RA 11036 - Mental Health Law

RA 11036

- act establishing national mental health policy

- enhancing delivery of integrated mental health services

- promoting and protecting rights of persons utilizing psychosocial health services

- appropriating funds and other purposes

Chapter 1

General Provisions

Section 1

shall be known as "Mental Health Act"

Section 2 - Declaration of Policy

- affirms basic right of all Filo to MH & rights of people requiring MH services

- promoting wellbeing; valued, promoted, protected, treated, prevented

- timely, affordable, high quality, culturally appropriate case available

- MHS free from coercion and accountable to service users

- persons affected by MH condition able to exercise full range of human rights, participate in society, work free from discrimination

- comply w obligations under UN Dec of Human Rights, Convention on Rights of PWD, etc

Republic act 7277 "Magna Carta for Disabled Persons" is recognized

RA 7277

Magna Carta for Disabled Persons

Section 3 - Objectives

a. strengthen effective leadership, governance for MH by formulating national policies strategies regarding MH

b. comprehensive integrated National MH care system responsive to needs

c. protect rights and freedoms

d. strengthen info systems and research

e. Integrated MH care in basic health services

f. Integrate strategies promoting mental health in educ institutions, workplace, communities

Section 4 - Definitions

• Addiction - primary chronic relapsing diseasem

• Carer - close personal, concernrn for patient

• Confidentiality - keep all info safe

• Deinstitutionalization - transitioning service users, insti to community 

• Discrimination- distinction, exclusion, restriction

• Drug rehabilitation - treatment to dependency of psychoactive substance such as alcohol, drugs

• Impairment or temp loss of decision-making capacity

• Informed Consent -  consent voluntarily given by a service user to a plan for treatment

• Legal representative - person designated by the service user 

• MH -  state of well-being

• MH condition - disturbance in condition

• MH facility - establishment 

• MH professional - medical doctor, psychologist, nurse, social work

• MH service provider - providing mental health services; public or private 

• MH service - psychosocial psychiatric or neurologic activities and programs

• MH worker - trained person, volunteer, advocate

• Psychiatric or neurologic emergency - condition presenting a serious and immediate threat to the health and well being

• Psychosocial problems - existence of dysfunction

• Recovery-based approach - intervention centered on strengths of service user 

• Service user - person with lived experience/ mental health condition 

• Support - informal and formal arrangement or services 

• Supported decision making - act of assisteing service user 

Chapter II

Rights of Service Users and Other Stakeholders

Section 5 - Rights of Service Users (Ch2)

- enjoy all rights of Constitution and UN Declaration of HR and Convention on Rights of PWD and etc

a. Freedom from discrimination and stigmatization

b. Exercise all civil etc rights respecting indiv qualities, no discrimination

c. Access to evidence-based treatment of same standard and quality regardless of.

f. Access to affordable essential health and soc services to achieve highest attainable standard of MH

e. Access to MH service at all levels

f. Access to comprehensive treatment integrating prevention addressing MH care needs thru recovery plan

g. Access to psychosocial care treatment in least restrictive manner

h. Humane treatment

i. Access to aftercare and rehab

j. Access to adequate info on MH services

k. Participate in mental health advocacy, policy planning, etc

l. Confidentiality of info, except when

1. required by law or pursuant to order issued by court

2. service user expressed consent to disclosure

3. life threatening emergency

4. minor and victim of abuse

5. required in case against professional ethics

m. informed consent

n. Participate in development and formulation of psychosocial care

o. Designate person as legal rep

p. Send/receive uncensored priv communication

q. Legal services, if cannot afford, Public Attorney's Office shall assist

r. Access to clinical records unless revealing would cause harm

s. Information w/n 24 hrs of admission to MH facility

t. File complaints of improperties and abuse

Section 6 - Rights of Family Members, Carers, and Legal Representatives

a. Receive appropriate psychosocial support

b. With consent of user, participate in formulation of treatment plan

c. Apply for release and transfer of service user to MH facility

d. Participate in MH advocacy, policy planning, etc

Section 7 - Rights of Mental Health Professionals

a. Safe supportive work envi

b. Participate in continuous professional dvlpmt program

c. Participate in planning, dvlpmt, and management of MH services

d. Contribute to dvlpmt and regular review of standards for evaluating MH services

