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THE MENTALLY DISABLED in PHILIPPINE


SETTING:
A Call for Equal Protection.
A Critique on the Rights and Privileges Of
Mentally Disabled Filipinos
And Their Place in Philippine Health Laws
_____________________________________________________________________________________

Authored by:

Naomi Therese F. Corpuz


University of the Philippines
College of Law

ABSTRACT

The research paper is a critique on the rights and privileges of the mentally disabled Filipinos.
The paper starts with an introduction on the history of mental illness, how it is connected to the brain
and how it is correlated to other physical illnesses. The paper also discusses, in terms of ranking as to
importance viz-a-vis other disabilities, the place of mentally disabled Filipinos on Philippine Health Laws
such as Republic Act 7277 also known as the Magna Carta for Disabled Persons, legislative policies
issued by the Department of Health and the pending House Bill 6679 otherwise known as, An Act for A
National Mental Health Care Delivery System Establishing For The Purpose The Philippines Council for
Mental Health And Appropriating Funds Therefore. The research was done by conducting a survey on
more than 90 respondent-psychiatrists by random sampling nationwide. The paper also discusses the
Philippine Health Insurance (PhilHealth) which is the first and only social- based insurance in the country
that is found, however, to be limited and unjust for the mentally disabled. This research also delves into
the passive role of psychiatrists in legislative policies affecting their patients. It culminates with a
conclusion and recommendations such as provisions of laws that can be amended and what the
Department Health, private sectors and mental health professionals can do in furthering the rights and
privileges of the mentally disabled Filipinos of the Philippines.

THE MENTALLY DISABLED in PHILIPPINE Setting:


A Call for Equal Protection.
A Critique on the Rights and Privileges Of Mentally Disabled Filipinos
And Their Place in Philippine Health Laws

I.

Introduction.4

II.

History of Mental Illness.5

III.

Mental Illness Defined ......8


a. Common Mental Illnesses....10
b. Connection to the Brain, Risk Factors and Correlation to Physical Illnesses..................12

IV.

Laws Affecting the Mentally Disabled.....14


A. Republic Act 7277, otherwise known as Magna Carta for Disabled Persons..14
B. DOH AdministrativeOrder No. 8 Series of 2001 and DOH Administrative Order No. 9
Series of 2007....21
C. Amendment of Republic Act 7277 otherwise known as Magna Carta for Disabled
Persons by Republic Act 9422 and DOH AdministrativeOrder No. 11 Series of 2009..22
D. Pending House Bill No. 6679...25

V.

Philippine Health Insurance Coverage of the Mentally Disabled.26

VI.

Conclusion & Recommendations33

VII.

Bibliography..35

ANNEX A Survey Form For Psychiatrists..39


ANNEX B Answers to Survey Form By Psychiatrists.42
ANNEX C Republic Act No. 7277, Magna Carta for Disabled Persons..59
ANNEX D Republic Act No. 9244, An Act Amending Magna Carta for Disabled Persons73

THE MENTALLY DISABLED in PHILIPPINE Setting:


A Call for Equal Protection.
A Critique on the Rights and Privileges Of Mentally Disabled Filipinos
And Their Place in Philippine Health Laws*
Naomi Therese F. Corpuz**

I. INTRODUCTION
If you will not give me a valid reason why you skipped the exam, I will give you a failing grade,
said a law professor to Maricar Estrella, a law student from one of the prestigious law schools in the
country. Maricar Estrella responded, I have clinical depression and anxiety disorder Sir. I had anxiety
attacks. I skipped the exam because I did not want to take the risk. I have prescriptions, medical receipts
and a medical certificate to prove it, to which the professor replied, You mean to tell me, you can skip
an exam anytime you want?1 With the professors response, it can be assumed that the latter was in
doubt or did not understand what depression and anxiety disorder means. Even with pertinent
documents that Maricar was willing to show as evidence to prove her mental illness, the professor
brushed it aside and instead made a sarcastic remark implying that she can skip an exam or class
anytime she wants because of her mental illness.
What is mental illness in the first place? Why is it that the above-mentioned law professor did
not believe it actually exists and that it adversely affects the studies of a student suffering from it?
In an interview with Maricar Estrella, she said she already had a failing mark in an examination
previously under a different law professor due to symptoms of the same illness. When she experienced
the same symptoms of her mental illness during the examination under a different law professor she did
not want to take the same risk of failing another subject, hence she decided to skip the exam. Though it
can be argued by professors that there is what they call academic freedom - that even illnesses cannot
be excused where then and how is the state policy found in our Philippine Constitution which states,
the State shall protect and promote the right to health of the people and instill health consciousness
among them2, put into place? Do not educators such as the law professor of Maricar violate this state
policy of our basic law which is the supreme law of the land? Another question would be, if Maricar had
another type of illness other than mental illness, would she have been given consideration by her law
professor? Maricar said in her interview that it is highly likely that she can be excused due to sore eyes
or high fever as what happened to her other schoolmates but not due to a mental disorder. If other
illnesses are given consideration, why not a mental illness?

*Cite as Naomi Therese F. Corpuz, THE MENTALLY DISABLED in PHILIPPINE Setting: A Call for Equal
Protection. A Critique on the Rights and Privileges Of The Mentally Disabled Filipinos And Their Place in Philippine
Health Laws (2013)
**J.D., University of the Philippines College of Law (2015 expected);A.B. Psychology, cum laude, University
of the Philippines (2003)
1
Interview with Maricar Estrella, lawstudent of one of the lawschools at the Univeristy Belt, Manila (May
30, 2012).
2
CONST. Art. II, 15

Patients with mental disorders have symptoms that only they themselves could feel, hence,
such disorders are difficult to understand by those who dont suffer from it because it cannot be
perceived or seen by the naked eye.
Few appreciate that mental health is, in fact, the matrix on which all health is built.3 People
with mental illnesses are discriminated against in various forms not only in education. There is also
unequal treatment when it comes to other rights and privileges i.e., persons afflicted with other
illnesses are given more benefits even in legislative policies. The aim of this paper is to provide
suggestions and recommendations and make known to all and sundry that persons with mental
disabilities, have become highly prevalent and that they are real. Considering the diseases debilitating
effects viz-a-vis other forms of illnesses, it must be given at least the same or even more, in terms of
economic and insurance benefits under our health laws and aspects of education and labor. This
research is also in consonance with the mission of the Philippine Psychiatric Association (PPA), among
others, to be committed to the welfare of its members and to the advancement of mental health care,
education, advocacy and research in the Philippines and the global community.

II. HISTORY OF MENTAL ILLNESS


The Crucible is a play written by well-known playwright Arthur Miller. It is a story based on true
to life accounts in 1602 at Salem, Massachusetts, where nineteen men and women and two dogs were
convicted and hanged4. They were put to death based on the accusation of young women in Salem who
were allegedly possessed, claiming that these nineteen people with two dogs were engaged in
witchcraft and bewitched them. Three hundred ninety years later5 this wrongful judgment was
rectified in a resolution of the court where families of those who died were paid civil damages.
Salem was a community ruled by theocracy, where the rule of the Church was also the rule of
law in the 16th Century. This is no different from the Philippines during the Spanish Era when
Christianity was ingrained in the mindset of Filipinos for more than three hundred years. Historically, it is
reported that the Philippines embraced two great religions, Islam and Christianity, five out of six of
which are Catholics.6 The Christian bible accounts describe possession involved evil spirits. Those who
were possessed were defiled and discriminated against. In Mark 5: 1-13, Jesus was reportedly to have
cured a man with an unclean spirit by transferring the devils that plagued him to a herd of swine, who,
in turn, became possessed and ran violently down a steep place in the sea.7 Similarly, in Matthew 10:1

MA. LUZ CASIMIRO QUERUBIN & SONIA CASTRO RODRIGUEZ, FINANCING HEALTH CARE: THE NATIONAL
HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF
THE NATIONS MENTAL HEALTH REPORT) (2002).
4
ARTHUR MILLER, THE CRUCIBLE vii (1995).
5
Id at vii.
6
WHO and Department of Health-Manila, Report on Mental Health System in the Philippines, 7 in WHOAIMS (2007)
7
Robert Carson et.al., ABNORMAL PSYCHOLOGY AND MODERN LIFE 33 (2000).

6
He called his twelve disciples to him and gave them authority to drive out evil spirits and to heal every
disease and sickness, that included mental diseases.
In the Middle Ages, there have been reports that many mentally disturbed people were accused
of being witches and thus were punished and have been killed.8
In Europe during the Middle Ages, apart from witchcraft, mass madness and exorcism relate to
abnormal behavior. Mass madness was a widespread occurrence of group behavior disorders that
were apparently cases of hysteria. Whole groups of people were affected simultaneously while in rural
areas were outbreaks of lycanthropy a condition in which people believed themselves to be possessed
by wolves and imitated their behavior.9 Management of the mentally-disturbed was left to the clergy
during this Era where humane treatment was practiced. Treatment consisted of prayer, holy water,
sanctified ointments, the breath or spittle of the priests, the touching of the relics, visits to holy places,
and mild forms of exorcism,10 which is still practiced not only in other countries but also the Philippines
up to this day11. The question here though, especially to the Catholic Church which practices exorcism if these prayers, holy waters and the like are not used to treat the mentally disabled, does it mean to say
they can never be treated without the intervention of medical psychiatry? Skepticism not only among
Catholics but Filipinos in general abounds when it comes to medical science of psychiatry. This is due to
our socio-cultural influences12.
In the Philippines, the evolution of treatment closely follows the path taken in Europe and
America.13 In the pre-Spanish Era, Filipinos believed in spirits and if they defiled and violated the
spiritual world, they would be punished thru some misfortune or illness in the material world, while in
the Spanish Era they believed in act of sorcery, mangkukulam (witches) and manggagaway (devilmen)14.
To cure the mental illnesses they go to herbolarios (herbmen) or the church for exorcism and some
patients who suffered in hysteria were even taken in boatrides only to be thrown to the river and if they
escaped drowning, patients illness is believed to be relieved.15
In the early nineteenth century, the first institution for the mentally-ill built in the Philippines
was Hospicio de San Jose.16 When the patients increased in number, some patients, particularly the
violent ones and those who committed crimes were kept at the Carcel de Bilibid.17
8

Id at 39.
Id at 37.
10
Id at 38.
11
Fr. JOSE FRANCISCO SYQUIA, EXORCISM: ENCOUNTERS WITH THE PARANORMAL AND THE OCCULT 1207 (2006)
12
BALTAZAR REYES & CONSTANTINE DELLA, TREATMENT OF MENTAL ILLNESS IN THE PHILIPPINES: A
HISTORICAL PERSPECTIVE (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE
NATIONS MENTAL HEALTH REPORT) (2002).
13
Id at 2.
14
See Querubin Supra at 49.
15
Id.
16
Id at 50.
9

There is no narrative account how the patients were treated in Carcel De Bilibid, however as the
term de bilibid which means the prison implies it is not farfetched that the patients were treated like
prisoners. Since the Philippines closely followed the history of Europe and America in treating mental
illnesses, it can be similar or at least close to Western asylums that grew in number starting in the
sixteenth century. The monastery of St. Mary of Bethlehem in London was officially made into an
asylum by Henry VIII18 but it became widely known for its inhumane treatment. The more violent
patients were exhibited to the public for one penny a look, and the more harmless inmates were forced
to seek charity on the streets of London in the manner described by Shakespeare: Bedlam beggars,
who, with roaring voices Sometime with lunatic bans, sometime with prayers, enforce their charity
(King Lear, II, iii).19
In La Bicetre Hospital in Paris, the chronically insane were treated like beasts,
The patients were ordinarily shackled on the walls of their dark,
unlighted cells by iron collars which held them flat against the wall and
permitted little movement. Oftimes there were also iron hoops around
the waist of the patients and both their hands and feet were chained.
Although these chains usually permitted enough movement that the
patient themselves could feed themselves enough with their bowls, they
often kept them from being able to lie down at night. Since little was
known about nutrition, and the patients were presumed to be animals
anyway, little attention was paid whether they were adequately fed or
to whether the food was good or bad. The cells were furnished only
with straw and never swept cleaned; the patient remained in the midst
of all the accumulated odor. No one visited the cells except at feeding
time, no provision was made warmth, and even the most elementary
gestures of humanity were lacking.20 (Emphasis Supplied)
Even today, there have been reports that some mentally disabled Filipinos are incarcerated in their own
homes.21 However due to the intervention of community-based mental health care,22there have been a
fortunate few who have been saved from these incarcerations and have been given the proper
treatment since then.

17

Id .
Carson, Supra Note 7, at 41.
19
Id.
20
Id.
21
nd
Dr. Lourdes Ladrigo-Ignacio, speech delivered at, the 2 Asia Pacific Conference on Psychosocial
nd
th
Rehabilitation in connection with the 22 Mid-year Convention and 27 Post graduate Court of the Philippine
Psychiatric Association (PPA), Dusit Thani Manila, Makati last July 28, 2011.
22
Id.
18

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The end of inhumane treatment to mentally disabled patients was not far from impossible. In
the late 18th century, hospitals in Europe and America were reformed and humanitarian treatment
received great impetus from the work of Philippe Pinel in France.23 As chains were removed and
patients were allowed to go outdoors and treated with human kindness, start of scientific knowledge of
mental illnesses burgeoned in the Philippines in 1892 1942, which covers the period of American rule.
Treatment centers started to flourish in the 1900s such as the NPH (National Psychopathic Hospital)
which is now the National Mental Health in Mandaluyong City.24 These treatment centers provided
scientific and mechanistic approach, and therapies for the mentally-ill.25
During the Japanese Occupation, psychiatric treatment did not improve, but rather was even on
a stalemate, but this ended after World War II and Japanese domination. There was an upsurge of
different forms of treatment and the first prefrontal and transorbital lobotomy were conducted in the
country.26 Lobotomy is the surgical treatment which involved severance of nerve fibers connecting the
frontal lobes to the thalamus for the relief of some mental disorders.27 All these happened in the 1940s
but the most radical change that paved the way to many successful treatments was in 195328 when
psychopharmacology29, the science of determining which drugs alleviate which disorders and why they
do so, was then introduced.
Today, Philippine Psychiatry has paved a long way since the early age. Psychiatrists and clinical
psychologists have increased through the years and even undergo further training abroad. However,
compared to other countries, the Philippines mental health still lag behind and way below the list of the
governments priorities. The mentally disabled patients in regard to access to maintenance treatment
are still highly marginalized especially when it comes to insurance, health services and legislative policies
which this paper aims to demonstrate.
III. MENTAL ILLNESS DEFINED
People refer to the mentally ill who are sirang-ulo or insane. Dr. Lourders Ignacio30 on the
other hand explains It is not just for the sirang-ulo or insane. Ignacio clarifies that to have a mental
health problem may simply mean that ones thoughts, feelings and behavior show disturbances which
threaten the balance and stability of a person in his daily life. Many of these disturbances can be called
reactions by those rendered vulnerable to extreme life experiences like disasters, and individual and

23

Carson, Supra Note 3, at 42.


Querubin Supraat 51.
25
Id.
26
Querubin Supra at 53.
27
Westers Dictionary at http://www.merriam-webster.com/medical/lobotomy (last visited May 16, 2012)
28
Querubin Supra at 54.
29
Carson, Supra Note 3, at G-17.
30
Rina Jimenez David, At Large Not just for the sirang ulo at http://opinion.inquirer.net/8977/not-just-forthe-%E2%80%98sirang-ulo%E2%80%99 (last visited November 22, 2012).
24

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community violence, but others can be traced to difficulties and anxiety triggered by changing life
circumstances.31
Mental illness is not always about insanity. Depression for instance, though a normal emotion
of human beings, can be a mental illness if it becomes very severe until clinical. Major depression which
is not tantamount to insanity or psychosis, can still be considered a mental illness if it is characterized by
an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in
normally enjoyable activities32. Coupled with symptoms of irritablity, agitation, restlessness, dramatic
change in appetite, often with weight gain or loss, fatigue and lack of energy, feelings of hopelessness
and helplessness, feelings of worthlessness, self-hate, and guilt, becoming withdrawn or isolated, loss of
interest or pleasure in activities that were once enjoyed33 are all indicators of major depression.
Clinical major depression is a common mental illness that affects about 121 million people across the
globe according to Dr. Lou Querubin, an attending psychiatrist at the Medical City in Manila,
Philippines.34
According to a Disability Manual of the Government of Australia,35 mental illness refers to those
causing a major disruption to a person's behaviour, emotions or thinking which lasts a period of time
from a few weeks or months to years. These episodes can come and go in a person's life. Several
contributing factors mentioned in the manual include the following:

Chemical imbalances in the brain

Family history of mental illness

Stress

Drug and alcohol abuse

Psychosocial factors such as poor physical health, trauma and abuses.36

In dictionary meaning, mental disorder on the other hand is used synoymously with mental
illness.37 The recently published Diagnostic Statistical Manual-V (DSM-V) which will be published in 2013

31

Id.
Major Depressive Disorder, available at http://en.wikipedia.org/wiki/Major_depressive_disorder (Last
visited: January 18, 2013).
33
Major Depression, available at http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm (Last
visited: January 18, 2013).
34
Cara. Davis, 7 Ways to Ward off Clinical Depression, Jun 20, 2011, 3,
at
http://halogentv.com/articles/7-ways-to-ward-off-clinical-depression/
35
Source: Government of Sourth Australia, Department for families and communities. Intellectual
Disability
and
Mental
Illness
(Dual
Disability)
available
at
http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Information%20sheets%20%20Disability%20SA/Intellectual%20disability%20-%20mental%20illnessdual%20disability%20%28PDF%20140kb%29.pdf (Last visited: June 9, 2012).
36
Id.
37
The Free Dictionary, available at http://medical-dictionary.thefreedictionary.com/mental+illness and
Wikipedia, available at http://en.wikipedia.org/wiki/Mental_disorder (Last visited: November 26, 2012).
32

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defines mental disorder38as a health condition characterized by significant dysfunction in an
individuals cognitions, emotions, or behaviors that reflects a disturbance in the psychological,
biological, or developmental processes underlying mental functioning. Some disorders may not be
diagnosable until they have caused clinically significant distress or impairment of performance. A
mental disorder is not merely an expectable or culturally sanctioned response to a specific event such as
the death of a loved one. Neither culturally deviant behavior (e.g., political, religious, or sexual) nor a
conflict that is primarily between the individual and society is a mental disorder unless the deviance or
conflict results from a dysfunction in the individual. (Emphasis Supplied).
The rationale why the terms psychological and biological are used is to emphasize the
inextricable links between the biological and the behavioral and psychological.39

Common Mental Illnesses


In a recent survey conducted among ninety-five psychiatrists, the top five most common cases
of mental disorders are Schizophrenia, Bipolar, Major Depression, Anxiety Disorder and Addiction40

Figure 1.41
700
600
500

Schizophrenia

653
587

613

571 555

Bipolar

460 482

510
400 423

400

Major Depression

386

Anxiety Disorder
Addiction

300

Dementia

200

Personality Disorder

100

Eating Disorder
Somatoform Disorder

0
Psychiatric Disorders

Sleep Disorder
Sexual Disorder

Schizophrenia is the most persistent and disabling of the major mental illnesses. It usually
attacks people between the ages of 16 and 30, as they are beginning to realize their potential. It affects
approximately one in 100 people worldwide, (one per cent of the population), affecting men and
38

DSM5.org, available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465


(Last visited: October 22, 2011).
39
Id
40
Survey conducted by Naomi Therese F. Corpuz on Psychiatrist-Respondents of Philippine Psychiatric
Association, Inc. (PPA), at Dusit Thani Manila, Makati City (July 28-30, 2011).
41
Id.

