Nueva Ecija Mental Health Status

8/11/2019 Nueva Ecija Mental Health Status

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Mental Health Delivery Service in aProvince in Nueva Ecija

JOHN RYAN A. BUENAVENTURA, RN, MAN, MHSS

Executive ManagerPhilippine Mental Health Association Nueva Ecija-Cabanatuan City Chapter

[email protected] (+6344) 463-76-30 | (+63) 927-5880702

PresidentPsychiatric-Mental Health Nurses Association of the Philippines, Inc.

[email protected] | [email protected]

mailto:[email protected]








Background: Area of Study

Nueva EcijaRegion: IIIPopulation: 1,955,373 (2010, Census)(45% Children)Poverty Incidence: 23 % (Region 12.2)Cities: 5Municipalities: 27Barangays: 849Industry: Agriculture



Background: Philippine Health System

• Specialty Hospital and Regional Hospital

Tertiary Level

• General Hospital

Secondary Level

• Municipal/Rural Health Units/Barangay Health Centers

Primary Level

N a t i o n a

l G o v e r n m e n t

L o c a

l G o v e r n m

e n t



Objectives

• describe profiles of mental health services inthe formal and informal sectors; and

• identify issues on the local mental healthservices



Study 1 – Formal

Mental HealthSystem

Study 2 – Informal

Mental HealthSystemDesign Descriptive Quantitative Descriptive Qualitative

Sampling Total enumeration Snowball (N=20)

Method Survey, Interview andLiterature Review

In depth interview

Instruments Interview schedule Interview guide

PeriodJanuary – March 2011 April – May 2012

Limitations Covers only areas ofCabanatuan City

Covers only Nueva EcijaNon-generalizable

Funding My Parents Ford Foundation



Formal Mental Health Care

*RegionalMental Health

Hospital

Psychiatric Servicesin General Hospital

Community Mental Health(NGO)

Primary Care Services

Specialist (Psychiatrist, PsychiatricNurses, Psychologist, SocialWorker

Psychiatrists

(3 private/1 government) Outpatient Service

Out patientAcute CareLong Stay Service

ServicesTeam

Referral

Referral

Psychologist

Generalist(GP, Nurses,Midwifes, BarangayHealth Workers))

*outside the province



Informal Mental Health Care

Structural

Family Caregivers’Characteristics

Family Units’Characteristics

Perceived Access toFormal Mental HealthSystem

Procedural

Management

Coping Support Seeking

Outcome

Physical

Psychological

Social Qualities of

FamilyCaregiving



StructuralMH Consumer

FamilyCaregiver

Family Unit

Formal MentalHealth System

Age (18-60); Gender (11male & 9female);Marital Status (Not Married); Onset (15-26);Years of Disability(3 to 29)

Age (35-65); Gender (female); Marital Status(Married); Relationship (Mother); Education(High School Grad); Function (Work; householdand caregiving)

Members (4-7); Income (3-5 USD/day); LivingArrangement ( with Parents); Kin network(nuclear and extended); Source of Income(Skilled work and farm related)

AvailabilityKind of Professional ( Multiple – 18; Psychiatrist

17; Folk healer 9; Nurse 1)Nature of Organization (Private 17; Government16; traditional 9; non-government 2)Level of Service (Private Clinic; Mental Hospital;Traditional System)

Affordability (out of pocket for bothgovernment mental hospital and private clinics)

Physical Accessibility (more than one hour travel)



“Hindi kasi pareparehas ang oras ng pag-aalaga. Ngayon, hindi na siyayoong alagain. Titingnan tingnan mo nalang. Hindi tulad dati naibibigay mo ang lahat. Yoong imomonitor mo. Halili-halili kami. Hindikami natutulog. Nakaduty kami na parang Nars ”

(Duration of caregiving for her varies. Now, we are justobserving her. Unlike before that you will monitor her. Weexperienced having lack of sleep and we even have

shifting schedules like nurses.)

“ Sa Mariveles, bumiyahe kami ng alas singko ng medaling araw atdumating kami doon ng halos alas-diyes. Mga lima hanggang anim naoras pag walang trapik .”

(We left here at five in the morning and we arrived atMariveles for almost ten. It was five to six hours travel ifthere is no traffic.)



Procedural

CopingStrategies

Support Seeking

FamilyManagement

Physical (39) Substance andFood Restrictions; Assistance toADLs; Provision of Medication andTreatment; Safety Provision &Physical Punishment

Psychological (27)Facilitating, Communicating,Threatening, Educating, RolePlaying, Concealing, Diverting

Social (19) AvoidingRelationships, RestrainingFreedom, Encouraging to work

Spiritual (10) Prayers fordeath(end suffering), strength (forthe caregiver), healing (for thecare recipient)

Psychological (23)Enduring, Avoiding, Withdrawing,Permissive, Tolerating, Denying,Accepting

Socio-economic (16)Borrowing Money, Asking forfamily support, Buying cheapermedicines, Raising Live stocks,Saving for medication

Physical (9)Prioritizing medication,Confronting verbally, Confining,Hurting, Isolating

Spiritual (7)Praying

Organization Support

TreatmentDiscontinued, Involuntary

MedicationPills (Caregiver Provided),Injection (PsychiatristAdministered), irregular/nomedication intake (n=12)

Tactical SupportFinancial (14); Treatment(7) ;

Physical (6); Custodial (3);

Food Assistance (1);Transportation (1)

Recruiting SupportFamily

(Financial-14; Food-5; andPhysical Assistance-5)

Community(Financial -6; Treatment – 6;

Transportation – 6)



“ Hindi ko na sinasabi iyong nararanasan ko. Kesa sa iba siya makasakit,pinipigil ko ang kamay niya ay niyayakap. Ako ang sinasabunutan, sinusuntokat tinatadyakan ”

(I am not telling to anybody what I am experiencing.Instead of she hurting others, I am just hugging her.In return, I am being beaten by her)

“ Kapag hindi siya nagpatulog, sinasampal ko siya. Tumitigil naman. Sa akin langnaman siya natatakot ”

(If she disturbs other, I slap her on her face. Shestops because she fears me.)



