Improving mental health policies in the Philippines

IDinsight has partnered with the Philippine Department of Health to conduct a national assessment of mental health literacy in the Philippines. These findings will be used to inform the design and implementation of national policies around mental health, including the country’s new 2024-28 Mental Health Strategic Plan.

Decision-maker’s challenge

To ensure their policies and programs are effectively tailored to communities’ needs, the Philippine Department of Health (DOH) needs comprehensive data on what everyday individuals’ knowledge, attitudes, and health-seeking behaviors are regarding mental health conditions.

Over the last five years, the Philippine government has made lengthy strides to develop policies, frameworks, and programs to address and improve mental health. The 2018 Mental Health Act laid the foundation for comprehensive, inclusive, and rights-based mental health services, but long-standing issues around human resources, limited knowledge and utilization of services, and community stigma remain a challenge. 

Filipinos’ mental health literacy – which refers to an individual’s ability to access, understand, and apply mental health information to make decisions for themselves and/or their household – plays a large role in how they handle mental health issues and whether or not they decide to seek care. 

This year, DOH launched the 2024-28 Strategic Framework for Mental Health which will guide future policy development and implementation – one pillar of this being improving mental health literacy.

Impact opportunity

Research conducted last year by IDinsight and DOH under the Health Promotion and Literacy Longitudinal Study (HPLS) identified several warning signs for mental health literacy: 

• Two-thirds (66.9%) of Filipinos are not able to recognize depression when presented with a fictional set of symptoms
• Only 18.2% of those who ever suspected they had a mental health condition ever sought professional care
• When asked how they would hypothetically support a friend with suicidal thoughts, only 16.3% recommended seeking help from a medical professional

To better understand current levels of mental health literacy, IDinsight partnered with the DOH Disease Prevention and Control Bureau (DPCB) to conduct the National Assessment of the Mental Health Literacy of Filipinos. The study provides a crucial opportunity to inform life-stage-specific interventions that reduce stigma, improve mental health awareness, and enhance service utilization. 

This study will also help guide the development and implementation of policies under the 2024-28 Strategic Plan.

Our approach

IDinsight conducted the National Assessment of the Mental Health Literacy of Filipinos in partnership with DOH-DPCB in two phases: 

1. An exploratory qualitative study to dive deep into attitudes and beliefs towards mental health issues, patients, and services that affect health-seeking behaviors. 
2. A nationally representative cross-sectional survey of 3,560 Filipinos to assess mental health literacy across key life stages, including children (via their caregivers), adolescents, adults, and the elderly. One outcome of this survey included a recommended tool for measuring mental health literacy for DOH to use in future studies to measure progress on mental health literacy.

The results

Mental health literacy:

Overall mental health literacy is notably low. Less than half of Filipinos were able to identify a mental health or neurological issue when prompted with descriptive scenarios of anxiety (33.9%), eating disorders (32.6%), bipolar disorder (38.4%), and depression (49.6%). The low levels of condition recognition for depression and anxiety are of particular concern due to their comparatively higher disease burden.

Aside from their ability to recognize these conditions, many respondents did not recommend seeking professional care to treat or address them: only around one-quarter of Filipinos (27%) recommend seeking professional help for depression. More concerningly, less than a quarter (21.0%) of Filipinos recommend seeking professional help when presented with a hypothetical scenario in which a friend admits to suicidal thoughts, with youth recommending seeking care the lowest (10.2%).

Low levels of mental health literacy are also reflected in the perceived causes of mental health issues. Most Filipinos cite interpersonal problems (63.2%), financial issues (51.6%), and work/school issues (30.6%), while much fewer mentioned physiological factors that are known to lessen risk and severity of mental health issues, such as a balanced diet (16.7%), physical activity (14.6%), and sleeping well (8.4%). Additionally, around 40% believe women are more predisposed and men are less predisposed to mental health issues. Many also believe men are less likely to share their issues with others and seek care.

Sources of information for mental health:

Common sources of information on mental health vary across age groups. Social media is a predominant source of information for mental health topics, particularly for youth (59.7%), whereas adults and older adults are more likely to receive information via the local healthcare system (54.9% and 57.2%). Across sources of exposure, the types of mental health information Filipinos have been exposed to are broadly consistent, with the highest exposure to information on self-care practices (63.5%) and recognizing symptoms (61.2%) of mental health conditions, and lowest exposure to treatment options (46.3%) and reducing stigma of mental illness (33.9%).

Utilization of mental health services and barriers to care-seeking:

Self-treatment is a preferred treatment option, often due to fears of stigma and the limited accessibility and affordability of mental health services. Around 2/3 respondents believe that handling one’s issues themselves is admirable (69.8%) and that people with strong character can get over mental health issues (66.5%). Although 62.4% agree that people with mental health conditions shouldn’t feel shameful about their condition, findings from the qualitative study showed that many still fear ostracization should others find out about their issues.

Some Filipinos reported available services in their area (45.4%), but more than half stated that it is not easy to secure an appointment (63.2%), and around 1/3 believe it is beyond their financial means (32.2%). For those respondents who have had experiences with mental health issues in the past, few ever sought professional care (8.7%) while more relied on informal support through family and friends (20.2%).

Recommendations:

This study highlights significant challenges in mental health literacy and service utilization in the Philippines. These findings suggest the need for targeted interventions that improve mental health literacy, normalize care-seeking behaviors, and expand access to mental health care resources and services. A summary of recommendations include:

1. Increase awareness of symptoms and care-seeking practices for conditions with the highest burden and lowest current literacy levels (depression and anxiety).
2. Implement campaigns that target normalizing care-seeking behavior and reducing stigma around mental health issues (for all, but with special emphasis on men).
3. Continue to leverage online and social media to spread information and resources on mental health, which are used by many, but broaden the content and messaging to address identified gaps.
4. Strengthen partnerships with the Department of Education and the education sector in general to broaden the school curriculum to focus more on care-seeking rather than just symptom recognition and collaborate with Department of Labor and Employment to enhance workplace exposure for adults and older adults.
5. Utilize touch points across the healthcare system (rural health units, community health workers) to ensure mental health information reaches older, unemployed, and less-educated adults.
6. All initiatives to promote mental health and well-being should be matched with key initiatives to increase the availability of care by upskilling care providers and linking to self-treatment or community-based treatment options.