MODULE-5-GROUP-2-FINAL-converted for the brand.pptx

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1. MODULE 5 Responding to Crisis and Providing Treatment and The Mental Health System in the Philippines GROUP 2

2. Learning Objectives and Outcomes At the end of this module, you should be able to: Know the definition of crisis Know the types of crisis Know the goals of crisis intervention Identify the aims and purpose of responding to crisis Identify different types of treatment in responding to crisis Know the definition of Mental Health Understand the importance of Mental Health and Wellness Understand the importance of addressing Mental Health Issues Identify factors that causes mental health issues Identify types of mental illness Understand the mental health in the Philippines Identify various ways in Philippine Mental Health System in addressing mental issues

3. INTRODUCTION

4. Most crisis plans that are actually completed these days are so complicated and compartmentalized that it defies even the most skillful leader’s abilities to lead effectively. Too many crisis plans focus on external issues and the media rather than providing a simple, sensible, constructive, achievable response strategy. The concept of strategy to drive crisis response using the preventive measures as the driving force. Very few management problems are crises, but all crises are management problems. Preplanning executive actions and decisions can avoid career-defining moments. Include specific executive leadership instructions in all plans and response scenarios. Consequently, Filipinos across the world have general reluctance and unfavorable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help. With this, the proponents will further discuss the aspects of both responding to crisis and the system of Philippines in addressing to mental health issues, collaboratively.

5. Lesson 1: The Importance of Promptness in Responding to Crisis

6. -is a crucial or decisive point or situation; a turning point. -A crisis (derived from the “krisis” which means critical) is any event that is, or is expected to lead to, an unstable and dangerous situation affecting an individual, group, community, or whole society. -Crisis as a dramatic emotional or circumstantial upheaval in a personal life and a stage in a sequence of events at which the trend of all future events, especially for better or determined , a turning point. -is a state of disequilibrium resulting from the interaction of an event with the individual’s or family’s coping mechanisms , which are inadequate to meet the demands of the situation combined with the individual’s or family’s perception of the meaning of the event. C R I S I S

7. Maturational or Developmental Crisis Situational Crisis Adventitious Crisis Developmental Crisis -also referred to as maturational or internal crisis -may occur at any transitional period in normal growth and development. -The transitional periods where individuals move into successive stage often generate disequilibrium, individuals are required to make cognitive and behavioral changes that accompany development, precipitate factors are normal stress of development (e.g. adolescence retirement, marriage and parenthood) Situational Crisis -sometimes called accidental or external crisis -is a response to a sudden and unavoidable traumatic event that largely affects a person’s identity and roles. -Examples of events that can participate situational crisis are sudden traumatic event. Eg. Unexpected job loss, serious car accidents, Loss of spouse, academic failure, birth of a child with a disability or diagnosis with a chronic or terminal illness) affects how people perceive themselves. Three Types of Crisis

8. Social Crisis -is accidental, uncommon and unanticipated and result in multiple losses and radical environmental changes. -An adventitious crisis occurs outside the person precipitate by an unexpected event. (eg.Natural Disaster,fires,floods,war etc.) -These crises affect many people who experience both acute and post- traumatic stress reaction. -This type of crisis is unlike maturational and situational crisis because it doesn’t occur in the lives of all people. Crisis Intervention -refers to the methods used to offer immediate, short term help to individual who experience an event that produces emotional, mental, physical and behavioral distress or problems. -A crisis can refer to any situation in which individual perceives a sudden loss of his or her ability to use effective problem solving and coping skills

9. Goals of Crisis Intervention -To decrease emotional stress and protect the crisis victim from additional stress. - T o ass i s t t h e v i c t i m i n o r g a n i z i n g a n d m o b i l i z i n g re s o u r c e s o r s upp o r t s y s t e m t o m ee t u n i q u e needs and reach a solution for the particular situation that precipitated the crisis. Assessment Of A Crisis Situation Triage Assessment Crisis Assessment Social and Cultural Assessment Crisis Intervention Procedures There are numerous crisis intervention procedures, all of which aim to restore stabilization in people who have been affected by a crisis. A person dealing with a crisis may be severely depressed, and even suicidal, so having these procedures in place helps to ensure the best and fastest care possible. The Seven-Stage Crisis Intervention Model, SAFER-R Model, the 10 Stages of Acute Traumatic Stress Management (ATSM) and Critical Incident Stress Management (CISM) create one comprehensive model that can be utilized in nearly all crisis situations.

