Manila (CNN Philippines Life) — Lena*, who studied in a prestigious university in Metro Manila, was an excellent student. Curious and driven, she performed well both in academics and extracurricular activities, and was successful in balancing the excitement of college life with its requisite pressures. College was where she experienced all-nighters for a research paper, participated in an ‘initiation’ for admittance to a college org, won medals and awards for her work, and built a set of friends knit by common interests and future plans.
Lena was well-liked, optimistic, and confident but she sometimes went off the grid. During long breaks when she went back home to her province, she cut off all contact with friends, and would not be heard of until classes resumed.
These intermittent and unexplained silences persisted during four years of graduate school, and eventually found an explanation when, as a young professional, Lena simply stopped going to work.
For around two weeks, she stayed in bed, spent most days sleeping, barely ate, barely communicated with anyone, including her roommate, who began asking around for help.
Lena was eventually diagnosed with major depressive disorder and was directed to take medication. Her well-being improved, but aside from family and some close friends, no one else knew what she had gone through.
When depression starts
The symptoms of depression, anxiety, and other mental health disorders are largely invisible. The medical consensus is that their root causes develop as early as 12 years old and below (the developmental stage in individuals), with majority of clinical symptoms present before the age of 14.
“When you go to college or [you’re] 18 and above, you’re actually firefighting [mental health problems] already,” says Gary Aguedo Faustino, director of guidance and counseling at Ateneo’s Loyola Schools. “The battle is in basic [education]. If you remember your psychology, the formative years are 12 years old and under. Much of the serious concerns really evolve in parenting.”
“Since the firefighting is here, when it’s in [grade school], you hardly see it, or you probably notice a few but still it's contained in the home. Or it’s just a virus starting to multiply, and it rears its ugly head here [in college],” Faustino adds.
Thus, while the formative years play a crucial role in shaping an individual’s mental health, issues may only surface through a confluence of stressors appearing at a particular time: life-changing decisions, the influx of hormones, peer and familial pressure, the strain of first relationships, academic and societal expectations, and the onslaught of information through technology, among others. All of these frequently appear when one enters university.
Entering college poses an increased risk for developing mental health problems, says Ronald Del Castillo, a clinical psychologist and an associate professor of health policy and administration, psychology, and behavioral sciences at the University of the Philippines’ College of Public Health. “You're going to have your first depressive episode, your first anxiety attack, around this age. And where are you? You're in the university.”
“For many of you, it's your first time away from home, being on your own, there's a lot of firsts: first relationship, first breakup — a lot of things compound your risks of developing problems,” Del Castillo adds.
Unlike Faustino, however, Del Castillo does not necessarily think that what counselors and psychologists do in the university level is ‘firefighting.’ “If anyone has sufficient support, psychosocial support, whether therapy or medication, I think we're well positioned to contain the ‘fire,’ if you will,” he says.
Related to Filipino students’ mental health is how Filipinos have their own indigenous concepts of well-being, and how local culture has taken a backseat to Western perspectives when it comes to psychology.
What we don’t know
Government data show that one out of five Filipino adults have a mental health disorder, but it is unclear how the numbers apply to high school and college students. There is a near absence of literature relating to incidents of depression and other mental health disorders in the Philippine context, more so with high school and college students.
For his part, Del Castillo is about to embark on the Diwa Mental Health Project: a UP-system-wide research on the mental health of students. Del Castillo, who was born in Iloilo but educated in the United States, went back to the Philippines through UP’s Balik-Ph.D. program, which provided research grants for returning alumni with Ph.D.’s and postdoctorate degrees, and who agree to teach and conduct research in the university. The Diwa Project is funded by the research grant.
When he started to teach three years ago, Del Castillo observed common mental health concerns — “I wouldn’t call them disorders,” he says — among students in UP Manila. “I'm the SRO [student relations officer], but they also know I'm a clinical psychologist. So they come to me for their concerns — academic, personal, or otherwise. And that’s where I wanted to steer my research course, knowing that kind of data was not really available.”
The Diwa survey is a prevalence survey, and aims to measure instances of depression, anxiety, somatization (physical complaints with psychiatric causes), alcohol use, suicide, and self-harm, among others.
