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POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

Strengthening Mental Health Act: Alternatives and Ammendments on the Current Policy

of the Republic Act No. 11036

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Presented to

PROF. Gerald Magno

In Partial Fulfillment of the Requirements Politics, Governance, and Citizenship

GEED 20023

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Presented by

ALCAZAR, MARK DANIEL MARBELLA, GRACELYN

AUSTRIA, CAILA JANE OLAD, XYZKY

BELTRAN, JUSTIN PAREDES, MICAELLA

DOMINGO, RICHELLE PASCUAL, SHIENA

MACAZO, KATE NICOLE PERIA, JESSYRENE

BSA 1-2

2019
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Executive Summary

The Philippines had officially passed the Republic Act No. 11036 known as the “Mental

Health Act” of the Philippines which was signed by President Rodrigo Roa Duterte on June

20, 2018 where it aims to enhance, promote and protect mental health services, provide better

access to mental health care and establish Philippine Mental Health Council in the country.

Although the Mental Health Law has already been passed, it is apparent that many

Filipinos seemed to neglect this matter due to lack of awareness which leads to disregarding

the significance of one’s mental health. Mental illness is also the third most common form of

disability in the country as stated by the National Statistics Office where bythis policy, it

would be possible to lessen the great numbers of Filipino people with mental health conditions

(Vardeleon, 2016).

One of the alternatives to the current policy is the implementation of mental health

assessment in educational institutions, particularly to high schools and tertiary level education

to provide assessments in order to identify youths experiencing mental health conditions and

provide them with adequate support and services. This policy could help students get access

to mental health services they need when their responses to the examinations reveal new

information regarding mental health that could be a way for studying their behavior that are

not observed at home. This policy also promotes discussion of mental health which could help

them to have stronger relationship with others and enhance their mental health condition. As

for the difficulties that the policy may encounter, these include the cost implementation and

the lack of adequate mental health service providers.

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The second proposed alternative policy is the public mental health organization which

caters the need of the people, especially for the indigenous people with mental health issues

in legal and medical aspect and provides free legal and medical assistance. Intended for an

extensive reach, this policy will be having local sections designated for easier access across

the whole nation. One of its advantages is giving an easier access to people with mental health

illness from the government since the legal representatives, tribunals, and supporters are

designated for them to participate in the decision making with the patient’s medical

information and its aims include to reach the very remote areas in our country. As for the

problems that it may face are the budget allocation and the requirement of huge amount of

institutions and professionals to attend the needs of mentally ill people.

For the third and last proposed policy is the National Monitoring and Mental Health

Action Plan of the Republic Act 11036 or the Mental Health Act since the Philippines faces a

huge challenge concerning the medical health system and it is currently having a crisis with

the available medical treatment for people with mental illness and an inadequate number of

mental health professionals and facilities. Its advantage is that the RA 11036 or Mental Health

Act will certainly be enacted and properly implemented where it will provide specific steps

and actions that will lead to the achievement of the objectives. Action plan will ensure that

the ideals and general concept of the law will not just remain as a mere concept and the law

will also lessen the commonly occurring problems in government projects and programs such

as corruption as it will be strictly monitored. As for its disadvantages, the creation of the action

plan involves a lot of research-based programs in order to efficiently impose the policy where

the monitoring processes need to be appropriately funded and there must be a budget

appropriated specifically for the purpose of research and the creation of the action plan.

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Since the Mental Health Law was only promulgated last 2018, it is recommended to

execute having a mental health examination among the high school and college students in

the country as this is the most possible and necessary foundation towards strengthening its

implementation. It is because most of the Filipinos today were not aware of a proper

classification whether if someone has a depression or not. Moreover, since the youth sector

has the most number of cases regarding their mental health, this national assessment would

help to reduce the number of adolescents experiencing issues on their mental health.

Furthermore, students must determine first whether they need a professional help from

medical practitioners specializing on mental health.

A public mental organization includes individuals who has a specialty or full knowledge

on mental health which seemed to be impossible to implement concretely as there are

inadequate number of workers specializing on mental health in the country. For the National

Monitoring and Mental Health Action Plan of the Republic Act 11036, it is also necessary to

be executed properly by the departments holding responsibility on observing the mental health

of the Filipinos. It will serve as a way of an overall assessment on the implementation of the

mental health law in the Philippines but it also suggests on increasing the number of facilities

which will require a large amount of fund from the government.

Rather than prioritizing on the national monitoring and a mental health action plan, it is

more convenient to execute first the mental health examination on high school and college

students as it will serve as the fundamental step on applying the law. When the national

assessment of mental health to students have already implemented continuously, the national

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monitoring and the mental health action plan will include this particular step for them to

observe the effects on it to people and to the country.

Overview/Background

Statement of Purpose

Philippines is known by the other foreign countries as one of the happiest nations in the

world. The country ranked 69th from the happiest country on earth, according to the United

Nations (Cabico, 2019). In this fact holds the reason that we are approaching devastating

circumstances in a positive way. Ironically speaking, the archipelago has its status for having

the highest number of depressed people in the Southeast Asian region (Reyes, 2019).

The issue on mental health becomes more and more prevalent through the years, and

adversely bringing an effect to Filipinos. In fact, according to the World Health Organization

(WHO), one out of five Filipino adults suffer from mental health disorders making it the

third of the most common disabilities in the country, as stated by the National Statistics

Office. Recent available data provided that depressive disorders affected 3.3 million

Filipinos, with suicide rates in 2.5 males and 1.7 males per 100, 000 (Global Burden of

Disease, 2015). Latest numbers from the World Health Organization also stated that over six

million Filipinos live with anxiety and depressive disorders. However, the statistics

presented and cases reported were only a portion of the actual number because there is a

stigma about mental health issues in the Philippines which makes the people suffering from

it avoid consultation and treatment (World Health Organization). The fact is, this is a

growing issue and still, it is one of the country’s least priorities.

