By Jelena Villorente

Trigger warning: This article contains topics about suicide and mental health issues.

Angst is a feeling that seems to be ubiquitous in nature, a feeling that not many may be able to name when it first hits, but still know all the same. It’s a feeling that’s grasped by people in vastly different ways, laced with fluctuating amounts of insecurity, anxiety, and dread about anything and everything. It takes the unsettlingly right concoction to push one over the edge — and oftentimes it’s the tangible, high-up type of edge.

Suicide, defined by the American Psychological Association as the act of intentionally taking one’s own life, has been an inextricable topic of mental health discussion for the longest time and is a plague that continues to creep up on struggling individuals. Heeding the staggering worldwide rates and answering the call beckoned by this exigent concern, World Suicide Prevention Day was promptly instituted — dating all the way back to 2003 through the care of the International Association for Suicide Prevention.

In a world where suicide continues to evade stigma and neglect, World Suicide Prevention Day was established to combat this unfortunate reality by encouraging awareness of the state of mental health worldwide. The Philippines, of course, is not exempt to this — especially as mental health began to emerge as a topic of discourse across the country in recent years.

A study by Ocampo et al. came forth to acknowledge how mental health came forth in its well-deserved recognition through the COVID-19 pandemic, with objectives aiming to identify its effects on the well-being of healthcare professionals, educators, and learners. Briefly, the study found that the pandemic brought significant challenges to holistic health, bringing about high levels of stress, anxiety, and even depression among this demographic.

Ultimately, this outlines how mental health has slowly progressed over time, gaining traction as an indicator not only of overall health, but of a broader system being adopted and propagated by our country. Reading between the lines and into the intertwined weave of culture and well-being, we are able to get a glimpse into how struggle is ultimately perceived within our nation — and how this ties into the downplay of something bigger.

Cultural Connotations

The Philippines is a country that deeply values its tradition, made evident in the way Filipinos hold old virtues dear even in the present. This culture, however, while valuing the importance of being grounded in conservativeness and preserving our heritage of values, can often lead to ways of living that neglect certain aspects of the holistic human — and one of these is the emotional aspect. 

Likewise, this greatly correlates with the way Filipinos generally view mental health as a topic. Back then, elders met mental health with ignorance, amidst an era wherein people would be told to “toughen up,” whilst battling serious inner turmoil, the kind of feeling one cannot so easily shake off. This ricocheted into a generational cascade of adopting a facade of stability, incentivizing mentally struggling Filipinos to keep their problems to themselves at the expense of their visceral well-being. 

In lieu of resilience, the birthing of this elusive mindset can be toxic once it gets to a far-fetched point — often pushing people to draw their narratives to a close too soon.

Succinctly, suicide can be described as a point wherein one is unable to cope with their own life any longer, especially characterized by feelings of loneliness, anxiousness, and hopelessness in the face of seemingly insurmountable struggle — and looking at the Philippine culture, it is not surprising that a number of deaths in the Philippines are often caused by suicide. A report by the Philippine Statistics Authority affirms this fact, calling out flaws in the way these numbers are being measured in the country and noting that accurate values would reflect more augmented mortality rates if these anomalies were to be addressed.

A study by Carlson et al. also draws attention to the stigma encompassing discourse on suicide, proving the prevalence of dismissing suicide as a “taboo” topic or the feeling of being suicidal as a “personal weakness” or as “attention-seeking” behavior. The same study also revealed how religion also ties into the picture, with people painting suicide as a “sin” and as an indicator of having a lack of faith in God, whilst also underscoring the influence of familial responsibility in dealing with a struggling family member.

Alongside this, there is also the underlying issue of people who exploit the sensitivity generated by mental struggle in order to incite sympathy and attention. In this way, mental health is reduced to a mere excuse, especially to soften the fall of shouldering accountability for bad behavior, or to victimize the self in certain situations. This topic entirely can become another significant point of discussion and deliberation, but in short, this mindset only undermines the gravity of mental issues and contributes to this collective stigma.

Overall, what this ultimately comes to is how suicide is severely downplayed in the Philippines, alongside mental health as a whole. It has become the norm to dismiss a person’s rants and tell them “Kaya mo na ‘yan!” It has become routine to wave off someone’s feelings and call them “weak” for showing any sign of hardship, especially when their problems don’t seem too great on the outside. 