10. T h e S e v e n - S t a g e C r i s i s I n t e r v e n t i o n M o d e l also known as the Assessment, Crisis, Intervention, Trauma, Treatment (ACT) Model, the Seven-Stage Crisis Intervention Model is designed to be followed as a guide to resolving crisis situations, and returning things to the way they were before the crisis occurred. The seven stages of the ACT Model are listed below: Plan and conduct a thorough biopsychological and lethality/imminent danger assessment Make psychological contract and rapidly establish the collaborative relationship Identify the major problems, including what precipitated the crisis Encourage an exploration of feelings and emotions Generate and explore alternatives and new coping strategies Restore functioning through implementation of an action plan Plan for follow-up and booster sessions

11. The SAFER-R Model is a popular treatment approach for effectively handling a crisis situation. Treatment in this approach follows a simple guide to returning an individual back to functioning similar to before the state of crisis. The SAFER-R Model includes the following six stages: Stabilize Acknowledge Facilitate understanding Encourage adaptive coping Restore functioning Refer The SAFER-R Intervention Model

12. The 10 Stages of Acute Traumatic Stress Management is a comprehensive list of steps to restoring balance and mental stability in an individual suffering from crisis trauma. The 10 stages of ATSM include: Assess for danger/safety for self and others Consider the mechanism of injury Evaluate the level of responsiveness Address medical needs Observe and identify Connect with the individual Ground the individual Provide support Normalize the response Prepare for the future The 10 Stages of Acute Traumatic Stress Management (ATSM)

13. Critical Incident Stress Management (CISM) The CISM is a comprehensive crisis intervention system that may be applied to individuals, small functional groups, large groups, families, organizations and even entire communities. CISM has seven core components: Pre-crisis preparation. This includes stress management education, stress resistance and crisis mitigation training. Disaster or large-scale incident, as well as school and community support programs including demobilizations, informational briefings, “town meetings” and advising staff. Brief small group discussions called defusing, which are provided within hours of a crisis for assessment, triaging and mitigating acute symptoms. Longer small group discussions known as Critical Incident Stress Debriefing (CISD). These structured group discussions are usually provided one to 10 days after a crisis to mitigate acute symptoms, assess the need for follow-up and, if possible, provide a sense of post-crisis psychological closure. One-on-one crisis intervention counseling or psychological support throughout the full range of the crisis spectrum. Family crisis intervention and organizational consultation. Follow-up and referral mechanisms for assessment and treatment, if necessary.

14. Lesson 2: Understand How to Determine the Appropriate Treatment Depending on the Nature of Crisis

15. A mental health crisis is any situation in which a person’s actions, feelings, and behaviors can lead to them hurting themselves or others, and/or put them at risk of being unable to care for themselves or function in the community in a healthy manner. Treatment can take place in two types of settings: Inpatient Treatment - Inpatient means the person is admitted to a treatment environment that requires staying overnight. It may be a hospital, a residential treatment center, or a crisis unit, but the treatment is provided while the person is on site at the treatment facility 24 hours a day. The length of stay in an inpatient setting varies and usually depends on the severity of the crisis as well as health insurance coverage. Outpatient Treatment - Outpatient means mental health services are provided while the person lives at home and continues their regular routine with work, school and family life. This treatment is considered the least restrictive form of treatment.

