 Good day, viewers! This is once again your Kaliusuga and Aikarapatan program. I'm Lilian de Lasliagas and have with me my co-host, the Chancellor of UP Manila, Dr. Carmen Sita Padilia. I'm anxious. Thank you, Dr. Lili. Good day to our viewers as well. Today, we're going to talk about Republic Act 11036 or the Philippine Mental Health Act has been signed into law on 20 June 2018 and is now part of the Philippine General Health Care System. What does this mean? This means help and support to those with mental problems are accessible. And one of the outstanding provisions of this act is that medical and psychoterapeutic services will be made available to the law-wish unit, which is the barangay. It will be made available in municipalities, cities and provinces. The law mandates that local government units or LGUs to allocate funds for the mental health programs and services. This includes the establishment of facilities to deliver services up to the tertiary hospitals in cities and municipalities. Chancellor, being involved in health concerns, it seems like we know something about the mental health problem. But I think we can deeper, deepen our viewers' knowledge about mental health if we ask help from the experts. Yes, Dr. Lili, let us expose, let us now start a discussion on the Mental Health Act and allow me to introduce our guest who will enlighten us on this particular law. Our first resource speaker is a professor emeritus of the University of the Philippines, Manila, who obtained her Doctor of Medicine degree from UP and later subspecialized in community and social psychiatry at the State University of New York, Syracuse, New York. She was the chief investigator for the Philippines in the WHO collaborative study undertaken in seven developing countries on strategies for extending mental health care. She has worked as World Health Organization consultant on mental health in many Asian countries like Mongolia, Cambodia, Vietnam, Laos, and many others. She received the 2014 Lifetime Asia Achievement Award from the Asian Federation of Psychiatric Associations in Kuala Lumpur. At first in the history of the Philippine Psychiatric Association in which one of its highly esteemed members is among the ranks of the most decorated psychiatrist in Asia. She has devoted much of herself in working towards the betterment of mental health service in our country as well as other Asian nations. She is currently a member of the Philippine Council for Mental Health, the policy-making and coordinating body for the implementation of the recently passed mental health law. The chair of the council is the secretary of health. I understand that the chair is also represented here by our very own commissioner Lillian de Lesliangas. So, ladies and gentlemen, may I present Dr. Ludas Lulu Ignacio. Our second resource person has a specialization in neurology and epileptology. She was the president of the Philippine League against epilepsy. She has spent the last 25 years not only in clinical practice but also as an educator, leader, researcher, and advocate of continuing health education. She received an award as one of the 2008 outstanding Filipino physicians. She is currently a professor and chair, Department of Neuroscience's UPPGH Medical Center. She was recently appointed as a member of the Philippine Council of Mental Health, representing academic research. Ladies and gentlemen, please welcome Dr. Leonor Cabral Lim. Dr. Leonor? Good afternoon, dear viewers. We're very happy to be here to share our knowledge on the recently enacted mental health law. So, let us start asking our resource speakers today on the pertinent provisions of the Mental Health Act. Can we start with Dr. Ignacio, Dr. Lulu? Thank you very much. This is a long-awaited mental health act. We've worked on it in the last two decades, I guess. And we look at this as really coming up with the reforms in our mental health system because it provides for a comprehensive, integrated, effective, accessible mental health services down the grassroots of our country. Because traditionally people tend to think that mental health care can only be availed of in hospitals and in clinics. Now the law is strong in providing for the system that will really bring mental health care to the grassroots. It has even a specific provision for the training of barangay health workers in mental health care, which is close to my heart because this is really where my own work in the university and in the NGO which I represent is concentrated on. And the law, of course, in providing these accessible services really upholds the right of every Pilipino to accessibility of much-needed mental health care, which has long been neglected. We still see a lot of people suffering from mental health problems that are remaining chronic, disabled, untreated, dehumanized in their particular state. And many of you who probably be listening to us would know that there is no community where this group of patients are really abandoned walking the streets, yur taong rasa, for example, even in the cities where we have already some services and families suffering from the stigma and discrimination that the illness suffers from. The law will be strong and we hope we really could get the necessary government and non-government support to get this implemented. This has been worked out in its own implementing rules and regulations and Dr. Lim and Dr. Dilel Yagas here and I who are members of the council will just do our best to really get this whole thing going. The law also provides that not only should we take care and provide the necessary services, we also must address the needs to promote the mental health and well-being of the greater number of the population. If you're talking about 110 million Filipinos, at least only 20% are affected by the mental disorders that we especially should probably address ourselves. The 80% are the well. The people who are going the streets, you and I are working on our respective jobs but are affected by various traces of daily life. They're affected by difficulties in our family structures. They're affected by overseas workers leaving children behind and therefore disrupting families. We're talking about the greater number of our people because we are a disaster prone country affected by disasters. They may be suffering from what so-called mental health problems but are cannot really taken