MANILA, Philippines – Survivors and health experts struggle to cope with mental health illnesses more than one year after Typhoon Yolanda, underscoring the uneven distribution of mental health services and expertise in this disaster-prone island nation.

Typhoon Yolanda (international name: Haiyan), ravaged central Philippines in November 2014, flattening entire villages, and leaving more than 6,000 dead and over 1,000 missing.

The World Health Organization (WHO) estimated that over 800,000 people in Yolanda-hit areas had suffered from mental health conditions like depression, anxiety, post-traumatic stress disorder and post-natal depression. These cases are expected to rise this year as more people are beginning to show signs of schizophrenia.

“The services and available skill in mental health are grossly inadequate—close to nil—if you compare it to the needs of the population,” said Prescy Cuevas, chief of the Department of Health (DOH) mental health program.

Numbers released by the DOH indicate that over 70% of the estimated 5,465 beds allocated for mental disorder cases are located in the Philippine capital of Manila and its neighboring cities. The rest are scattered across the 81 provinces of the country. Only 27 government run-medical centers and hospitals offer mental health services. 

About 5% of the annual DOH budget is appropriated for mental health, but most of it is spent on the upkeep of facilities and salaries of personnel.  

A WHO survey estimates that there are about 3.47 mental health practitioners for every 100,000 people of the general population. 

Mental Health Treatment Gap 

Globally, the scarcity and inequitable distribution of mental health services is most prevalent in low-to-middle income countries (LMIC) where an estimated 70-85% of persons with serious mental illnesses have never been seen by a mental health professional.

In LMICs, there are about 6 mental health professionals per 100,000 population and only about 0.67 get treatment. Health budgets fall way below the US$3-4 spending for a basic package of mental health care recommended by the WHO. 

Availability of information on prevalence of mental illnesses is another problem.

The Mental Health Atlas, which covers 184 member states, shows that 24% of countries do not have systems to collect even basic mental health information. 

In the Philippines, the latest available statistics on mental illness dates back to 2000.  The survey done by the National Statistics Office (NSO) showed that close to 70,000 Filipino suffered from mental illness. 

This poses a bigger problem in the archipelago that is regularly besieged by natural disasters. Located within the Pacific Ring of fire in southeast Asia, the Philippines is prone to typhoons, earthquakes and volcanic eruptions. An average of twenty typhoons a year is a staple weather advisory.

“About one in 10 people will experience a mental health illness within their  lifetime. This number doubles when there is a natural disaster or calamity,” said Julie Hall WHO Representative to the Philippines. 

The inherent stigma attached to mental disorders does not help. “A mental illness is seen as a character flaw to be ashamed of rather than a condition that can be treated with proper diagnosis and care,” added Hall. 

According to Hall, about 98% of mental health disorders can be treated with a combination of talk therapy, medication and support from one’s community of family and neighbors.

If diagnosed early enough, common mental illnesses like depression, which can later lead to schizophrenia, can be treated with outpatient services that can be done by a general practitioner. 

Community interventions

One positive outcome of Yolanda noted by health experts was it brought out the need to discuss grief and depression. The collective suffering created a sense of normalcy around the taboo topic. 

Jonathan Corpus Ong, a media and communication researcher at the University of Leicester in the UK, explored the role of digital technology in humanitarian response. He discovered that some survivors have taken to social media sites like Facebook to create their discussion groups where they can share their experiences. 

“The platform allows them to share their experiences with others who have gone through the same thing. It provides them an outlet to cope with the loss they continue to live with everyday,” said Ong. 

“The mass casualty and outpouring of grief created an increased demand for mental healthcare services,” said Dinah Nadera WHO medical officer for mental health. 

Efforts are in place to maximize interventions and current policies.

The Philippine Health Information System on Mental Health Conditions started the first integrated database system in 2014 as a first step in effectively recording mental illnesses.

Integrating psycho-social first aid in the humanitarian response and making it part of the essential services provided in during a disaster along with food and shelter is also a crucial step.

“The framework for this is already in place. We just need to implement it when disaster hits,” said Nadera, who admitted that urgent needs for food in the emergency response phase make it easy to overlook mental health.

In Tacloban, where most of the Yolanda fatalities were recorded, under the WHO, international mental health experts are training local health care professionals to administer mental health care services at the community level.

“It is going to be a huge challenge for us,” said Cuevas about almost starting from scratch. “We will start by empowering communities with information and expertise.” – Rappler.com