As the moving force behind the Citizens’ Network for Psychosocial Response (CNETPSR), a loose multisector coalition of mental health professionals and NGOs engaged in psychosocial interventions, Dr. June Pagaduan-Lopez, a noted psychiatrist, professor of psychiatry, and stress and trauma expert, was among the first volunteers to hit Tacloban in January 2014.
It was a National Commission on Culture and the Arts-supported effort to process the survivors of Supertyphoon “Yolanda,” and to help them come to terms with what they had just gone through.
“Post-‘Yolanda,’ an international NGO found psychiatric patients living in cages, who had been left there during the calamity,” she recounts.
“The families didn’t know what to do, and had been advised to cage them, or they may be liable for any harm caused. All that misinformation, misconception and lack of proper services drives the poor families and patients to a level of chronicity that becomes acceptable to the community, so mental illness is set aside as something to be ashamed of.”
A video made by The Guardian documented this scenario, which was, as Pagaduan-Lopez says, “like a scene from the medieval ages.”
She is also one of the authors of the proposed Mental Health Bill, an initiative of the Philippine Psychiatric Association (PPA), which hopes to finally give mental health in the Philippines the attention—and resources—it deserves, as a way to protect the rights of the mentally ill.
There have been no less than 16 bills crafted under various administrations through the years, Pagaduan-Lopez reveals, all focused on the creation of a Philippine Mental Health Council as part of the executive branch. The Philippines has no laws covering mental health.
Rights-based
“This new version is more rights-based than any previous incarnation,” Pagaduan-Lopez says.
As opposed to a public health approach, which is concerned with determining causes of diseases and decreasing incidence, a rights-based approach “focuses on the obligation of the state to provide sufficient, adequate healthcare as a basic human right,” she says.
In other words, it is the government’s job to provide access to healthcare, quality of life, and freedom from any cruel or degrading treatment—like being locked in a cage.
As Pagaduan-Lopez stated in a speech before the Asean Federation for Psychiatrists and Mental Health in November 2014, “Abuse and ill treatment in health-care settings, be it in hospitals, hospices or prison clinics, are not a new phenomenon. Everywhere discrimination and stigma constitute a failure to respect human dignity and equality by devaluing those affected, often exacerbating the inequalities already experienced by those vulnerable and marginalized groups, abuse is most likely to happen.”
A 35-year veteran of the profession, Pagaduan-Lopez has seen the vast range of mental illnesses—from the trauma of calamity and abuse victims to the depression that pushes many to end their lives.
It is an epidemic of the generation, she agrees. “Global statistics show that in terms of DALY (disability-adjusted life year, a measure of overall disease burden, or the extent to which a specific disease causes disabilities), mental disorders score worse than cardiovascular and neurological diseases and cancer.”
Stigmatized
According to statistics from the World Health Organization (WHO), every year a million people commit suicide, which is the third leading cause of death among young people worldwide.
“We’re seeing more suicides among adolescents, as well as other self-destructive and high-risk behavior, like drinking, promiscuity, drugs, an inimical lifestyle,” Pagaduan-Lopez says.
“Yet there remains a tendency not to talk about it, as mental illness in general is stigmatized and negatively influences your other chances in life, your work, your hireability. There is fear of being talked about, of being blamed, and suspicion from others. That is torture for families.”
A lot of successful suicides are also now based on genetically determined psychological disorders, Pagaduan-Lopez adds, a fact that compounds the stigma.
The proposed bill espouses a “least restrictive alternative,” which includes a community component—a tall order in a country where basic health services have yet to be addressed in some barangays.
“Many hospitals don’t have psychiatric units, much less outpatient care,” Pagaduan-Lopez says. “There are about 600 board-certified psychiatrists registered with the PPA for a country of 100 million people, most of them in cities. People end up languishing in the one and only state hospital in the country because relatives don’t want to bring them out. Meanwhile, there is a flourishing business in unaccredited halfway homes.”
So what if it’s vaccines, for instance, that are more urgently needed?
“It’s not an either/or,” Pagaduan-Lopez insists. “Health means mental, physical, emotional, even spiritual health, as defined by the WHO.”
As Pagaduan-Lopez and her colleagues have discovered time and again, mental illness and psychosocial trauma take a while to heal, as clearly evidenced in their experience in Tacloban.
“It’s ironic—when we marked the first anniversary of ‘Yolanda’ last November, there was all that debate as to whether people had indeed recovered,” she notes.
So much grief
Earlier, in August 2014, her group was about to train barangay health workers in Tacloban on mental and psychosocial issues related to disasters—but the experts realized there was still so much grief.
“The whole group of 30 volunteers still broke down when they recalled what happened. We had to backtrack to processing, to give them the opportunity to recognize how they feel. LGU people, mayors, municipal development officers—they were getting all sorts of seminars and new jobs, and they hadn’t even been processed yet.”
CNETPSR started as a “spontaneous reaction” after calamities in 2007.
In 2009, the group worked with the Department of Health’s Health Emergencies Services to conduct training for psychosocial response in all regions of Mindanao affected by armed conflict, even producing a manual on psychosocial services for health emergencies and disasters.
The group has recently registered with the Securities and Exchange Commission as Bahay Kalipay Training and Resource Center for Psychosocial Response, and continues to partner with the United Nations Children’s Fund in conducting psychosocial processing of LGU health workers and disaster responders in 41 municipalities affected by “Yolanda,” to enhance the resilience and disaster preparedness of their health systems.
A graduate of the University of the Philippines Manila College of Medicine, Pagaduan-Lopez has been a member of the UP Faculty of Medicine since 1980, and has worked tirelessly in human rights and the rehabilitation of torture survivors and their relatives, even as she maintained a private practice.
She was named one of the Ten Outstanding Women in the Nation’s Service in 1989 and was elected to the United Nations Subcommittee on the Prevention of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment in 2012.
“Of course it affects me,” Pagaduan-Lopez says when asked if all the emotional work gets under her skin. “Trauma is contagious, and being a witness can lead to vicarious traumatization. That’s why we’re advocates of creating caring communities, especially among responders and carers.”
Getting the Mental Health Bill finally passed, Pagaduan-Lopez says, will make a world of difference in their work.
Last October 2014, at the end of the Healthy Mind Summit, the draft bill was submitted to Sen. Pia Cayetano for shepherding.
“We are told that it can take a decade or so to pass a bill into law in our Congress,” Pagaduan-Lopez said in her 2014 lecture. “It might happen way beyond the lifetimes of many of us. Nonetheless, we cannot be daunted. The questions we must ask ourselves are, can we get our act together, and do we have what it takes to pull it through? My answer is, ‘Yes.’”
The 3 p.m. show on July 26 of the PETA hit musical “Rak of Aegis” at the PETA Theater in New Manila, Quezon City, will be for the benefit of CNETPSR’s orphaned scholars. Check the Citizens’ Network for Psychosocial Response Facebook page for details, or contact Ticketworld at 8919999 or José Lino Borbe at 0916-7434423.