It was a perfect storm.

Having been admitted to a large and prestigious private university, Chris (not his real name) suddenly found himself alone and isolated. His high school friends had gone to other schools, and he found himself surrounded by strangers.

His high school had been liberal and easygoing. In contrast, the culture of his new university was strict and conservative, and he found the rules constricting and suffocating. It was a kind of culture shock.

He had difficulty connecting with his new classmates, with whom he seemed to have nothing in common.

The recent separation of his parents did not help. Add to that the stress of an excruciatingly slow, two-hour commute to school, and an even longer rush-hour trip home, more schoolwork than he was used to, and the usual angst of late adolescence—and Chris was one unhappy camper.

He slept badly, if at all. He took to spending more and more time online, where his social media scribblings started taking a very dark turn.

He started missing classes, and eventually entire school days. Things got so bad he decided to take a deferment rather than go back for another semester of what seemed like the same hopeless grind.

Luckily for Chris, some of his friends were woke: Alarmed by his social media posts about the worthlessness of life, and how it might be better if he was just to disappear from this world, they reached out to his parents.

They in turn sought advice from a psychiatrist, who put Chris on a regimen of anti-depressants and anti-anxiety medication.

Slowly, over a few months, he began to dig himself out of the black hole of depression.

He’s decided to take another crack at college, staying in a nearby dormitory to avoid the stress of a long commute. Maybe he could even make a few new friends this time around.

And if they started to talk about feeling hopeless and maybe ending their suffering, he’d know how to help them.

Chris’ story is by no means an isolated case.

3.3 million

A global school-based survey conducted by the World Health Organization in 2011 indicated that 16 percent of students between the ages of 13 and 15 have thought about killing themselves, while 13 percent have actually tried one or more times during the previous year.

Department of Health statistics indicate that 3.3 million Filipinos suffer from depressive disorders.

Last Jan. 22, the implementing rules and regulations for the Mental Health Act, which was passed in June 2018, were finalized.

Among other things, it declared mental health as a basic right of all Filipinos. It included an entire section on the integration of mental health in the educational system.

Section 25 states: “Educational institutions such as schools, colleges, universities and technical schools shall develop policies and programs for students, educators, and other employees designed to raise awareness on mental health issues, identify and provide support and services for individuals at risk, and facilitate access, including referral mechanisms of individuals with mental health conditions to treatment and psychological support.”

It makes sense to place schools at the forefront of mental health: Young people seem to be most at risk of developing psychological disorders during the unsettled period of adolescence, which can stretch from age 12 to the late 20s.

Changing how young people look at mental health will take time.

Social stigma

In many cases, depression and other psychological disorders are still viewed through the fog of guilt, shame and uncoolness. The social stigma prevents sufferers from seeking help, or even admitting that they have a problem.

“Mental health is a continuum, it’s not just having or not having a disease,” says Dr. Dinah Palmera P. Nadera, resident psychiatrist of the University Health Service of the University of the Philippines (UP) Diliman.

“There are many people with no diagnosable medical condition, but who have very bad mental health. They don’t have depression, schizophrenia or bipolar disorder, but they pull you down. They’re dysfunctional. Conversely, there are many people with depression but who have good mental health—they accept that they have been through depression, they are working through it, they accept their limitations and they know what they can do.”

Nadera heads the UP Health Service’s Mental Health Clinic, which was created in August last year as part of the school’s growing focus on mental health. She is UP’s first resident psychiatrist, and students are able to avail themselves of her services free of charge.

It’s part of the university’s multi-pronged approach to promoting mental health, she says.

“Students are provided with options for mental health services,” says Nadera.

“You have psychotherapy services provided by Psychological Services which is under the Office of the Chancellor, you have guidance and counseling services under the Office of Student Affairs, and psychiatric services through the Mental Health Clinic. The student has a choice of where to go, where they feel most comfortable.”

Buddy system

Under Psychological Services, peer counselors are trained by clinical psychologists in the faculty to help fellow students through their rough patches. This includes a “buddy” system, where one student can look after another.

There are also other ways a student can find help. An alert professor or college secretary can spot signs of trouble—such as slipping grades, increased absences, trouble with schoolwork—and direct students to Nadera’s clinic if they suspect mental health issues are the cause.

“There are many stories of students on the verge of harming themselves calling their therapists or their college, and being brought here,” she says. “Students know where to go for help, and access is easy because there’s no paperwork. Some colleges go to the extent of providing free medicines to students if they need them.”

The passage of the Mental Health Law has gone a long way toward increasing awareness of mental health, she adds. Situating the Mental Health Clinic within the University Health Service also makes it more acceptable to students.

“The mere fact that it’s in a public health setting and not a specialty clinic or mental hospital lessens the stigma,” she says.

Nadera believes the way forward is through mental health literacy.

Mental capital

“Mental health is fundamental public good,” she says. “We must make it accessible to more people because it’s part of well-being. It’s also part of economic development. Young people go to college with a stock of mental capital. If your mental health is not good, where will that mental capital go? That’s usually what I tell parents—we in the mental health field help protect that mental capital so it can be optimized and maximized.”

At Ateneo de Manila University, dealing with mental health issues falls within the purview of the Loyola Schools Office of Guidance and Counseling.

“Mental health is a pressing matter, and it’s something that everybody should know and accept because otherwise, we’re losing young people, brilliant minds,” says Gary Faustino, director of the Office of Guidance and Counseling.

“Since the Mental Health Law was just passed, it’s still in its infancy,” he adds. “We’re at the stage of establishing it at the school level and trying to unify it within the school system.”

One major hurdle is overcoming the stigma associated with going to the Guidance and Counseling Office, which in many private schools has come to mean having disciplinary problems and having to have your parents called to school.

“Not everyone is really comfortable with the idea of mental health, although there is a growing awareness and acceptance,” says Faustino. “Some parents have a hard time accepting that their children are depressed, even when it’s the psychiatrist that tells them.”

Ideally, he says, incoming students and their parents should alert the school if the student has mental health issues, so they can be prepared to help them. But in many cases, families are either unaware or are in denial.

“The school has ways of detecting problems, but they’re not foolproof,” he adds.

“A student may not show any markers in a psychological test, but later on, with the stresses of school, start to manifest symptoms. We have all sorts of interventions and programs, and we try to educate the staff and faculty on detection of signs, such as falling grades, frequent absences, but those are not guarantees.”

Psychosocial

Perhaps unique to the Ateneo is the presence on campus of psychosocial counseling services with a spiritual component. The Center for Family Ministries, the Ugat ministry for grassroots families, the Emmaus Center for Psycho-Spiritual Formation, and the Ateneo Bulatao Center for Psychological Services combine counseling and psychotherapy with spiritual guidance based on the tenets of Ignatian philosophy.

“You can go to them for spiritual direction, and if you need mental health counseling, they can refer you,” says Faustino.

To a large extent, however, it’s still up to the school community:

“We value the students because they’re usually the first one to detect [mental health problems], once they know what to look for,” he says.

“The teacher is the next one: Teachers must be vigilant when it comes to students who are reacting in class, being abnormally quiet, or crying, or exhibiting other behaviors.”

In any case, the school is a better environment for detecting and treating depression and other mental health issues early.

“If you are open about it, and seek help, we can help you,” says Faustino. “But if you hide it, it’s going to be hard.”