e. Participate in dvlpmt of mental and health policy and service delivery guidelines

f. Except in emergency situations, manage and control all aspects of practice and can decline service user

g. Advocate for rights of service user when their wishes are at odds w family's

Chapter III

Treatment and Consent

Section 8 - Informed Consent to Treatment

- provide informed consent prior to treatment

- all persons presumed to possess legal capactity

- children have right to express views on all matters affecting themselves

Section 9 - Advance Directive

may set out preference of treatment thru notarized advance directive executed. can be revoked by new directive/notarized revocation

Section 10 - Legal Representative

may designate person of legal age to act as legal rep thru notarized docu

Declining an Appointment - may decline, must take reasonable steps to inform SU and MH professional or worker

Functions of Legal Representative

1. Provide SU w support and help, represent interests, receive medical info

2. Act as substitute decision maker when temporary impaired of decision making capacity

3. Assist SU w exercise of any right

4. Be consulted abt treatment or therapy of SU.

Failure to appoint - in order

1. Spouse; if permanently separated, then

2. Non-minor children

3. Parent by mutual consent if SU is minor

4. Chief, administrator, medical director of mental health care facility

5. Person appointed by Court

Section 11 - Supported Decision Making

- may designate up to 3 persons or "supporters" including SU's legal representative for decision making

- supporters have authority to access SU's medical info, consult w SU about treatment, be present during appointments

Section 12 - Internal Review Board

- reviews all cases, disputes involving treatment; comprises of

1. Rep from DOH

2. Rep from CHR

3. Person nominated by org representing service accredited by PH Council for MH

4. Other designated members deemed necessary under implementing rules and regulations (IRR)

Internal Review Board Power and Funcitons

1. regular review of all cases involving treatment of SUs

2. Inspect MH facilities to ensure no cruelty

3. Investigate cases

4. Take all necessary action to rectify/remedy violations of SU's rights

Chapter IV

Mental Health Services

Section 13 Exceptions to Informed Consent

During psychiatric or neurologic emergencies, or when there is impairment or temporary loss of decision-making capacity in whether physical or chemical, may be administered or implemented pursuant to the following safeguards and conditions:

• (a) In compliance with the service user's advance directives, if available, unless doing so would pose an immediate risk of serious harm to the patient or another person;

• (b) Only to the extent that such treatment or restraint is necessary, and only while a psychiatric or neurologic emergency, or impairment or temporary loss of capacity, exists or persists;

• (c) Upon the order of the service user's attending mental health professional, which order must be reviewed by the internal review board of the mental health facility where the patient is being treated within fifteen (15) days from the date such order was issued, and every fifteen (15) days thereafter while the treatment or restraint continues; and

• (d) That such involuntary treatment or restraint shall be in strict accordance with guidelines approved by the appropriate authorities, which must contain clear criteria regulating the application and termination of such medical intervention , and fully documented and subject to regular external independent monitoring , review, and audit by the internal review boards established by this Act.

Section 14 Quality of Mental Health Services

Mental health services provided pursuant to this Act shall be:

• (a) Based on medical and scientific research findings;

• (b) Responsive to the clinical, gender, cultural and ethnic and other special needs of the individuals being served;

• (c) Most appropriate and least restrictive setting:

• (d) Age appropriate; and

•  (e) Provided by mental health professionals and workers in a manner that ensures accountability.