The data above shows that the current status of the mental health of the Filipinos are

unstable. Issues about Mental Health needs to be addressed. The Philippine status quo shows

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that suicide cases and youth mental health issues continues to increase, and according to

experts it is primarily due to the new era of social media and technology. According to the

study conducted by the Association for Psychological Science (2017), adolescents who spent

more time online has a higher probability to be affected by mental health issues. In line with

this, Philippines becomes the world leader in terms of social media usage as the internet

users in the country reached 67 million Filipinos (Camus, 2018). This is one of the reasons

why mental health issues are becoming prevalent at this time which is why emphasizing the

need to focus on the Mental Health of every Filipino should be a priority.

Indeed, there exists a mental health law in the Philippines, the Republic Act No.

11036 (or RA 11036) or "An Act Establishing a National Mental Health Policy for the

Purpose of Enhancing the Delivery of Integrated Mental Health Services, Promoting and

Protecting the Rights of Persons Utilizing Psychiatric, Neurologic and Psychosocial Health

Services, Appropriating Funds Therefore and for Other Purposes" shortly known as the

Mental Health Law, officially declared as a law in June 20, 2018 to answer the mental health

problem. However, it is also clear that many Filipinos seemed to disregard this serious

matter. Lack of awareness about the existing law is also a problem. Filipinos tend to neglect

the importance of an individual’s mental health.

Even though the Mental Health Law has already been passed, it is evident that many

Filipinos are still suffering from this issue, helpless. That is the reason for the need to modify

and strengthen the current policy. It needs to be properly implemented and executed. There

should be a solid foundation to determine and assess the people’s mental health state.

Reformation and improvements should now be implemented to provide accessible and

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affordable services for the people with mental health illness who are not capable of to sustain

and help themselves. It is time that every individual’s mental health be prioritized.

REVIEW THE CURRENT POLICY

Currently, the Philippines had officially acknowledged a Mental Health Bill which was

signed by President Rodrigo Roa Duterte on June 20, 2018. The Republic Act No. 11036

known as the “Mental Health Act” of the Philippines is an act which aims to enhance, promote

and protect mental health services, provide better access to mental health care and establish

Philippine Mental Health Council in the country. It gives basic and fundamental rights to the

Filipino people who needs mental health services which ensures that people’s mental health

are given enough attention by appropriating an accessible, affordable and a high-quality

service for mental health care. The Mental Health Act seeks to integrate mental health

programs, to improve the mental health facilities and also to promote it to the educational

institutions and workplaces.

Although it was a major victory for the mental health advocates, the truth is, it was

pending in Congress for about 20 years. Also, several bills were already proposed as early as

1980s, but it was not given any focus, thus making the Philippines as one of the few countries

in the world without a mental health law. In addition, it was signed into a law during the time

wherein suicides rates are drastically high.

According to the Republic Act No. 11036, there are main objectives for the

implementation of this Mental Health Act which could help solve mental health problems in

the country. First, to be able to increase the effectivity of the State to lead and to govern mental

health issues by implementing different programs, strategies, national policies and regulations

concerning mental health. Also, it has an objective to have a mental health care system that

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accordingly protects the rights and freedom of people including psychiatric, neurologic and

psychosocial health needs. It aims to increase the knowledge consisting information systems

and other researches related to mental health issues. It also has a purpose to provide basic

health services that would be able to help enhance mental health care through different plans

and strategies including the use of educational institutions, workplace and communities. All

of these objectives enable the people to receive the best help and mental health services to all

the Filipino people with mental health conditions.

With regards to the increasing statistics of people with mental illnesses and with the

current situation of the Philippines concerning mental health, this policy is necessary in order

to strengthen the psychosocial well-being of the Filipinos. As a matter of fact, according to

the National Statistics Office, third most common form of disability in the country is the

mental illness. As for the most recent data released by the Department of Health (DOH), there

is a percentage of 17 to 20 percent of Filipino adults who have psychiatric disorders, 10 to 15

percent of Filipino children from age five to fifteen which all suffers from mental health

problems. It is said that there are 88 cases of mental health problems for every 100,000

Filipinos. With this policy, it aims to achieve its purpose and objective to lessen these great

numbers of Filipino people with mental health conditions. (Vardeleon, 2016)

Based on the situation of the Philippines right now, the access to mental health facilities

is uneven as noted in the report of World Health Organization - Assessment Instrument for

Mental Health Systems (WHO-AIMS). Majority of the facilities are located in the National

Capital Region which makes it hard for those places who are far from it. The budget allocated

to the health department is not sufficient because only 5% of its annual budget is given to the

mental health.

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In the country, concerning the mental health professionals, there is a very low number of

professionals involving the mental health. According to the World Health Organization,

although there is only up to 20 percent of the population having mental health disorder, it is

inadequate with the numbers of mental health professionals in our country with only 700

psychiatrists and 1,000 nurses and more than that almost all of them work for profit or in

private practice which receives low-income and do not have enough access and support. The

country has insufficient mental health professionals which simply shows how the Philippines

needs to improve a lot when it comes to the problems involving mental health with what we

are currently doing in our country (Magtubo, 2016).

It is absolutely of no doubt that psychiatric services are expensive and costly which is

why this act was pursued to provide an accessible and affordable mental health services.

People with mental health disorders are also being driven more into poverty by the high costs

and inaccessibility of the treatment (Solitario, 2017). It also has to coordinate with drug

rehabilitation centers, and shall have a referral system which public and private health and

social welfare service providers are to be involved. It was mid-last year when it was

implemented yet there are still no definite reports about its status since the enactment. It is

largely seen by many as if it is of no effect.

The provisions of the act actually impressed the masses as it was regard to be a huge step

that Philippines has taken towards improving mental health. But again, the anticipated

outcomes are still of nowhere to be found. Although there have been a number of advocates

that are on the move, as the Philippine Star noted, it holds no significance with regards to its

national effect.

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Moreover, research and development must also be founded and are responsible in

producing relevant information and data that would be used in making mental health programs

that are inclined with the certain customs and practices of different regions and indigenous

groups. But, as per Philippine News Agency, Dr. Dinah Palmera P. Nadera, a mental health

policy consultant who is part of the task force supervised by Department of Health, explained

that they still have to meet and consult with various agencies to consider on how to engage

and deal mental health with the differing customs and practices throughout the whole

archipelago. To put it all together, a span of time is sure to be taken to produce the expected

results of the implementation. The previous years have shown that Philippines has no enough

research about Mental Health.

