Ola! Welcome to Semi-Online, issue #15.
Let’s go back to July 2022. I was scrolling through my Facebook feed when an ad for KonsultaMD’s mental health consultation services popped up.
I thought Facebook’s algorithm was at work again because I’d recently done a related search, and friends have posted about mental health before. But this may also be the first time I liked an ad. Mental health — and access to adequate services — is now a big conversation in the Philippines, one that’s long overdue.
However, I should’ve taken screenshots of the discouraging reactions and comments. There were plenty of Laugh emoji reactions and comments saying mental health issues were only for the rich, privileged, and self-centered in the Philippines. I’ve heard those sentiments and experienced that swift dismissiveness all my life, and from so-called well-meaning and well-educated adults. It pissed me off then, and on that particular day.
I was still curious and angry the next day, so I made a KonsultaMD account and went straight to the Mental Health Support section. At the time, KonsultaMD offered chat consults with a partner psychologist for a ₱70 promo price per session (the regular price is ₱399), and video consults for ₱600 per session. The prices alone made me wanna go for it.
But the words ‘24/7 consultation’ and ‘no appointment needed’ stayed in my head long after that day. These are the biggest complaints Filipinos have about our available mental health services.
As I said before, we don’t have enough healthcare professionals here (because we ship our nurses, doctors, and caregivers out to work in other countries!). Most of our remaining medical professionals are based in the National Capital Region too, which means those outside it have fewer options. And the Philippine healthcare system involves a lot of ‘hurry up and wait’, but mental health issues don’t follow regular business hours. Sometimes, you need help right now.
Yet few of us seek help because our own people tell us not to.
Filipinos are obsessed with public image and reputation. The mere act of going to a hospital and asking for mental health assistance is scary for a lot of people, so scary at times that they won’t even bother. Many fear they’d be outed at work and home as ‘having problems’.
Similarly, some are afraid of people discovering that immediate or secondary family members are in treatment or seeking it. That worry is legit; Mariteses will whisper about it, or others will use it as an insult during pivotal moments in arguments. 🙄
Some also truly believe that because they’re suffering in their own lives, everyone else should. Keep quiet, and keep the peace. It’s crab mentality mixed with harmful Filipino ‘traditions’ that we teach our young and take to our graves.
I’m sure you’ve heard all this shit before, or even said them to others. I know I have back when I didn’t know any better:
- “Lahat tayo may pinagdadaanan. Bakit special ka?”
- “Sus, everyone has some mental health issue these days.”
- “Doctors are just drugging patients to make money. There’s nothing wrong with them!”
- “You need to be in a psych ward. Sira-ulo ka.”
- “Ikulong na sa mental ‘yan! May sayad!”
- “Depressed yarn?”
- “Buti ka pa, pwedeng mag-inarte lang. Rich kid ka kasi.”
- “Eto ba yung may kamag-anak na psycho?”
- “Ano naman problema nito? Ang ganda kaya ng buhay niya!”
- “Wow, alam kaya ng magulang/asawa/anak niya ‘to?”
- “Mag-trabaho ka nalang. Keep busy. Or pray to God. Mawawala din ‘yan.”
There is only one simple outcome. Those with mental health problems don’t get the long-term help and support they need. Then they pay the price and carry others’ harsh (and frankly, irrelevant) judgment for life.
A legitimate national crisis
These ignoramuses (ignoramii? LOL) have no idea how seriously mental health should be taken, and how that should’ve been done in the last decade or so.
This April 2023 editorial in the Philippine Daily Inquirer provides some (slightly outdated, but still important) numbers on mental health in the Philippines, as well as additional reasons for the low uptake in mental health services:
- “…3.6 million Filipinos, based on 2020 data from the Department of Health, suffer from mental illness and this number is most likely to have increased in the past three years…”
- Especially in marginalized communities, mental health pales compared to the constant challenges of daily survival (e.g., food, water, work, shelter)
- There was a ₱2.15 billion budget in 2022 for mental health resources, but that’s still low compared to the Philippine government’s other priorities
- That means first-response and satellite hospitals have few available beds and staff, and local government units (LGUs) carry the bulk of the community work with little resources
- The result is that people get “inadequate, inaccessible, ineffective mental health services.”