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women almost equally. While it is treatable with proper medication and therapy, there is as yet no cure
for schizophrenia.42People stricken with this disease may hear voices, see objects that arent really
there, or assume that others are reading and controlling their minds.43
Bipolar Disorder is illustrated by severe mood swings that impair patients daily life and
negatively affect their relationship; these mood swings include highs (mania), when individuals feel
either on top of the world or on edge, and lows (depression), when they feel sad and hopeless. 44
Suicide attempts are common in bipolar disorder, especially during depressive episodes.45
Major Depression46is a mental health disorder which causes prolonged feelings of despair,
worthlessness, irritability, and fatigue (see a more complete set of depression symptoms below). It can
strike at any age, although it is most common in young adulthood. Both men and women can experience
major depression, however the disorder is more common in women.47 Depression is sometimes called
the "common cold" of mental health, because it is so common--nearly 10% of the population suffers
from a depressive illness in any given year, according to National Institute of Mental Health.48 It is the
leading cause of disability in the US and worldwide, according to the World Health Organnization.49
Its symptoms50 are:

Despair and hopelessness


Little motivation to complete even simple tasks
Thoughts or attempts of suicide
Low self-esteem and self-confidence
Low energy levels, tired and run-down
Trouble falling asleep, nightmares, waking and can't fall back asleep
Daily life is severely affected
Loss of sex drive
Loss of appetite
Loss of interest in formerly pleasurable activities
Symptoms last longer than two months

Anxiety Disorder is a blanket term covering several different forms of a type of common
psychiatric disorders characterized by excessive rumination, worrying, uneasiness, apprehension and
fear about future uncertainties either based on real or imagined events, which may affect both physical

42

World Fellowship for Schizophrenia and Allied Disorders, available at http://www.worldschizophrenia.org/disorders/schizophrenia.html(Last visited: November 26, 2012).
43
Meeting of Minds, available at http://www.medobserver.com/article.php?ArticleID=440(last visited May
17, 2012).
44
Margarita
Tartakovsky
M.S.,
The
Bipolar
Fact
Sheet,
available
at
http://psychcentral.com/lib/2009/bipolar-disorder-fact-sheet/Last visited: November 26, 2012).
45
Id.
46
Major Depression, available at http://www.depressedtest.com/major_depression.html(Last visited:
November 26, 2012).
47
Id.
48
Id.
49
Id.
50
Id.

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and psychological health.51 It has many types which include panic disorder, obsessive compulsive
disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized
anxiety disorder. Though anxiety is a normal human emotion that everyone experiences at times,
anxiety disorders, however, are different. They can cause such distress that it interferes with a person's
ability to lead a normal life. An anxiety disorder is a serious mental illness. For people with anxiety
disorders, worry and fear are constant and overwhelming, and can be crippling.52
Addiction is the continued use of a mood altering substance or behavior despite adverse
dependency consequences, or a neurological impairment leading to such behaviors.53 Addiction is a
condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an
activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and
interferes with ordinary life responsibilities, such as work or relationships, even health. Users may not
be aware that their behavior is out of control and causing problems for themselves and others.54

Connection to the Brain, Risk Factors and Correlation to Physical Illnesses


Mental Disorders do exist with scientific basis. According to studies, scientists have largely
attributed it to the brains functioning. Most scientists believe that mental illnesses result from
problems with the communication between neurons in the brain called neurotransmission55 and
chemical compounds called neurotransmitters. For instance the neurotransmitter serotonin levels of
those with depression are lower than normal individuals. Apart from serotonin there could also be
other changes in other neurotransmitters in the brain.56 In schizophrenia, studies show that there are
disruptions in neurotransmitters dopamine, glutamate and norepinephrine.57
Scientists have also identified the risk factors that make one mentally ill. Some of these are
environmental, genetic and social factors.58 These factors may also combine and interact that lead to
mental illness. Environmental factors such as head injury, poor nutrition, and exposure to toxins
(including lead and tobacco smoke) can increase the likelihood of developing a mental illness.59 Illnesses
which most likely have a genetic component are autism, ADHD or attention deficit disorder, bipolar
disorder and schizophrenia.60
51

Anxiety Disoder, available at http://en.wikipedia.org/wiki/Anxiety_disorder (Last visited: November 26,

2012).

52

Anxiety and Panic Disorders Health Center, available at http://www.webmd.com/anxietypanic/guide/mental-health-anxiety-disorders(Last visited: November 26, 2012).
53
Addiction, available at http://en.wikipedia.org/wiki/Addiction(Last visited: November 26, 2012).
54
What is Addicition?, available at http://www.psychologytoday.com/basics/addiction(Last visited:
November 26, 2012).
55
Information
about
Mental
Illness
and
the
Brain,
available
at
http://science.education.nih.gov/supplements/nih5/mental/guide/info-mental-b.htm (Last visited: November 26,
2012).
56
Id.
57
Id.
58
Id.
59
Id.
60
Id.

13

Mental Disorders can also be psychosomatic. Psychosomatic pertains to physical ailments that
are caused by or notably influenced by emotional factors,61 such factors that can be attributed to mental
disorders. Dr. Jercyl Leilani Demeterio says that mental disorders are as debilitating as any form of
illness affecting the persons ordinary daily activities, even relationships and even results to, if not
correlated with, physical illnesses such as heart diseases, thyroidism, stroke, cancer and many others.62
Psychopharmacology on the other hand only proves further that mental disorders have a
connection with the brain. Psychopharmacology is the scientific study of the actions of drugs and their
effects on mood, sensation, thinking, and behavior; this field studies a wide range of substances with
various types of psychoactive properties, focusing primarily on the chemical interactions with the
brain.63 It is also defined as, the study of drug-induced changes in mood, thinking, and behavior.
These drugs may originate from natural sources such as plants and animals, or from artificial sources
such as chemical syntheses in the laboratory. These drugs interact with particular target sites or
receptors found in the nervous system to induce widespread changes in physiological or psychological
functions.64
However, as aptly explained by Dr. Jercyl Leilani Demetetrio65, it is a sad state that despite
studies and evidence that mental disorders are attributed to brain function there are still many who do
not believe that there is a connection of emotions and feelings to the brain. Mental Illness is a
disability like any other form of disability. However, as emphasized by Dr. Constantine Della, the term
disability, is associated with other forms of disabilities, such as physical handicap, blindness, and
deafness among others but rarely is such term associated with mental illness.66 This is a sad truth
despite the fact that psychiatry is a specialty and a subject in the school of medicine. This is also an
undesirable result and can be greatly attributed to our belief systems largely influenced by religion,
culture and traditions.

61

Dictionary.com, available at http://dictionary.reference.com/browse/psychosomatic (Last visited:


November 26, 2012).
62
Interview with Dr. Jercyl Leilani-Demeterio, Past-PPA President, former Professor of Psychiatry of U.P.
College of Medicine and current private practioner at Cardinal Medical Santos Center, Mandaluyong City (August 6,
2011).
63
Psychopharmacology
From
Wikipedia,
the
free
encyclopedia
at
http://en.wikipedia.org/wiki/Psychopharmacology (last visited May 17, 2012).
64
Psychopharmacology, available at http://www.sciencedaily.com/articles/p/psychopharmacology.htm
(Last visited: November 26, 2012).
65
Interview with Dr. Jercyl Leilani Demeterio, past Philippine Psychiatric Association president, former
professor of U.P. College of Medicine and current psychiatrist at Cardinal Santos Medical Center, Quezon City (May
15, 2012).
66
Interview with Dr. Constantine Della, President, Philippine Psychiatric Association, Inc. (PPA), at the 2nd
Asia-Pacific Conference on Psychosocial Rehabilitation in connection with the 22nd Mid-Year Convention and 27th
Post Graduate Course of the PPA, Dusit Thani Manila, Makati City (July 28, 2011).

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IV. LAWS AFFECTING THE MENTALLY DISABLED

The two provisions of the Constitution which mention the term disabled are in Article XIII
entitled Social Justice and Human Rights. Its Section 11 and Section 13 state:
Section 11. The State shall adopt an integrated and comprehensive
approach to health development which shall endeavor to make essential
goods, health and other social services available to all the people at
affordable cost. There shall be priority for the needs of the
underprivileged, sick, elderly, disabled, women, and children. The State
shall endeavor to provide free medical care to paupers.(Emphases
supplied)
Section 13. The State shall establish a special agency for disabled
persons for their rehabilitation, self-development, and self-reliance, and
their integration into the mainstream of society. (Emphases supplied)
What does social justice mean in the first place? According to Matthew Robinson, in conditions
of social justice, people are "not be discriminated against, nor their welfare and well-being constrained
or prejudiced on the basis of gender, sexuality, religion, political affiliations, age, race, belief, disability,
location, social class, socioeconomic circumstances, or other characteristic of background or group
membership."67 Social justice is generally equated with the notion of equality or equal opportunity in
society.68
Social justice then is equal opportunity. However though Section 13 emphasizes priority for
the needs of the disabled, it is a provision which does not clearly pertain to mental disability or even to
include mental disability among all forms of disabilities. According to WHO (World Health Organization),
the laws that govern the provision of mental health services are contained in various parts of
promulgated laws such as the Penal Code, Magna Carta for Disabled Person, Family Code and Dangerous
Drug Act,69 however there is no single mental health legislation but only mental health policies such as
Administrative orders issued by the Department of Health and a single Republict Act which is R.A. 7277,
also known as the Magna Carta for Disabled persons that is not even specific to mental disabilities.
A. Critique on Republic Act 7277, otherwise known as Magna Carta for Disabled Persons

Republic Act 7277 was approved on March 24, 1992 entitled, An Act Providing for the
Rehabilitation, Self-Development and Self Reliance of Disabled Persons And Their Integration Into The
Mainstream Of Society And For Other Purposes. This is otherwise known as the Magna Carta for
Disabled Persons which provides rights and privileges of disabled persons under its Title II which are
67

Matthew
Robinson,
What
is
Social
http://www.pscj.appstate.edu/socialjustice/whatissocialjustice.html (Last visited January 14, 2012).
68
Id.
69
WHO and Department of Health-Manila, Supra Note 6.

Justice?,

15
Equal Opportunity for Employment, Access to Quality Education, National Health Program, Auxiliary
Social Services, Telecommunications and Accesibility. Although these six are listed in the law with
comprehensive descriptions and how they are adopted, people with mental disability are marginalized
in the real scenario and other people with illnesses are given more benefits, though not apparent.
Section 5 of Title II states:
Section 5. Equal opportunity for employment. No disabled person shall
be denied access to opportunities for suitable employment. A qualified
disabled employee shall be subject to the same terms and conditions of
employment and the same compensation, privileges, benefits, fringe
benefits, incentives or allowances as a qualified able bodied person.
Five per cent of all casual, emergency and contractual positions in the
Departments of Social Welfare and Development, Health, Education,
Culture and Sports, and other government agencies, offices or
corporations engaged in social development shall be reserved for
disabled persons.(Emphases Supplied).
As mentioned above, A qualified disabled employee shall be subject to the same terms and
conditions of employment and the same compensation, privileges, benefits, fringe benefits, incentives or
allowances as a qualified able bodied person. Persons with physical disabilities could easily fit the term
qualified disabled employee but not for the mentally disabled. In Chapter VI of Title II of R.A. 7277
Section 25, it implements Batasang Pambansa 344, which states:
Sec. 25. Barrier-Free Environment. The State shall ensure the
attainment of a barrier-free environment that will enable disabled
persons to have access in public and private buildings and
establishments and such other places mentioned in Batas Pambansa
Bilang 344, otherwise known as the "Accessibility Law.
The national and local governments shall allocate funds for the
provision of architectural facilities or structural features for disabled
persons in government buildings and facilities.(Emphases Supplied).
Batasang Pambansa 344, Section 1 states:

Section 1. In order to promote the realization of the rights of disabled


persons to participate fully in the social life and the development of the
societies in which they live and the enjoyment of the opportunities
available to other citizens, no license or permit for the construction,
repair or renovation of public and private buildings for public use.
Educational institutions, airports, sports and recreation centers and
complexes, shopping centers or establishments, public parking places,
work-places, public utilities, shall be granted or issued unless the
owner or operator thereof shall install and incorporate in such
building, establishment, institution or public utility, such architectural
facilities or structural features as shall reasonably enhance the

16
mobility of disabled persons such as sidewalks, ramps, railings and
the like. If feasible, all such existing buildings, institutions,
establishments, or public utilities to be constructed or established for
which licenses or permits had already been issued may comply with the
requirements of this law: Provided, further, That in case of government
buildings, street and highways, the Ministry of Public Works and
Highways shall see to it that the same shall be provided with
architectural facilities or structural features for disabled persons. In
the case of the parking place of any of the above institutions, buildings,
or establishment, or public utilities, the owner or operator shall reserve
sufficient and suitable space for the use of disabled persons. (Emphases
Supplied)
Again, notice the term disabled persons is used in the above-quoted provision but the cited
law only benefits the physically disabled but not persons afflicted with mental illnesses.
Apart from this there are still discriminations against mentally disabled particulary in
employment and education.
Overseas contract workers for instance, prior to departure, must undergo neuropsychiatric
screening and those found with symptoms of mental distress and symptoms are not certified to leave
for overseas employment.70 Any reapplication must be accompanied by psychiatric clearance, according
to a noted psychiatrist Dr. Bernardo Conde of University of Santo Tomas.71 This regulation of the
Department of Labor and Employment (DOLE) is unfair and a total violation of social justice. With this
regulation those who are afflicted with mental disorders have no opportunity of having greener pastures
abroad to help their families but those with physical disabilities do since the latter do not have the same
kind of regulation. Yet, according to Dr. Jercyl Leilani Demeterio, with proper treatment or psychotherapy and medication, workers with mental illnesses can function as normal individuals.72 If this is the
case why does the DOLE not accept them with the same regulation as normal individuals?
One reason for this is poverty. Although the Magna Carta For Disabled Persons in its policy,
states that:
Sec. 2. Declaration of Policy The grant of the rights and privileges for
disabled persons shall be guided by the following principles:
(a) Disabled persons are part of Philippine society, thus the State shall
give full support to the improvement of the total well-being of disabled
persons and their integration into the mainstream of society. Toward
this end, the State shall adopt policies ensuring the rehabilitation, selfdevelopment and self-reliance of disabled persons. It shall develop their
70

Dr. Bernardo Conde, Philippines mental health country profile, International Review of Psychiatry, 166

(2004).

71

Id.
Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65.

72

17
skills and potentials to enable them to compete favorably for available
opportunities.
(b) Disabled persons have the same rights as other people to take
their proper place in society. They should be able to live freely and as
independently as possible. This must be the concern of everyone the
family, community and all government and nongovernment
organizations. Disabled persons' rights must never be perceived as
welfare services by the Government.
(c) The rehabilitation of the disabled persons shall be the concern of
the Government in order to foster their capacity to attain a more
meaningful, productive and satisfying life. To reach out to a greater
number of disabled persons, the rehabilitation services and benefits shall
be expanded beyond the traditional urban-based centers to community
based Programs, that will ensure full participation of different sectors as
supported by national and local government agencies. xxx (Emphases
Supplied).
Not all Filipinos afflicted with mental disabilities can afford to have the maintainance treatment and
medication. In the Philippines alone, a disability survey done in 2000 by the National Statistics Office
(NSO) found out that mental illness was the third most common form of disability.73 Prevalence rate of
mental disorders were 88 per 100,000 populations and was highest among the elderly group. This
finding was supported by a more recent data from the social weather survey commissioned by the
Department of Health(DOH) in 2004. 74It revealed that 0.7% of the total household have a family
member afflicted with mental disability.75
The policy of the Magna Carta cited above which states that (a) the State shall give full support
to the total well-being of the disabled, (b) Disabled persons have the same rights as other people to take
their proper place in society, (c) The rehabilitation of the disabled persons shall be the concern of the
Government in order to foster their capacity to attain a more meaningful, productive and satisfying life,
are not fully enforced because of the miniscule budget alloted by the Government to mental health.

73

Interview with Mr. Nelson Mendoza, National Program Coordinator, National Mental Health Program
and Degenerative Disease Office, Department of Health, Philippines (March 30, 2012).
74
Id.
75
Id.