16. UNDERSTAND THE PRESENT SITUATION OF M E N T A L H E A L T H S Y S T E M IN THE COUNTRY Lesson 3:

17. The stigma surrounding mental health issues in the Philippines is still prominent to this day. This makes raising awareness about the need for improved mental healthcare in the country an imperative. It is to no surprise that the Philippines is one such country that faces these struggles. Numerous obstacles still stand in the way for providing much needed services to those affected even in this age where there have been many strides made to improve mental health treatment. Martinez et al. (2020) states that mental illness is the third most common disability in the Philippines. It has always been a growing concern in the country considering there are at least 3.6 million Filipinos suffering from one kind of mental, neurological, and substance use disorder. (WHO, 2020). This makes the country the third highest rate of mental health problems in the Western Pacific Region (WHO, 2017). The real number of those affected may actually be higher because these statistics only include the disabled population and mental health cases are notoriously unreported in the country. To help combat the rising number of mental health issues in the country, the Philippines has recently passed its first Mental Health Act or RA NO. 11036 which seeks to establish access to comprehensive and integrated mental health treatment in the country. To add to this, the act also ensures the protection of rights of people with mental disorders and their family members (Lally et al, 2019). Even though this is the case, resources are still poorly allocated to the mental health sector. According to the WHO and Department Health (2006), only 3 to 5 percent of the total health budget is spen t on mental health, and 70% of this is utilized on hospital care. The ratio of mental health workers to the total population of the Philippines is at 2-3 per 100,000 people with an estimate of over 500 psychiatrists in practice. (WHO and DOH, 2006). The majority of the aforementioned psychiatrists work in the private sector, mainly in the major urban areas such as Metro Manila (Samaniego, 2017).

18. This creates a scenario where most of mental healthcare can only be provided in hospital settings and there are underdeveloped community mental health services nationwide. A 2014 study conducted by the WHO estimated per 100,000 people, there are only 1.08 mental health beds in general hospitals and 4.95 beds in psychiatric hospitals. Accordingly, there are only 46 out-patient facilities or .05 per 100,000 and 4 community residential facilities or 0.02 per 100,000. Tertiary care hospitals, the type of hospitals where highly specialized medical care is given over an extended period of time that involves advanced and complex procedures performed by medical specialists, are available in only two locations for those seeking mental health treatment in the Philippines: The National Center for Mental Health in Mandaluyong (equipped with only 4,200 beds), and the Mariveles Mental Hospital (500 beds). Additionally, there are 12 smaller satellite hospitals affiliated with the National Center which are located nationwide but like their bigger counterparts, overcrowding, poorly functioning units, and lack of staff and funding plague these mental health institutions.

19. On the topic of health care staff or lack thereof, in general, there is 1 doctor available to every 80,000 Filipinos (WHO and DOH, 2012). This lack of specialists is further intensified in the mental health sector with only a little over 500 psychiatrists in practice. It is stated earlier that the ratio of mental health workers in the country is 2-3 per 100,000. When it is compared to neighboring countries such as Malaysia (4.9) and Indonesia (3.1), it is significantly lower despite having similar economic status. According to Isaac et al. (2018), data indicates that there are only .52 psychiatrists per 100,000. WHO (2014) states that there are 0.07 psychologists and 0.49 mental health nurses per 100,000. The numbers clearly show that there is a severe shortage of mental health specialists in the Philippines. To add to the inaccessibility to proper treatment facilities and professionals, there are also other factors that influence Filipinos to not seek out mental health care. The first of which is poverty. Impoverished people with mental illnesses are less likely to seek help because it is unaffordable to them. Given it is already difficult to find a psychiatrist, finding an affordable one is even harder to achieve. According to Moneymax (2019), a single therapy session can range from PHP 100 to PHP 4,500. Depending on the case of the patient, they may be advised to visit their psychiatrist once or twice a month. The sessions do not include other expenses such as professional fees, confinement, and medicine. Medication is known to be quite expensive. Brands such as Xanax and Prozac, which are used as anti-depressants and anti-psychotics, can range from PHP 130 to PHP 300 per tablet. According to Lally et al. (2019), there are scarce amounts of data on the prescription rates and the use of psychotropic medicine in treating medical disorders.