In the last three years, mental illnesses and suicide cases have risen drastically. Even

though there has already an act regulating about mental health, it seems to have no effect in

the overall condition of mental health in the Philippines. This is caused by numerous factors

that affect its implementation and effectiveness, such as those which are discussed in this

review including the inadequate number of mental health professionals and personnel in the

country, and to add, these few professionals are only concentrated in urban areas (Philippine

Star, 2018). From the required ratio of one per 50,000 people, Philippines only has one per

250,000 people. Second is the insufficient supplies and equipment which are needed to provide

an efficient and appropriate service for the patients, that even the health care facilities itself

lack. In addition, there are also inadequate institutions that facilitate mental health services in

the Philippines. Research and development is still of low and poor performance because the

country has been encountering problems in dealing with the country's varying customs and

practices.

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These challenges also come due to the financial problems that the government has been

encountering for the implementation to be effective. There are no quite enough resources to

fund the necessities in compliance with all the provisions under the act. According to the 2007

report by Department of Health and World Health Organization, only five percent of the health

care budget is charged towards mental health, which 95% of it is allocated to the operation

maintenance and salary of the personnel. Raymond John Naguit, the national chairperson of

Youth for Mental Health Coalition, conveyed his concern on the availability of funds for

mental health services as the adequacy of mental health professionals depend on it.

Although it is still too early to conclude whether the act is a success or a failure, other

can say that for the past few months since the act was signed, there has been no relevant

changes in the mental health condition of the country. But, for some people thinking that

before this policy was passed into law, it is really a big problem for the mental health patients

since there are few benefits that they can rely on. But now, although there has been facts which

concludes the insufficient mental health facilities, inadequate mental health professionals,

huge number of people with mental health conditions and other problems concerning mental

health, the public’s perception with this policy is that they accepted and supported this Mental

Health Act since it would benefit a lot of people suffering from mental health conditions. It is

recognized by the public as a tool in order to improve, to be aware and to have greater access

for the mental health facilities, professionals and other things involving mental health issues.

For now, we are still in the process of making betterment and improvement concerning mental

health which also makes the Filipino people be hopeful in accessing more services, resources

and benefits that they could get in this Mental Health Act. This Mental Health Act aims to

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have a progress and changes in our country which concerns different issues regarding mental

health system.

STATEMENT ON THE NECESSITY FOR CHANGE

Recently there has been a progress in terms of addressing this mental health concern when

President Rodrigo Duterte signed the Philippine Mental Health Law, also known as Republic

Act 11036 last June 21, 2018. this is the first to pave the way for better aid to mental health

problem. The law seeks to integrate mental health services and programs from the down to

the regional and local level. It will improve mental health facilities in all regional, provincial

and tertiary hospitals and spread the information in schools and even in workplace. Moreover,

there is additional psychiatrist for the public. According to Sen. Hontiveros, having this

national law will be a big help, for it allocates the needs of mentally ill people to lessen their

suffering.

Aside from the status of the Filipinos’ mental health stated from the preceding sections,

new approach is necessary in order to develop and create a shift in the perspective of the

Filipinos regarding the Mental Health.

Based on Stanford University School of Medicine -ethno-geriatrics study, Filipinos’ only

way of dealing with mental health disorders is by seeking help from family, friends, and by

faith in God. It was also common for the adults to consider people with mental health illness

a financial burden. There was limited awareness and there is a lacking scientific-based

perceptions about mental health. Consequentially, there is a strong necessity for new and

effective approach to stop this crisis.

The approval and passing of this law reflects that the government is now ready to attend

and cater the mental health needs of its citizens. This calls for the need to propose policies

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necessary to effectively implement the law. The signing of the Mental Health Law is a major

change that lead the people to rationalize and think critically of what the newly signed law

should be.

DISCUSSION

ALTERNATIVE POLICY OPTIONS

POLICY 1. Mental Health Examinations in Education Institutions

According to the World Health Organization (WHO, 2018), adolescence is a crucial

period for the development of a person. One in six people are 10-19 years old and mental

health conditions form 16% of the world’s problem of disease and injury in people this age.

Most cases of mental health conditions are not treated and detected, and half of these

conditions start at 14 years of age. In addition, emotional disorders usually occur during the

adolescence. Aside from depression and anxiety, adolescents may also experience anger,

frustration, or irritability. Globally, the eighth and ninth leading cause of illness and disability

among all adolescents are anxiety and depression. In the Philippines, 3.3% of the total

population suffer from depressive disorders, 3.1% suffer from anxiety disorders, and 2,558

reported suicide cases. Among high school students, 17% with ages 13-15 years old have

attempted suicide at least once, 12% seriously considered attempting suicide, and 11% have

made plans on how they would commit suicide (Reyes and Gonzales, 2017). There are several

determinants of mental health such as: social factors like violence and socio economic

pressures, psychological factors related to social change and human rights violations, and

biological factors which include genetic factors.

A research by (Lee et.al, 2013) in their study entitled “Factors Associated with

Depressive Symptoms among Filipino University Students” discovered a set of social and

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demographic factors related with higher levels of depressive symptoms among Filipino

students. The study used the University Students Depression Inventory with measures on

lethargy, cognition-emotion, and academic motivation, and was performed among 2,436

students. The study that the frequency of smoking, frequency of drinking, not living with

biological parents, level of satisfaction with one’s financial condition, and levels of closeness

with parents and peers were the factors associated with higher levels of depressive symptoms.

The researchers emphasized that depression can be prevented if its symptoms are addressed

early and effectively. Prevention of depression among university students is rare in the

country, but is urgent because of the rising rates of suicide among the group.

The symptoms of mental health disorders are mostly unnoticed and their causes

develop as early as 12 years old and below (developmental stage) with majority of clinical

symptoms existing before the age of 14. Gary Aguedo Faustino, director of guidance and

counseling at Ateneo’s Loyola Schools stated that the struggle is in basic education or the

formative years of 12 years and below, and it is contained in home. When a person is entering

college or is 18 years old and above, they are fighting mental health problems already. The

formative years are important in shaping the mental health of an individual, but issues rise

because of the combination of stressors such as life-changing decisions, influx of hormones,

peer and familial pressure, strain of first relationships, academic and societal expectations,

and flow of information through technology which frequently appear when an individual

enters university. Furthermore, Ronald Del Castillo, a clinical psychologist and an associate

professor of health policy and administration, psychology, and behavioral sciences at the

College of Public Health of the University of the Philippines asserted that admission to college

increase risk for developing mental health problems (Bueno, 2018).

