains low. This parallels the Philippine situation where there was a marked increase in mental health awareness but where government spending on mental health remained incredibly low, with the Department of Health (DOH) allotting only 0.3 percent of its total budget toward mental health, according to their 2022 budget briefer. The recommendations of the WHO, with its emphasis on community-based care, promotion and prevention, and a multisectoral approach, were surprisingly aligned with my own views. I say surprisingly because the WHO has not always been the most holistic when it comes to health and nonmedical voices weren’t always heard. As of this writing, a new DOH secretary has yet to be appointed. Whoever they will be, I hope that they strongly consider prioritizing public mental health that is not necessarily limited to hospital care. The following is my wish list for our country’s public mental health:
I wish for a public mental health policy that veers away from hospital-based care. Hospitalization for mental health concerns should be considered as the last resort response, as this is generally reserved for acute, severe, and psychiatric conditions. An investment focus on hospitalization means we are neglecting the majority of mental health concerns and conditions that can be addressed at the home or community level—thereby risking the escalation of these conditions that warrant hospitalization in the future. Hospital-based treatment should be a necessary part of any comprehensive mental health plan, but it shouldn’t be its center. Good public mental health requires a heavy investment in community-based care instead. This involves programs and campaigns that target community and living conditions that promote or hinder mental well-being: addressing safety and security needs, removing stigma and discrimination, fostering social support systems, educating parents on proper mental health care for their children, and training employers and management on balancing work demands while respecting well-being needs. Community-based care is also best suited to address a wide spectrum of mental health concerns, from complicated problems of living to long-term management of psychiatric conditions such as depression and anxiety. One never heals from depression and anxiety from a hospitalization stay. After initial stabilization in the hospital, the individual eventually still has to learn to manage their condition in the real world.
Community-based care can also use a broader range of mental health providers, from lay support to specialized care. I was once part of an outpatient center where we had a full-time social worker who helped with the case management of our psychotherapy clients. She was an indispensable member of our team, as she helped advocate and liaison for our clients to get the needed resources, such as housing, work, food, and transportation. She was also a vital source of support for the clinicians, as we felt handicapped to help our clients since their problems mostly stem from societal conditions that psychotherapy alone would be ill-equipped—and unethical—to handle. I worked in another setting with a nutritionist on the team who allowed for more holistic care as the improvement of the body leads to improvement of the mind, and vice versa. I was privileged enough to almost always work in interdisciplinary settings, which made me see how much more effective they can be in solving mental health concerns.
Promotion and prevention strategies should also be prioritized. Most mental health programs that I have seen are centered on direct services: medication management, hospitalization, and psychotherapy/counseling services. While these are necessary, they shouldn’t be the only component of a mental health program. In public health, we address issues like sanitization, hygiene, and healthy lifestyles to prevent health problems. For example, we emphasize the best hygiene and dietary practices in oral health to minimize future dental issues. However, are people aware of what can prevent significant mental health issues in mental health? In my imagined public mental health campaign, I envision teaching children and adults practical life skills that will allow them to pursue their own goals, protect their self-esteem and self-worth, and be adequate support to others.
There is no health without mental health—and mental health is much more than just health.
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