“I'm also interested in health care access,” adds Del Castillo, “so it's not enough to know how many people have symptoms of depression or anxiety. I want to know if the university knows about it; have you ever seen a psychologist, does your insurance cover it, those kinds of things.”
Diwa’s research design is also meant to provide specific insight on each campus, which may hopefully be replicated in other universities. “I want to encourage each of the campuses and the system in general: How can we better promote and support the mental health of students using this data?” he asks. “How can we better create programming and policies? How can we better support our teachers?”
What universities do
Notwithstanding the deficiency of specific data with which to inform policy, university guidance counselors are at the helm of multiple awareness programs to promote mental health and prevent disorders in universities. The usual approach combines traditional as well as clinical measures.
In Far Eastern University, director for guidance and counseling Sheila Marie Hocson says students are oriented in their first year on how to recognize symptoms of mental health issues, alongside discussions on sexual harassment, bullying, and HIV awareness, among others.
Hocson, who simultaneously chairs the Philippine Guidance and Counseling Association, also helped pioneer the Peer Organization of the Philippines, comprised of senior high school and college facilitators trained in basic counseling skills and knowledge of referral systems. They will stand as “junior affiliates of guidance counselors,” she says.
Also crucial is an accessible referral system cascaded throughout the whole university, says Hocson. Peers, facilitators, teachers, and administrators may refer a student to the office upon exhibition of the following signs: absenteeism, lack of energy, abusive behavior, sleepiness in class, lack of personal hygiene, low self-esteem, or poor academic performance.
“Usually we have a mechanism that they can go here [to the office] for referral. They can also go online, there’s a form,” she says.
The student referred to the office undergoes a routine interview, assessments, observation, and standardized and clinical testing.
“‘Pag na-recognize namin na may red signal siya, suicide for example with tendencies for depression, borderline, pinapatawag na namin usually ‘yung mga significant people in their lives,” says Hocson. “This is in collaboration with our health service, so kami ‘yung nag-re-refer sa psychiatrist.” Procedural protocols follow.
This approach recognizes a shift on the role of university guidance and counseling offices.
“We’re no longer probably basic education counselors of the young, monitoring the way you study, organize yourself, how you’re coping with your education,” says Faustino. In Ateneo, the shift included adding more psychologists to match the counselors in its roster. “We’re not discarding the traditional guidance counseling,” says Faustino, “but we’re putting in some resources to address the trend.”
Formation programs are integrated at each university level, and includes psychology and mental awareness programs in the first year, and programs on grit, resilience, stress management, and time management in the succeeding years.
The programs on grit and resiliency respond to observations about how students are perceived to deal with problems today.
“You get the feeling that there’s a lack of foundation among students. Foundation in terms of resiliency, self-efficacy, grit, as we call it. You don’t bounce back after a failure,” says Faustino. “That’s how we see students now. They panic. They get very anxious and eventually they become depressed.”
Aside from a lack of strength of personalities, “[there’s] also lack of resiliency,” Hocson agrees. “Ang mga bata talaga ngayon, you have to teach them life skills.”
As in FEU, when intervention is needed, a referral system is also in place in Ateneo. The office is also planning to form its own student arm to facilitate peer discussions.
“The whole idea is to teach people how to listen properly and be able to respond in a non-judgmental, unconditional way,” says Faustino. A university wellness policy is also in the works.
The assignment of student relations officers such as Del Castillo is also one way to bring student concerns within the knowledge of the university, whether such concerns are academic or not.
“The initial complaints [of students] are stress and academic concerns,” says Del Castillo. “From my experience, that is what they present with, but there are other things that’s on their mind. Trouble at home, history of trauma … there might be symptoms of anxiety and depression. They are very common for people in their age.”
While the formative years play a crucial role in shaping an individual’s mental health, issues may only surface through a confluence of stressors appearing at a particular time. All of these frequently appear when one enters university.
The situation outside Metro Manila
The measures mentioned are similarly deployed in many major universities outside Metro Manila. In Dumaguete’s Silliman University, for example, the guidance counseling office provides, among others, peer outreach programs as well as consultation and referral services, where “parents, faculty, staff and other professionals may confer with counselors on issues affecting mental health of students and other individuals.”