18
Figure 2.76

The Philippine Government only gave 5% of its DOH budget to the National Mental Health
Program where only 5% of which are for health care expenditures by the government health
department directed towards mental health. Of all expenditures on mental health, 95% are spent on
the operation, maintenance and salary of the personnel of mental hospitals. The percentage of the
population that has free access to psychotropic medication is unknown.77 For those that pay out of
pocket, the cost of antipsychotic medication is 0.46% and antidepressant medication is 11.4% of the
minimum daily wage.78
There is also a scarce resource of Mental Health Workers. In a study conducted by World Health
Organization in 2007:
Figure 3.
# of Mental
Health Workersper 100,000 pop
Psychiatrists*

412

0.42

Nurses

769

0.91

Psychologists

119

0.14

Social Workers

74

0.08

Occupational Therapists

72

0.08

1,372

1.62

Others

*237 (58%) of the Psychiatrists practice in the NCR


76

Id.
Id.
78
Id.
77

19
Out of 412 Psychiatrists in the Philippines, a majority of 237 of them are based in the National Capital
Region, making medical treatment from health therapists our of reach to patients from provinces and
far-flung barrios. Apart from this, The majority of mental health facilities are still located in the National
Capital Region.79 Hence, access to mental healthfacilities is uneven across the country, favoring those
living near the main cities.80
In education on the other hand, the introduction of this paper is an example of what a student
with mental disability ordinarily experiences in school. As any other mentally disabled patient, a
student also suffers from schizophrenia, ADHD (Attention Deficit Disorder), bipolar disorder, clinical
depression and anxiety disorders among others.81
A mentally disabled student must be given considerations similar to students with physical
disabilities. If railings and ramps are built for students with physical handicap, is there no special
treatment that can be given to mentally disabled students? Some authorities, particularly professors
and instructors find this questionable since most have the impression that mentally disabilities are not
life-threatening, but as previously discussed in this paper mental disabilities are as debilititating as any
form of illness that can even lead to death. In a World Health Organization Report of 2007, more than
150 million people suffer from depression at any point in time and nearly 1 million commit suicide every
year.82
Special considerations though are given to disabled students that are categorically stated in
Section 12 of Title II of R.A. 7277:

Sec. 12. Access to Quality Education.


xxx
The State shall take into consideration the special requirements of
disabled persons in the formulation of educational policies and
Programs. It shall encourage learning institutions to take into account
the special needs of disabled persons with respect to the use of school
facilities, class schedules, physical education requirements, and other
pertinent consideration.
The State shall also promote the provision by learning institutions,
especially higher learning institutions of auxiliary services that will
facilitate the learning process for disabled persons. (Emphases
Supplied).
What this pertinent consideration of the above-cited provision means though is not specific.
Legislators must specify the meaning of pertinent consideration or at least the National Mental
Health Program of the Department of Health must make a separate Implementing Rule and Regulation
79

Interview with Mr. Nelson Mendoza, Supra Note 40


Id.
81
Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65.
82
Department of Health Administrative Order No. 9 (2007).
80

20
for Schools with mentally disabled patients that will specifically describe these pertinent considerations
and mandate such schools to implement such rules. Although Chapter II on Education of R.A. 7277 has a
specific provision on Special Education which states:
Section. 14. Special Education. The State shall establish, maintain
and support complete, adequate and integrated system of special
education for the visually impaired, hearing impaired, mentally retarded
persons and other types of exceptional children in all regions of the
country. Toward this end, the Department of Education, Culture and
Sports shall establish, special education classes in public schools in cities,
or municipalities. It shall also establish, where viable, Braille and Record
Libraries in provinces, cities or municipalities. Xxx (Emphases Supplied).
and Section 17 for State Universities and Colleges:
Sec. 17. State Universities and Colleges. If viable and needed, the
State University or State College in each region or province shall be
responsible for (a) the development of material appliances and technical
aids for disabled persons; (b) the development of training materials for
vocational rehabilitation and special education instructions; (c) the
research on special problems, particularly of the visually-impaired,
hearing-impaired, speech-impaired, and orthopedically-impaired
students, mentally retarded, and multi-handicapped and others, and
the elimination of social barriers and discrimination against disabled
persons; and (d) inclusion of the Special Education for Disabled (SPED)
course in the curriculum. xxx (Emphases Supplied).
The provision makes use of the term mentally retarded which only includes those pupils and students
with subaverage intelligence and impaired adaptive functioning.83 However mental retardation is not
synonymous to mental disability. Mental Retardation is only one ofthe kinds of mental disabilities. In
fact there are persons with mental disabilities with superior intelligence which is the total opposite of
mentally retarded persons.84
Section 12 and Section 17 of Title II of Magna Carta for Disabled Persons are discriminatory as it
only provides privileges to the visually-impaired, hearing-impaired, speech-impaired, orthopedicallyimpaired students, mentally retarded, and multi-handicapped but there is no mention of mentally
disabled persons.
A sound suggestion was made by Carla Laforteza, a bipolar patient and a physical therapist
student of University of Santo Tomas with superior intelligence. She said that the Government must

83

Mental Retardation, http://emedicine.medscape.com/article/1180709-overview (Last visited: January

14, 2013).

84

Interview with Dr. Jercyl Leilani Demeterio, Supra Note 65.

21
create special schools for the mentally disabled85 those suffering not only of mental retartdation but
all types of mental disorders, such as the common major illness of clinical depression. Though it is
difficult to establish special schools for courses such as medicine and law, a special class that is
segregated can be created solely for them.The schools can hire certified psychiatirists and clinical
psychologists. These schools and/or special classes can be regulated and monitored by these certified
psychiatrists and clinical psychologists to determine the veracity and gravity of the illness of the
student-patient from time to time and assess their capacity to learn. From these assessments, school
rules and regulations can be adjusted accordingly and not prevent a student from becoming a doctor,
lawyer or inhibit them from finishing other courses they want to pursue. To emphasize, social justice as
mentioned earlier is equal opportunity - a policy of the Constitution that our State must uphold.
B. DOH AdministrativeOrder No. 8 Seriesof 2001 and DOH AdministrativeOrder No. 9 Series of 2007
AdministrativeOrder No. 8 entitiled theNational Mental Health Policy(AO 08-01) was signed
on April 5, 2001 by former Department of Health (DOH) Secretary Manuel Dayrit. DOH formulated AO
08-01 which prescribed the national policy framework towards the attainment of a good state of health
for all Filipinos. The mental health strategy of the policy is to improve mental health and integrate
services for people with mental disorders. In its objective, it states that the National Mental Health
Policy shall be pursued through a National Program strategy prioritizing the promotion of mental health,
protection of the rights and freedoms of persons with mental diseases and the reduction of the burden
of the consequences of mental ill- health, mental and brain disorders and disabilities. To implement this
strategy, the policy identifies twelve policy statements which are Leadership, Collaboration and
Partnership, Empowerment and Participation, Equity, Standards for Quality Mental Health Services,
Human Resource Development, Health Service Delivery System, Mental Health Care, Stability and
Sustainability, Information System, Legislation and Monitoring and Evaluation.
Although AO 08-01 have valuable goals and objectives there is a problem in the
implementation of its planned mental health strategy since there are no specific and designated
agencies, NGOs or groups that can help such goals and objectives to materialize.
When this was realized by the Department of Health, it took though 6 years to adopt another
Administrative Order which is Administrative Order No. 9 Series of 2007(AO 09-07)entitled
Operational Framework for the Sustainable Establishment of a Mental Health Program, designed to
provide policy guidelines and procedures for establishing mental health program at the national and
local levels. Its objective is to provide guidelines for stakeholders in the government and private sector
on the development and implementation on the National Policy on Mental Health through plans and
programs. The beauty of this AO 09-07 is that it covers the Department of Health including its attached
agencies, the local government units, non-government organizations and other devolved health
services. It also includes public and private sectors such as national agencies, including governmentowned and controlled corporations, faith-based organizations, academe, media, professional
associations, civil society and international development agencies whose activities contribute to the
improvement of the state of mental health of the Filipino people.
One of the implementing mechanisms of AO 09-07 is a management structure. Such structure
necessitates institutionalization of a functional management structure that sets mental health
stakeholders into committees and teams: the National Program Management Committee (NPMC), the
85

Interview with Carla Laforteza, Physical Therapist Student of University of Santo Tomas (November 13,

2012).

22
Program Development and Management Teams (PDMT), the Regional Mental Health Teams ((RMHT),
and the Local Government Units for Mental Health (LGUTMH).
Although the beauty of this management structure is the devolution of responsibilities from the
national level to the ground level, it does not mean it does not have loose ends. Once one of the
committees or teams will not perform its designated job, the mechanism of the management structure
becomes futile considering for instance that not all Local Government Units (LGUs), which is the group
nearest to the people, are actively involved in Department of Healths Mental Health Programs. In fact,
the LGUs are not mandated to follow this mechanism of management structure of AO 09-07. If such
LGUs do not follow the flow of the mechanism then the goals and objectives of AO 09-07 is put to
naught.

C. Amendment of Republic Act 7277 otherwise known as Magna Carta for Disabled Persons by
Republic Act 9422 and DOH AdministrativeOrder No. 11 Series of 2009

During the term of former President Gloria Macapagal Arroyo, Republic Act No. 9422 was
enacted entitled as, An Act Amending Republic Act No. 7277, Otherwise known as the Magna Carta for
Persons with Disability as Amended, and For Other Purposes Granting Additional Privileges and
Incentives and Prohibitions on Verbal, Non-Verbal Ridicule and Vilification Against Persons with
Disability. It is the objective of Republic Act No. 9442 to provide persons with disability, the
opportunity to participate fully into the mainstream of society by granting them at least twenty percent
(20%) discount in all basic services. Section 1 of R.A. 9422 states:

SECTION 1. A new chapter, to be denominated as "Chapter 8. Other


Privileges and Incentives" is hereby added to Title Two of Republic Act
No. 7277, otherwise known as the "Magna Carta for Disabled Persons",
with new Sections 32 and 33, to read as follows:
"CHAPTER 8. Other Privileges and Incentives
"SEC. 32. Persons with disability shall be entitled to the following:
(a) At least twenty percent (20%) discount from all establishments
relative to the utilization of all services in hotels and similar lodging
establishments; restaurants and recreation centers for the exclusive use
or enjoyment of persons with disability;
(b) A minimum of twenty percent (20%) discount on admission fees
charged by the theaters, cinema houses, concert halls, circuses, carnivals
and other similar places of culture, leisure and amusement for the
exclusive use or enjoyment of persons with disability;

23
(c) At least twenty percent (20%) discount for the purchase of
medicines in all drugstores for the exclusive use or enjoyment of persons
with disability;
(d) At least twenty percent (20%) discount on medical and dental
services including diagnostic and laboratory fees such as, but not limited
to x-rays, computerized tomography scans and blood tests, in all
government facilities, subject to guidelines to be issued by the
Department of Health (DOH), in coordination with the Philippine Health
Insurance Corporation (PHILHEALTH);
(e) At least twenty percent (20%) discount on medical and dental
services including diagnostic and laboratory fees, and professional fees
of attending doctors in all private hospitals and medical facilities, in
accordance with the rules and regulations to be issued by the DOH, in
coordination with the PHILHEALTH;
(f) At least twenty percent (20%) discount on fare for domestic air and
sea travel for the exclusive use or enjoyment of persons with disability;
(g) At least twenty percent (20%) discount in public Railways, skyways
and bus fare for the exclusive use and enjoyment of persons with
disability;
Xxx(Emphases Supplied).
Under the law, there are seven (7) types of basic services cited above where persons with disability can
avail of atleast twenty percent (20%) discount.
The Department of Health adopted Administrative Order No. 9 Series of 2011 (AO 09-11)
entitled, Guidelines to Implement the Provisions of Republic Act 9422 , Otherwise Known as An Act
Amending Republic Act 7277, otherwise known as Magna Carta for Persons, and for other Purposes, for
the provision of medical and related discounts and special privileges, which is an order issued to
support the Implementing Rules and Regulations of R.A. 9422. Under this Order, the objective is to
prescribe procedures and guidelines for the implementation of the 20% discount in all health related
services of Persons with Disabilities (PWDs).
Although Republict Act 9422 is a big step in alleviating the financial burden of PWDs, it is not
without any disadvantage to persons with mental disability. In relation to Republic Act 9422, to avail of
the discount, a person with disability must present his//her identification card issued by the National
Council on Disability Affairs (NCDA) or by the Local Government Units (LGUs) where he/she resides.86 In
addition, a purchase booklet issued by the LGUs to persons with disabilities for free shall be presented
every time a purchase of medicine is made.87 Hence, although a mentally disabled can avail of a
discount in in public railways, skyways and bus fare or in purchasing medicines there is an undeniable
fact that there is a stigma attached to persons with mental disablity while there is none to those who
86

National Council for Disability Affairs, Administrative Order No. 1, Series of 2008.
Id.

87

24
are suffering from other illnesses. If an illness of a patient is not apparent, it is inevitable that one of the
assumptions of the persons seeing a PWD identification card is that the patient who owns the card has
a mental disability which he can possibly identify as sirang ulo. Infact a mother of an autistic child said
that she does not want to avail of the PWD identfication card because she doesnt want anybody to
identify that her daughter is, sirang ulo,88 though a mentally disabled patient with a PWD
identification card is not insane or sirang ulo per se.
It is best if the legislators of R.A. 9422 and NCDA have thought of a different term instead of
Person With Disability (PWD) that will not identify the patient, with non- apparent illness, in any way
to be suffering from mental disability. Persons With Discounts, or Persons With Special Discounts
are terms that can be used for instance that will not identify the patient to be suffering with any form of
mental disability.
Also, in the experience of Perlas Reodica, when she bought the generic medicine Clonazepam, a
sedative for her anxiety disorder with her PWD identification card in a known drugstore in Sta. Mesa,
Manila, three of the pharmacists told her, Drug addict ka ano? (You are a drug addict arent you?).89
This experience only shows the discrimination and ridicule that the PWD identification card can cause to
a mentally disabled patient. This also shows that there is a need for a wider dissemination of
information of R.A. 9422 particularly Prohibitions on Verbal, Non-verbal Ridicule and Vilification Against
Persons With Disability90 and its penal clause91.
Another problem caused due to poor dissemination of information of R.A. 9422 is the
discounted professional fees in private health facilities for in-patient and outpatient medical, dental, and
other health care professional services where the corresponding physician or dentist must issue a
corresponding official receipt.
Figure 4. Survey on 95 Psychiatrist-Respondents92
Have you heard of
R.A. 7277 Magna
Carta for Disabled
Persons as amended
by R.A. 9422?
YES
58
NO
37

Do you think you


need to know more
about the Magna
Carta for Disabled
Persons?
90
5

In a recent survey, although 58 out of 95 psychiatrist-respondents have heard of the Magna


Carta for Disabled Persons, 90 of the 95 respondents are ignorant of the contents of the said law. If this
is the case, how can the patient avail of its twenty percent discount from her doctor if her own physician
is not aware of the said law? This is also shows the passive role of psychiatrists in legislation who must
keep themselves abreast not only of the latest in medicine but also of laws affecting their patients.
88

Interview with Mrs. Gene Lesaca, mother of a a 10 year old autistic child (October 7, 2012).
Interview with Perlas Reodica, patient with anxiety disorder (November 12, 2012).
90
Rep. Act. No. 9244 2 (2007). This is known as the Amendment to R.A. 7277 otherwise known as the
Magna Carta for Disabled Persons of 2007 (hereinafter R.A. No. 9422)
91
3.
92
Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
89

25

The downside however, if psychiatrists will learn of the twenty percent discount that can be
availled under R.A. 9422, since there is no ceiling price in their professional fees, they would be inclined
to jack up their prices.

D. Pending House Bill No. 6679


During the 15th Congress of 2009, House Bill 6679 entitled , An Act for A National Mental Health
Care Delivery System Establishing For The Purpose The Philippines Council for Mental Health And
Appropriating Funds Therefore, was introduced by Representatives Prospero C. Nograles and Arthur Y.
Pingoy. Since 2009, the bill has remained pending.
Representive Nograles and Pingoy introduced the bill since mental health programs, facilities,
projects and services are not evenly distributed in the country.93 This bill will also establish a "National
Mental Health Care Delivery System" and the "Philippine Council for Mental Health.94" It also aims to
enact a national mental health policy and to establish a national mental health care delivery system in
the Philippines that is effectivethat will deliver appropriate services and interventions, treatments and
other essential services to every Filipino with mental illness and or disability.95
The salient feature of this bill is the establishment of the National Management Committee for
Mental Health to provide for a coherent, rational and unified response to mental health problems,
concerns and efforts through the formulation and implementation of the National Mental Health Care
Delivery System stated in Section 5 of the bill. However, the probability of passing the bill into a
Republic Act is nil since our very own Department of Health (DOH) is not supportive of the idea of
creating a National Management Committee for Mental Health. In the Department of Healths position
paper on this bill, it said that it cannot support the establishment of the Philippine Council for Mental
Health (which refers to the National Management Committee for Mental Health) since there is already
an existing National Program Management Committee (NMPC) in the DOH as per Administrative Order
No. 9 Series of 2007.
The Department of Health though seems to forget that the National Program Management
Committee (NMPC) that they created is not only focused on mental health but also other areas of
health.96 We need a committee that will solely focus on mental health which is one of the objectives of
House Bill 6679. Also though the DOH position paper boasts that NMPC is to be chaired by the
Undersecretary of Health of the policy and standards Development Team for Service Delivery, cochaired by the Director IV of the National Center for Disease prevention and Control and composed of
mental health advocates from central regional DOH units; hospital, medical and other attached
agencies; other public agencies; the academe, local government units, donor organizations, media,
93

Adrian Jeric G. Pena, Mental Health and Mental Illness in the Philippines at http:// http://mentalhealthph.wikispaces.com/5.+Salient+Points+of+House+Bill+6679(last visited January 17, 2012).
94
Id.
95
Id.
96
Interview with Mr. Nelson Mendoza, Supra Note 73.

