The Reality of Psychiatric Nursing Placements in The Philippines: What They Don't Teach You
Her name was Lisa. She was in her late 30’s, but she acted like she was no more than 8 years old. From her social history, which wasn’t really much to go on, it said that she was found wandering the streets looking dishevelled. She was my patient in my 3rd year of nursing school. My placement was at a psychiatric (forgive the wording, “mental health” was not yet coined back then.) facility. I say facility rather than hospital, because that was exactly what conditions the patients were in. There were bars on the windows, and metal gates that locked from the outside to keep patients from wandering into the common areas. Don’t get me wrong, this wasn’t meant to be inhumane in any way, it just so happened that they were having their mental health issues while living in a relatively conservative third world country, whose culture does not believe that mental health is a legitimate thing.
Mental health statistics in the Philippines and Southeast Asia paint a troubling picture that directly connects to Lisa's story. In the Philippines, an estimated 6 million people suffer from depression and anxiety, yet the treatment gap exceeds 85% according to the World Health Organisation. The region as a whole faces similar challenges, with only 2% of health budgets allocated to mental health services in most Southeast Asian countries. This severe underfunding manifests in facilities like the one where Lisa is staying—institutional rather than therapeutic, with limited resources and outdated approaches. The cultural stigma mentioned isn't just anecdotal; studies show that over 70% of Filipinos believe mental illness is a character flaw or spiritual weakness rather than a medical condition. This widespread misconception leads to delayed treatment, with patients typically waiting 10+ years before seeking help, often only after their condition has severely deteriorated. Lisa's childlike regression at nearly 40 years old represents the human cost of this systemic failure—patients who might have recovered with early intervention instead becoming institutionalised for decades in facilities ill-equipped to provide proper care.
I do not know where to shift the blame, as even I myself am part of this culture and severely questioned the legitimacy of non-physical health problems while I was growing up. It was just so taboo to accept that the reason why someone’s life is not in order is because they were overwhelmed by their feelings and emotions. This goes against the applauded trait of resilience and sacrifice in the Filipino culture.
To my very young and ignorant brain, these patients have always been labelled as “crazy” and as people who have “lost their minds.” So, I sat with Lisa and asked her if she remembers anything about her life before being admitted. She doesn’t look at me when she answers “No, not really.” in a very hushed tone, as if she was making sure that no one else around would be able to hear her talk.
Then, as if from a scene in a movie, one of the other patients started to get agitated. She wrapped her head in a shirt and started yelling that she was a member of the militia and that she was going to kill everyone. I’m not too sure, but I think she was diagnosed with Schizophrenia and Multiple Personality Disorder. I bit my lips to keep myself from laughing out loud at was was going on, because my clinical instructors were there and laughing at your mental health patients is generally frowned upon. I refused to meet any of my classmates in the eye because for sure that would be the end of us and our nursing careers.
That placement lasted for 2 weeks, but it felt like a lifetime. I don’t know if any of the conditions in that institution has improved since then, but for patients like Lisa and that lady from the militia, I truly hope it has.