as sick or as ill but as really affected by the adversity of life called stresses that must be addressed. So that's the other portion of the population where we need to have promotions for mental health programs, address the vulnerable in the disaster prone areas and provide emergency care when such stresses happen. So the whole law will be addressing that. It's formidable but I think it's workable. Okay, so I just have two follow-up questions. When you say comprehensive, you talked about mental disorders but can you give us a list of what's covered by the conditions when you say under the Mental Health Care Act? Mental disorders in the Mental Health Care Act is interestingly enough including the neurology disorders now and that also will show you where the science is expanding. We talk about those you traditionally know have mental problems. You would not forget the depression, psychosis, all those that fall under the specific classification of disorders for mental disorders but a greater number and that because I've worked very much also in disaster mental health, a greater number of the people we provide services to now especially in the areas that have long been affected by the disorder at what we call the psychosocial problems. We name this because we do not look at them as sick right away. We look at them as vulnerable if not taken care of. Vulnerable for depression, vulnerable for psychosis, vulnerable for the illnesses, anxiety, if not taken care of. So that psychosocial problems are in the big category of the people affected by extreme life experiences, disasters, victims of domestic violence, victims of child abuse and so you get to the children part, victims of community violence, victims of armed conflict. There are a lot there and our newspapers cannot spare us from being aware of this and we do need to address those issues and that's in the mental health field. That's in fact the growing concern of the mental health condition in the last two decades and the law has also articulated that we have to address those. The other group is Dr. Cabral's lean specialty. We are marrying psychiatry and neurology because we like to say that when you do have mental disorders it's not just a problem of, a problem there. You lost your husband, you lost your job, a problema. It really is a conglomerate of several factors, biologic factors as well as social factors. There is something in your body that also makes you vulnerable for depression. Padiliya's line of genetics get into our interest. That's in the field of neuroscience because environment affects gene expressions and therefore can really be looked at as, it's not just genetic predisposition, it's also environmentally predisposed. So the whole range of the mental health law in the Philippines is unique. It's the only law that carries these three conditions to address. The mental disorders, the psychosocial problems and the neurologic disorders. Other countries will only address the mental disorders. So which shifts now to Dr. Yunor, can you tell us about the component of the neurologic disorders covered by the mental health care? Actually, I am very happy that Dr. Ignacio mentioned about the marriage because we started courting each other when we joined in late 2015 and I always tell this during the meetings, we're very happy that Psycaya 3 welcome asked when we were working on having the bill passed and even working in all the meetings with this. So I'm very happy to know that, like what Dr. Oro said, this is the only mental health law globally that includes neurologic services and it adapts the framework of the WHO looking at these conditions under the MNS acronym meaning mental neurologic and substance abuse and the priority conditions that are identified for mental health for the psychiatric depression, psychosis, self-harm and suicide for the neurologic is epilepsy, mental and behavioral disorders in children, dementia and substance abuse. So, of course, there's a lot of neurologic disorders. In fact, since the mental health law defines we did not define mental illness, we defined it as mental health condition and it is stated there that the mental health conditions include neurologic and psychiatric disorders so that we will not go on amending as the science progresses. It is defined there that the definition will defend on the evidence that is going to be available that is current. So I believe because this is really formidable that as far as the services is concerned most likely we will start with the priority conditions who are actually in the MHGAP program because these are the ones that are highly stigmatizing. These are the ones that have a high socioeconomic burden and these are the ones that are associated with the social determinants of health. So actually, if you look at it the definition of mental health in the bill is in the Filipino version is more encompassing in the sense that it does not only include that they are able to cope with the stresses of life. It even includes there that you should be resilient to adversities keeping in mind that we are prone to disasters and also it includes in the contribution to society that you have a positive contribution to society, not just a contribution to society. I was just interested because you mentioned mental, neurologic and substance abuse. Substance abuse actually is covered in the spectrum of conditions. So can you just give the viewers an example where it that's included in the provision? Substance abuse includes alcohol abuse, nicotine abuse, drug abuse. So actually, even before the bill was passed there was already a DOA's administrative order that expanded the components of the national mental health program and that's doctora mentioned the components are wellness and then the other one is resiliency, disasters and then you have the psychiatric, neurologic and then substance abuse. It's already in the national mental health program of the Department of Health. So actually anything that is contrary to mental health is contrary to government at the bill. Okay. It just gives you some view now that it's everybody's business because we're not only going to be there not abnegating our own specialization we have to take care of the mental disorders but we have to help other sectors of society who are there in the whole arena of taking care of the people, the population promote mental health. Your area in