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One of the alternatives to the current policy is the implementation of mental health

assessment in educational institutions, particularly to high schools and tertiary level education.

The country needs to provide assessments in order to identify youths experiencing mental

health conditions and provide them with adequate support and services.

The government, through the Implementing Rules and Regulations (IRR) of Republic

Act no. 11036 otherwise known as Mental Health Act provided the education and promotion

of mental health in educational institutions. This option is in accordance with the IRR as it

can help students have access to mental health care services they need.

Educational institutions include schools, colleges, universities, and technical schools.

Schools are an important part of the lives of children. They are an ideal place to provide mental

health services for children and youth (NASP, 2016). Accordingly, (Carothers, 2015) believes

that school-based mental health screenings help reduce barriers to learning and allow youths

to have services for mental health care. Moreover, it would likely provide researchers and

clinicians with information about mental health symptoms which could help in developing

clinical practice, research, and policy. Mental health screenings in schools are an essential

step to prevent mental illnesses.

Mental examination is as important as physical examination. In this proposed

alternative, mental health examinations shall be mandatory. This is to help protect the mental

well-being of the students. The examinations shall be conducted by competent mental health

professionals and service providers. They shall identify the necessary questions, the useful

assessment tools, and carefully analyze the data they collect. Mental health assessments shall

also be implemented routinely and need to have second opinion before any results is conveyed

to the parents, family members, carers, or legal representatives of the service user.

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Confidentiality regarding the result shall be strictly observed pursuant to the right of service

users.

The proposed policy is in agreement with Republic Act no. 11036 or Mental Health Act

which acknowledges the rights right of the Filipinos to mental health and the fundamental

rights of people who need mental health services. Through mental health examinations,

students, their families, and other concerned personnel will be able to have awareness of their

mental health conditions and conduct measures to develop their mental health well-being. The

policy would need an adequate funding for its proper implementation. The budget for the

policy will be taken from the amount allocated for mental health in the Department of Health

budget and in the budget of other agencies with specific mandates provided in the Act, which

is based on the strategic plan formulated by the Council, in coordination with other

stakeholders. Proper implementation of the policy should be observed. Examinations shall be

supervised by competent personnel and results shall be interpreted and analyze by competent

mental health service providers. The policy shall take place with strict observance of the rights

of the service users, their family members, carers, or legal representatives, and mental health

professionals. All the information gathered shall be treated with utmost confidentiality.

One of the advantages of this policy is that it could help students get access to mental

health services they need. The collaboration of educational institutions with the Department

of Health and other mental health service providers increases the possibility of helping the

students. The policy can provide researchers with information about mental health which

could help develop clinical practice, research, and policy. The students’ responses to the

examinations and its subsequent interpretation and analysis by competent mental health

providers could help reveal new information regarding mental health. It can also make way

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for studying the behavior of students that are not observed at home. The policy promotes

discussion of mental health which can help students feel safe to communicate with their

family, teachers, or counselors. A more open communication concerning mental health could

help students have stronger relationship with others and enhance their mental health condition.

Routine mental health examinations decrease the possibility of delayed treatment and can help

erase the stigma of mental health conditions. The lack of knowledge about mental health

results to discrimination or stigma against people suffering from mental health problems.

Information gathered could help advance awareness and sensitivity associated with mental

health. In addition, mental health examinations serve as an initial step for detection, treatment,

and promotion of a person’s mental well-being. The symptoms of mental health problems are

usually undetected and could get worse. Examinations could help raise awareness of one’s

mental health condition, and help prevent mental health problems from getting worse. The

policy likewise supports the governments’ campaign for the integration of mental health into

educational institutions. Chapter 5 Section 25 of the Metal Health Act’s IRR calls for the

awareness on mental health issues, identify and provide support and services for individuals

at risk, and facilitate access to treatment and support. It also agrees with the state’s aim to

affirm the basic right of the Filipinos to mental health and the fundamental rights of people

who need mental health services.

On the other hand, there will also be difficulties in this alternative policy. The most

evident complication that this policy may encounter is the cost of implementation. Some of

the costs needed for the implementation include payments for mental health providers,

examinations, and subsequent mental health services. A sufficient fund is a requisite for

ensuring proper implementation. Another is the lack of adequate mental health service

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providers. There is still a need to increase and train mental health service providers to ensure

quality mental health services. Failure to provide for the necessary services after mental health

examination could also negatively affect service users. If educational institutions commit to

mental health examinations, they should ensure access for mental health services.

The country, nevertheless, already conducted simple actions concerning Mental

Health. Last October 23-24, 2018, the Department of Education (DepEd) conducted the first

National School Mental Health Forum to discuss concerns related to mental health. Present in

the event were health personnel, guidance counselors, teachers, non-teaching personnel from

Central, Regional, and Division Offices, public schools, and external partners to present

programs and research studies related to school mental health. According to DepEd Assistant

Secretary for Public Affairs Service and Alternative Learning System G.H. Ambat, the

department has made important actions in promoting the well-being of the personnel and

learners. Some of these were trainings on mental health and psychosocial support, and

issuance of policies like child protection and dealing with bullying, as well as unloading

children of homework during weekends. In addition to these, concepts regarding mental health

have been integrated in health and values education subjects. The department called for more

guidance counselors. Secretary Leonor Briones initiated the improvement of the qualifications

for guidance counselors and their increase in salary in order to adequately pay for their

services. (Philippine Information Agency, 2018).

Guidance counselors in some of the universities in the country have created

multiple awareness programs to promote mental health and prevent disorders in the university.

