Filling the gap with mhGAP

The lack of psychiatrists was put into highlight in the aftermath of typhoon "Yolanda" when survivors and emergency responders were faced with the harrowing sight of the devastation that would need them to process the whole experience to maintain their mental balance.

The World Health Organization, in partnership with Department of Health, introduced the Mental Health Gap Action Program to scale up health facilities and medical practitioners to render mental services. The program is targeted to be implemented in low- and middle-income countries where mental health service is lacking.

The idea is to integrate mental health care into the primary and secondary health care system. Doctors, nurses, and community workers were trained on psychosocial care and support so that mental health problems can be addressed down to the grassroots level.

"We are one of the first countries in Southeast Asia that were given the chance to train general practitioners and doctors who are non-psychiatrists to be able to give basic mental health services in their respective areas," says Dorego.

The DoH reported that between June 2014 and March 2015, some 1038 community workers were trained in psychosocial care and support and 290 non-specialized healthcare providers received training in the assessment and management of mental health conditions including on-the-job supervision.

In the same period, 155 of 159 primary healthcare units, 21 of 24 District Hospitals, and all eight provincial hospitals had a doctor and a nurse trained in the assessment and management of mental health conditions.

Dorego said training on mhGAP is still done every year even at the height of the Covid-19 pandemic albeit on a lesser scale to comply with the standard health protocol. She said this is to replenish some municipalities where the mhGAP-trained have already retired or transferred to another area.

"Mental health program in Eastern Visayas is going strong because most of our local government units, especially the provinces, have already made mental health one of their priority programs," she said.

Dorego said all provincial health offices have an assigned focal person for mental health programs as well as in the LGUs under their respective provinces.

Under the mhGAP, medical personnel are trained in the diagnostic and treatment of 10 common disorders including depression, bipolar, psychosis, suicide and self-harm, epilepsy, dementia, developmental disorders and behavioral disorders.

"Cases, where the service user has comorbidities or those with complicated cases, are referred to psychiatrists in EVMC, Schistosomiasis Hospital, or TRC. Sometimes they are also referred to private practitioners," she said.

Reality on the ground

In the adjacent town of Pastrana, a fifth-class municipality, nurse Leslie Mangubatmans one of the inoculation booths for Covid-19. Some other times, she can be seen helping her fellow nurses or the midwife perform their tasks.

Mangubat is the town's point person for the mental health program where her main tasks are to keep the registry of mental health patients in Pastrana, dispense their medication which is done periodically and on a specific schedule, and ensure that the service user is taking the medication.

The LGU reports to DoH the number of patients and their respective illnesses for the allocation of medicine. The supply chain was interrupted for some time during the pandemic due to problems in logistics and the LGU had to use its own money to buy the medicines.

"We are just lucky that our mayor has allotted sufficient funds to buy medicines so we were able to provide an uninterrupted service to our patients," Mangubat said. But not all LGUs, though, enjoy such a privilege especially since psychotropic drugs are expensive.

Pastrana had two personnel who were trained on mhGAP, a midwife who has already retired and the municipal health officer who also oversees all the programs of the DoH that are implemented in the municipality. The MHO also represents in meetings called by the LGU and DoH as well as other functions that may be assigned to her.

To be continued