20. This should not be the case anymore because PhilHealth now offers mental health packages. They can now cover the cost of therapy consultations and members can avail of it just like any other medical treatment. Other health providers are also capable of covering mental health related consultations and medications, but all of them should. There are also mental health facilities that offer free therapy and consultations such as the National Center for Mental Health, Philippine General Hospital, and East Avenue Medical Center. An emergency counseling hotline was also launched back in May 2019 which is open to the public 24/7. There are also internal factors such as perceived or internalized stigma that has been shown to be a hindrance to help-seeking behavior in Filipinos (Tuliao and Velasquez, 2014). It is known that Filipinos put an emphasis on the community and would rather choose to seek help from friends or family before seeking out a mental health professional. There are also some feelings of shame associated with mental illnesses due to the persistent stigma. People would rather hide their symptoms rather than discussing them which often results to the worsening of their mental state.

21. Understand How to Appreciate the Difference Beliefs and Practices of Filipinos that Affect their Mental Health L E SS ON 4 :

22. Filipinos are know to believe in superstitions. Almost every Filipino is superstitious for they adapted it through generations originating from their ancestors.

23. Toxic Filipino family cultures occurs in almost every household. Mental health was very trivial for Filipinos. Families, and parents don't realise the effect of factors that affect an individual's mental health. Precolonial Philippines has always believed in the term "pamahiin", which directly translates as superstitions. If Filipinos believe this after generations, why must mental health be a trivial issue for them? If they esily believe things without exact proof, why must mental health with enough evidences of taking place is not necessary? In a household, if a child comes up to their parents about feeling certain ways, specifically experiencing mental health problems such as anxiety, depression, etc.— the parents will only say they are "nag- iinarte", "arte" which means acting out in an exaggerated way. Filipinos with mental health issues prefer to seek help from close family and friends, instead of therapy. Not everyone can afford a therapy, leading for Filipino people to jist either cope with it, or take it out to their close family and friends. The other way for families to react to mental health issues is "Pagpapasadiyos", believing that religion can cure it, God can cure it. Just pray to Him and it's done. Filipinos are very religious people, so "Pagpapasadiyos" was always their resort to every problem. Health Beliefs and Behaviors : Health Behaviors

24. Patience and Endurance (Tiyaga): the ability to tolerate uncertain situations Flexibility (Lakas ng Loob): being respectful and honest with oneself Humor (Tatawanan ang problema): the capacity to laugh at oneself in times of adversity Fatalistic Resignation (Bahala Na): the view that illness and suffering are the unavoidable and predestined will of God, in which the patient, family members and even the physician should not interfere Conceding to the wishes of the collective (Pakikisama) to maintain group harmony Coping Styles Coping styles common among elderly F ilipino America ns in times of illness or crisis include:

25. R E S P O N S E S T O M E N T A L I LL N E S S Indigenous traits common among elderly Filipino Americans when faced with illness related to mental conditions:

26. Difficulty in utilizing mental health services during usual hours because of the unavailability of working adult family members Mental illness connotes a weak spirit, and may be attributed to divine retribution as a consequence of personal and ancestral transgression Lack of culturally oriented mental health services Devastating shame (Hiya) Sensitivity to criticism (Amor Propio) Common Perceptions of Filipinos about Mental Illness Unwillingness to accept having mental illness, which leads to the avoidance of needed mental health services due to fear of being ridiculed Involvement of other coping resources such as reliance on family and friends or indigenous healers, and dependence on religion which can diminish the need for mental health services Prioritizing of financial and environmental needs which preclude the need for mental health services Limited awareness of mental health services resulting in limiting access

27. Mental health in Philippines as a subject still has a long way to go. Filipinos must realise that not everything can be solved with faith in God, practical and medicinal procedures exist for a reason. Mental health is a real issue that can happen for every individual. Beliefs and superstitions influenced Filipino people in lots of ways.