In Far Eastern University (FEU), first year students are oriented with topics like how to

identify symptoms of mental health issues, discussions on sexual harassment, bullying, and

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HIV awareness. FEU director for guidance and counseling Sheila Marie Hocson who also

manages Philippine Guidance and Counseling Association helped establish the Peer

Organization of the Philippines, which is made up of senior high school and college facilitators

trained in basic counseling skills and knowledge of referral systems. In Ateneo, they added

more psychologists to correspond with the counselors. Programs in psychology and mental

health awareness in the first year, and programs in grit, resilience, stress management, and

time management in the later years are included in each university level. Animal-assisted

activities and therapy is also being considered in preventing anxiety attacks. Ateneo has

referral systems and plans to form a student branch to assist peer discussions. Universities

outside Metro Manila such as Silliman University in Dumaguete, University of San Carlos in

Cebu, Xavier University in Cagayan de Oro, also organized measures to promote mental

health. These include peer outreach programs, consultation and referral services, counseling

and development centers, and individual and group sessions. Due to lack of registered

guidance counselors and psychologists, lack of budget to manage tests, and cultural

influences, not all programs are offered in all universities (Bueno, 2018).

The country also celebrates World Suicide Prevention Day (September 10), World

Mental Health Day (October 10) and the National Mental Week (2nd week of October). The

Republic Act 11036, otherwise known as the Mental Health Act was just signed into law last

June 20, 2018. The Implementing Rules and Regulations was signed on January 22, 2019. The

government is set to work on the integration of mental health into the educational system and

educational institutions within two years from the affectivity of the IRR.

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POLICY 2. Public Mental Health Organization

Chapter III of the Republic Act 11036, commonly known as the Mental Health Act,

discusses about the Consent to Treatment and Safeguards. Moreover, there is a section in the

said provision which refers to legal representatives in making decisions of the person with any

mental health illnesses.

In Sec. 11 Legal Representative of the chapter, it discusses the designation of a legal

representative through a notarized document executed for that prupose (Chap. III, Sec. 11, p.

5). In lieu with the designation of private legal representative, tribunal, and supporters, the

alternative policy is about having a government organization that works as a tribunal as well

as independent advocate. It aims to have a better platform for people with mental health issues

in every class of the society. This will address the need of the people with mental disability

who could not afford to appoint or designate lawyers, psychiatrist and a support group that

they will need in legal actions, and other medical-related matters.

The Implementing Rules and Regulations of the Mental Health Law, although does not

provide the mentally ill person to have a legal representative and other professionals be

appointed compulsory, presents how useful this tribunal and other support groups in order to

give the people with mental health issues a smooth transaction in legal matters as well as a

better medical assistance.

Like any other organizations, government or non-government (i.e. Public Attorneys’

Office and Philippine Red Cross), the purpose of having a public mental health organization is

to be able to extend its hands to the people with mental health issues giving them a just and

equitable services, and assistance in legal and medical cases free of any charge. Building and

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spreading local branches of the said proposal would be the best way to help many Filipino

citizens.

Aforementioned on the preceding paragraph, the mental health organization under the

government control will act as a tribunal and independent advocate. Like a court of law, a

tribunal is a panel that can tell the hospital or any mental health institution to discharge the

person with mental health illnesses. Under the provisions of Mental Health Act 1983 from

United Kingdom, a mental health tribunal is composed of a three-member panel:

• a judge – the chairperson of the panel

• a medical member – a psychiatrist (who does not work in the same hospital the patient

is in)

• a lay person – a professional with relevant experience

The tribunal hearing will happen on the hospital where the person with mental health

issue is sectioned or the hospital where he is being treated on a Community Treatment Order.

A Community Treatment Order is where a psychiatrist says that a patient must have a

certain treatment or live in a certain place in their local community. The tribunal will listen to

the facts surrounding the case, and make sure that a person is only detained in hospital in

keeping with the law. Patients have the right to be represented at the mental health tribunal by

a legal representative who is appointed by them. They will also arrange for an independent

medical examination to be carried out by a Consultant Psychiatrist.

The function of the mental health tribunal is to either revoke or affirm an admission or

renewal order. Mental health tribunals can also consider proposed transfers to the mental

hospitals and proposals related to the use of psycho-surgery.

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Moreover, the mental health organization will act as an independent advocacy.

According to POhWER, an example of an independent advocacy for mental health act in

United Kingdom, it is a legal duty of the local authority and providers of care for patients

detained under the Mental Health Act (including private mental healthcare providers) to

provide information regarding independent mental health advocacy support to all eligible

people, and to support communications and referrals for those patients who wish to engage

with the service. An IMHA is an independent advocate who is trained to work within the

framework of the Mental Health Act to support people to understand their rights under the Act

and participate in decisions about their care and treatment. They must be a public health care

provider.

Independent Mental Health Advocacy services are independent, confidential and free of

charge. IMHA’s service to people with mental health issues are optional, and may change their

mind at any time. It does not replace other forms of groups, advocacy or legal support, but can

work with them.

According to the research of Susan Eades on the implementation of independent

advocacy as an inclusion to the provisions in the Mental Health Act 1983 in U.K., although

limited, qualitative research evidence has identified that IMHA support helps to empower

their partners (referred to in the text as patients or patient partners) to be more self -

determined. This is an important finding, particularly for those patient partners detained

under the Mental Health Act, given the often disempowering and autonomy reducing

nature of mental illness and the characteristics of detained environments. However, a gap

in the literature exists for quantitative outcome data identifying the specific impact that

IMHA support has for patients. Obtaining measurable outcome data which seek to

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understand how and why Independent Mental Health Advocacy support impacts its patient

partners is essential for developing and validating outcome measures that can lead to best

practice improvements in IMHA service delivery. Furthermore, this knowledge is pivotal

in optimizing IMHA services’ potential for empowering patients and providing

commissioners with the much-needed evidence for effective commissioning of such

services.

The proposed public mental health organization shall be an autonomous and independent

office, but attached to the Department of Health and Department of Justice under the Mental

Health Law (RA 11036). This shall be the primary office of the Government in extending free

legal and medical assistance to indigent mentally ill persons in criminal, civil, labor,

administrative, health, and other quasi-judicial cases. In the exigency of the service, the public

mental health organization may be called upon by proper government authorities to render

such service to other persons, subject to existing laws, rules and regulations.

