Philippines: Delivering mental health services closer to the communities

LEON, ILOILO – A few people are on queue waiting for Dr Winnerfreda "Winner" Valenzuela, the municipal health officer of Leon. These patients are just a handful of the over 30 patients Dr Winner regularly sees as part of their community-based mental health programme in the municipality.

"We were already managing and treating mentally-ill patients but then we lacked logistics, especially the medicines," explains Dr Winner. "I had this idea that if I am going to make a programme, I can access the local funds. So with the help of my staff, we coined the term Operation Green."

The programme is called Operation Green because of a local folk belief that green air is present in someone afflicted with mental illness. It is also a reference to grinotok from the local Karay-a language denoting a crowded mind.

Operation Green was launched in October 2016 but the municipal health office was already seeing mental health patients in 2015, right after Dr Winner participated in a Mental Health Gap Action Programme (mhGAP) training. As a general practitioner, the municipal health officer was at first hesitant to deal with mental health patients in their community but became more confident thanks to the training.

Municipal health officer Dr Winner Valenzuela talks to a mental health patient in the rural health centre in Leon, Iloilo.
WHO/F. Tanggol

"It helped because before that I was not equipped on how to manage mental health patients," says Dr Winner. "After the training in mental health, I was given the knowledge and the courage how to deal with it."

The mhGAP training is a collaboration between the World Health Organization, the Department of Health, and local government units to strengthen the mental health services in local communities in the Philippines. Over a few years, non-specialized health workers in all 18 regions in the country have participated in the training, empowering them to make decisions and manage mental health patients close to where it is most needed. Leon is one of the first municipalities to have a comprehensive community-based mental health programme in the country.

Meeting Lourdes

The first patient that the municipal health officer managed was Lourdes Cabafranca, a 52-year-old Leon resident. When Dr Winner was assigned as a rural health officer in 1992, Lourdes was already wandering around downtown Leon as a vagrant and sometimes sleeping at the rural health centre.

"Sometimes she roamed in random places," shares Karen Cabafranca, Lourdes’ cousin and the barangay (village) captain of Jamog Gines. "Every now and then, she slept downtown, sometimes for a week or so. You could find her roaming around. Then sometimes she went home. Even if we brought her back, she kept on leaving."

Karen also explains that Lourdes’ behaviour at that time was erratic with regular outbursts and cursing.

Lourdes and Karen during a visit to Lourdes’ home in Barangay Jamog Gines.
WHO/F. Tanggol

"After the training on September, when I went back to the main health center, I looked for Lourdes and started the medicines because I am already equipped. I already have the knowledge," Dr Winner says.

"Every day, I drink my medicines. The doctor gives me medicines every day. I make sure to take it continuously and get refills every month," says Lourdes.

Lourdes brings a black shoulder bag with her everywhere she goes where she puts her daily medications. As part of Lourdes’ support system, Karen helps in reminding her cousin to take her medicines every day. She also accompanies Lourdes when she gets refills every month from Dr Winner.

Lourdes brings out from her bag the medications prescribed to her by Dr Winner.
WHO/F. Tanggol

Just a few months of being on psychiatric medication, the people around Lourdes already noticed a change in her. When before she was unkempt, she would now take a bath every day. She would currently also help in the household chores, sweeping the floors, doing the laundry, and washing the dishes. More importantly, Lourdes is now at home and no longer wandering around Leon.

"I am okay now," shares Lourdes. "Thank you for the medicines provided to me."

"It's the overall work of the community," Dr Winner says of the success of the community-based mental health programme. "It’s the support of the local government, the help of the community, and the family. There’s also our compassion as health workers and being knowledgeable because we have trainings. Health workers are instrumental in bringing back to life those who are long considered ‘dead’ and neglected by the society, the mentally-ill. These are the factors why we have a success mental health programme."

Lourdes Cabafranca is the first mental health patient managed by the municipal health officer in Leon, Iloilo.
WHO/F. Tanggol