Section 15 Mental health services at community level

Mental health Services at community (every LGu and acad institution create own program in accordance w PCMH)

Section 16 Community-based Mental Health Care Facilities 

• Community based Mental health (facilities)

• The national government through the DOH shall fund the establishment and assist in the operation of community-based mental healthcare facilities in the provinces, cities and cluster of municipalities based on the needs of population

Section 17 Reportorial Requirements

LGUs make quarterly report to PCMH thru DOH

The report shall include, among others, the following data:

number of patients/service users attended to and or served, the respective kinds of mental illness or disability, duration and result of the treatment, and patients/users' age, gender, educational attainment and employment without disclosing the identities of such patients/service user for confidentiality

Section 18 Psychiatric, Psychosocial, and Neurologic Services in Regional, Provincial, and Tertiary Hospitals.

including private hospitals rendering service to paying patients, shall provide the following psychiatric, psychosocial, and neurologic services;

• (a) Short-term, in-patient, hospital care in a small psychiatric or neurologic ward for service users exhibiting acute psychiatric or neurologic symptoms;

• (b) Partial hospital care for those exhibiting psychiatric symptoms or experiencing difficulties vis-à-vis their personal and family circumstances;

• (c) Outpatient in close collaboration with existing mental health programs at primary health care centers in the same area;

• (d) Home care services for services users with special needs as a result of, among others, long-term hospitalization, noncompliances with or inadequacy of treatment, and absence of immediate family;

• (e) Coordination with drug rehabilitation center vis-a-vis the care, treatment, and rehabilitation of persons suffering from addiction and other substance-induced mental health conditions; and

• (f) A referral system involving other public and private health and social welfare service providers, for the purpose of expanding access to programs aimed at preventing mental illness and managing the condition of persons at risk of developing mental, neurologic, and psychosocial problems.

Section 19 - Duties of mental health facilities

a. Establish policies to minimize restrictive care and involuntary treatment

b. Inform service user of rights

c. Provide every service user w complete info

d. Ensure informed consent obtained from service users prior to implementation of treatment

e. Maintain register containing info on all medical treatments

f. Ensure legal reps are appointed after requirements of this act

Section 20 Drug Screening Services

Pursuant to its duty to provide mental health service and consistent with the policy of treating drug dependency as a mental health issue, each local health care facility must be capable of conducting drug screening

.

Section 21

• Suicide prevention

• Mental health services shall also include mechanisms for suicide intervention, prevention, and response strategies, with particular attention to the concerns of the youth

Section 22

Public awareness

DOH and LGUs initiate and sustain heightened nationwide multimedia campaign to raise level of public awareness

Chapter V

Education, Promotion of Mental Health in Educational Institutions and in the Workplace

Section 23 - Integration of Mental Health into Educ System

- state ensure integration of MH in educational system

a. Age-appropriate content pertaining to MH into curriculum

b. Psychiatry and neurology required subjects in all med and health courses

Section 24 - Mental Health Promotion in Educational Institutions

• Educational Institutions, such as schools, colleges, universities, and technical schools, shall develop policies and programs for students, educators, and other employees designed to: raise awareness on mental health issues,

- raise awareness on mental health issues, identified and provide support for indivs at risk and facilit access

- public and priv educ institutions required to have complement of mental health professionals

Section 25 - Mental Health Promotion and Policies in the Workplace

• Employers develop policies and programs on MH issues, correct the stigma and discrimination, identify provide support for indivs w MH conditions

Chapter VI

Capacity Building, Research and Development

Section 26

Capacity Building, Reorientation, Training

Section 27

Capacity Building of Barangay Health Workers (BHWs)

Section 28

Research and Development

Section 29

National Center for Mental Health (NCMH)

- premiere training and research center development of interventions on mental and neurological services in the country