The public mental health organization is a proposed policy that caters the need of the

people with mental health issues in legal and medical aspect free of charge. It is in line with

the provisions in the Republic Act no. 11036 or the Mental Health Act on the intervention of

legal representatives and tribunal in legal matters and in the cases of people undergoing a

medication and the community treatment order. Designed for a widespread reach, this proposed

policy will be having local chapters designated for easier access across the whole nation. The

project would really need huge budget allocation for effective implementation. Thus, the main

source of the budget allocation will be from the Department of Health as well as the Department

of Justice, and some other organizations and agencies that that will be involved in the

provisions of the proposed policy. There must be a strict implementation of the said policy for

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better results. This would require the different government agencies to work together,

specifically the Department of Health for the mental health practitioners, Department of Social

Welfare and Development for the conducive mental health center equipped with competent

personnel for support and the Department of Justice for the legal services. The said public

mental health organization should be accessible especially for the indigent mentally ill persons.

All of the information, file, and cases gathered of every individual with metal health issues

must be treated with utmost confidentiality.

Public mental health organization aims to provide free legal and medical assistance

especially for the indigent people with mental health issues. One of the advantages of the said

proposed policy is giving an easier access to people with mental health illness for support from

the government. Legal representatives as well as tribunals and supporters, as stated in the

current Mental Health Act in the Philippines, are designated by the patient for them to

participate in the decision making with the patient’s medical information. This designation

would really require an amount of money for their professional services. With the aid of the

proposed policy, everything that the patient would worry was about his state of mental health.

Moreover, the proposed policy aims to reach until the very remote areas in our country. Dr

Dinah Nadera of the University of the Philippines Diliman said, in rural areas especially, there’s

still that spiritual aspect tied to mental health, the belief that these disorders are a result of other-

worldly spirits or witchcraft. Aside from addressing the concern of mentally ill people, the

proposed policy helps in overcoming the stigma of mental health disorder by raising awareness

and providing information and education.

One of the problems that this proposed policy may encounter must be the difficulty in

budget allocation. Presented in the article from Philippine Star, under the law, the amount
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needed for the Mental Health Act implementation will be charged against the 2018 budget of

the Department of Health. The items to be funded are maintenance and other operating

expenses of the national mental health program, capital outlays for the development of

psychiatric facilities among selected government hospitals and formulation of the strategic plan

for mental health. For the succeeding years, the amount for mental health in the DOH budget

and in the budget of other agencies with mandates stated in the law will be based on a strategic

plan to be crafted by the Philippine Council for Mental Health. The country spends about 5%

of the total health budget on mental health and substantial portions of it are spent on the

operation and maintenance of mental hospitals. Weighing the necessity, if the budget allocation

for mental health would be increased, the other succeeding medical health issues must also

increase proportionally. This would imply a decrease on allocation on other annual budgeting

factors.

Moreover, if the proposed policy aims to reach every Filipino in this archipelago, it would

require huge amount of institutions and professionals to attend the needs of mentally ill people.

In the current statistics, there are approximately 700 psychiatrists and 1000 psychiatric nurses

in the Philippines. This is very insufficient to attend the needs of 88 cases of mental health

problems for every 100,000 Filipinos as per the Department of Health.

POLICY 3. National Monitoring and Mental Health Action Plan of the Republic

Act 11036 or the Mental Health Act

Philippines, being one of the lower middle income countries, faces a huge challenge

concerning the mental health system. The status quo shows that there is a crisis with the

available medical treatment for people with mental illness. There is an inadequate number of

mental health professionals and facilities. Budget is insufficient to cater the health needs and
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to regulate the whole health system (Mental Health and Integration, 2016). Due to these

conditions, it calls for the need of substantial changes and improvement in the mental health

system of the country. Thus, the approved Mental Health Law is a great leap towards the

improvement. Unfortunately, the law is still too vague and ideal to really create impact and

evident changes in the status quo.

On July 22, 2019, the Implementing Rules and Regulations of the Republic Act 11036

or the Mental Health Act was released and it contains the provisions that will be implemented

concerning the mental health of every Filipino. The sections included in the IRR will take full

effect within the two years from release. However, the IRR only encompasses the general

provisions and actions that will be taken in the country without specifically including the

necessary detailed plans and actions.

In the Chapter I, General Provisions, Sec. 3 of the IRR, its objectives are as follows:

a) Strengthen effective leadership and governance for mental health by, among others,

formulating, developing, and implementing national policies, strategies, programs, and

regulations relating to mental health;

b) Develop and establish a comprehensive, integrated, effective, and efficient national

health care system responsive to the psychiatric, neurologic, and psychosocial needs of the

Filipino people;

c) Protect the rights and freedoms of persons with psychiatric, neurologic, and

psychosocial health needs;

d) Strengthen information systems, evidence and research for mental health;

e) Integrate mental health care in the basic health services; and

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f) Integrate strategies promoting mental health in educational institutions, workplace, and

in communities.

Nevertheless, the IRR does not provide specific actions to achieve its objectives. It

only provides general concepts that does not actually create a clear path towards achieving its

established goals. This problem is mainly apparent in the Chapter IV, Mental Health Services

of the RA 11036. One good example is in this paragraph from Sec. 15, stating that:

“Further, mental health services shall be accessible, available, affordable, and

acceptable; delivered by an adequate number of competent health workers who have been

trained to provide mental health care according to their level and setting; provide reasonable

accommodation to persons with disabilities; and guided by high professional and ethical

standards.” This paragraph only reiterates the objectives established in Chap. 1, Sec. 3. It does

not provide any specific solution as to how the services will be accessible, affordable, and

acceptable.

Also, Sec. 16, Mental Health Services at the Community Level, shows that the

provisions indicated in the IRR does not make the national government responsible to impose

specific plans that will be implemented from national up to the local level. In Sec. 17 of the

same Chapter, the Community-based Mental Health Care Facilities, only indicates the obvious

necessities in regards with the matter. It does not clearly specify the facilities being mentioned.

It also excludes the required number of facilities per barangay. There are no specifics. These

are mere goals with no certain plans for proper implementation and action. The IRR itself does

not give assurance to the proper and strict implementation of the law.

For the reasons mentioned above, it is indeed necessary to provide a specific action

plan in the implementation of the law. Specific rules and regulations must be observed. It

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should cover and answer the ideals indicated in the IRR. The Department of Health is now

establishing the Philippine Council for Mental Health (PCMH) which is a policy-making

advisory body which aims to develop a national multi-sectoral strategic plan. It is also being

created to ensure the implementation through a monitoring and evaluation of policies and

guidelines (IRR for Mental Health Act signed, 2018).

