Versus the years prior, people are more open and receptive to conversations surrounding mental illness. All of these things are signs of progress, but what about courses of medication to treat those mental illnesses?
According to the World Health Organization (WHO) and the Department of Health (DOH), the Philippines has the third highest incidence of mental health problems in the Western Pacific region. There are an estimated 3.6 million Filipinos suffering from mental, neurological, or substance use disorders. Of those 3.6 million people, 1,145,871 suffer from depression.
But of those 3.6 million people, who’s actually seeking professional help? And more than that, who’s actually getting the medical treatment and psychiatric medicine that they need?
Filipinos seek help, but…
There’s a lot of fear and misunderstanding surrounding psychiatric treatment and medication. Some of those misconceptions are that the medication is addictive, it has zombie-like side effects, it’ll make the condition worse, negatively affect the brain, or that people will have to take them forever, according to Dr. Maria Elena Del Mundo-Nepomuceno, a member of the Department of Psychiatry and Behavioral Medicine at the University of the Philippines (UP) – Philippine General Hospital.
Dr. Nepomuceno is a board licensed child, adolescent, and adult psychiatrist and a clinical associate professor at the UP College of Medicine.
In her professional opinion, there’s a psychiatric medication hesitancy problem in the country.
“It primarily stems from the belief that mental health is not a medical illness—that one should be able to counteract anxious and depressive feelings using one’s inherent strengths or for highly religious people, through strengthening of faith.”
And that’s the case for many people, formerly including myself.
I saw therapy and taking psychiatric medication as a last ditch effort to get better, something I avoided until I couldn’t. Once I was open to the option of therapy, I still saw psychiatric medication as something I should avoid. I was under the impression it was the last nail in my “crazy” coffin. I thought I could get away with just talking to a therapist and that would be the end of it.
These sentiments, apparently, are shared by many prospective patients.
“There are patients who come to see me and opt out of taking medication,” says Dr. Nepomuceno.
“Some of them have tried various coping mechanisms they found online, like mindfulness and meditation practices, talking to a counselor via video conferencing, or using supplements they read about online or were recommended by friends—which didn’t work. So they come to see us as a last resort.”
Dispelling a big myth
When starting their course of medication, one of the primary concerns that most patients share is how long they’ll be prescribed medicine. While it’s always a case-to-case basis, Dr. Nepomuceno assures that most patients won’t need to be on medication forever.
“Anxiety and depressive disorders alone, for instance, may respond to three to six months of medication combined with talk therapy. Some conditions respond very well to as needed doses of mild anxiolytics or hypnotics combined with talk therapy,” she said.
She does explain that there are different internal and external factors that might affect the severity of the condition, which can prolong the need for prescription medication.
Treatment at a cost
Aside from the preconceived notions people have about psychiatric medicine, cost is another gigantic barrier. Relative to income, medical costs are generally expensive in the Philippines. For psychiatry—a specialized field of medicine—it can be even more costly.
The average cost of a therapy session can range from P1,000 to P3,000 on average. That’s not taking the prescribed medication and transportation costs into account. Most health insurance firms also don’t include mental health in their coverage, which means the cost will often fall on patients.
A small silver lining in the cost issue is that some local government units (LGUs) offer free mental health prescription medication. Quezon City is a prime example. Residents who are registered persons with disabilities (PWDs) can avail of free medication when they present their card to their local barangay health center.
However, this practice isn’t commonplace and accessible to everyone.
(Some) changes in attitudes
While there’s still a lot of hesitance surrounding psychiatric medication, Dr. Nepomuceno has noticed a few changes due to the conversation around mental health.
“I’ve observed that the severity of the condition increases the openness to take psychiatric medication. The more apparent the functional impairment is in a patient, the higher the likelihood of agreeing to taking medication,” she said.
Parents of young children are more likely to opt out of medicating their children, unless there’s a noticeable impairment in their academic performance.
Her other observations include how men seem to be less hesitant to take medication in comparison to women. Some people coming in for their first psychiatric consultation also have a better idea of what their diagnosis and treatment options might be due to research they’ve done beforehand.
Not all these changes happen to be positive, though.
Dr. Nepomuceno also noted that parents of young children are more likely to opt out of medicating their children, unless there’s a noticeable impairment in their academic performance. When presented with two treatment options (talk therapy and medication or just talk therapy), most patients will still choose talk therapy alone.
A more inclusive conversation
When we talk about mental health, we can’t stop at its existence. Treating mental illness as an illness means we must also address the proper course of its treatment. That includes normalizing taking prescription medicine as a way of getting better.
I used to view taking medicine as physical proof that I was struggling with mental illness, but now I can say that it has really improved my life. Again, it’s a case-to-case basis and a trial and error process with both therapy and medication, but it’s something I’m glad I decided to do.
The conversation surrounding mental health has become more acceptable in public circles, so it’s also time we normalize taking psychiatric medication. For people who are suffering, it’ll likely do more good than any harm.