education is very crucial to this from because the mental health blog gives you also the view that every provision must have a life course perspective so it's from womb to tomb. Yes. Doctoras, Chancellor mentioned the law is available. We need to give our viewers an opportunity to know how big this problem is in mental health conditions. Is there a statistics that would tell us how big this problem is in the Philippines? That's the other unfortunate thing because the statistical study on prevalence is ongoing. That's UPPGH. On Friday we're finalizing from my organization the World Association for Psychosocial Rehabilitation. We're finalizing the PCHRD sponsored defining the research agenda on mental health in the Philippines where really information systems, the prevalence, the way by which recording of that are going to be taken cared of are going to be put in place. So I will not yet answer what is the extent. But if you don't really see the fact that you will not need a figure when you know that out in the streets you'll find 10 people dehumanized, untreated, tied to the lamppost because they're mentally sick and their families abandon them or if you see the overcrowding in mental hospitals at this point in time and you will not know many of these who are not hospitalized are also that sick yet, you know. You will know that the problem is really from the mental disorders point of view but I think everybody in the country is aware that there are so many stories about young students jumping off quite unusual for these are of the higher income class, this kind of thing and we know what in PG-8s we have a regular row of overseas workers coming in broken down in severe mental disorders my feel as a clinical person and as a human being I would not need the figures anymore to know that we should really come up with accessible care for these people. The statistics would provide an estimate of how much we need such that the universal health care can really allocate certain amount to make sure that the mental health law is going to be accessible from the level of tertiary to the level of barangay so of course, statistics perhaps would be available in terms of UP Manila PG-8 classification of mental health problems which would comprise what is the spectrum of the psychiatric mental health disorders from the point of view of PG-8s The PG-8s study is a national study Yes, it's a PCHRDDOH Commission study it's ongoing at the moment and that's with our clinical epidemiology group also if we go back to past figures that I will be comfortable The study in WHO looking into how many persons ordinarily consulting a health center our study area was in Sampalok Balik Balik area How many persons would have a mental health problem who would not go there for a mental health problem but will go there for family planning tuberculosis follow up dots blood pressure etc the figure came up to be 20% of people ordinarily consulting the health center would have a mental health problem 40% of those were diagnosed to be in depression 48% of those were in anxiety disorders collected to the chronic tuberculosis the stroke problem that they would ordinarily go to the health center or mothers and mothers who would be subject to domestic violence in the home but coming with mental health problem but not really saying I'm depressed but saying I can't stand being having to have babies anymore this kind of thing so you'll know that the mental health problem in the situation among those so it's embedded yes that's why we are advocating that in health centers mental health care must be part of the whole general health service so let me follow up this is very interesting the context of public view about the severity of this major public health problem in the Philippines doctora yunoran doctor lulu is there such a thing as education based program to detect for example in schools rapid behavior of pupils is there such a thing as school based mental health prevention promotion program there's a mental health week long time ago at least in the health center we have such a thing as the self-report questionnaire that a midwife or a nurse could give an ordinary consultee so we would be able to detect the mental health problem I think this screening instruments in schools is still something that we have to work out because practically for neurology there's really nothing in place except like in our volunteer organization where we have the epilepsy caravan where we educate the school children about epilepsy but this is a volunteer tie up with it's not an official that's why we're very happy that since there is a law now that all the NGOs akadem and everybody can work together look at what we already have so that we don't have to reinvent the wheel doctora that's very interesting looking at it as a psychosocial cultural health problem in the Philippines and we have the readiness already to face this I think what I'm seeing is that whereas in the past when you talk about mental you're always looking at the end of the spectrum you're talking about a patient who will go to a psychiatric hospital or a mental hospital what I'm hearing now is that really it really ranges anywhere from just a psychosocial event to something more severe or it can be part of the neurologic condition and I just want to follow up your comment Dr. Lili that yes the schools probably will have a big role because we want to catch the children a little bit earlier and actually in UP Manila for the past several years with the help of the department of psychiatry we actually implemented a very simple screening model we actually have and we're picking up some of the students much earlier and surprisingly we really have students who need help they're not really at the end of the spectrum but they can be picked up early so with the law I am hoping that this is something that we can introduce much earlier because actually college is too late already we will have to do it much earlier because of the stresses around us I want to we just had we just discussed universal healthcare and I thought that we can ask our resource speakers now to talk about how does it integrate for the universal healthcare law your law was signed earlier but the goal now is to integrate both so I'll start with Dr. Yanor on how can we integrate the two? because I've been attending all the stakeholders meeting and the other meetings with