Former DOH-Calabarzon Director Eduardo Janairo
By Glen S. Ramos/Benjamin F. Cuaresma
MANILA — The Department of Health (DOH)-Calabarzon (Cavite, Laguna, Batangas, Rizal, Quezon) has successfully conducted treatment and management of 84 schizophrenic patients in pilot areas in the provinces of Rizal and Laguna during the one-year implementation of its Community-Based Mental Health Program (CMHP) Initiative.
According to Regional Mental Health Coordinator, Paulina A. Calo, the CMHP was initiated by former Regional Director Eduardo C. Janairo with the objective of integrating mental health into the primary health care system to facilitate person-centered treatment and provide complete services of mental health patients in the community.
Calo said that the CMHP aims to integrate mental health into primary care to facilitate person-centered and holistic services, consistent with the mandate of Republic Act 11036 (Mental Health Act of 2017), including the primary values and principles of primary health care.
“The core of CMHP is a referral system between health centers and tertiary-level mental health services for the diagnosis and continuing management of persons with mental health conditions, as well as the use of innovative medication, specifically for people with schizophrenia,” she explained.
Schizophrenia is the leading mental disorder among Filipinos and it is estimated that about 1% of the population are affected. It is a disabling, chronic type of mental health condition.
Persons with this health condition are diagnosed clinically and the management depends on the severity of the condition and may use a combination of antipsychotic agents and non-pharmacologic interventions.
Calo disclosed that schizophrenia (25%) and psychosis (22%) are among the most frequently reported mental health conditions in CALABARZON in 2019.
The regional office provided medicines such as second-generation antipsychotic long-acting injectable therapies (SGA LAI) and paliperidone palmitate once-monthly injection (PP1M), which was distributed and used as the primary treatment to schizophrenia patients in the four pilot implementation sites in Jala-Jala in the province of Rizal and Mabitac, Sta. Maria, Siniloan and Pagsanjan in the province of Laguna.
“Product training for the consumption of the medicines we conducted to the recipients’ Municipal Health Officers (MHOs) and community workers were conducted and psychiatrist-consultants were brought in to provide support for the pilot sites,” she added.
Reports of patients’ improvement in most symptom categories of schizophrenia were recorded by caregivers. “A caregiver in Laguna reported that during the duration of the treatment program, they no longer restrain their patient when at home and they also have better functionality after administration of PP1M,” Calo disclosed.
No relapsed or hospitalized patients were also reported during the one-year program implementation. There were also fewer or no adverse effects with the PP1M compared to their prior medications.
Former Regional Director Eduardo C. Janairo, who authored the CMHP Initiative, stated that the cost of treatment for schizophrenia patient at the community level during the one-year pilot implementation which includes medications, services provided by healthcare providers, transportation for patients in crisis from the community to the hospital, hospitalization of relapse patients, and lost income by caregiver during the period of hospitalization is less compared to the conventional treatment and can save at least 800 thousand pesos in resources.
“The implementation of mental health services at the primary care level can be achieved but requires strong leadership and support from various levels of care and cooperation from the local government units for resource mobilization, field implementation, and ensured sustainability because of the chronic and relapsing nature of mental health conditions which requires a longer provision of appropriate treatment modalities,” he added.
“With the integration of mental health into the primary care system, individuals can be assured of better access to mental health services and better health outcomes including recovery and social integration.”
“It is also very important that a professional psychiatrist be present at the regional or provincial level to undertake diagnosis and initiate treatment for new cases and provide periodic assistance to local health officers in the continuing management of patients,” he emphasized.
The innovative treatments during the conduct of the CHMP were proven to be successful and more economical and financially viable in the long run. “When implementing the program, the decision point should not just be the price per dose of a treatment intervention but also the potential savings from reduced health resource utilization, including other tangible and intangible benefits.”
“We have proven that this innovative approach is successful, it is time that we consider its implementation in our health care system to help improve psychiatric care at the community level for the benefit of individuals with mental health concerns,” Janairo urged.
The Community-Based Mental Health Program in Calabarzon: Preliminary report from an internal review of an innovative service integration initiative for schizophrenia” was published at the Philippine Journal for Health Research on June 30, 2021.
OIC-Regional Director Paula Paz M. Sydiongco stated that the CMHP program is still ongoing and will be expanded to support the management and treatment of schizophrenia patients in other areas of the region.
“Health care is a basic right and the government must do everything they can to provide it. Although schizophrenia is a low prevalence disorder, we still need to provide therapeutic modalities to those affected for them to recover and be reintegrated again to society,” Sydiongco emphasized.
HOW THE CMHP WORKS
The DOH-CALABARZON CMHP Initiative is designed for the identification and management of patients with schizophrenia in a primary care setting.
When a person suspected to have mental health conditions is identified at the community level, he/she will first be assessed by health centers prior to referral to an identified tertiary mental health facility, which will provide diagnosis and initiate treatment.
Monitoring of patient compliance will be the principal responsibility of health centers, with periodic follow-up scheduled in tertiary mental health facilities. (ai/mtvn)