26
professional associations, civil society and international development agencies the magnititude of
their responsibilities are wide since it is not only mental health that they focus on but also other
illnesses.97
There is also a dearth of participation of psychiatrists in supporting and pushing this bill into law.
Infact, many of them are ignorant what this bill is about.
Figure 5. Survey on 93 Psychiatrist-Respondents98
Have you heard of the Do you think you
pending
National need to know more
Mental Health Bill (HB about the contents of
6679) in Congress?
the Bill?
YES
50
90
NO
43
3
In a recent survey of 93 psychiatrist-respondents, almost half (48 out of 93) have not heard of House Bill
6679 and 90 out of 93 of them need to know more about the contents of the bill. If these psychiatrists
are informed of the bill, then they can assist and support in fighting for the passage of House Bill 6679
into law. It appears though that our Filipino psychiatrists are active in their own medical professions but
passive when it comes to legislative policies that will greatly advance the rights and privileges of their
patients which they must keep in mind to be one of their major responsibilities.

V. PHILIPPINE HEALTH INSURANCE COVERAGE OF THE MENTALLY DISABLED


Insurance as defined in the Insurance Code of the Philippines is an agreement whereby one
undertakes for a consideration to indemnify another against loss, damage, or liability arising from an
unknown or contingent event.99 Although this definition may sound business for some, which
objectively is for private insurance companies and corporations, it is legitimate for it serves as protection
where the risk insured against by the insured is compensated by the insurer when this contingent event
arises. One of the risks highly insured is health.
Health insurance in the Philippines started with Philippine Medical Care Act of 1969 (RA 6111)
which was organized and implemented by the Government Service Insurance System (GSIS) and Social
Service Security (SSS).100 To target the lower income and non-salaried populations, it later tied-up with
Local Government Units (LGUs) and Health Maintenance Organizations (HMOs).101 In the early 1990s
studies were made for the need of social based insurance. Hence in 1995 under President Fidel
97

Id.
Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
99
Pres. Dec. No. 1460, 2 (1978). This is the Insurance Code of the Philippines.
100
MARIA OFELIA ALCANTARA, FINANCING HEALTH CARE: THE NATIONAL HEALTH INSURANCE SYSTEM
(eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH
REPORT) (2002).
101
Id at 43.
98

27
Ramoss leadership, the National Health Insurance of the Philippines was made into effect known as RA
7875. RA 7875 gave birth to Philhealth which became the driver in implementing the first and only
social based insurance in the Philippines.
In a benefit package of R.A. 7875 of 1995 which states:
SEC. 10.Benefit Package. - Subject to the limitations specified in this Act
and as may be determined by the Corporation, the following categories
of personal health services granted to the member or his dependents as
medically necessary or appropriate, shall include:
a) Inpatient hospital care:
1) room and board;
2) services of health care professionals;
3) diagnostic, laboratory, and other medical examination services;
4) use of surgical or medical equipment and facilities;
5) prescription drugs and biologicals; subject to the limitations stated in
Section 37 of this Act;
6) inpatient education packages;
b) Outpatient care:
1) services of health care professionals;
2) diagnostic, laboratory, and other medical examination services;
3) personal preventive services; and
4) prescription drugs and biologicals, subject to the limitations described
in Section 37 of this Act;
c) Emergency and transfer services; and
d) Such other health care services that the Corporation shall determine
to be appropriate and cost-effective: Provided, That the Program, during
its initial phase of implementation, which shall not be more than five (5)
years, shall provide a basic minimum package of benefits xxx.
(Emphasis Supplied)
There has been no mandate of insurance given to the mentally-ill. Since the first health insurance was
created in 1969, there has been no insurance given to any mental disability only until a circular was
issued in 2010.
Figure 6.
RA 7875 National Health
Insurance Act 1995

SEC.

11.

Excluded

RA 7875 National Health


Insurance Act 1995
(as amended by RA 9241)

Personal SEC.

11.

Excluded

PhilHealth Circular No. 09-2010

Personal Coverage Rules of Psychiatric

28
Health Services The benefits
granted under this Act shall not
cover expenses for the services
enumerated hereunder except
when the Corporation, after
actuarial studies, recommends
their inclusion subject to the
approval of the Board:

Health Services The benefits


granted under this Act shall not
cover expenses for the services
enumErated hereunder except
when the Corporation, after
actuarial studies, recommends
their inclusion subject to the
approval of the Board:

a) non-prescription drugs and a) non-prescription drugs


devices;
and devices;
b) out-patient psychotherapy
and counselling for mental b) alcohol abuse or dependency
treatment;
disorders;
c) drug and alcohol abuse or d) cosmetic surgery;
dependency treatment;
e) optometric services;
d) cosmetic surgery;
e) home
services;

and

f) fifth and subsequent normal


rehabilitation obstetrical deliveries; and

f) optometric services;
g) normal obstetrical delivery;
and
h) cost-ineffective procedures
which shall be defined by the
Corporation. xxx (emphasis
supplied)

g) cost-ineffective procedures
which shall be defined by the
Corporation.

Conditions Requiring Admission


In
order
to
facilitate
reimbursement of claims on
confinements for psychiatric
conditions, the following rules
are hereby issued:
1. Claims for mental and
behavioral disorder shall
be compensable only for
patients with acute
attacks or episodes
admitted for any of the
following reasons:
a. When aggressive of
assaultive behavior
presents danger to
self or others;
b. When the patient is
suicidal;
c. When the patient
becomes manic or
depressed and there
is gross impairment
in judgement and
reality testing;
d. When medication
side effects became
disabling or
potentially life
threatening (e.g.
severe
parkinsonism,
severe tardive
dyskinesia,
neuroleptic
malignant
syndrome);
e. For special medical
procedures such as
electric convulsive

29
therapy. xxx
(emphasis supplied)

Above are the provisions and the circular implemented and issued respectively by the PhilHealth
affecting mental illness in chronological order. The lack of insurance coverage prior PhilHealth Circular
No. 09-2010was made categorical under sec. 11 of the National Health Insurance Act of 1995 (RA 7875):
SEC. 11. Excluded Personal Health Services The benefits granted under
this Act shall not cover expenses for the services enumErated hereunder
except when the Corporation, after actuarial studies, recommends their
inclusion subject to the approval of the Board: xxx
b) out-patient psychotherapy and counselling for mental disorders;
RA 9241, The Act Amending the National Health Insurance in 2003 amended RA 7875,
particularly the benefit b) out-patient psychotherapy and counselling for mental disorders of section
11 as shown in the first column of Figure 6 above. This benefit was removed (as shown in the second
column of Figure 6) as one of those excluded for personal benefits thus making it vague if mental
disorders are now covered by PhilHealth.
Although the present psychiatric conditions covered was made clear after 8 years when
PhilHealth Circular No. 09-2010 was issued ,102 it is surprising to know that out of 94 respondentpsychiatrists in a survey done by random sampling nationwide, 51 of them (54.26% of the respondents)
did not know that such health insurance coverage for their patients exists.103
This only goes to show that there is poor dissemination of informationby the PhilHealth to the
people, especially psychiatrists the most important health provider for the mentally disabled.
Although some of the guiding principle and policies of National Health Insurance of 1995 are
health for all especially the poor, universality and equity as provided in section 2:
SEC. 2. Declaration of Principles and Policies. Section II, Article XIII of
the 1987 Constitution of the Republic of the Philippines declares that
the State shall adopt an integrated and comprehensive approach to
health development which shall endeavor to make essential goods,
health and other social services available to all the people at
affordable cost. Priority of the needs of the underprivileged, sick,
elderly, disabled, women, and children shall be recognized. Likewise, it
shall be the policy of the State to provide free medical care to paupers.
102

Philhealth Circ. No. 09-2010. This is the Coverage Rules of Psychiatric Conditions Requiring Admission
(hereinafter PH Circular 09-10).
103
Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.

30

In the pursuit of a National Health Insurance Program, this Act shall


adopt the following guiding principles:
xxx
b) Universality The Program shall provide all citizens with the
mechanism to gain financial access to health services, in combination
with other government health programs.
The National Health Insurance Program shall give the highest priority to
achieving covErage of the entire population with at least a basic
minimum
package of health insurance benefits;
c) Equity The Program shall provide for uniform basic benefits. Access
to care must be a function of a persons health needs rather than his
ability to pay;xxx (emphasis supplied)
it can be gleaned that the PhilHealth insurance coverage for mental disorders as issued in its PH Circular
09-10 is limited only to acute inpatient care(as shown in the third column of Figure 6 above).104
Apart from being limited, PhilHealth did not operationally define what acute is and how
different it is from chronic. Thus, it can only be assumed that the terms acute and chronic are
understood in their laymans terms: acute for short period attacks105 and chronic for persistent and
long-lasting attacks.106
104

Phil Health Circular No. 09-2010 states:


CovErage Rules of Psychiatric Conditions Requiring Admission
In order to facilitate reimbursement of claims on confinements for psychiatric
conditions, the following rules are hereby issued:
1.

Claims for mental and behavioral disorder shall be compensable only for
patients with acute attacks or episodes admitted for any of the following
reasons:
a) When aggressive of assaultive behavior presents danger to self or others;
b) When the patient is suicidal;
c) When the patient becomes manic or depressed and there is gross
impairment in judgement and reality testing;
d) When medication side effects became disabling or potentially life
threatening (e.g. severe parkinsonism, severe tardive dyskinesia,
neuroleptic malignant syndrome);

e) For special medical procedures such as electric convulsive therapy.xxx


(Emphasis Supplied)
Acute (medicine), available at http://en.wikipedia.org/wiki/Acute_%28medicine%29 (Last visited:
January 18, 2013).
106
Chronic (medicine), available athttp://en.wikipedia.org/wiki/Chronic_%28medicine%29 (Last visited:
January 18, 2013).
105

31

It is important to distinguish the two because it is only inpatients with acute attacks or
episodes are covered in the PH Circular 09-10. The Circular merely gave five reasons where this acute
inpatient care is limited to, which are:
(a) when aggressive of assaultive behavior presents danger to self or
others;
(b) when the patient is suicidal;
(c) when the patient becomes manic or depressed and there is gross
impairment in judgement and reality testing;
(d) when medication side effects became disabling or potentially life
threatening (e.g. severe parkinsonism, severe tardive dyskinesia,
neuroleptic malignant syndrome);
(e) for special medical procedures such as electric convulsive
therapy.(Emphases Supplied)
This means that even if a mentally-ill patient is confined for acute (short period) attacks, but for
reasons that do not fall under the five conditions above, he or she will not be covered by PhilHealth
insurance. According to Dr. Israel Francis Pargas107, patients confined with chronic (long-lasting)
physical illnesses such as leukemia or in need of dialysis for kidney failureare covered by Philhealth
when they are confined, same with mentally-ill inpatients also confined falling under the acute
attacksor episodeslimited to the five conditions enumerated. This also means, persons with chronic
physical illnesses confined are covered by PhilHealth but not persons with chronic mental illnesses.
What is questionable then iswhy only confine insurance with inpatient acute episodes limited to only 5
conditions but not mental illnesses that can also be chronic?By this fact alone there is already a unfair
and unjust treatment of PhilHealth giving insurance coverage to other chronic ailments subject to
confinement that are not mental.
Unfortunately these chronic mental illnesses are not in equal footing with other chronic physical
illnesses under PhilHealth Insurance. This then could lead to more deleterious effects if inpatient
chronic mental illnesses are not covered by insurance while other forms of inpatient illnesses are, may
they be chronic or acute.
Evidence shows that delays in treatments for mental disorders can lead to increased morbidity
and mortality and one of the determinants for this delay is income and lack of health insurance
coverage.108 Less well known is the fact that those with severe mental illness (SMI) are less likely to
have health insurance coverage of any kind.109 There have been reports that chronic illnesses such as
107

Interview with Dr. Israel Francis Pargas, Senior Manager for Benefits Development and Research of
PhilHealth, Pasig City (July 22, 2011).
108
Catherine Mclaughlin, Delays in Treatment in Mental Disorders and Health Insurance Coverage, 39
Health Serv. Res. 221-224 (2004).
109
Id.

32
mental health problems, including depression and schizophrenia, are among the 10 leading causes of
disability worldwide.110 According to a World Bank study, depression will become the second leading
cause of disability in 2010.111Clinical depression is a common mental disorder that affects about 121
million people across the globe.112 It is estimated that by 2020, clinical depression will be the second
most leading cause of disability worldwide second only to cardiovascular illness.113 If these are the
cases, and at the same time confinement of such chronic mental illnesses are not covered by Philhealth,
mentally-ill adults are more likely to be unemployed relative to other adults.114 Multivariate studies of
labor force outcomes have generally found unemployment levels to be lower among persons with
mental illness.115 If they are unemployed, this would also result to non-eligibility for employer
sponsored insurance, the primary source of health care for elderly adults.116 They also become ineligible
to insurance disability benefits from GSIS or SSS if they stop working for the government or a private
employer respectively.
Although the basis of Philhealth in all its insurance coverage are actuarial studies, it can be of
help to widen the scope given to mentally-ill patients if there are psychiatrists who can explain that early
intervention in treatment of mental illness lessens its reccurrence or even with greater probability to be
completely cured. Onset of mental illness occurs during late adolescence or young adulthood
especially the aged 25-34 years.117 This is the same age group that has the highest level of uninsurance;
in part because mental illness often begins during late adolescence or young adulthood, it is more likely
to have greater impact on educational attainment and income than many other chronic conditions.118
Philhealth is not the only insurance corporation which limits its insurance coverage to the
mentally ill but also private insurance companies such as HMOs (Health Maintenance Organizations).
Although under the National Insurance Code of the Philippines (RA 7875) these HMOs can be accredited,
to date, there has been no accredited HMO by PhilHealth.119
HMOs also do not provide any form of insurance, inpatient or out-patient, for the mentally
disabled for the belief that mental disorders are chronic and will consume too much of their funds.
HMOs and other entities must however be educated and informed that mental illnesses that are not
treated early can lead to worse conditions. If there is early intervention and compliance to treatment
for mental disorders, which can be done through the support of an insurance coverage, there is shorter
110

Sol Jose Vanzi, Mental Health Problems: Psychiatrists Tap Social Science, available
athttp://www.newsflash.org/2004/02/si/si001922.htm (last visited October 25, 2004).
111
Id.
112
Cara Davis, 7 Ways to Ward off Clinical Depression, 3, at http://halogentv.com/articles/7-ways-toward-off-clinical-depression/ (last visited: June 20, 2011).
113
Id.
114
Maclughlin, Supra Note 104.
115
Id.
116
Id.
117
Id.
118
Id.
119
Interview with Dr. Israel Francis Pargas, supra note 103.

33
duration for the improvement, and lesser dosages and treatment needed120. If there is decrease in
dosages and maintenance treatment, then this will lead to decrease in expenses, decrease in
hospitalization and decrease for the need for insurance benefits. There is also a possibility of completely
not using such insurance if the patient is completely cured. Early treatment of disorders like depression,
anxiety and drug and alcohol dependence can cut the risk that the problem will persist past young
adulthood, noted by the researchers, led by Dr. Carlos Blanco of the New York State Psychiatric Institute
at Columbia University.121

VI. Conclusion with Recommendations


According to the World Health Organization, there is at least one percent of the global
population that may be suffering from mental health problems. Worldwide, endogenous or major
depression is set to become second only to cardiovascular disease as the most diagnosed condition by
year 2020. It is already the fourth most common diagnosis as of 1998,122 and the Philippines is no
exception from these statistics.123Unfortunately, Filipinos with mental illness are dicriminated against in
various forms where there is unequal treament when it comes to rights and privileges that persons
afflicted with other forms of illnesses that are not mental are given more benefits and privileges in
legislative policies.
In R.A. 7277 also known as the Magna Carta for Disabled Persons alone, there are provisions
that are questionable, thus need to be modified inorder for mentally disabled Filipinos can be given fair
treatment vis a vis other people afflicted with non-mental disabilities.
In education for instance, there are no considerations given to mentally disabled people. The
term mentally retarded is used in Section 14 and 17 of the Act together with persons afflicted with other
illnesses who are given considerations in education. However mental retardation is not the same as
mental disability for it does not cover schizophrenia, major depression, bipolar, anxiety disorder,
addiction the top five most common mental illnesses124 and other mental illnesses. To give special
120

Interview with Dr. Jercyl Leilani Demeterio, supra note 62.