the department of health and I'm very happy to note that the department of health is saying we will integrate this in the entire healthcare system meaning for the child it will be there will be an integration with child care even the immunization programs are important to prevent these conditions like epilepsy and developmental disorders and then what we want is we want all these conditions to be recognized at the primary care we want to capacitate the primary care that if you go to a primary care center they can take care of you and then the small percentage at least for neurologic which will be 30% that are difficult to treat are the ones who's going to be referred to the specialist but this will need a lot of capacity building and reorientation because right now before you ask the primary care physicians they will tell you we don't want to touch neurologic conditions that is for the neurologists and at the start there was a fear among there were people who voice out that they were criticizing us thinking that we wanted this bill because we wanted to be the ones to be out there treating these conditions and we're saying no way we're even saying we are going to teach you how to take care of them because they don't have to come to us so there's really no intention for the specialist to do that the intention really is to provide equity for all for these conditions that we are committed to serve okay what about the doctor Lilo well I've been into primary health care work in the last 20 years and really just got me convinced that we should be there of course we use our other resources than government but I think if we have to address the whole population this is the biggest challenge we have to convince not only our leaders our policy makers but the people providing care down the field that mental health is part of the general definition of health if you are going to say I'm going to be healthy I should not be healthy only because my blood pressure is okay my body is okay I should also say I'm healthy because I can think clearly my emotions are stable I just don't blurt out at any one time or conk anybody on the head or that I'm healthy because my relationships are okay and stable that's one of the thing that we have to push and I'm saying this for a general public information education because you are body and mind I mean you know tell me if you have any problem at all that you'll just have loose bowel movement and not worry you do and that's a mental health issue so on top of that therefore the general public may feel that way but our own doctors in the field at the moment and this is again a defect of our own medical education nursing education we have been very biomedical we have been very concentrated on the body it's taking us the psychiatrists and neurologists time to even get curricular hours for putting that in a medical school curriculum talking of curriculum we were getting there because the law is now giving that push a little bit but if we go out there and show the municipal health officer the rural health officer the rural health midwife the rural health nurse that it is not all of psychiatry it is not all of neurology it's really the convulsive disorders that are untreated dementia grandmother because cannot orient herself go back home it's really the chronic psychotic that has long been crazy but not treated but who can be treated the depressive the anxious because it's been left behind by a husband etc very defined conditions when we go out there and tell them we can help you take care of these patients and therefore with simple medications with simple advocacy to the mayor to put it in their own municipal budget because these medications can be suggested by the specialists among these cheaper medications we have shown in our projects and you know and I have been out there for her convulsive disorders and dementia myself for the chronic mentally ill for the chronic depressive suicidal they do not need to take to call us because we are here in Manila but they now because of their own experiences to see some benefits some improvements that they start taking care of them so the whole big challenge is really convincing the policy makers decision makers that okay let's go then convincing people that out there caregivers that help is being provided and can be provided to capacitate you to do that and a referral system will be worked out with the specialists that's now part of that integrated comprehensive plan it sounds good we're happy that we have the mental health care act and then we have university health care act but then how long in your opinion will it take us to see the full implementation of this law the mental health gap actually I know that it was handed to DOH in 2008 but started rolling late 2015 and then actually it's in the process now but there's still a need for reorientation and in fact at least we're happy that DOH for the neurologic disorders they gave us the imprimatur to modify the module because we're saying the module that was handed was not capacitating the primary care but always ends up saying referring so we have to cut up with those who need to be to have the education in the medical schools I think this is where chair this important at least in the university we've been teaching already our medical students the basic and telling them when you go out there you can take care of this for years and so we're proud that our graduates can do that but the bill provides for neurology and psychiatry to be included in the medical curriculum and other allied health courses and even post graduate courses psychiatry and neurology so in the IRR there was a deadline for the different agencies like I think most of the agencies were given maximum of two years to come up with the guidelines but I think DOH is already working into it there's already actually a mental health access program committee where they're identifying the medicines that should be given in the primary care so if you ask me how long will it take I hope within the next five years but because the challenges you mentioned are one we need to the human resources the capability building that should happen and I'm hoping that it will align with the universal health care wherein the primary care provider will also be equipped to do this funding seems not to have to be a problem because we have the universal health care I think so plus the