Chapter VII

Duties and Responsibilities of Government Agencies

Section 30 - Duties and Responsibilities of DOH

a. Formulate national MH Program

b. Ensure safe envi w sufficient privacy in all MH facilities; regulation, licensing, monitoring

c. Integrated mental health into routine health innfo systems and report MH data to improve MH service delivery

d. Improve research capacity and acad collaboration

e. Ensure all pub and priv MH institution uphold right of patients

f. Coordinate w PH Insurance Corp to ensure insurance packages are available to patients affected by MH conditions

g. Prohibit forced/inadequately remunerated labor in mental health facilities

h. Provide support services for families and coworkers of service users, mental professionals, workers

i. Dvlp alternatives to institutionalization

j. Ensure all health facilities establish respective Internal review boards

k. Establish balanced system of community based and hospital based MH services at all levels

l. Ensure all health workers undergo human rights trainings

Section 31 - Duties and responsibilities of CHR

a. Establish mechs to investigate abuse and impropriety

b. Inspect Mh facilities

c. Investigate all cases w involuntary treatment

d. Appoint focal commissioner for MH tasked w protecting and promoting rights of SUs and MH professionals and workrs

Section 34 - Duties and responsibilities of DepED, CHED, TESDA

a. Age appropriate content abt MH into curriculum

b. Develop guidelines and standards on MH programs

c. Pursue strategies promoting realization of MH and wellbeing

d. Ensure MH promotions complemented w qualified MH professionals

Section 35 - Duties and Responsibilities of DOLE and CSC

a. Dvlp guidelines and standards on appropriate and evidence based MH programs for workplace

b. Dvlp policies that promote MH in the workplace, address stigma and discrimination suffered

Section 36 - Duties and responsibilities of DSWD

a. Refer service users to Mh facilities

b. Provide/facilitate access to group housing facilities

c. In coordination w LGu and DOH, develop community resilience and wellbeing training

Section 36: Duties and responsibilities of LGU

a. Review and develop regulations and guidelines on implementing MH care

b. Integrate MH services in basic health care services

c. Establish training programs to enhance capacity of MH care service providers

d. Promote deinstitutionalization and other recovery based approaches

e. Establish, modernize MH care facilities necessary

f. If independent living arrangements not available, provide access to public housing facilities

g. Refer SU to MH facilities

h. Establish multisectoral stakeholder network for management and prevention of MH conditions

Chapter VIII

Philippine Council for Mental Health

Duties and Functions of PCMH

a. Develop, update national multi sectoral strategic plan for MH for objectives of this Act

1. countries target in protecting rights of Filos w MH needs

2. govt plan to establish rational service delivery network for MH services

3. budgetary reqs and investment plan for implementation

b. Monitor implementation of rules and regulations of Act

c. Ensure implementation of policis in Act

d. Coordinate activities, strengthen working relationships among national govt agencies

e. coordinate w foreign and intl orgs regarding data collection, research

f. Coordinate joint planning and budgeting of relevant agencies to ensure funds

g. Call upon other govt agencies and stakeholders to provide data and info in formulating policies and programs

Composition of PCMH

(a) Secretary of DOH as Chairperson

(b) Secretary of DepED

(c) Secretary of DOLE

(d) Secretary of the Department of the Interior and Local Government (DILG)

(e) Chairperson of CHR

(f) Chairperson of CHED

(g) One (1) from the academe/research

(h) One (1) representative from medical or health professional organizations

(i) One (1) one representative from nongovernment organizations (NGOs) involved in mental health issues.

Chapter IX

Mental Health for Drug Dependents

Section 43 - Voluntary Submission of Drug Dependent to Confinement, treatment Rehabilitation

Persons voluntarily submitting and persons charged pursuant to RA No. 9165 "Comprehensive Dangerous Drugs Acts of 2002)

undergo examination for mental health conditions and if found to have MH conditions, shall be covered

Chapter X

Miscellaneous provisions

Section 44 - Penalty Clause

any person who commits any shall be punished by no less than 6 months, but not more than 2 years, or fine of > Php 10000, but not more than Php 200k, or both, at discretion of court

a. Failure to secure informed consent

b. Violation of confidentiality of info

c. Discrimination against person w MH condition (Section 4e)

d. Administering inhumane cruel degrading harmful treatment not based on medical sci evidence (section 5h)