Reuters, Mental health disorders common in young adults: survey, at http://www.abscbnnews.com/lifestyle/12/14/08/mental-health-disorders-common-young-adults-survey (last visted May 19,
2012).
122
Medical Observer, Mental State, http://www.medobserver.com/article.php?ArticleID=437 (last visited
July 23, 2011).
123
Supra note 2. In the Philippines today, a WHO document on Mental Health and Development (2010)
reports that one of every four households worldwide have members with mental health problems. A Population
Survey for Mental Disorders conducted in four provinces in Western Visayas (Iloilo, Capiz, Antique, Negros
Occidental) showed that one out of three households have members with mental health problems. Another WHO
study conducted among patients in seven developing countries (the Philippines included) showed 17-25% of
patients consulting at health care centers have diagnosable psychiatric disorders that, however, are not recognized
by the general physician, midwife, and community health workers in these areas. Mental health problems are
predominantly treated in psychiatric clinics and mental hospitals located in urban centers, thus mental health
services are inaccessible to the majority of Filipinos in rural areas. www.bworld.com.ph, A mental health care
advocate,
at
http://www.bworld.com.ph/content.php?section=Opinion&title=A-mental-health-careadvocate&id=34287 (last visited July 23, 2011)
124
Survey conducted by Naomi Therese F. Corpuz, Supra Note 40.
121

34
considerations to mentally disabled students, the Government can create a pilot study where schools
and/or special classes can be regulated and monitored by certified psychiatrists and clinical
psychologists to determine the veracity and gravity of the illness of the student-patient from time to
time and assess their capacity to learn. These assessments of a pilot case study can be used to
determine special considerations that can be made that are not provided by R.A. 7277.
In labor, a provision must be added to R.A. 7277 where it should categorically state that though
people are diagnosed with mental illnesses it should not be a reason for them to be not accepted from
work. No single provision is stated as such in the Act. Infact, mentally disabled overseas contract
workers are not allowed by the Department of Labor and Employment (DOLE) to leave for overseas
contract employment although it is a fact that with therapy and medication such workers can function
as normal individuals do.
A difficult problem to solve in relation to above is poverty and this is aggravated by the
miniscule budget given to mental health by the DOH. A meager 5% are directed for mental health while
95% are spent on operation, maintenance and salary of the personnel of mental hospitals. The DOH and
other private sectors such as the Philippine Psychiatric Association must think of ways to compensate
the miniscule budget. Such private sectors must lobby for larger budget but sadly the country has
psychiatrists who are passive when it comes to the advancement of their patients rights particularly in
legislative policies.
R.A. 7277 which gives atleast twenty percent discounts to disabled persons for basic health
services is not well-known among the Filipino Psychiatrists in the country. In a survey of 95 respondentpsychiatrists across the Philippines, 90 out of 95 are ignorant of the contents of the Act. Also the
pending House Bill 6679 which pushes for the establishment of a National Mental Health Care Delivery
System and the Philippine Council for Mental Health, is not known to these psychiatrists where 90
out of 93 of them are not also aware of the substance of the law. If the main health professionals such
as psychiatrists are ignorant of the pending bill, how can they start to support and lobby for the
enactment of House Bill 6799? The Congress must create campaign materials to strengthen advocacy
and public information campaign on mental health. They can also mandate each and every psychiatrist
of the Philippines to attend seminars on the laws and bills affecting the mentally disabled. Campaign
materials are not also meant for psychiatrists but also for Local Government Units where every region
down to the barangays which is the smallest political unit are made aware of the laws and bills affecting
mentally disabled patients.
There is also a poor dissemination of information of the benefits and privileges given to mentally
disabled patients covered by the Philippine Health Insurance (PhilHealth). PhilHealth Insurance
coverage for the mentally ill is limited only to acute inpatient care which must fall under 5 conditions
enumerated by PH Circular 09-10. While PhilHealth covers chronic illnesses that are not mental subject
to confinement, it does not cover chronic mental illnesses subject also to confinement which only
shows the unjust treatment to mentally disabled patients. This PH Circular 09-10 must be amended by
making known by the DOH, private sectors, mental health professionals such as psychiatrists that
mentally disabled patients with chronic illnesses subject to confinement must be covered by insurance
of PhilHealth as evidence shows that delays in treatments for mental disorders can lead to increased
morbidity and mortality and one of the determinants of this delay is income and lack of health insurance
coverage.

35
VI. BIBLIOGRAPHY
Laws
1987 Philippine Constitution
Batasang Pambansa 344. AN ACT TO ENHANCE THE MOBILITY OF DISABLED PERSONS
BY REQUIRING CERTAIN BUILDINGS, INSTITUTIONS, ESTABLISHMENTS AND PUBLIC UTILITIES TO INSTALL
FACILITIES AND OTHER DEVICES
Rep. Act No. 7277, The Magna Carta for Disabled Persons
Rep. Act. No. 9244. This is known as the Amendment to R.A. 7277 otherwise known as the
Magna Carta for Disabled Persons of 2007
DOH AdministrativeOrder No. 8 Series of 2001
DOH AdministrativeOrder No. 9 Series of 2007
National Council for Disability Affairs Administrative Order No. 1, Series of 2008
Pres. Dec. No. 1460, 2 (1978) Insurance Code of the Philippines
RA 7875 National Health Insurance Act 1995
RA 7875 National Health Insurance Act 1995 (as amended by RA 9241)
PhilHealth Circular No. 09-2010
House Bill 6679 entitled An Act for A National Mental Health Care Delivery System Establishing
For The Purpose The Philippines Council for Mental Health And Appropriating Funds Therefore

Books
ARTHUR MILLER, THE CRUCIBLE vii (1995).
BALTAZAR REYES & CONSTANTINE DELLA, TREATMENT OF MENTAL ILLNESS IN THE PHILIPPINES:
A HISTORICAL PERSPECTIVE (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE
STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002).
Fr. JOSE FRANCISCO SYQUIA, EXORCISM: ENCOUNTERS WITH THE PARANORMAL AND THE
OCCULT 1-207 (2006)
MA. LUZ CASIMIRO QUERUBIN & SONIA CASTRO RODRIGUEZ, FINANCING HEALTH CARE: THE
NATIONAL HEALTH INSURANCE SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE
PHYSICAL: THE STATE OF THE NATIONS MENTAL HEALTH REPORT) (2002).

36

MARIA OFELIA ALCANTARA, FINANCING HELATH CARE: THE NATIONAL HEALTH INSURANCE
SYSTEM (eds. Ma. Luz Querubin & Sonia Rodriguez, BEYOND THE PHYSICAL: THE STATE OF THE
NATIONS MENTAL HEALTH REPORT) (2002).
Robert Carson et.al., ABNORMAL PSYCHOLOGY AND MODERN LIFE 33 (2000).

Papers
Dr. Bernardo Conde, Philippines mental health country profile, International Review of
Psychiatry, 166 (2004).
WHO and Department of Health-Manila, Report on Mental Health System in the Philippines, 7 in
WHO-AIMS (2007)
Catherine Mclaughlin, Delays in Treatment in Mental Disorders and Health Insurance Coverage,
39 Health Serv. Res. 221-224 (2004).

Websites
Major
Depressive
Disorder,
available
http://en.wikipedia.org/wiki/Major_depressive_disorder (Last visited: January 18, 2013).

at

Major Depression, available at http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm


(Last visited: January 18, 2013).
Cara Davis, 7 Ways to Ward off Clinical Depression, Jun 20, 2011, 3,
http://halogentv.com/articles/7-ways-to-ward-off-clinical-depression/

at

Source: Government of Sourth Australia, Department for families and communities. Intellectual
Disability
and
Mental
Illness
(Dual
Disability)
available
at
http://www.sa.gov.au/upload/franchise/Community%20Support/Disability/Information%20sheets%20%20Disability%20SA/Intellectual%20disability%20-%20mental%20illnessdual%20disability%20%28PDF%20140kb%29.pdf (Last visited: June 9, 2012).
The Free Dictionary, available at http://medical-dictionary.thefreedictionary.com/mental+illness
and Wikipedia, available at http://en.wikipedia.org/wiki/Mental_disorder (Last visited: November 26,
2012).
DSM5.org,
available
at
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=465 (Last visited: October
22, 2011).
Rina Jimenez David, At Large Not just for the sirang ulo at http://opinion.inquirer.net/8977/notjust-for-the-%E2%80%98sirang-ulo%E2%80%99(last visited November 22, 2012).

37
Westers Dictionary at http://www.merriam-webster.com/medical/lobotomy (last visited May
16, 2012)
World Fellowship for Schizophrenia and Allied Disorders, available at http://www.worldschizophrenia.org/disorders/schizophrenia.html(Last visited: November 26, 2012).
Meeting of Minds, available at http://www.medobserver.com/article.php?ArticleID=440(last
visited May 17, 2012).
Margarita
Tartakovsky
M.S.,
The
Bipolar
Fact
Sheet,
available
http://psychcentral.com/lib/2009/bipolar-disorder-fact-sheet/ Last visited: November 26, 2012).

at

Major Depression, available at http://www.depressedtest.com/major_depression.html(Last


visited: November 26, 2012).
Anxiety Disoder, available at http://en.wikipedia.org/wiki/Anxiety_disorder (Last visited:
November 26, 2012).
Anxiety and Panic Disorders Health Center, available at http://www.webmd.com/anxietypanic/guide/mental-health-anxiety-disorders (Last visited: November 26, 2012).
Addiction, available at http://en.wikipedia.org/wiki/Addiction (Last visited: November 26, 2012).
What is Addicition?, available at http://www.psychologytoday.com/basics/addiction (Last
visited: November 26, 2012).
Information
about
Mental
Illness
and
the
Brain,
http://science.education.nih.gov/supplements/nih5/mental/guide/info-mental-b.htm
November 26, 2012).

available
at
(Last visited:

Dictionary.com, available at http://dictionary.reference.com/browse/psychosomatic (Last


visited: November 26, 2012).
Psychopharmacology
From
Wikipedia,
the
free
http://en.wikipedia.org/wiki/Psychopharmacology (last visited May 17, 2012).

encyclopedia

at

Psychopharmacology,
available
at
http://www.sciencedaily.com/articles/p/psychopharmacology.htm (Last visited: November 26, 2012).
Mental Retardation, http://emedicine.medscape.com/article/1180709-overview (Last visited:
January 14, 2013).
Adrian Jeric G. Pena, Mental Health and Mental Illness in the Philippines at http://
http://mentalhealth-ph.wikispaces.com/5.+Salient+Points+of+House+Bill+6679 (last visited January 17,
2012).
Acute (medicine), available at http://en.wikipedia.org/wiki/Acute_%28medicine%29 (Last
visited: January 18, 2013).

38

Chronic (medicine), available athttp://en.wikipedia.org/wiki/Chronic_%28medicine%29 (Last


visited: January 18, 2013).
Sol Jose Vanzi, Mental Health Problems: Psychiatrists Tap Social Science, available
athttp://www.newsflash.org/2004/02/si/si001922.htm (last visited October 25, 2004).
Cara Davis, 7 Ways to Ward off Clinical Depression, 3, at http://halogentv.com/articles/7ways-to-ward-off-clinical-depression/ (last visited: Jun 20, 2011).
Reuters, Mental health disorders common in young adults: survey, at http://www.abscbnnews.com/lifestyle/12/14/08/mental-health-disorders-common-young-adults-survey (last visted
May 19, 2012).
Medical Observer, Mental State, http://www.medobserver.com/article.php?ArticleID=437 (last
visited July 23, 2011).

39
ANNEX A
SURVEY FORM FOR PSYCHIATRISTS

Please take time to answer the following questions.


The information you will provide will be treated with UTMOST CONFIDENTIALITY.
1) Hospitals/Institutions: Check as many as applicable
Private Hospital: ( ) Specialized
( ) General
Government: ( ) Specialized Institution
( ) Genera.l Hospital
( ) Own Clinic
( ) Others, pls specify _______________
2) Services:
( ) Outpatient care
( ) Home visits
( ) Inpatient care
( ) Group Sessions
( ) Others, pls specify ____________________
3) Location of Institutions associated with:
( ) NCR
( ) North Luzon ( ) South Luzon ( ) Central Luzon
( ) Visayas
( ) Mindanao
4) Years of Practice:
( ) Less than 1 yr( )11-20 yrs( ) 31-40 yrs
( )1-5 yrs( ) 21-30 yrs( ) Above 50 yrs
( )6-10 yrs
( ) 41-50 yrs
5) Estimated number of outpatient consults in a week:
( ) 1-5
( )11-20
( ) 31-40 ( ) 51-60
( ) 6-10
( ) 21-30 ( ) 41-50
( ) Above 60
6) Estimated number of in-patients in a month:
( ) at least 5 / month ( ) around 10 / month
( ) approximately 20 / month
( ) others, ____________________

7)Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by
Republic Act 9244)?
( ) Yes
( ) No
Comments: ___________________________________
8) Do you think you need to know more about it?
( ) Yes
( ) No
Comments: ___________________________________
9) Is there a present Health Insurance Coveragefor psychiatric illnesses that you know of?

40
( ) Yes
( ) None
Comments: ___________________________________
10) What are your insights regarding health Insurancefor psychiatric patients?
_____________________________________________
_____________________________________________
11) Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of
psychiatric disorder in your medical practice:
_______ schizophrenia
_______ bipolar
_______ majordepression
________ anxiety disorder
________ addiction (substance-use disorder)
________ dementia
________ personality disorder
________ eating disorder
________ somatoform disorder
________ sleep disorder
________ sexual disorder
Comments: ___________________________________
_____________________________________________
12)Are there other psychiatric disorders that you commonly encounter apart from those listed
above? If Yes, please specify ___________________________
13) Estimated number of consults patient would need before adequate recovery is perceived:
(in terms of the top 5 common disorders you Ranked in no. 11)
( ) 1 consult is enough ( ) 11-15
( ) 2-3 consults
( ) 16-20
( ) 4-5 consults
( ) 21-25
( ) 6-10
( ) 26-30
( ) Above 30
Comments: ___________________________________

14)Yourestimated cost for consultations before some adequate recovery is perceived per
patient:(in terms of the top 5 common disorders you ranked in no. 11)
OUTPATIENT
IN-PATIENT
If Private Setting:
If Private Setting:
____________
____________
weekly ____________ bi- weekly ____________ biweekly
weekly
____________
____________
monthly
monthly
____________
____________
quarterly
____________ quarterly
____________
yearly
yearly

41
If

Government

If

Government

Setting:

Setting:
____________
____________
weekly ____________ bi- weekly ____________ biweekly
weekly
____________
____________
monthly
monthly
____________
____________
quarterly
____________ quarterly
____________
yearly
yearly
Comments: ___________________________________
15) Your estimated cost of medications per patient would need to spend on a monthly basis:
(in terms of the top 5 common disorders you ranked in no. 11)
( ) P100 P500
( ) P3000 P4, 500
( ) P600 P 1000
( ) P5000 P8,000
( ) P1, 500 P 2, 500 ( ) P8000 P10,000
() Above P10,000
Comments: ___________________________________
16) Have you heard of the pending National Mental Health Bill in Congress?
( ) Yes
( ) No
Comments: __________________________________________________
17) Do you think you need to know more about it?
( ) Yes
( ) No
Comments: __________________________________________________
IMPORTANT REMINDER: We want to ensure retrieval of this survey form, hence submission of
each psychiatrist-participant will be checked after it is completely filled-out. Kindly return after
answering the form to the registration site for the checking of your submission of such form. Thank you
very much.

42
ANNEX B
ANSWERS TO SURVEY
BY PSYCHIATRISTS
1.

Hospital/ Institutions: Check as many as applicable

Table 1

Private Hospital

a.)
Specialized

GenEral

25

41

Government Hospital
Specialized
Institute
27

GenEral
Hospital
37

Table 2

b.)

Own Clinic

51

Others, pls. Specify


(if there is no. it mins. The number
of person with the same answers)
1. Psychologist
2. Home care =3
3. Multispecialty Clinic
4. Academe
5. Shelter for street children
6. Multispecialty private clinic
7. San Bernabe Med. Clinic,
8. NGO=2
9. Visiting.

2. Services:
Table 3

Outpatient Care

91

Inpatient Care
88
Home Visit
22
Group Session
22
Others, pls. specify
1. E.R. Patient=2
(if there is no. it means. 2. Psychiatric Education
The number of person 3.Detoxification

43
with the same answers)

3. Location of institutions associated with:


Table 4
NCR
North Luzon
South Luzon
Central Luzon
Visayas
Mindanao

52
8
10
3
21
10

4. Years of Practice:
Table 5

Less than 1 yr.


1-5 yrs.
6-10 yrs.
11-20 yrs
21-30 yrs.
31- 40yrs.
41-50 yrs.
Above 50 yrs.

8
20
25
22
12
8

5. Estimated number of outpatient consults in a week.


Table 6
1-5
6-10
11-20
21-30
31- 40
41-50
51-Above

7
25
13
14
10
5
21

44
6. Estimated number of in- patient in a month:
Table 7

Less than 5/month


Less than 5/month
At least 5/month
Around 10/month
Approximately 20/month
51-100/month
200/month
20-50/month
500/month
Others,
(if there is no. it means.
The number of person
with the same answers)

10
10
39
12
10
4
3
5
1
1. Variable or one / 3
months
2. Once a month
3. None-All patients are
Outpatients
4. 20/month
5. None/ n.a. (OPD)
6. 5X / year
7. Seldom
8. More than 20/ month
9. 500/month
10. 1-3/month
11.Less than 5/month
12. more than 20/month
13. 50 inpatients, at
present
14. 500 inpatients of the
whole hospital
15. 50/month-in govt.
hospital
16. 100
17. 5
18. 1-2 patients
19. 100/month
20. 5/month
21. 100/month or more
22. 150-200/month=2
23. more than 50 in a
month
24. occasional only

45
25. 3 patients/month=2
26. 5000
27.Approximately
200/month
30. 5/month

7. Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by
Republic Act 9244)?
Table 8
YES
NO
COMMENTS:

58
37
1. Needs copy of R.A. 7277.
2. I know there is one but I havent
read it
3. Given emphasis for the physically
disabled including the mental.
4. Not totally though
5. Not aware of this Act

8. Do you think you need to know more about it ?


Table 9
YES
NO
COMMENTS:

90
5

9 .Is there a present Health Insurance CovEragefor psychiatric illnesses that you know of?
Table 10
YES
NONE
COMMENTS:

44
51
1. Phil health for acute cases only=3

46
2. Phil health= 8
3. It is limited
4. Psychiatric patients should be covered
by Insurance
5. very limited only for admitted patients
6. SSS/GSIS disability claim
7. Phil health for inpatients
8. Phil health very selective cases only
9. Sources only acute cases
10. Their limited to certain illness
11. Phil health but still not implemented for
hospitals w/o psychiatric wards.

10. What are your insights regarding health Insurancefor psychiatric patients?
Table 11
1.) Should also include chronic cases
2.) Coverage should include OP's medicators
3.) It is a necessity
4.) Health Insuranceshould be instituted for care for mental health patients
5.) Needs to be given fair assistance from Insuranceco.
6.) Long term to have one
7.) Took time to have one
8.) Very less of a privilege & opportunity
9.) Health Insuranceco. seems reluctant to cover psychiatric conditions
10.) They needed it badly esp. for indigent patients
11.) Most health Insurancedo not recognize psychiatric illness
12.) It is necessary since most mental illness is chronic
13.) None
14.) I think it will help those who are not economically -privileged to avail
services
15.) limited coverage due & high cost of medicines & hospitalization.
16.) It is needed but none is available
17.) It will be very helpful if approved
18.) They deserve to have an Insurancetoo for humanizations reason
19.) It is highly recommended since psychiatric care is costly
20.) This should be a must for voluntary consultations & regular treatment
21.) Psychiatric patients should be covered by Phil Health
22.) It does not sum to realize that psychiatric conditions are chronic &
patients are mostly a lifetime maintain treatment
23.) Health Insuranceco. just make money for themselves. They dont pay
current consultations/professional fees for doctors pay even up to several
years late.