A 2022 Inquirer article also notes that the 3.6 million Filipinos with mental illness “suffer from one kind of mental, neurological, and substance abuse disorder.” And while the reported numbers for patients with depressive disorder (1,145,871), bipolar disorder (520,614), and schizophrenia (213,422) are already alarming, the DOH National Mental Health Program head Frances Prescilla Cuevas also called these figures an “understatement” because so many other conditions haven’t been accounted for yet.
What we have so far
I know I talk shit about younger millennials and Gen-Z kids all the time. But one of the biggest societal shifts they can take credit for is creating, and then amplifying and sustaining, attention on mental health. Because of that, we’re less shy about bringing it up ourselves — and creating tech-driven solutions for anyone who needs them.
Aside from KonsultaMD, we now have more apps for mental health services, paperwork, and prescriptions:
The Philippine Star also lists the National Center for Mental Health (NCMH) and private initiatives such as Mental Health First Response and Gray Matters Psychological and Consultancy Inc. among the viable choices for mental health care, psychiatric services, and counseling.
All these are great for Filipinos (with both internet access and financial stability) who want to address their concerns in private and/or in their own homes. But keep in mind that they don’t fully cover national numbers and needs, or even the barest of services for those without internet access and financial stability.
The mental health business is booming
Especially in the early years of COVID-19, more mental health-centered startups targeting both individual clients and companies went live in Southeast Asia — and made ‘mental health’ a hot new buzzword in a region that traditionally didn’t give a shit about it. The Philippines-based InfinitCare and MindYou + SEA players like Intellect, MindFi, ThoughtFull, and Riliv got all the regional media and VC attention for their fundraising and service expansions.
While I’m all for the private sector stepping in during a global health crisis, this rapid industry growth also makes me super worried (and afraid for those who don’t know any better).
First, entrepreneurs and startups are in the mental health sphere for profit. I mean, nice origin story, bro. But the truth is that business is about meeting market demands and getting paid for it. Here, no one is 100% altruistic, and nobody cares about your feelings. If people want private mental health services, we’re all free to create a company, hire licensed and experienced professionals to provide those services at specific prices, then cover up our collective greed through Corporatese (a.k.a. marketing) so no one feels guilty about it. 🙃
And even non-profit mental health services ask for something non-monetary in return. For example, the Ateneo Bulatao Center is clear about its research and training activities. Anonymized parts of client session records might be shared with other Center psychologists and trainees for very specific problems, and under special circumstances. Trainees may also sit in and observe physical or online sessions. These sessions may be recorded and/or used in research studies.
Those who avail of the Center’s paid psychotherapy sessions must consent to these conditions, and they may be asked to sign additional consent forms. Clients can also withdraw their consent at any time.
Second, just because they work in the mental health industry doesn’t mean they’re truly all about it. I’ve worked around and in startups for most of my writing and editing career, and startups can be toxic as fuck. And mental health startups are no different from other startups. They can be as damaging to your mental health as any other workplace. Behind the screen, they’re still workplaces run by people not necessarily as trained on or aware of mental health triggers, conditions, and interventions as the actual healthcare professionals.
And toxic startup folks usually stay within the same work circles and networks. They can also be either oblivious to their bullshit or have an astounding level of audacity. When I learned that an ex-client/boss — one with whom I’m definitely not friendly today, and who caused me considerable career trauma — worked for one of these mental health companies, this was my reaction:
⚠⚠⚠ WARNING ⚠⚠⚠
Third, even if these startups help make mental health care much less of a taboo, they’re (and we’re) still impacted by a worldwide shortage of healthcare professionals. And those we do have are underpaid and overworked to the point of burnout and loud quitting, or participating in labor strikes.
The Ken’s Southeast Asia edition highlighted this exact staffing problem faced by InfinitCare in 2021. And I’ve seen multiple psychiatrists and psychologists on multiple telemedicine apps who also keep regular schedules at hospitals and clinics. This should make us think hard about how few healthcare workers we have left, and how often they set their own health/care aside to tend to ours.