However, the PCMH is still not working and it is not yet fully established. The

alternative policy being proposed includes that of the necessary actions to be undertaken by

this council. It should create a specific action plan to impose the rules and regulations for the

RA 11036. This policy is quite similar to the Department of Budget and Management’s 2019

People’s Proposed Budget which aims to create specific steps and to designate specific actions

towards the fulfillment of the IRR’s objectives. In creating the action plan for the Mental

Health Law, it is necessary to truly include specific plans for action.

The World Health Organization created a Mental Health Action Plan (2013) for the

year 2013-2020. It follows six cross-cutting principles and approaches such as Universal

Health Coverage, Human Rights, Evidence-based practice, Life-course approach,

Multisectoral approach and Empowerment of persons with mental disorders and psychosocial

disabilities. Furthermore, WHO’s core objectives are followed by specific actions to be

undertaken in order to achieve those objectives (Mental Health Action Plan 2013-2020, p.11).

Adopting this approach, the Philippines should create its own action plan to make sure

that the objectives in the IRR will be met. Also, the action plan should be localized and put in

the nation’s perspective in order to produce a more personal and closer actions. To ensure the

just and proper regulation of the planned action, the council should also strictly monitor every

programs and projects that was implemented.

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In Chapter IV, Sec. 18 of the IRR of RA 11036, it stated that LGUs should make a

quarterly report to the PCMH through the DOH. The alternative policy also involves national

monitoring, aside from the quarterly reports by different sectors. There should be quarterly

visitation and assessment to every LGU in order to be assured that the action plans are being

properly implemented. This will ensure that the action plans of the IRR are being implemented

and done.

Generally, this alternative policy will have essential implications. The Mental Health

Act will surely create improvements and progress regarding the country’s Mental Health

System. The objectives will be achieved and the law will be properly imposed towards the

citizens. Also, it might lead to better fund appropriations because there will be specific

programs, projects and number of facilities in the action plan. This will also secure that the

plans will surely be enacted.

The Department of Health is now making efforts to establish a comprehensive and

effective Philippine Council for Mental Health that will be designed for the regulation and

implementation of the law.

The main advantage of this policy is that the RA 11036 or Mental Health Act will

certainly be enacted and properly implemented. This alternative policy will provide specific

steps and actions that will lead to the achievement of the objectives. Action plan will ensure

that the ideals and general concept of the law will not just remain as a mere concept. This

action plan is necessary because it will develop a more detailed and concrete steps to achieve

the purpose of the law. This law will also guarantee that it will be put into action. It will also

lessen the commonly occurring problems in government projects and programs such as

corruption because it will be strictly monitored.

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Conversely, there are also disadvantages in this policy. The creation of the action plan

involves a lot of research-based programs in order to efficiently impose the policy. There

should be a budget appropriated specifically for the purpose of research and the creation of

the action plan. The monitoring processes will also need to be appropriately funded.

COMPARING THE THREE ALTERNATIVE POLICIES

I. Institutions Involved

Policy 1. Mental Health Examinations in Education Institutions

- Department of Health, Department of Education, Commission on Higher Education

Policy 2. Public Mental Health Organization

- Department of Health, Other Government and Non-Government Organizations

Policy 3. National Monitoring and Mental Health Action Plan

- Department of Health and Philippine Council for Mental Health

II. Specific Goals

Policy 1. Mental Health Examinations in Education Institutions

- To include Mental Health Examinations as part of the programs being implemented in

the secondary and tertiary education institutions.

- To serve as the foundation of the research and development programs for Mental Health

in the country.

Policy 2. Public Mental Health Organization

- To establish a Mental Health Organization that will cater the mentally ill people who are

from the lower class of the society.

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- To create a government funded and supported organization exclusively for the legal

representation, treatment, consultation, etc. of Filipinos who cannot provide for

themselves.

Policy 3. National Monitoring and Mental Health Action Plan

- To create a detailed action plan stating all the necessary steps in order to achieve the

Mental Health Law’s objectives.

- To ensure that the plans in the IRR will be put into action.

- To regularly check, monitor and assess the country’s status concerning the law.

III. Target Beneficiaries

Policy 1. Mental Health Examinations in Education Institutions

- People with mental health conditions, students, researchers

Policy 2. Public Mental Health Organization

- Poor Filipinos with mental health conditions

Policy 3. National Monitoring and Mental Health Action Plan

- Every Filipino with mental health conditions

IV. Success Indicator

Policy 1. Mental Health Examinations in Education Institutions

- Decrease in the rate of people with mental health problems.

- Active participation of students about Mental Health (campaigns, volunteers, etc.)

- Improved research regarding the Mental Health in the Philippines.

- Positive reports and feedback about the status of mental health.

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Policy 2. Public Mental Health Organization

- Decrease in the rate of people in the lower social class with mental health problems.

- Eradication of the stigma about Mental Health problems and its costly treatment.

Policy 3. National Monitoring and Mental Health Action Plan

- Successful implementation of the law and achievement of the general objectives in the

IRR.

- Regular monitoring and assessment should have a positive report regarding the Mental

Health in the country.

Recommendation

Various proposed policies regarding on the intensified implementation of a mental health

law on the archipelago all can contribute towards concrete results. However, since the mental

health law was promulgated last 2018, with which it is just starting on its implementation, the

most possible one, and the necessary foundation towards strengthening its application is the

execution of having a mental health examination among the high school and college students

in the country.

Having a mental health assessment should be the first one to be implemented in a proper

way in accordance to the application of the mental health law. The usual scenario in our

country is that, most of the Filipinos today tend on not knowing what the difference between

a depression and a sadness, or being nervous to having an anxiety. The thing is, we tend to

self - diagnose. Most of the citizens were not aware of a proper classification whether if

someone has a depression or not. In that case, a proper mental health assessment should be

the first one to be executed properly.

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Furthermore, the sector of youth has the most number of people having cases on their

mental health. Through this national assessment, it can help reduce the number of adolescents

experiencing issues on their mental health, by this examination.