The effect of this long-established, perennial mindset can only become more and more apparent — and between the fissures of those exploiting the sensitivity begat by mental health and those choosing to disregard this reality altogether, there will always be the individuals truly experiencing the hardship on a more intense level.

People only see these hardships come to life when the people experiencing them choose to end it.

Mental Healthcare for the Masses

While the stigma has admittedly subdued over the years, especially as the new generation starts to embrace active sensitivity towards these issues, formal help still remains largely inaccessible to the public even when it is a significant aspect of holistic health. 

For one, psychological services in the country are quite costly and can thus only be afforded by a smaller demographic. While prices vary depending on professionals, psychotherapy costs can generally range from around P1,000 to P4,000 and above. More affordable options for psychiatric care are provided by the National Center for Mental Health (NCMH), where prices can get as low as P400, but only at the expense of quality facilities and well-kept conditions. A 2023 Inquirer article recognizes the poor physical settings of the NCMH, characterized by foul-smelling environments, overly cramped wards, and the lack of proper ventilation, sufficiently illustrating the state of public mental health institutions in the country.

With these circumstances, one could only imagine the situation for those living away from the metro — where access to fundamental services is generally scarce and challenging to get by. Even the World Health Organization (WHO) affirms that there is only one psychiatrist and one psychiatric nurse to extend professional mental healthcare services for every 200,000 people in the country; per one million people, there is merely one psychologist.

Shifting perspectives, it was recently noted by Education Secretary Sonny Angara that there exists a severe shortage of guidance counselors catering to schools in the Philippines, and that there are a mere 4,069 licensed counselors in the country as of 2022. It fails to meet the necessitated threshold of 50,000 counselors in order to abide by the global ratio of one counselor per 250 students, and is most unlikely to reach this benchmark over the next five years given the limited outcome of guidance counseling graduates. This thereby poses a critical situation in the aspect of immediate healthcare provision within institutions, implying detrimental effects to students and faculty alike in the realm of mental health.

With all of these being said, only one bottom line can be drawn — mental healthcare continues to be severely overlooked on a larger scale within the country. Based on a mental health investment case jointly launched by the Department of Health and the United Nations in 2021, mental health conditions amount to a P68.9 billion expenditure on behalf of the Philippine economy every year, which translates to 0.4% of the GDP, and with this, it becomes increasingly alarming that efforts towards the cultivation of mental healthcare remain insufficient, both in quality and in quantity. 

The existence of Republic Act No. 11036, also known as the Mental Health Act ratified in 2018, should already be grounds for efficiency in streamlining sustainable psychological health services — yet, with these issues in place, how could the Philippines’ healthcare in the mental aspect advance towards a more inclusive, adaptable, and effective system? Must Filipinos continue to forge through not merely the stigma, but the ineptness of the country’s current healthcare framework?

The questions only get darker when we bring in suicide to the picture. How are we to aid these suffering Filipinos with the absence of a decent system?

Beyond the Body

At the end of the day, all this goes to show how remarkably integral mental health is when it comes to caring for the whole person. It’s not enough when one is physically fit — staying mentally healthy is important, too. 

In a country that values its conservative ideal in line with culture, it must also cross to mind that dynamicity in changing times is inevitable as well, and that by acknowledging it, our nation grows alongside the people that shape it. The modern era now continues to segue towards the sensitization of society, particularly into being actively cognizant of the role we play in embracing mental health as a facet of our wellness, and in this light, it is crucial that feelings don’t end up being dismissed, but heard, accepted, and responded to with unparalleled genuineness.

Weaving this into the Atenean context, nurturing mental wellness intertwines with the Ignatian maxim of Cura Personalis, as we are continually taught to value ourselves as holistic beings. At the end of the day, God created us as human beings — and in the spirit of recognizing the limitations each of us hold beyond the physical body, it stands to reason that we acknowledge the significance of our mental and emotional dimensions as individuals, learning to grow and be more sensitive with ourselves and others.

In the end, suicide can no doubt be considered the worst-case scenario within the facet of psychological well-being, for it signifies not only a person’s incapacity to cope, but also the state of the environment around them, enabling this individual to tolerate their suffering and letting their angst germinate until it all boils down to threatening their own life. 

Within the context of the Philippines, much is to be done to aptly respond to this crisis on the systemic level, but remembering that suicide can be prevented, not only on the 10th of September but with every single day, is an earnest call. Answering it means acknowledging the angst, the anxiety, the withdrawal, and the silence — and that it already is a profound step to recognize that we all must listen when the mind speaks.