local government units are being encouraged to put some money but what are the other challenges right now I mean it seems like we know the problem about human resources we know about the issue on funding and the local government what are the other challenges that we have to deal with quite honestly from my vantage point as we sit in the Philippine council for mental health the challenge I feel is to really get our colleagues the leaders out there in the council in fact and allow me to say this to get kind of reorientation to the whole concept of mental health the whole issue of the nature of mental disorders that have to be attended to and the strategies for these kinds of implementation because at the moment I think it is fair to say that the concept is still very traditional so what is your proposed concept that we just do not address the issues of the clinics the clinical view because when everybody talks mental health you are ordinarily talking mental illness so when you are looking for the policy maker the decision maker there they will start looking at what do we do for them I want to have a step back and really say what are you doing now that provides and promotes mental health and well-being in every person so it becomes a generalist view what does it mean for you to feel well what does it mean for you to feel healthy as I said you have to have the four dimensions in your own life as a human being you have physical health mental health, social health and really I will dare say as spiritual health especially in disaster victims you get into that very very strongly when all else fails your house is down three of your people dead your livelihood is down you just go back to your own self and say okay what else can I do but that is the kind of message that probably it's picking up now promotion mental health promotion well-being look at definition of health not just from the physical point of view but your mind your social relationships your relationship with your supreme being that's health and anybody can really come up with programs within the context of their own institutions and agencies that addresses the bigger number of the people under their administration or under their care the department of education the department of local government department of social services and we're doing it now global so the clinical thing is leave it to the specialist actually mental health is within the framework of UHC and I know it is clear from the point of view of government that it includes mental health and that includes the spectrum of wellness yes yes and that is why all this NGA government agencies are actually mandated to look at it from a comprehensive perspective like making the workplace a conducive environment being nurturing values formation in school in fact I was telling myself supposedly for optimal brain health we should think clearly and make the right decisions I was even telling myself wow isn't it right if the Filipino can make the right decision to vote for the right people so for example disasters for example we hear so much about resilience we would like to have a resilient barangay so we talk about resiliency of humans and resiliency at the level of barangay resilience is a very generic term and looking at the mental health aspect of resilience this is where the mental the law would really be very much applicable can you say can you link resilience and mental health of course you can't have mental health without your basic resiliency so everything is about I mean everybody can really have resilience coping is what you do when something happens but each one of us given a crisis we do something we stand up we talk to someone we ease ourselves depending on the gravity of the situation but we have a way of easing ourselves so that is now the context of the law from the tertiary clinical view or the lens to the barangay level resilience in the community if you talk about community resiliency I've worked with them marabot, summer down the ground etc and we have a program for that you need to just look at this group of people who have themselves had their lives in there allow for them to call upon themselves at some point of course help them not fall victim to dependency of foreign people but I have faith in the fact that when I see them they know what to do they just need help from the outside in the beginning so that they can rise above the rubble but when they do they can execute depending again but you must grant everyone the nature of resiliency to me it's a natural gift to be resilient you don't develop resiliency you have it so in the context of community preparedness during disasters natural and man-made it is very important for the local government to need also to have a full understanding so you think as mental health experts and advocates you think it is important that the local government to need has a program for resiliency from the mayor to the barangay level is there a program already for local government the barangays have their programs to sustain their lives to sustain what they have empower themselves they have health, they have social welfare they have labor, they have sports they have neighborliness I go out there and I'm really truly a faith in the Filipino sense of neighborliness that's where it is in our mental health program all we did was really ident in the barangay because part of our mental health program is not just taking care of those with the mental health problem it really was helping mental health concepts pervade community development upon rehabilitation from disaster work so what we had done with the help of a community development specialist we have a social worker was done that is really work with the barangay there whoever they have entrusted and whoever they can tell us what they can do given the loss of livelihood given the death that has happened given the need for relocation of housing choosing for alternative but on all we need that was really facilitate their development of their own sense of empowerment and I guess mental health continues to give you that faith that you can do something Dr. Yulu and Dr. Yanor are are we together in saying the limanized thinking about the stigma attached to mental health patients is always sending the patient to the Philippines center for mental health it is existing and how do we address this stigma attached to this I don't even