“Eh ayaw man namin siyang ikulong, wala kasi kaming magagawa eh. Noong kasingmga nakaraang panahon, hinahabol siya ng mga kabataan at niloloko. May pagkakatan pa na pinaso siya sa tagiliran .”

(Even though we do not like him confined, we cannot doanything because there are times that he was bullied bychildren and harmed by others.)

“ Kapag pasaway at maingay, ako ang humaharap diyan. Sinasabi ko na haharumbanginko iyang nguso niya para matakot ”

(If he gets uncontrollable, I am the one who deals with her. Itold her that I will punch her mouth to fear me.)

“ Ngayon ay nakatali siya pero may plano kami na ikulong siya. Iyon ang payo ng mgamanggagamot. BAwal daw ang pag tali at hindi daw bawal pag nakakulong .”

(The folk healer adviced us that instead of tying him, it isbetter if we put him in a cage because it is more acceptable.)



Outcomes

Social(40)

Psychological(28)

Physical(23)

Contribute to financialdifficulties (15),Affects social

relationships (12),loss of productivity(10),Social benefits (3)

Feel emotions offear(11), Pity(5),Anger(4), Guilt(1),Sadness(1)

Think of killing thepatient(2), worryingabout the continuity ofcare(2), think ofreceiving more benefitPerceive of gettinginsane (2)

Reduced Sleep and Frequentheadache (9), Reduced physicalmobility and experienced bodyweakness (4), Reduced Weight (2),increased blood pressure (1),abnormal tissue growth (1)



Physical Outcomes

(neurologic, musculo-skeletal, body injuries,nutrition, cardiovascular, and abnormal tissuegrowth)

“Kung hindi pa siya natutulog, hindi ako natutulog.Kahit masakit na iyong ulo ko sa antok, hindi akonauunang matulog sa kanya .”



Psychological Outcomes

“ Hindi mo naman masasabi lalo na kung babaena mauto siya ng lalaki at pasok siya sa bahayat mapagsamantahan. Iyon ang hindi kokayang tanggapin .”

(You cannot tell that she cannot get harmed andabused by others. If that happens, I cannotaccept that.)



Social Outcomes

“ Pag may anak kang ganyan, kasiraan yan. Kahihiyan ng pamumuhay .”

(If you have a child with schizophrenia, it causes no good.It puts us into shame.)

“Para bang iniiwasan ka ng ibang tao. Napapnsin ko naiba na sila at hindi na nagpupunta sa bahay .”

(People are moving away from me. I noticed that they arenot anymore visiting us at our home.)



Local Mental Health Situation*Regional

MentalHealthHospital

PsychiatricServices in

GeneralHospital

Community MentalHealth

Primary Care Services

Family Caregiving

Self-Care

Sole provider of acute psychiatric centerLimited services (acute and long stay psychiatric care)

Mainly Private Providerin Private Hospital

Unavailability of Services

High out of pocket expenseReceived limited support from Local Health(Education, Treatment and Social Support)

Burdened Physically, Psychologically andSocio-economically

High Treatment Discontinuation

Unutilized PrimaryHealth Care System



PROJECT DESIGN: “MAG B -P(BAGONG PAG-ASA) TAYO”

Community Mental Health: AssertiveCommunity Treatment

This project aims to bridge the gap of mental health system and makeuse of existing resources in the communities to optimize mental healthservice. Specifically, it aims to:

• Increase treatment adherence through lowering cost of care• Provide comprehensive mental health care with family and

community support• Utilize existing resources such as social services, livelihood

programs and health providers in the community for mental healthcause



Project Framework



Advantages of the project

• Lower cost of care for up to 50 %

Cost of Care Private CMH

Direct Cost 700.00 500.00

Indirect 300.00 50.00

Total 1000.00 550.00

Opportunity

Cost

High Low




• More Care BenefitsKind of Care Private CMH

Consultation Yes Yes

One on OneEducation

Yes (Short) Yes (Moderate)

Family Education None Yes

Group Dynamics None Yes

CommunityParticipation

None Yes

Resource Utilization None Yes




• Utilization of Community ResourcesAgencies like

Education (ALS program),Health (primary health care),Social services (livelihood program) and

Civic participation (organized community group)




• Work for the nurses in the communityProvider Number of

Barangays(week/month)

Number of Clientfor 4 days (5

clients per day)

Cost perclient

(share ofnurse)

TotalRevenue

Nurse A 2/8 20 100 2000(400/day)

Nurse B 3/12 20 100 2000

(400/day)Nurse C 4/16 20 100 2000

(400/day)Nurse D 5/25 20 100 2000

(400/day)







Acknowledgment



SALAMAT PO

Documents

Nueva Ecija Mental Health Status