47

24.) Too difficult to be specific depends on patients recovery & response too
25.) Necessary
26.) They should benefit from Insurancesince treatment is usually long term
27.)There should be expansion of the coverage for psychiatric patients
28.) Psychiatric admissions should be included in health insurance
29.) It is a must
30.) Government needs to come up with a nahomel mental health Program
to create awareness, politics & employer respond to wellness Programs, price
control on medicines .
31.) It should also outpatient services
32.) It is necessary esp. with the cost of medications and hospitalization
during relapse.
33.)Theres a need
34.) neglected by private Insuranceco. & ignored by gov't. but a basic need
and right for the mentally disabled
35.) Badly needed
36.) we need more health Insurancebenefits for both psychotic & non
psychotic admission an OPD consult
37.) There is a definite need for it but it will all fall down to financial liability
38.) Health Insuranceshould include all illnesses including psychiatric
conditions except for substance we abuse /dependence
39.) About time we have a comprehensive one
40.) Psychiatric disorders are also medical conditions and should share equal
benefits together with all other illnesses
41.) This should be a must for voluntary consultations & reg. treatment
42.) There should be good somewhere for it if there was one
43.) It would entail to much cost
44.)When will it be available
45.) Most psychiatric patients are claiming for Insurance-they need to be
provided for
46.) It is important
47.) Inadequate
48.) Should have
49.) Should be included in the Health Insurance CovErageof Phil Health
50.) Needs to cover non psychiatric cases/doctors
51.) It is limited and some disorders /mental disorders are allegedly not
covered private health insurances dont cover it
52.) Unfair & lacking
53.) It should have adequate coverage like medical illnesses
54.) It is needed
55.) Need ,it is acknowledge that it is a chronic conditions and will really
go through government resources.
56.)Good & helpful
57.)Mental illnesses should be covered by health Insurance
58.) Insurancecompanies (private coverage of psychiatric patients as well as

48
government should accept all of them
59.) Health Insuranceshould also be made available for psychiatric patients
60.) It is important
61.) Wanting
62.) They need it
63.) It would be a help of both in the caregivers & patient, it will make them
prompt /OPD for consult
64.) Its non-existent
65.) It should cover up to 3-6 months
66.) Needs to be reinforced
67.) There should be HMO provider
68.) Still needs to be more extensive covering more illness
69.) It would be a great help for our patients
70.) Limited to some illness, & this is unfair knowing that mental illness are
recurrent & treatment serve longer time
71.) Health Insurancefor psychiatric patients should have a broader coverage
72.) Public is not aware and extensive review of coverage should be done
because usually mental problems is excluded in health coveR.A.ge
73.) Need so much because of relapses(financial problems)
74.) Needs wider coverage
75.) Will take a long
76.) Imperfect, but at least its a start.
77.) I think psychiatric patient

11. Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of psychiatric
disorder in your medical practice:
Table 12
SCHIZOPHRENIA
653
BIPOLAR
587
MAJOR DEPRESSION
613
ANXIETY DISORDER
571
ADDICTION
(Substance-use
disorder)
555
DEMENTIA
460
PERSONALITY DISORDER
482
EATING DISORDER
400
SOMATOFORM DISORDER
423
SLEEP DISORDER
510
SEXUAL DISORDER
386
COMMENTS:
1. Adjustment disordering have
anxiety or depressive symptoms
2. Other patient has dual diagnose

49
3. at times they exist co-morbidly

12. Are there other psychiatric disorder you commonly encounter apart from those listed above?
If yes Pls, Specify
Table 13
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

ADHD=3
No
Marital problems
Suicide
Adjustment disorder, physical abuse, sexual abuse
School phonic , ADHD, Mental retardation, conduct disorder
Panic disorder, post traumatic stress disorder
ADHD & learning disorder , mental retardation
Schzo affective disorder
PTSD
Relationship disorder/problem
none except co-morbid conditions
additional developmental disorder like ADHD; MR; Conduct disorder
Marital problems & work related problems
mixed anxiety depression disorder delusional disorder
Dismpture disorder
ADHD; Autism

13. Estimated number of consults patient would need before adequate recovery
is perceived: (in terms of the top 5 common disorders you Rankin no. 11)
Table 14

24
1 -5 CONSULTS
38
6--15
20
16--30
30 Above
COMMENTS:

13 (answer of NEW QUESTIONNAIRE


included)
1. I practice psychotherapy. The
approach in psychiatry
2. Several factors should be considered
here like financial support and patients
insight

50
3. It really depends on the severity of
each illness ,the social support available
for the patient & mental capacity of the
patient
4.
recovery
also
depends
on
patient/family
compliance
with
medication and advice given by the
doctor
5. Continues psychiatric care is
recommended
6. Some patients do not recover
completely
7.Patients needs also continuous
monitoring & follow up there after
8. Lifetime
9. Treatments for each disorder is too
varied in terms of approaches &
pharmacology , psychotherapy consults
10. Case to case basis
11. Per need-it varies
12. Follow up consults still needed even
if patients is asymptomatic already
13. If seen at once (acute)given
treatment improvements is seen
14. Mental illness is lifetime disease
15. I cant answer this as the top 5
Mental illness is the recurrent &
recovering is not possible disorder to
the nature or cause of thinking.

CORRECT ANSWERS

51
Table 15
OUTPATIENT

IN-PATIENT
If

Private(Pesos)
WKLY

1,000

If Private(pesos)
BIWKLY

MNTLY

QTRLY

YRLY

500

600

600

600

600
400

1,200
2,500

1,200
12k

36,000
1,8000

1,500
20,000
1,000
20,000

6,000
2,500
1,200
3,000

1,200
1-2k
2,000
5,000

1,500
2,500

36k
7,200
1012k

2,000
2,000

1,500
700

1,500
600
500
At least
1,000
500
500
600
800/
Session
4,000
1-2k
1,000
1,500-2k
6,000
1,000
500

1,000
800
1,500700
2k
2,000 1,000
4,000
20k
2k

WKLY

BIWKLY

1,000/
Day

1,000/
Day

600
3,000
20k
20,000
6,000
5,000
2,500
Room
rate
7,000

16,000
1,000/
12,000 Day
18,000 24,000
5,000

35,000
20,000
10-15k
3,000

QTRLY

YRLY

1,000/
Day

1000/
day

72,000
105,000

60,000
72,000
420,00

1,500
6,000
1520k
1-2k
7,000
30,000
1,000
1,000
1,000
15,000
5,000
20k

OUTPATIENT
If Government
WEEKLY

MNTLY

BI-WEEKLY

MONTHLY

IN-PATIENT
If Government
QUARTERLY YEARLY

52
300
500
1,ooo
Free
Free
50
100
600
200
200
0

200
free
0

0
1-3k
1,500-3k
Free charity

Others: 8-10,000
COMMENTS:

Table 16
1.) Cant be measured
2.) In government setting no PF so consultation cost will be in terms of medicine &
laboratory work-up
3.) Cant be measured
4.) Depends
5.) Socialized
6.) Not very clear question & what we are being asked too
7.) Just voluntarily/part of the duty
8.) Not possible knowing that recovery is not possible.
9.) Hospitalization can be avoided if patient regularly follow up our out patient basis.

15. . Your estimated cost of medications per patient would need to spend on a monthly Basis : (in
terms of the top 5 common disorders you ranked in no.11).

53

Table 17
P100-P500
P600-P1000
P1, 500-P2, 500
P3000-P4, 500
P5000-P8, 000
Above P8,000
COMMENTS:

4
4
15
27
17
20
1. For treatment resistant psychotic patients
using a
typical antipsychotics
2. Assuming we use the best medications
available
3. Range in terms of generic medicines
4. the disorder ranked 1-5 are too varied to
describe by the above choices
5. Depends
6. No idea, not discussed with patient
7. Esp. if branded/innovator drugs will be
used
8. Varies on patients capacity to buy
9. Mightly meds P26-7/month
10. Depending on the medications
prescribed

16. Have you heard of the pending National Mental Health Bill in Congress
Table 18
YES
NO
COMMENT:

50
43
1. It was remained to be pending for the past 12
yers
2. Needs to push
3. Long been pending
4. Not apperceived because there were more
important one.

17. Do you think you need to


know more about it?
Table 19
YES

89

54
NO
COMMENT:

3
1. More involved about it, involvement & multi sectoral group
2. to nosy
3. Just pass it they just say , medicines are costly
4. One has to know somebody intensive follow up
5. it would be good if there is .

GRAPHS
3. Location of institutions associated with:
Figure 1
60

52

50

NCR

40

North Luzon
South Luzon

30
21

Central Luzon

20
10

10

10

Visayas

3
Mindanao

0
Locations

4. Years of Practice.
Figure 2
25
25

22

Less than 1 yr.

20
20

1-5 yrs.
6-10 yrs.

15
10

12
8

11-20 yrs.

21-30 yrs.
31-40 yrs.

41-50 yrs.

Above 50 yrs.

No. of psychistrist answered

TOTAL=95

5. Estimated number of outpatient consults in a week.


Figure 3
25
25
21

1-5

20
6-10

15

13

14

11-20

10
10

21-30

7
5

31-40
41-50

55

TOTAL=95
6. Estimated number of in- patient in a month:
Figure 4
39

40

Less than 5/month

35

At least 5/month

30
25

Around 10/month

20

Approximately 20/month

15

12

10

51-100/month

10

10
4

200/month

5
1

20-50/month

500/month

No. of psychiatrist answered

TOTAL = 84

7. Are you aware of the Magna Carta for Disabled Persons (Republic Act 7277 as amended by
Republic Act 9244)?
Figure 5

58
37

YES
NO

TOTAL = 95

56
9 .Is there a present Health Insurance CovErage for psychiatric illnesses that you know of?
Figure 6

51
YES

44

NO

TOTAL 95

10. Please Rankon a scale of 1 to 11, 11 being the highest, as the most common case of psychiatric
disorder in your medical practice

Figure 7
Schizophrenia

700
600
500

653
587

613

Bipolar

571 555

Major Depression

510

460 482
400

423

400

Anxiety Disorder

386

Addiction
Dementia

300

Personality Disorder

200

Eating Disorder

100

Somatoform Disorder

0
Psychiatric Disorders

Sleep Disorder
Sexual Disorder

57

13. Estimated number of consults patient would need before adequate recovery
is perceived: (in terms of the top 5 common disorders you Rank in no. 11)

Figure 8
38

40
35
30
24

25

1-5

20

6-15

20
13

15

16-30

10

30 above

5
0
No. of Consults needed by a patient

TOTAL = 95
15. Your estimated cost of medications per patient would need to spend on a monthly basis:
(in terms of the top 5 common disorders you ranked in no.11).

Figure 9

30

27

25
20
20

17
15

15

P100-P500
P600-P1000
P1,500-P2,500
P3,000-4,500

10

P5,000-P8,000

4
Above P8,000

0
Estimated cost of medication/ patient

58
16. Have you heard of the pending National Mental Health Bill in Congress?
Figure 10

43

50

YES
NO

TOTAL = 93

17. Do you think you need to know more about it?


Figure

11

90

YES
NO

TOTAL = 93

59
ANNEX C
Republic Act No. 9277
March 24, 1992

AN ACT PROVIDING FOR THE REHABILITATION, SELF-DEVELOPMENT AND SELF-RELIANCE OF DISABLED


PERSONS AND THEIR INTEGRATION INTO THE MAINSTREAM OF SOCIETY AND FOR OTHER PURPOSES.

TITLE I
GENERAL PROVISIONS
CHAPTER I
BASIC PRINCIPLE
Section 1. Title. This Act shall be known and
cited as the "Magna Carta for Disabled
Persons."
Sec. 2. Declaration of Policy The grant of the
rights and privileges for disabled persons shall
be guided by the following principles:
(a) Disabled persons are part of Philippine
society, thus the State shall give full support to
the improvement of the total well-being of
disabled persons and their integration into the
mainstream of society. Toward this end, the
State shall adopt policies ensuring the
rehabilitation, self-development and selfreliance of disabled persons. It shall develop
their skills and potentials to enable them to
compete favorably for available opportunities.
(b) Disabled persons have the same rights as
other people to take their proper place in
society. They should be able to live freely and as
independently as possible. This must be the
concern of everyone the family, community
and all government and nongovernment
organizations. Disabled persons' rights must
never be perceived as welfare services by the
Government.

(c) The rehabilitation of the disabled persons


shall be the concern of the Government in
order to foster their capacity to attain a more
meaningful, productive and satisfying life. To
reach out to a greater number of disabled
persons, the rehabilitation services and benefits
shall be expanded beyond the traditional urbanbased centers to community based programs,
that will ensure full participation of different
sectors as supported by national and local
government agencies.
(d) The State also recognizes the role of the
private sector in promoting the welfare of
disabled persons and shall encourage
partnership in programs that address their
needs and concerns.
(e) To facilitate integration of disabled persons
into the mainstream of society, the State shall
advocate for and encourage respect for
disabled persons. The State shall exert all
efforts to remove all social, cultural, economic,
environmental and attitudinal barriers that are
prejudicial to disabled persons.

Sec. 3. Coverage. This Act shall cover all


disabled persons and, to the extent herein
provided, departments, offices and agencies of
the National Government or nongovernment
organizations involved in the attainment of the
objectives of this Act.chanrobles virtual law
library

60

Sec. 4. Definition of Terms. For purposes of


this Act, these terms are defined as
follows:chanroblesvirtualawlibrary
(a) Disabled persons are those suffering from
restriction or different abilities, as a result of a
mental, physical or sensory impairment, to
perform an activity in the manner or within the
range considered normal for a human being;

(1) qualified interpreters or other effective


methods of delivering materials to individuals
with hearing impairments;
(2) qualified readers, taped tests, or other
effective methods of delivering materials to
individuals with visual impairments;
(3) acquisition or modification of equipment or
devices; and

(b) Impairment is any loss, diminution or


aberration of psychological, physiological, or
anatomical structure or function;

(4) other similar services and actions or all types


of aids and services that facilitate the learning
process of people with mental disability.

(c) Disability shall mean 1) a physical or mental


impairment that substantially limits one or
more psychological, physiological or anatomical
function of an individual or activities of such
individual; 2) a record of such an impairment; or
3) being regarded as having such an
impairment;

(h) Reasonable Accommodation include 1)


improvement of existing facilities used by
employees in order to render these readily
accessible to and usable by disabled persons;
and 2) modification of work schedules,
reassignment to a vacant position, acquisition
or modification of equipment or devices,
appropriate adjustments or modifications of
examinations, training materials or company
policies, rules and regulations, the provision of
auxiliary aids and services, and other similar
accommodations for disabled persons;

(d) Handicap refers to a disadvantage for a


given individual, resulting from an impairment
or a disability, that limits or prevents the
function or activity, that is considered normal
given the age and sex of the individual;
(e) Rehabilitation is an integrated approach to
physical, social, cultural, spiritual, educational
and vocational measures that create conditions
for the individual to attain the highest possible
level of functional ability;
(f) Social Barriers refer to the characteristics of
institutions, whether legal, economic, cultural,
recreational or other, any human group,
community, or society which limit the fullest
possible participation of disabled persons in the
life of the group. Social barriers include
negative attitudes which tend to single out and
exclude disabled persons and which distort
roles and inter-personal relationships;
(g) Auxiliary Aids and Services include:

(i) Sheltered Employment refers to the


provision of productive work for disabled
persons through workshops providing special
facilities, income-producing projects or
homework schemes with a view to giving them
the opportunity to earn a living thus enabling
them to acquire a working capacity required in
open industry;
(j) Auxiliary Social Services are the supportive
activities in the delivery of social services to the
marginalized sectors of society;
(k) Marginalized Disabled Persons refer to
disabled persons who lack access to
rehabilitative services and opportunities to be
able to participate fully in socioeconomic
activities and who have no means of livelihood
and whose incomes fall below the poverty
threshold;

61
(l) Qualified Individual with a Disability shall
mean an individual with a disability who, with
or without reasonable accommodations, can
perform the essential functions of the
employment position that such individual holds
or desires. However, consideration shall be
given to the employer's judgment as to what
functions of a job are essential, and if an
employer has prepared a written description
before advertising or interviewing applicants for
the job, this description shall be considered
evidence of the essential functions of the job;

(o) Covered Entity means an employer,


employment agency, labor organization or jointlabor management committee; and

(m) Readily Achievable means a goal can be


easily attained and carried out without much
difficulty or expense. In determining whether an
action is readily achievable, factors to be
considered include

CHAPTER I
EMPLOYMENT

(1) the nature and cost of the action;


(2) the overall financial resources of the facility
or facilities involved in the action; the number
of persons employed at such facility; the effect
on expenses and resources, or the impact
otherwise of such action upon the operation of
the facility;
(3) the overall financial resources of the
covered entity with respect to the number of its
employees; the number, type and location of its
facilities; and
(4) the type of operation or operations of the
covered entity, including the composition,
structure and functions of the work force of
such entity; the geographic separateness,
administrative or fiscal relationship of the
facility or facilities in question to the covered
entity.
(n) Public Transportation means transportation
by air, land and sea that provides the public
with general or special service on a regular and
continuing basis;

(p) Commerce shall be taken to mean as travel,


trade, traffic, commerce, transportation, or
communication among the provinces or
between any foreign country or any territory or
possession and any province.
TITLE II
RIGHTS AND PRIVILEGES OF DISABLED PERSONS

Sec. 5. Equal Opportunity for Employment.


No disable person shall be denied access to
opportunities for suitable employment. A
qualified disabled employee shall be subject to
the same terms and conditions of employment
and the same compensation, privileges,
benefits, fringe benefits, incentives or
allowances as a qualified able bodied
person. chan robles virtual law library
Five percent (5%) of all casual emergency and
contractual positions in the Departments of
Social Welfare and Development; Health;
Education, Culture and Sports; and other
government agencies, offices or corporations
engaged in social development shall be
reserved for disabled persons.
Sec. 6. Sheltered Employment If suitable
employment for disabled persons cannot be
found through open employment as provided in
the immediately preceding Section, the State
shall endeavor to provide it by means of
sheltered employment. In the placement of
disabled persons in sheltered employment, it
shall accord due regard to the individual
qualities, vocational goals and inclinations to
ensure a good working atmosphere and
efficient production.