bother with stigma I just tell them hey look you have a depression let's do something about it but that's the problem of the community and they don't like the stigma too but they're stigmatized they're marginalized because of their mental health condition but that's where your work in the community our work in Samar and Ilu Ilu had gone to the barangay health workers there are our allies so that would be the strategies now for capacity building I believe because the law provides mental health education at all levels of our educational system and the workplace that this is going to go a long way because I think even in the workplace the reason they are afraid to hire them is because of ignorance of thinking that they cannot handle these patients but once you overcome that barrier and they are aware and they have the knowledge I think it goes a long way and you need enough knowledge later on to go into advocacy so your role in the department of education is very crucial the department of education from childhood to adult so I mean I think this is good because what we're saying now is that we would want to focus on wellness as part of the whole concept of health care act so we want to take care of the well that's what you're saying so that they don't slide down into the recognizable conditions or the complications of your neurologic disorders and I'm hearing that we have the ingredients at the level of the community and we only have to scale it up am I getting that message that but how many of our barangays would have this capacity not yet because I think it's good that we have some models but then we really have to scale it up where in all of them we'll have this capacity of taking care of the people so how far are we off? of course at the moment we're talking about what's on paper some of us have already been out there in specific projects and have gotten passionate to believe that it can be done now the challenge at the Philippine Council for Mental Health where the department of local government is part of this whole thing is to roll down there with the help of specialists the other thing I want to really say is the structure of the Philippine Council for Mental Health which is going to implement this is the fact that it's multi-sectoral the specialists are us in the civil society group professional group the non-government group and the academy the rest of the six members are coming from the crucial members of the government department of education department of labor department department of local governments commission on human rights and dole therefore the message is because we're talking about the other major aspect of the program which is wellness, promotion of mental health this is now therefore the implementation of the multi-sectoral network and the message is therefore mental health that used to be traditionally only looked at as the responsibility of a specialty group that's us the psychiatrists cannot therefore now be just there the psychiatrists are nowhere to be found there are only how many of us in this country but the whole big thing that I'm trying to emphasize is really the multi-sectoral involvement at policy making down the delivery of services along which is capacity building and the research that's needed to find the services this gives me a lot of hope I look at the future generation to be here because probably will have a healthier community the schools probably will have the mechanism to cope with these problems but and you know we're happy that the mental health care act and the universal health care act are both here to make this as a reality but you know as the time is is up again so but we'd like to give some time for both of our resource speakers to probably have a parting message to our viewers we are very happy that the mental health act was passed and actually it is very opportune that it actually came ahead of the universal health care but we as healthcare providers are also very happy with the universal healthcare act because we want equity for healthcare for everybody but of course we understand the role of us also in the and also in the and also us just Filipinos who want to take care for a better Philippines. Thank you very much and I want to enjoy everybody to support these aspects especially I'm very happy that the neurology community is united and has committed to supporting this Thank you very much. Doctor Lillu, parting message. As a psychiatrist it's really good we've always been out there in the periphery kinakatakutan pangakame ikinahihia pangakame but right now we're on the forefront and when I took my oath member of the council the secretary of health was really saying oh now it's your time to do something so sabi ko that's a formidable challenge but the content of the law is what we had felt should be there in fact a little pioneering over the other countries because we have included our colleagues in the neuroscience field neurology emphasizing the fact that psychiatry too is a science it's not just something hanging around you na but really it also involves a multi-sectoral involvement so that there is a publication commission on mental health that really says mental health is now everybody's business because mental health is something everybody should have so we thank you for inviting us here to share our thoughts and we look forward to really hard days ahead because we still have to get our feet going and the strategic plan for the Philippine council for mental health is still being finalized and I'm sure that that will again go through a lot of reviews but the good thing is it is going it is moving at its own schedule we finish the IRR in six months time which everybody said wow mga obsessive compulsive sila doon tapos kaagad but the IRR is there the Philippine council is now activated and we of course need to advocate some more with the people and our colleagues in the policy making body to really get us the budget that the other thing pa okay thank you very much mental health is everybody's business what a stimulating discussion we've had today about mental health and I'm sure that our viewers have learned a lot as Dr. Lidia I did we have to say goodbye though but promise to be back again for another KK episode thank you for watching and listening I hope we'll still have you for our next episode Dr. Lilu and Dr. Yanar goodbye at mabuhay ang kalusugan ay karapatan