28. Meet Our Team A l z o n a , R a v e n C a r a s i g , D a q u i w a g , K a l - E l D a n n a D i a z , O l i v e r G o n z a l e s , I v o r y L a z o , J u s t i n e M a r t i n e z , I a n P e s p e s , K r i s l y n P o n s o n e s , J u l l i e S a l i g a n , J o e a n n T u i c o , M a r i a n n e G R O U P 2

29. REFERENCES: Authority, P. S. (2016). Highlights of the Philippine population 2015 census of population. Philippine Statistics Authority. Isaac, M. (2018, September 31). Postgraduate training in psychiatry in Asia. Current opinion in psychiatry. https://pubmed.ncbi.nlm.nih.gov/30015670/. Lally, J., Conghaile, A. ó, Quigley, S., Bainbridge, E., & McDonald, C. (2018, January 2). Stigma of mental illness and help-seeking intention in university students: The Psychiatrist. Cambridge Core. https:// www.cambridge.org/core/journals/the- psychiatrist/article/stigma-of-mental-illness-and-helpseeking-intention-in-university- students/B86F23B88A147D071B19F7552405DBD5. Martinez, A. B., Co, M., Lau, J., & Brown, J. S. L. (2020, August 20). Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Social Psychiatry and Psychiatric Epidemiology. h tt p s : // l i n k . s pr i n g er . c o m / a r t i c l e / 1 . 1 7 / s 1 2 7 - 2 - 1 9 3 7 - 2 # re f - C R 1 . Mental Illness in the Philippines: Cost of Therapy and Medication. Moneymax. (2020, September 30).https:// www.moneymax.ph/personal-finance/articles/cost-of- therapy- philippines#:~:text=Cost%20of%20Professional%20Mental%20Health%20Treatment,- Instagram%20photo%20by&text=Because%20of%20expensive%20treatment%20costs,M edication%20is%20quite%20expensive%2C%20too. Samaniego, R. M. (2017). The Evolution of Psychiatry and Mental Health in the Philippines. 臺 灣 精 神 醫 學 . https:// www.airitilibrary.com/Publication/alDetailedMesh? docid=10283684-201706-201707040025-201707040025-101-114%2Bii.

30. REFERENCES: The State of Mental Healthcare in the Philippines. BORGEN. (2020, October 16). https:// www.borgenmagazine.com/mental-healthcare-in-the-philippines/. Tuliao, A. (2014, May). Mental health help seeking among Filipinos: a review of the literature. Taylor & Francis. https://www.tandfonline.com/doi/abs/10.1080/21507686.2014.913641 . WHO (2017) Mental health atlas 2017. World Health Organization World Health Organization. (1999). Global health observatory. World Health Organization. "Health service delivery profile: Philippines." (2012). World Health Organization (WHO) and Department of Health (2006) WHO-AIMS Report on Mental Health System in The Philippines. World Health Organization. YOUR MIND MATTERS: DOH CALLS FOR UNIFIED RESPONSE TO MENTAL HEALTH: Department of Health website. YOUR MIND MATTERS: DOH CALLS FOR UNIFIED RESPONSE TO MENTAL HEALTH | Department of Health website. (2020, October 10). https://doh.gov.ph/press-release/YOUR-MIND- MATTERS-DOH-CALLS-FOR-UNIFIED-RESPONSE-TO-MENTAL-HEALTH. https://geriatrics.stanford.edu/ethnomed/filipino/filipino_references.html https://geriatrics.stanford.edu/ethnomed/filipino/fund/health_beliefs/heal th_behaviors.html

31. REFERENCES: https://www.ncbi.nlm.nih.gov/books/NBK559081/ https://en.m.wikipedia.org/wiki/Crisis_intervention https://vertavahealth.com/addiction-treatment/intervention/crisis/ https://www.csuci.edu/caps/crisis-intervention.htm https://online.grace.edu/news/bachelors/responding-to-trauma-crisis-intervention- counselor-models/ https:// www.verywellmind.com/what-is-crisis-counseling-2795060 Lally, J., Samaniego, R. M., & Tully, J. (2019, August). Mental health legislation in the Philippines: Philippine Mental Health Act. BJPsych international. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC6646847/. Lally, J., Tully, J., & Samaniego, R. (2019, August). Mental health services in the Philippines. BJPsych international. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC6646843/.

32. T h a n k Y o u ! Hey! You Matter, Thanks for Existing. :)