Addressing the gaps in the Philippine public mental health strategy

We agree with Campion and colleagues¹ that implementing primary interventions that target the social determinants of health can effectively address mental health. These population-based strategies are sorely needed in low-income and middle-income countries such as the Philippines, where poverty, unemployment, hunger, displacement, and conflict are rife.²

With the growing global movement for public mental health, the Philippines passed the Mental Health Act in 2018, with a strategic plan for 2019–23.³ Despite the Mental Health Act's acknowledgment of social risk factors for mental health, these are absent in the strategic plan, which focuses instead on four pillars: mental health promotion, governance, service delivery, and information and research.³ Consequently, the current Mental Health Act disproportionately focuses on building resilience and individual coping, with an overemphasis on clinical mental health.

The staggering productivity cost and economic effect of mental illness calls for a committed, sustainable funding stream for mental health. The Philippines lost 68·9 billion pesos in 2019 from expenditure and decreased productivity due to mental illness,⁴ but the 2021 Department of Health budget only allocated 286 million pesos, or 3% of the Department of Health budget, to mental health.³ Curative and administrative expenses are prioritised over preventive interventions, with a 58% allocation towards medicines alone.³

Campion and colleagues posit that one action to address public mental health implementation gaps is to communicate the economic benefits of public mental health investment to the country's leadership.¹ At present, however, evidence on which interventions yield the best returns are meager,⁴ and the paucity of research from the Philippines translates to an absence of evidence-based, culturally sensitive policies.

The COVID-19 pandemic is a wake-up call for public mental health stakeholders. Imposed quarantines reduce access to social support,² and the unmet need for mental health services grows because of a fragmented referral network. Poor mental health conditions are exacerbated by a loss of job security, selective social amelioration programmes, and the overwhelmed health-care system.²

There is a misconception that mental health only equates to mental health care. Public mental health policy cannot work independent of state social services, insofar as it is one, and all other social services likewise factor into overall mental health. We recommend that the public mental health strategy be restructured to a true rights-based approach, which views social interventions as the cornerstone of policy, and acknowledges mental health care as only one complementary piece in the broader context of public mental health.

We declare no competing interests.