In Cebu’s University of San Carlos, counseling and development centers provide mental health counseling on issues such as “depression, loneliness, anxiety, substance-dependence, suicide, change adaptation, and relationships,” while licensed psychometricians and counselors “utilize standardized tests and non-psychometric instruments to assist students in their self-awareness and decision-making needs.” Peer facilitator programs are also available.
Xavier University in Cagayan De Oro recently celebrated World Mental Health Day on October 2017, a campaign to raise awareness and “actualize” efforts in sustaining mental health. Trained counselors also conduct individual and group sessions for students’ special concerns, and peer counselors are trained to develop more sensitivity to peers’ concerns.
While not all programs are present in all universities (some may be hindered by the lack of licensed guidance counselors to service huge student populations, the lack of budget to conduct tests, the lack of available psychologists, and cultural influences), some schools have taken to novel ways to prevent and address mental health issues.
Ateneo, for example, has been exploring animal-assisted activities and therapy with Communitails, an idea Faustino got from the use of dogs in U.S. prisons for therapy.
“[The] activity would be the dog would sit with a group of five students and they get to play with the dog for an hour,” says Faustino. Animal-assisted therapy, on the other hand, are usually one-on-one sessions, which would depend on the therapist’s creativity.
“I am hoping it will work against anxiety attacks,” adds Faustino. “There's an emergency, somebody goes into a panic attack, I bring the dog and my belief is that the student will pacify faster than with the counselor.”
Perhaps the most important thing when it comes to universities’ roles in promoting mental health is how their measures must be attuned to the needs of their intended beneficiaries: the students. And it’s not an easy task, considering the complicated cultural background of mental health in the Philippines.
“When students are in the depressive state, it’s not easy for [them] to identify that [they] have those kinds of symptoms and needs,” says Erickson Maclid, a student relations officer and instructor at UP’s Department of Family Life and Child Development.
Most of the time, says Maclid, students need spaces to open up — spaces that may be provided by teachers who are ready to accommodate differences brought about by mental health concerns and disorders.
Since students also prioritize their academic responsibilities foremost, they may sometimes forego programs that may promote their mental health, despite the university’s best efforts. Because of this tendency, Maclid says the department is considering programs fit for the students’ schedules.
Also essentially related to Filipino students’ mental health is how Filipinos have their own indigenous concepts of well-being, and how local culture has taken a backseat to Western perspectives when it comes to psychology.
“For example, there’s a common misconception of the phrase ‘bahala na,’” says Del Castillo, referring to pioneering psychologist Virgilio Enriquez’s Sikolohiyang Pilipino. “‘Bahala na,’ it tends to be in Fil-Am psychology, if someone is expressing concern about mental health being, it’s understood [in contemporary times] as a dismissive and negative phrase to say to someone. But if you look at early Sikolohiyang Pilipino, ‘bahala na’ actually means something else. It means a sense of empowering myself, ‘I can do this.’ Notice that this is a vast misunderstanding from how we understand it today.”
“You get the feeling that there’s a lack of foundation among students. Foundation in terms of resiliency, self-efficacy, grit, as we call it. You don’t bounce back after a failure. That’s how we see students now. They panic. They get very anxious and eventually they become depressed.”
“Even in Western culture, depression is very much culture-based,” says Del Castillo. “There are nine symptoms of depression, five of which you need to make criteria. Now think about this. Who decides nine and why five? A bunch of white people in a room who are mostly men.”
Any effective measure to combat mental health issues must therefore be more community-based, sensitive to local cultural expressions, and focused on building conducive environments, whether in the family, at school, or in the office.
“In those rare times you might fall into depression or anxiety, what is our system in place to ensure you are taken care of? The majority of students will not need clinical intervention,” says Del Castillo. “The majority of students need prevention-related efforts.”
But while there can be a plethora of prevention and intervention-related efforts, a simple thing such as providing a dedicated student lounge, for example — as Del Castillo wishes for UP Manila — can do wonders.
“Where do [the students] hang out? They just sit in the hallway. To me that’s a big deal, because we demand a lot from them academically, they need some rest, obviously,” he says. “I don’t think there’s any magic to it.”
*The name is changed to protect the respondent’s privacy