In addition, in order to reach the objectives of the mental health law, with which is to

solve problems regarding on mental health disorders, is determining whether if someone needs

a professional help from medical practitioners specializing on mental health. This is the key

foundation of the law itself. Also, it is the most possible one to be executed properly,

especially on the case that this law is still fresh. By coordinating with the Department of

Education, Commission on Higher Education, and other departments included on this

responsibility must joined their hands together in order for this mental health assessment every

year be done in a proper and in a purposeful way.

Although it has its issue regarding on the disclosure agreement or privacy of a certain

Filipino, the thing is, it is the protocol. Just like in a medical check - up, in order to cure a

mental health disorder must undergo through its basic step, the assessment. Furthermore, the

proposed policy also has its inclusions with regards to non - disclosure agreement between the

parties thereof.

The remaining two alternatives regarding on the current policy on the mental health status

in the Philippines were also needed. However, there are some certain factors that makes the

suggestion of having a mental health examination among students should be the first one to

prioritize when it comes to implementation.

A public mental organization here in the country is necessary as it helps to create,

advocate, and to apply such programs regarding on how to overcome such mental health

disorders. This proposed organization should include individuals who has a specialty or has a

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full knowledge on mental health. However, this seemed to be impossible to implement

concretely as the status on the number of workers specializing on mental health is grossly

inadequate. As of 2016, there are only 700 psychiatrists and 1000 nurses in the country, a

disproportionate condition when compared to the number of Filipino suffering with regards

to mental health (Magtubo, 2016). In fact, more than half of them are working on private

institutions, since many of them are working for a higher income.

With this case that the number of medical health practitioners specializing on mental

health is lacking greatly, creating a public mental health organization that is impossible to

form in this current year. If the country has its capability to solve this particular circumstance,

by making the number of employees having an expertise on mental health increase and reach

the right number, a public health organization can exist, and can extend its hand to help fight

on mental disorders. Implementing a mandatory mental health examination to students as a

part of assessment should be implement first.

National Monitoring and Mental Health Action Plan of the Republic Act 11036 (Mental

Health Act) is also necessary to be executed properly by the departments holding

responsibility on observing the status of mental health of the Filipinos. It will serve as a way

of an overall assessment on the implementation of the mental health law in the Philippines. It

also suggests on increasing the number of facilities for those who have mental health

disorders. However, this requires a large amount of fund from the government.

In conclusion, if the government does not appropriate fund properly on the sector of

mental health, the whole implementation of the mental health law will be impaired. It will

lead to a domino effect that the mental health law will be affected adversely if there is no

enough budget for its monitoring.

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Rather than prioritizing on the national monitoring and a mental health action plan, it is

more convenient to execute first the mental health examination on high school and college

students as it will serve as the fundamental step on applying the law. When the national

assessment of mental health to students have already implemented continuously, the national

monitoring and the mental health action plan will include this particular step for them to

observe the effects on it to people and to the country.

Among the other suggestions on intensifying the mental health law, this should be the

first one to be implemented, as it will serve as the main foundation for the execution of the

mental health program. Public mental health organization, and the national monitoring and a

mental health action plan will follow.

Implementation

After discussing the present act regarding mental health, examination for the mental

health of the students was chosen as the additional provision of the Republic Act 11036. The

process of implementing the mentioned proposal is stated below:

1. ORGANIZATIONAL AWARENESS AND APPROVAL

This step is the most significant because without the approval and awareness of these

organizations then implementing the proposed provision would be impossible. It will enable

organizations such as Commission on Higher Education (CHED), Department of Education

(DEPED), Department of Health (DOH), Psychology Association of the Philippines (PAP),

etc. to have a grasp about the provision and have a chance to collaborate with each other,

discuss about their concerns or suggestions and eventually to make the provision more reliable

and attainable.

- Identify key institutions and organizations needed to approve the policy.

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- Communicate to the key institutions to get included in meeting agendas for approval.

- Set the date and place for meeting agendas with the key institutions.

- Discuss the agendas regarding the implementation of the mental health examination for

students.

- Ask for the approval of the implementation of the new policy from the key institutions.

2. CONSTRUCTION OF MENTAL HEALTH EXAMINATION

Construction of mental health examination is very crucial because this will be the center

of the provision. In fact, the mental health test will be a great factor in helping the students to

be aware of their own mental health status and for them to receive immediate consultation

from professionals in case of positive results. Thus, the structure of the exam should be

filtered cautiously to make the exam efficient and effective.

- Seek for the compatible professionals who will facilitate the construction of mental health

examination for the students.

- Search for the target respondents who will take the pilot examination.

- Validate the constructed examination thru reliability test of each question. In case of

inaccuracy, revision of the exam is mandatory.

3. HOUSE OF REPRESENTATIVES APPROVAL

The implementation of mental health examination for the students is an additional

provision for the Republic Act 11036 that’s why approval of the House of Representatives is

required. The bill will undergo in three separate readings and approval in each reading is

essential in order to ensure the necessity and relevance of the bill.

- Pass the proposed policy to the Bill Drafting Division of the Reference and Research

Bureau for the preparation and drafting of the bill.

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- The bill will be filed with the Bills and Index Service for the first reading. The bill will

undergo in Committee Consideration/Action. Bill will be referred to the Committee on

Rules and will be scheduled for the second reading.

- Engrossed bill will be included in the Calendar of Bills for third reading. Approved bill

will be transmitted to the Senate for its concurrence. Bill will undertake the same

legislative process in the Senate.

- Members from each House of Congress will settle and reconcile the differences or

disagreements on any provision of the bill. Transmittal of the bill to the President.

4. APPROVAL OF THE PRESIDENT OF THE PHILIPPINES

Approval of the president will now permit the mental health examination as part of the

education sector’s program for the students as a new provision of Republic Act 11036. With

this, there will be new assigned RA entitled as the act amending the mentioned RA and will

be transmitted to the House where it is originated.

5. CONDUCTING THE EXAMINATIONS

After the approval of the amendment in the law, the examinations will be conducted in

the secondary and tertiary education institutions. This will serve as the foundation of research

and monitoring on the Mental Health status of the Philippines, particularly the students.

- Securing the confidentiality of the results.

- Strengthening the Research and Development for Mental Health with the examination

results as foundation.

- Ensure that the necessary services for people who need it shall be provided.

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