Fourth point: If more startups are setting up shop, that also means we now have more grifters and fraudsters. Again, I’ll use Facebook (and its insidious algorithm) as an example.
On July 21, I was served three consecutive ads on my feed from three smaller ‘mental health’ companies of dubious origins. Two didn’t have official websites, and one used a free Wix account. There was no info on who was running these companies or who their healthcare professionals are, or everyone’s credentials and associations. Their service pages had vague language with the usual mental health buzzwords, and they weren’t on any of the legit-resource links I put up earlier in this newsletter.
In the style of a popular meme format in the Philippines:
🚩 🤸♀️ RED 🤸♀️ FLAG 🤸♀️ YAN 🤸♀️ BESHIE 🤸♀️ KO 🤸♀️ ! 🚩
For my mental health
Here’s where I am right now. I’m dealing with several heavy life issues at once. I’ve had growing and persistent feelings of overwhelm and frustration over several decades. And I’m from the “Therapy? LOL WTF NO” generation, so you bet I’ve always muscled through tough times and known/done nothing else.
I’ve finally had enough of all that. So I asked for help.
I chose to do online psychotherapy sessions with the Ateneo Bulatao Center, mainly for its established track record and good feedback from its previous and current clients. (This also tells you why I know about its policies on informed consent and use of client records: I had to read and sign their forms.) And because I’m already taking prescribed medication for a prior condition, I didn’t want to load up on strong pharmaceuticals and experience a host of side effects. So, talk therapy it is.
It’s still early days. But I feel good about it so far, and I like my psychologist/counselor. And I also like having the freedom to talk and feel and explore as much as I want. I’m also in control of the pace and depth of our discussions. Those things are new for me, and surely for other counseling clients battling the same demons I am.
The downside is I’m impatient and always have been. I fight the urge to ask for immediate and actionable feedback or simple solutions, or wonder why I’m not seeing results yet. Therapy is a long game, and small goals and actions (even the not-so-obvious ones) add up. I just need to be reminded of this regularly. 😆
Then again, sometimes you’ll just know if a mental health professional or service is right for you or not. Don’t be afraid to ask for what you need, try other options, or switch professionals altogether. It doesn’t always work out on the first try, and you can always make other positive choices for your well-being.
Whatever happens, don’t forget this: if I, a stubborn middle-aged mule, can ask for help, you can too. Take care of yourself, and start talking. 💗
Some questions to ask yourself
My advice is to decide on these matters before seeking therapy:
- How urgently do you need help? Has your situation escalated to ‘life or death’? Or can you still wait for help to come to you?
- Do you want a psychologist or psychiatrist? And how would you like them to talk to you — gently and carefully, kindly but also matter-of-factly, or directly/bluntly? Communication is about the intent, content, and method/manner.
- Do you want to do talk therapy/counseling? Or do you think you need clinical intervention (a.k.a. treatment by medication)?
- Do you want physical or in-person sessions, or online sessions via video calls or SMS chats?
- Do you live alone, or in a full house? Online sessions are great for those living outside Metro Manila or consulting with professionals outside Metro Manila, as well as those who live alone.
- But in-person sessions could be better for those surrounded by people all the time, or don’t have much privacy at home. Moreso for those whose problems are rooted mainly within the home.
- What’s your budget? Free is always great and I’ll always prefer that 🤣 But if you’re paying, how much can you afford per week/month?
- Do you have a Person with Disability (PWD) ID? This can help with your recurring expenses and medications. And depending on your mental health care professional and diagnosis, you could apply for a PWD ID as you continue therapy/counseling.
- What are your short-term and long-term goals? How would you like to feel and be now and in the future?
- This helps you and your mental health care professional set paths to explore in future sessions.
- What are your ‘go’ topics and ‘no-go’ topics? Some things are easy to talk about and process. Some, not so much, and maybe not right now.
Please call the following FREE 24/7 hotlines if you are in crisis!