62
Sec. 7. Apprenticeship. Subject to the
provisions of the Labor Code as amended,
disabled persons shall be eligible as apprentices
or learners: Provided, That their handicap is not
as much as to effectively impede the
performance of job operations in the particular
occupation for which they are hired; Provided,
further, That after the lapse of the period of
apprenticeship, if found satisfactory in the job
performance, they shall be eligible for
employment.
Sec. 8. Incentives for Employers. (a) To
encourage the active participation of the
private sector in promoting the welfare of
disabled persons and to ensure gainful
employment for qualified disabled persons,
adequate incentives shall be provided to private
entities which employ disabled persons.
(b) Private entities that employ disabled
persons who meet the required skills or
qualifications, either as regular employee,
apprentice or learner, shall be entitled to an
additional deduction, from their gross income,
equivalent to twenty-five percent (25%) of the
total amount paid as salaries and wages to
disabled persons: Provided, however, That such
entities present proof as certified by the
Department of Labor and Employment that
disabled persons are under their employ:
Provided, further, That the disabled employee is
accredited with the Department of Labor and
Employment and the Department of Health as
to his disability, skills and qualifications.
(c) Private entities that improve or modify their
physical facilities in order to provide reasonable
accommodation for disabled persons shall also
be entitled to an additional deduction from
their net taxable income, equivalent to fifty
percent (50%) of the direct costs of the
improvements or modifications. This Section,
however, does not apply to improvements or
modifications of facilities required under Batas
Pambansa Bilang 344.

Sec. 9. Vocational Rehabilitation. Consistent


with the principle of equal opportunity for
disabled workers and workers in general, the
State shall take appropriate vocational
rehabilitation measures that shall serve to
develop the skills and potentials of disabled
persons and enable them to compete favorably
for available productive and remunerative
employment opportunities in the labor market.
The State shall also take measures to ensure the
provision of vocational rehabilitation and
livelihood services for disabled persons in the
rural areas. In addition, it shall promote
cooperation and coordination between the
government
and
nongovernmental
organizations and other private entities
engaged in vocational rehabilitation activities.
The Department of Social Welfare and
Development shall design and implement
training programs that will provide disabled
persons with vocational skills to enable them to
engage in livelihood activities or obtain gainful
employment. The Department of Labor and
Employment shall likewise design and conduct
training programs geared towards providing
disabled persons with skills for livelihood.
Sec. 10. Vocational Guidance and Counseling.
The Department of Social and Welfare and
Development, shall implement measures
providing and evaluating vocational guidance
and counseling to enable disabled persons to
secure, retain and advance in employment. It
shall ensure the availability and training of
counselors and other suitably qualified staff
responsible for the vocational guidance and
counseling of disabled persons.
Sec. 11. Implementing Rules and Regulations.
The Department of Labor and Employment
shall in coordination with the Department of
Social Welfare and Development (DSWD) and
National Council for the Welfare of the Disabled
Persons (NCWDP) shall promulgate the rules
and regulations necessary to implement the
provisions under this Chapter.

63
CHAPTER II
EDUCATION

Sec. 12. Access to Quality Education. The


State shall ensure that disabled persons are
provided with access to quality education and
ample opportunities to develop their skills. It
shall take appropriate steps to make such
education accessible to all disabled persons. It
shall be unlawful for any learning institution to
deny a disabled person admission to any course
it offers by reason of handicap or
disability.chanrobles virtual law library
The State shall take into consideration the
special requirements of disabled persons in the
formulation of educational policies and
programs. It shall encourage learning
institutions to take into account the special
needs of disabled persons with respect to the
use of school facilities, class schedules, physical
education requirements, and other pertinent
consideration.chanrobles virtual law library
The State shall also promote the provision by
learning institutions, especially higher learning
institutions of auxiliary services that will
facilitate the learning process for disabled
persons.
Sec. 13. Assistance to Disabled Students. The
State shall provide financial assistance to
economically marginalized but deserving
disabled students pursuing post secondary or
tertiary education. Such assistance may be in
the form of scholarship grants, student loan
programs, subsidies, and other incentives to
qualified disabled students in both public and
private schools. At least five percent (5%) of the
allocation for the Private Education Student
Financial Assistance Program created by virtue
of R.A. 6725 shall be set aside for disabled
students pursuing vocational or technical and
degree courses.
Sec. 14. Special Education. The State shall
establish, maintain and support complete,

adequate and integrated system of special


education for the visually impaired, hearing
impaired, mentally retarded persons and other
types of exceptional children in all regions of
the country. Toward this end, the Department
of Education, Culture and Sports shall establish,
special education classes in public schools in
cities, or municipalities. It shall also establish,
where viable, Braille and Record Libraries in
provinces, cities or municipalities.
The National Government shall allocate funds
necessary for the effective implementation of
the special education program nationwide.
Local government units may likewise
appropriate counterpart funds to supplement
national funds.
Sec. 15. Vocational or Technical and Other
Training Programs. The State shall provide
disabled persons with training in civics,
vocational efficiency, sports and physical
fitness, and other skills. The Department of
Education, Culture and Sports shall establish in
at least one government-owned vocational and
technical school in every province a special
vocational and technical training program for
disabled persons. It shall develop and
implement sports and physical fitness programs
specifically designed for disabled persons taking
into consideration the nature of their handicap.
Sec. 16. Non-Formal Education. The State
shall develop non-formal education programs
intended for the total human development of
disabled persons. It shall provide adequate
resources for non-formal education programs
and projects that cater to the special needs of
disabled persons.
Sec. 17. State Universities and Colleges. If
viable and needed, the State University or State
College in each region or province shall be
responsible for (a) the development of material
appliances and technical aids for disabled
persons; (b) the development of training
materials for vocational rehabilitation and
special education instructions; (c) the research

64
on special problems, particularly of the visuallyimpaired, hearing-impaired, speech-impaired,
and orthopedically-impaired students, mentally
retarded, and multi-handicapped and others,
and the elimination of social barriers and
discrimination against disabled persons; and (d)
inclusion of the Special Education for Disabled
(SPED) course in the curriculum.
The National Government shall provide these
state universities and colleges with necessary
special facilities for visually-impaired, hearingimpaired, speech-impaired, and orthopedicallyimpaired students. It shall likewise allocate the
necessary funds in support of the above.
CHAPTER III
HEALTH

Sec. 20. Health Services. The State shall


protect and promote the right to health of
disabled persons and shall adopt an integrated
and comprehensive approach to their health
development which shall make essential health
services available to them at affordable cost.
The National Government shall provide an
integrated health service for disabled persons
which shall include, but not limited to, the
following:
(a) prevention
of
disability
through
immunization,
nutrition,
environmental
protection and preservation, and genetic
counseling; and early detection of disability and
timely intervention to arrest disabling
condition; and
(b) medical treatment and rehabilitation.

Sec. 18. National Health Program. The


Department of Health in coordination with the
National Council for the Welfare of Disabled
Persons, shall institute a national health
program which shall aim to attain the
following:chanroblesvirtualawlibrary
(a) prevention of disability, whether occurring
prenatally
or
postnatally;
(b) recognition and early diagnosis of disability;
and

The Department of Health shall field medical


personnel specializing in the treatment and
rehabilitation of disabled persons to provincial
hospitals and, when viable, to municipal health
centers. It shall also train its field health
personnel in the provision of medical attention
to disabled persons. It shall further ensure that
its field health units have the necessary
capabilities to fit prosthetic and orthotic
appliances on disabled persons.chanrobles
virtual law library

(c) early rehabilitation of the disabled.

Sec. 19. Rehabilitation Centers. The


Department of Health shall establish medical
rehabilitation centers in government provincial
hospitals, and shall include in its annual
appropriation the necessary funds for the
operation of such centers. chan robles virtual
law library
The Department of Health shall formulate and
implement a program to enable marginalized
disabled persons to avail of free rehabilitation
services in government hospitals.

CHAPTER IV
AUXILIARY SOCIAL SERVICES

Sec. 21. Auxiliary Social Services. The State


shall ensure that marginalized persons are
provided with the necessary auxiliary services
that will restore their social functioning and
participation in community affairs. Towards this
end, the Department of Social Welfare and
Development shall develop and implement
programs on auxiliary social services that
respond to the needs of marginalized disabled

65
persons. The components of such a program
shall be as follows:
(a) assistance in the acquisition of prosthetic
devices and medical intervention of specialty
services;
(b) provision of specialized training activities
designed to improve functional limitations of
disabled persons related to communication
skills;
(c) development among disabled persons of a
positive self-image through the provision of
counseling, orientation and mobility and
strengthening daily living capability;
(d) provision of family care services geared
towards developing the capability of families to
respond to the needs of the disabled members
of the family;
(e) provision of substitute family care services
and the facilities therefor for abandoned,
neglected, abused and unattached disabled
persons who need custodial care;
(f) provision of after care and follow-up services
for the continued rehabilitation in a
community-based setting of disabled persons
who were released from residential care or
rehabilitation centers; and
(g) provision of day care services for disabled
children of pre-school age.
CHAPTER V
TELECOMMUNICATIONS

Sec. 22. Broadcast Media. Television stations


shall be encouraged to provide a sign
language inset or subtitles in at least one (1)
newscast program a day and special programs
covering
events
of
national
significance.chanrobles virtual law library

Sec. 23. Telephone Services. All telephone


companies shall be encouraged to install special
telephone devices or units for the hearingimpaired and ensure that they are commercially
available to enable them to communicate
through the telephone system.chanrobles
virtual law library
Sec. 24. Free Postal Charges for the Disabled.
Postal charges shall be free on the following:
(a) articles and literatures like books and
periodicals, orthopedic and other devices, and
teaching aids for the use of the disabled sent by
mail within the Philippines and abroad; and
(b) aids and orthopedic devices for the disabled
sent by abroad by mail for repair:
Provided, That the aforesaid items are for
personal purposes only: Provided, further, That
the disabled person is a marginalized disabled
as certified by the Social Welfare and
Development Office of the local government
unit concerned or the Department of Social
Welfare and Development.chanrobles virtual
law library

CHAPTER VI
ACCESSIBILITY

Sec. 25. Barrier-Free Environment. The State


shall ensure the attainment of a barrier-free
environment that will enable disabled persons
to have access in public and private buildings
and establishments and such other places
mentioned in Batas Pambansa Bilang 344,
otherwise known as the "Accessibility Law".

The national and local governments shall


allocate funds for the provision of architectural

66
facilities or structural features for disabled
persons in government buildings and facilities.
Sec. 26. Mobility. The State shall promote
the mobility of disabled persons. Disabled
persons shall be allowed to drive motor
vehicles, subject to the rules and regulations
issued by the Land Transportation Office
pertinent to the nature of their disability and
the appropriate adaptations or modifications
made on such vehicles.
Sec. 27. Access to Public Transport Facilities.
The Department of Social Welfare and
Development shall develop a program to assist
marginalized disabled persons gain access in the
use of public transport facilities. Such assistance
may be in the form of subsidized transportation
fare.
The said department shall also allocate such
funds as may be necessary for the effective
implementation of the public transport program
for the disabled persons.
The "Accessibility Law", as amended, shall be
made suppletory to this Act.
Sec. 28. Implementing Rules and Regulations.
The Department of Transportation and
Communications shall formulate the rules and
regulations necessary to implement the
provisions
of
this
Chapter.

CHAPTER VII
POLITICAL AND CIVIL RIGHTS

Sec. 29. System of Voting. Disabled persons


shall be allowed to be assisted by a person of
his choice in voting in the national or local
elections. The person thus chosen shall prepare
the ballot for the disabled voter inside the
voting booth. The person assisting shall bind
himself in a formal document under oath to fill
out the ballot strictly in accordance with the
instructions of the voter and not to reveal the

contents of the ballot prepared by him.


Violation of this provision shall constitute an
election offense.
Polling places should be made accessible to
disabled persons during national or local
elections.chanrobles virtual law library
Sec. 30. Right to Assemble. Consistent with
the provisions of the Constitution, the State
shall recognize the right of disabled persons to
participate in processions, rallies, parades,
demonstrations,
public
meetings,
and
assemblages or other forms of mass or
concerned action held in public.
Sec. 31. Right to Organize. The State
recognizes the right of disabled persons to form
organizations or associations that promote their
welfare and advance or safeguard their
interests. The National Government, through its
agencies, instrumentalities and subdivisions,
shall assist disabled persons in establishing selfhelp organizations by providing them with
necessary technical and financial assistance.
Concerned government agencies and offices
shall establish close linkages with organizations
of the disabled persons in order to respond
expeditiously to the needs of disabled persons.
National line agencies and local government
units shall assist disabled persons in setting up
specific projects that will be managed like
business propositions.
To ensure the active participation of disabled
persons in the social and economic
development of the country, their organizations
shall be encouraged to participate in the
planning, organization and management of
government programs and projects for disabled
persons.
Organizations of disabled persons shall
participate in the identification and preparation
of programs that shall serve to develop
employment opportunities for the disabled
persons.

67
TITLE III
PROHIBITION ON DISCRIMINATION AGAINST
DISABLED PERSONS
CHAPTER I
DISCRIMINATION ON EMPLOYMENT

(e) Favoring a non-disabled employee over a


qualified disabled employee with respect to
promotion, training opportunities, study and
scholarship grants, solely on account of the
latter's disability;
(f) Re-assigning or transferring a disabled
employee to a job or position he cannot
perform by reason of his disability;

Sec. 32. Discrimination on Employment. No


entity, whether public or private, shall
discriminate against a qualified disabled person
by reason of disability in regard to job
application procedures, the hiring, promotion,
or discharge of employees, employee
compensation, job training, and other terms,
conditions, and privileges of employment. The
following constitute acts of discrimination:
(a) Limiting, segregating or classifying a disabled
job applicant in such a manner that adversely
affects
his
work
opportunities;
(b) Using qualification standards, employment
tests or other selection criteria that screen out
or tend to screen out a disabled person unless
such standards, tests or other selection criteria
are shown to be job-related for the position in
question and are consistent with business
necessity;
(c) Utilizing standards, criteria, or methods of
administration that:
(1) have the effect of discrimination on the
basis of disability; or
(2) perpetuate the discrimination of others who
are subject to common administrative control.
(d) Providing less compensation, such as salary,
wage or other forms of remuneration and fringe
benefits, to a qualified disabled employee, by
reason of his disability, than the amount to
which a non-disabled person performing the
same
work
is
entitled;

(g) Dismissing or terminating the services of a


disabled employee by reason of his disability
unless the employer can prove that he impairs
the satisfactory performance of the work
involved to the prejudice of the business entity:
Provided, however, That the employer first
sought to provide reasonable accommodations
for disabled persons;
(h) Failing to select or administer in the most
effective manner employment tests which
accurately reflect the skills, aptitude or other
factor of the disabled applicant or employee
that such tests purports to measure, rather
than the impaired sensory, manual or speaking
skills of such applicant or employee, if any; and
(i) Excluding disabled persons from membership
in labor unions or similar organizations.

Sec. 33. Employment Entrance Examination.


Upon an offer of employment, a disabled
applicant may be subjected to medical
examination, on the following occasions:
(a) all entering employees are subjected to such
an examination regardless of disability;
(b) information obtained during the medical
condition or history of the applicant is collected
and maintained on separate forms and in
separate medical files and is treated as a
confidential medical record; Provided, however,
That:chanroblesvirtualawlibrary
(1) supervisors and managers may be informed
regarding necessary restrictions on the work or

68
duties of the employees and necessary
accommodations;chan robles virtual law library

(c) a motion picture, theater, concert hall,


stadium, or other place of exhibition or
entertainment;

(2) first aid and safety personnel may be


informed, when appropriate, if the disability
may require emergency treatment;

(d) an auditorium, convention center, lecture


hall, or other place of public gathering;

(3) government
officials
investigating
compliance with this Act shall be provided
relevant information on request; and

(e) a bakery, grocery store, hardware store,


shopping center, or other sales or rental
establishment;

(4) the results of such examination are used


only in accordance with this Act.

(f) a bank, barber shop, beauty shop, travel


service, funeral parlor, gas station, office of a
lawyer, pharmacy, insurance office, professional
office of a health care provider, hospital or
other service establishment;

CHAPTER II
DISCRIMINATION ON TRANSPORTATION

Sec. 34. Public Transportation. It shall be


considered discrimination for the franchisees or
operators and personnel of sea, land, and air
transportation facilities to charge higher fare or
to refuse to convey a passenger, his orthopedic
devices, personal effects, and merchandise by
reason of his disability.

CHAPTER III
DISCRIMINATION ON THE USE OF PUBLIC
ACCOMMODATIONS AND SERVICES

Sec. 35. Public Accommodations and Services.


For purposes of this Chapter, public
accommodations and services shall include the
following:chanroblesvirtualawlibrary
(a) an inn, hotel, motel, or other place of
lodging, except for an establishment located
within a building that contains not more than
five (5) rooms for rent or hire and that is
actually occupied by the proprietor of such
establishment as the residence of such
proprietor;
(b) a restaurant, bar, or other establishment
serving food or drink;

(g) a terminal, depot, or other station used for


specified public transportation;
(h) a museum, gallery, library or other place of
public display or collection;
(i) a park, zoo, amusement park, or other place
of recreation;
(j) a
nursery,
elementary,
secondary,
undergraduate, or post-graduate private school,
or other place of education;
(k) a gymnasium, health spa, bowling alley, golf
course; or
(l) other place of exercise or recreation.

Sec. 36. Discrimination on the Use of Public


Accommodations. (a) No disabled person
shall be discriminated on the basis of disability
in the full and equal enjoyment of the goods,
services, facilities, privileges, advantages or
accommodations of any place of public
accommodation by any person who owns,
leases, or operates a place of public
accommodation. The following constitute acts
of discrimination:

69
(1) denying a disabled person, directly or
through contractual, licensing, or other
arrangement, the opportunity to participate in
or benefit from the goods, services, facilities,
privileges, advantages, or accommodations of
an entity by reason of his disability;
(2) affording a disabled person, on the basis of
his disability, directly or through contractual,
licensing, or other arrangement, with the
opportunity to participate in or benefit from a
good service, facility, privilege, advantage, or
accommodation that is not equal to that
afforded to other able-bodied persons; and
(3) providing a disabled person, on the basis of
his disability, directly or through contractual,
licensing, or other arrangement, with a good,
service, facility, advantage, privilege, or
accommodation that is different or separate
form that provided to other able-bodied
persons unless such action is necessary to
provide the disabled person with a good,
service, facility, advantage, privilege, or
accommodation, or other opportunity that is as
effective as that provided to others;

For purposes of this Section, the term


"individuals or class of individuals" refers to the
clients or customers of the covered public
accommodation that enters into the
contractual, licensing or other arrangement.

(b) Integrated Settings Goods, services,


facilities,
privileges,
advantages,
and
accommodations shall be afforded to individual
with a disability in the most integrated setting
appropriate to the needs of the individual.
(c) Opportunity
to
Participate

Notwithstanding the existence of separate or


different programs or activities provided in
accordance with this Section, an individual with
a disability shall not be denied the opportunity

to participate in such programs or activities that


are not separate or different.
(d) Association It shall be discriminatory to
exclude or otherwise deny equal goods,
services, facilities, advantages, privileges,
accommodations or other opportunities to an
individual or entity because of the known
disability of an individual with whom the
individual or entity is known to have a
relationship or association.
(e) Prohibitions For purposes of this Section,
the following shall be considered as
discriminatory:
(1) the imposition or application of eligibility
criteria that screen out or tend to screen out an
individual with a disability or any class or
individuals with disabilities from fully and
equally enjoying any goods, services, facilities,
privileges, advantages, or accommodations,
unless such criteria can be shown to be
necessary for the provision of the goods,
services,
facilities,
privileges,
or
accommodations being offered;
(2) a failure to make reasonable modifications
in policies, practices, or procedures, when such
modifications are necessary to afford such
goods,
services,
facilities,
privileges,
advantages, or accommodations to individuals
with disabilities, unless the entity can
demonstrate that making such modifications
would fundamentally alter the nature of the
goods,
facilities,
services,
privileges,
advantages, or accommodations;
(3) failure to take such steps as may be
necessary to ensure that no individual with a
disability is excluded, denied services,
segregated or otherwise treated differently
than other individuals because of the absence
of auxiliary aids and services, unless the entity
can demonstrate that taking such steps would
fundamentally alter the nature of the good,
service, facility, privilege, advantage or

70
accommodation being offered or would result
in undue burden;
(4) a failure to remove architectural barriers,
and communication barriers that are structural
in nature, in existing facilities, where such
removal is readily achievable; and
(5) where an entity can demonstrate that the
removal of a barrier under clause (4) is not
readily achievable, a failure to make such
goods,
services,
facilities,
privileges,
advantages, or accommodations available
through alternative methods if such methods
are readily achievable.chan robles virtual law
library

Sec. 37. Use of Government Recreational or


Sports Centers Free of Charge. Recreational
or sports centers owned or operated by the
Government shall be used, free of charge, by
marginalized disabled persons during their
social, sports or recreational activities.

Sec. 38. Implementing Rules and Regulations.


The Department of Public Works and
Highways shall formulate the rules and
regulations necessary to implement the
provisions of this Chapter.chanrobles virtual law
library

TITLE IV
FINAL PROVISIONS

Sec. 39. Housing Program. The National


Government shall take into consideration in its
national shelter program the special housing
requirements of disabled persons.
Sec. 40. Role of National Agencies and Local
Government Units. Local government units
shall
promote
the
establishment
of
organizations of disabled persons in their
respective territorial jurisdictions. National

agencies and local government units may enter


into joint ventures with organizations or
associations of disabled persons to explore
livelihood opportunities and other undertakings
that shall enhance the health, physical fitness
and the economic and social well-being of
disabled persons.chanrobles virtual law library
Sec.
41. Support From Nongovernment
Organizations. Nongovernment organizations
or private volunteer organizations dedicated to
the purpose of promoting and enhancing the
welfare of disabled persons shall, as they, are
hereby encouraged, become partners of the
Government in the implementation of
vocational rehabilitation measures and other
related programs and projects. Accordingly,
their participation in the implementation of said
measures, programs and projects is to be
extended all possible support by the
Government.
The Government shall sponsor a volunteer
service program which shall harness the
involvement of private individuals in the
provision of assistance to disabled persons.
Sec. 42. Tax Incentives. (a) Any donation,
bequest, subsidy or financial aid which may be
made to government agencies engaged in the
rehabilitation of disabled persons and
organizations of disabled persons shall be
exempt from the donor's tax subject to the
provisions of Section 94 of the National Internal
Revenue Code (NIRC), as amended and shall be
allowed as deductions from the donor's gross
income for purposes of computing the taxable
income subject to the provisions of Section 29
(h) of the Code.
(b) Donations from foreign countries shall be
exempt from taxes and duties on importation
subject to the provisions of Section 105 of the
Tariff and Customs Code of the Philippines, as
amended, Section 103 of the NIRC, as amended
and other relevant laws and international
agreements.

71
(c) Local manufacturing or technical aids and
appliances used by disabled persons shall be
considered as a preferred area of investment
subject to the provisions of Executive Order No.
226 otherwise known as the "Omnibus
Investments Code of 1987" and, as such, shall
enjoy the rights, privileges and incentives as
provided in said Code such as, but not limited,
to the following:
(1) repatriation of investments;
(2) remittance of earnings;
(3) remittance
contracts;

of

payments

on

(17) exemption from wharfage dues and any


export tax, duty, impost and fee.

Sec. 43. Continuity Clause. Should any


department or agency tasked with the
enforcement or formulation of rules and
regulations and guidelines for implementation
of any provision of this Act is abolished, merged
with another department or agency or
modified, such shall not affect the enforcement
or formulation of rules, regulations and
guidelines for implementation of this Act to the
effect that

foreign

(4) freedom from expropriations;


(5) freedom from requisition of investment;
(6) income tax holiday;
(7) additional deduction for labor expense;
(8) tax and duty exemption on imported capital
equipment;
(9) tax credit on domestic capital equipment;
(10) exemption from contractor's tax;
(11) simplification of customs procedures;

(a) In case of abolition, the department or


agency established to replace the abolished
department or agency shall take-over the
functions under this Act of the abolished
department or agency.
(b) In case the department or agency tasked
with the enforcement or formulation of rules,
regulations and guidelines for implementation
of this Act is merged with another department
or agency, the former shall continue the
functions under this Act of the merged
department or agency.chanrobles virtual law
library
(c) In case of modification, the department or
agency modified shall continue the functions
under this Act of the department or agency that
has undergone the modification.

(12) unrestricted use of consigned equipment;


(13) employment of foreign nationals;
(14) tax credit for taxes and duties on raw
materials;
(15) access to bonded manufacturing/traded
warehouse system;
(16) exemption from taxes and duties on
imported spare parts; and

Sec. 44. Enforcement by the Secretary of


Justice.
(a) Denial of Right
(1) Duty to Investigate the Secretary of
Justice shall investigate alleged violations of this
Act, and shall undertake periodic reviews of
compliance of covered entities under this Act.
(b) Potential Violations If the Secretary of
Justice has reasonable cause to believe that

72
(1) any person or group of persons is engaged in
a pattern or practice of discrimination under
this Act; or
(2) any person or group or persons has been
discriminated against under this Act and such
discrimination raises an issue of general public
importance, the Secretary of Justice may
commence a legal action in any appropriate
court.chanrobles virtual law library
Sec. 45. Authority of Court. The court may
grant any equitable relief that such court
considers to be appropriate, including, to the
extent required by this Act:
(a) granting
temporary,
permanent relief;

preliminary

or

(b) providing an auxiliary aid or service,


modification of policy, practice or procedure, or
alternative method; and
(c) making facilities readily accessible to and
usable by individuals with disabilities.

Sec. 46. Penal Clause. (a) Any person who


violates any provision of this Act shall suffer the
following penalties:chanroblesvirtualawlibrary
(1) for the first violation, a fine of not less than
Fifty thousand pesos (P50,000.00) but not
exceeding One hundred thousand pesos
(P100,000.00) or imprisonment of not less than
six (6) months but not more than two (2) years,
or both at the discretion of the court; and
(2) for any subsequent violation, a fine of not
less than One hundred thousand pesos
(P100,000.00) but not exceeding Two hundred
thousand pesos (P200,000.00) or imprisonment
for not less than two (2) years but not more
than six (6) years, or both at the discretion of
the court.chanrobles virtual law library

(b) Any person who abuses the privileges


granted herein shall be punished with
imprisonment of not less than six (6) months or
a fine of not less than Five thousand pesos
(P5,000.00), but not more than Fifty thousand
pesos (P50,000.00), or both, at the discretion of
the court.

(c) If the violator is a corporation, organization


or any similar entity, the officials thereof
directly involved shall be liable therefor.
(d) If the violator is an alien or a foreigner, he
shall be deported immediately after service of
sentence
without
further
deportation
proceedings.
Sec. 47. Appropriations. The amount
necessary to carry out the provisions of this Act
shall be included in the General Appropriations
Act of the year following its enactment into law
and thereafter.
Sec. 48. Separability Clause. Should any
provisions of this Act be found unconstitutional
by a court of law, such provisions shall be
severed from the remainder of the Act, and
such action shall not affect the enforceability of
the remaining provisions of this Act.
Sec. 49. Repealing Clause. All laws,
presidential decrees, executive orders and rules
and regulations inconsistent with the provisions
of this Act are hereby repealed or modified
accordingly.
Sec. 50. Effectivity. This Act shall take effect
fifteen (15) days after its publication in any two
(2) newspapers of general circulation.

73
ANNEX D
REPUBLIC ACT NO. 9442
April 30, 2007
AN ACT AMENDING REPUBLIC ACT NO. 7277, OTHERWISE KNOWN AS THE "MAGNA CARTA FOR
DISABLED PERSONS, AND FOR OTHER PURPOSES"
Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:
SECTION 1. A new chapter, to be denominated
as "Chapter 8. Other Privileges and Incentives"
is hereby added to Title Two of Republic Act No.
7277, otherwise known as the "Magna Carta for
Disabled Persons", with new Sections 32 and
33, to read as follows:
"CHAPTER 8. Other Privileges and
Incentives
"SEC. 32. Persons with disability shall be
entitled to the following:
(a) At least twenty percent (20%)
discount from all establishments
relative to the utilization of all services
in hotels and similar lodging
establishments; restaurants and
recreation centers for the exclusive use
or enjoyment of persons with disability;
(b) A minimum of twenty percent (20%)
discount on admission fees charged by
the theaters, cinema houses, concert
halls, circuses, carnivals and other
similar places of culture, leisure and
amusement for the exclusive use or
enjoyment of persons with disability;
(c) At least twenty percent (20%)
discount for the purchase of medicines
in all drugstores for the exclusive use or
enjoyment of persons with disability;
(d) At least twenty percent (20%)
discount on medical and dental services

including diagnostic and laboratory fees


such as, but not limited to x-rays,
computerized tomography scans and
blood tests, in all government facilities,
subject to guidelines to be issued by the
Department of Health (DOH), in
coordination with the Philippine Health
Insurance Corporation (PHILHEALTH);
(e) At least twenty percent (20%)
discount on medical and dental services
including diagnostic and laboratory
fees, and professional fees of attending
doctors in all private hospitals and
medical facilities, in accordance with
the rules and regulations to be issued
by the DOH, in coordination with the
PHILHEALTH;
(f) At least twenty percent (20%)
discount on fare for domestic air and
sea travel for the exclusive use or
enjoyment of persons with disability;
(g) At least twenty percent (20%)
discount in public railways, skyways and
bus fare for the exclusive use and
enjoyment of persons with disability;
(h) Educational assistance to persons
with disability, for them to pursue
primary, secondary, tertiary, post
tertiary, as well as vocational or
technical education, In both public and
private schools, through the provision
of scholarships, grants, financial aids,

74
subsidies and other incentives to
qualified persons with disability,
including support for books, learning
materials, and uniform allowance to the
extent feasible: provided, that persons
with disability shall meet minimum
admission requirements;
(i) To the extent practicable and
feasible, the continuance of the same
benefits and privileges given by the
Government Service Insurance System
(GSIS), Social Security System (SSS), and
PAG-IBIG, as the case may be, as are
enjoyed by those in actual service;
(j) To the extent possible, the
government may grant special
discounts in special programs for
persons with disability on purchase of
basic commodities, subject to
guidelines to be issued for the purpose
by the Department of Trade and
Industry (DTI) and the Department of
Agriculture (DA); and
(k) Provision of express lanes for
persons with disability in all commercial
and government establishments; in the
absence thereof, priority shall be given
to them.
The abovementioned privileges are
available only to persons with disability
who are Filipino citizens upon
submission of any of the following as
proof of his/her entitlement thereto:
(I) An identification card issued
by the city or municipal mayor
the barangay captain of the
place where the person with
disability resides;
(II) The passport of the persons
with disability concerned; or

(III) Transportation discount


fare Identification Card (ID)
issued by the National Council
for the Welfare of Disabled
Persons (NCWDP).
The privileges may not be claimed if the
persons with disability claims a higher
discount as may be granted by the
commercial establishment and/or
under other existing laws or in
combination with other discount
program/s.
The establishments may claim the
discounts granted in sub-sections (a),
(b), (c), (e), (f) and (g) as tax deductions
based on the net cost of the goods sold
or services rendered: provided,
however, That the cost of the discount
shall be allowed as deduction from
gross income for the same taxable year
that the discount is granted: provided,
further, That the total amount of the
claimed tax deduction net of valueadded tax if applicable, shall be
Included in their gross sales receipts for
tax purposes and shall be subject to
proper documentation and to the
provisions of the National Internal
Revenue Code (NIRC), as amended."
"SEC. 33. Incentives. - Those caring for
and living with a person with disability
shall be granted the following
incentives;
(a) persons with disability shall be
treated as dependents under Section
35(A) of the National Internal Revenue
Code, as amended and as such,
individual taxpayers caring for them
shall be accorded the privileges granted
by the code Insofar as having
dependents under the same section are
concerned; and

75
(b) Individuals or nongovernmental
institutions establishing homes,
residential communities or retirement
villages solely to suit the needs and
requirements of persons with disability
shall be accorded the following:
(i) Realty tax holiday for the
first five years of operation; and
(ii) Priority in the building
and/or maintenance of
provincial or municipal roads
leading to the aforesaid home
residential community or
retirement village."
SEC. 2. Republic Act No. 7277 is hereby
amended by inserting a new title, chapter and
section after Section 38 to be denominated as
Title 4, chapters 1 and 2 and Sections 39, 40, 41
and 42 to read as follows:
"Title Four
Prohibitions on Verbal, Non-verbal
Ridicule and VilificationAgainst Persons
with Disability
"CHAPTER 1. Deliverance from Public
Ridicule.
"SEC. 39. Public Ridicule . - For purposes
of this Chapter, public ridicule shall be
defined as an act of making fun or
contemptuous initiating or making
mockery of persons with disability
whether in writing or in words, or in
action due to their impairment/s.
"SEC. 40. No individual, group or
community shall execute any of these
acts of ridicule against persons with
disability in any time and place which
could intimidate or result in loss of selfesteem of the latter.

"CHAPTER 2. Deliverance from


Vilification
"SEC. 41. Vilification. - For purposes of
this chapter, vilification shall be defined
as:
(a) the utterance of slanderous and
abusive statements against a person
with disability; and/or
(b) An activity in public which incites
hatred towards serious contempt for, or
severe ridicule of persons with
disability."
"SEC. 42. Any individual, group or
community is hereby prohibited from
vilifying any person with disability
which could result into loss of selfesteem of the latter."
SEC. 3. Section 46 of Republic Act No. 7277 is
hereby amended to read as follows:
"SEC. 46. Penal Clause. (a) Any person who violates any
provision of this Act shall suffer the
following penalties:
(1) For the first violation, a fine
of not less than Fifty thousand
pesos (P50,000.00) but not
exceeding One hundred
thousand pesos (P100,000.00)
or imprisonment of not less
than six months but not more
than two years, or both at the
discretion of the court; and
(2) For any subsequent
violation, a fine of not less than
One hundred thousand pesos
(P100,000.00) but not
exceeding Two hundred
thousand pesos (P200,000.00)

76
or imprisonment for not less
than two years but not more
than six years, or both at the
discretion of the court.
(b) Any person who abuses the
privileges granted herein shall be
punished with imprisonment of not less
than six months or a fine of not less
than Five thousand pesos (P5,000.00),
but not more than Fifty thousand pesos
(P50,000.00), or both, at the discretion
of the court.

cancellation or revocation of the


business permit, permit to operate,
franchise and other similar privileges
granted to any business entity that fails
to abide by the provisions of this Act."
Sec. 4. The title of Republic Act No. 7277 is
hereby amended to read as the "Magna Carta
for Persons with Disability", and all references
on the said law to "disabled persons" shall
likewise be amended to read as "persons with
disability".

(d) If the violator is an alien or a


foreigner, he shall be deported
immediately after service of sentence
without further deportation
proceedings.

SEC. 5. The Department of Social Welfare and


Development, the National Council for the
Welfare of Disabled Persons, and the Bureau of
Internal Revenue, in consultation with the
concerned Senate and House committees and
other agencies, organizations, establishments
shall formulate an agencies, organizations,
establishments shall formulate an implementing
rules and regulations pertinent to the provisions
of this Act within six months after the effectivity
of this Act.

Upon filing of an appropriate complaint,


and after notice and hearing the proper
authorities may also cause the

SEC. 6. This Act shall take effect fifteen (15)


days after its publication in any two newspapers
of general circulation.

(c) If the violator is a corporation


organization or any similar entity, the
officials thereof directly involved shall
be liable therefore.