Mental Health Stigma Among Filipinos: Time For A Paradigm Shift
Ana Kriselda B. Rivera * and Carl Abelardo T. Antonio
*Corresponding author's email address: firstname.lastname@example.org
1College of Public Health, University of the Philippines Manila
2Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila
This paper aimed to provide a review of mental health stigma in the Philippines, its implications on policy and
programs, and interventions on addressing the issue. Stigma towards people with mental illnesses in the
Philippines is rampant; there seems to be lack of sensitivity in referencing mental health issues. Many forms of
stigma affect people with mental illnesses. Stigmatizing attitudes and discriminatory behaviors are evident at
home, school, workplace and healthcare settings. Stigma is a major barrier to the recovery of mentally ill
persons. Increasing the awareness of the public on mental illnesses through health education and promotion is
already an established intervention. Various strategies can also be done, such as integrating culture and arts,
by providing incentives to companies which have mental health policies, and recognizing institutions and
media agencies which promote positive portrayals of people with mental illnesses.
Keywords: social stigma, mental health, mental disorders, Philippines
SH O RT R E V I E W
Stigmatizing attitudes date back to the 16th century
when manifestations of mental illnesses are associated
with witchcraft, magic and evil doings. People with mental
illnesses were treated harshly – they were placed in
asylums far from the public, while some are even detained
in jails and madhouses; they were ridiculed and called
names. It was not until the 19th century when mental
illnesses were slowly being viewed to be of medical causes
rather than supernatural in nature. Today, on account of
the advancements made in psychiatric research, we now
understand the science behind many mental illnesses, and
have explanations for management and treatment.
However, despite these developments, stigma remains in
our society. People with mental illnesses are still suffering
from the same stigmatizing attitudes and discriminatory
In the Philippines, stigmatizing attitudes towards people
with mental illnesses are typically demonstrated with humor
or hatred; whereas, media representations of them are
usually associated with harm and misconduct. Stigma exists
in school settings, in the workplace and even in medical
institutions among healthcare practitioners. Stigma
continues to be the biggest barrier to the development of
the mental health system in general – it affects planning and
organizing of mental health programs, influences the
allocation and prioritization of resources for mental health,
and impedes the delivery of mental health services.
This paper provided a brief discussion on the perception
of Filipinos on mental illness as influenced by stigma. This
paper also discussed the implications of stigma on people
with mental illness, the general public and on public health.
Lastly, this paper enumerated possible interventions and
strategies that may address the issue.
Mental health stigma among Filipinos
Abdullah and Brown , highlighted that stigma is
inextricably bound to culture. Culture influences behaviors
and beliefs, and sets the standard for what is considered
normal and acceptable to a society. Beliefs about mental
health and illness are, therefore, also culturally bound.
For the Filipino culture, having mental illness is viewed as
a family's mental illness . In a study, private stigma (self-
stigma) is said to mediate the relationship between public
stigma and attitudes of seeking professional help; private
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Philippine Journal of Health
Research and Development
stigma also has a negative correlation with intentions to
seek professional help; while another study found that loss
of face has been found to be directly associated with
per c eived sti g m a for both seeking an d re c eiving
psychological help among Filipinos .
Although mental health stigma evidently persists in the
Philippines, there is very limited information on the depth of
its burden among Filipinos with mental illness. The
Department of Health (DOH) cons iders the lack of
promotional programs on mental health a reason for the
persistently high stigma in the country . Derogatory terms
such as “abnoy” and “baliw” are easily incorporated in
casual conversations. People often use mental illness insults
in describing annoying politicians ; the President himself
is not spared of these insults. Restraining of people with
mental illness is not something new; sometimes, their
family members are even the ones who detain and keep
them far from the public. The Filipinos' knowledge on
mental illness appears to be simplistic, the opinions can be
quite unforgiving, and the stigmatizing behaviors seem to
Implications of stigma
Stigma towards people with mental illness is conceived
not only by the public, but by those with mental illness as
well, towards themselves. Public stigma is the negative
attitudes and discriminatory response of the people
towards people with mental illness. Self-stigma results
when people with mental illness internalize the stigmatizing
notions of the public towards them .
Stigmatizing attitudes have been found to increase over
time . Stigma entails a great deal of negative outcomes to
individuals suffering from mental illness. Public stigma
presents as danger to social opportunities. Results of a study
in the U.S. revealed that 56% of Americans are reluctant to
spend an evening socializing with people who have mental
illness, 58% are reluctant to work closely with them, and
68% would not allow them to marry into their family .
Des p i t e t h e i r w i lli n g n es s to w o r k , e m p loy m e n t
opportunities of people with mental illnesses are also
compromised. It is evident from the limited data available,
that people with mental health problems, particularly those
wit h p sycho t i c d i sorde rs, have ve r y l ow rate s o f
employment . Furthermore, a study found that more
than 50% of its sample population have deliberately
concealed their condition (schizophrenia) from co-workers
and friends out of fear of being stigmatized .
Media plays a critical role in shaping the public's
perceptions of mental illness. Tragic news concerning
people with mental illness is often sensationalized. An
analysis of tabloids made by Angermeyer & Schulze  in
Germany found that news articles included very little
information on the mental illness of people involved with
serious crimes. Meanwhile, a different analysis by Corrigan
 in the U.S. found that 39% of violence may be
attributed to mental illnesses. Similarly, people with mental
illness face stigmatizing responses from the police. A study
showed that they are more likely to be arrested by the
police ; meanwhile, a survey on the attitudes of police
officers in Greece found that 60% believed that people with
mental illness are more dangerous than the general
population, 47% thought that these people should be on
continuous medication, 67% thought that they should be
permanently hospitalized, more than 60% believed that
they are rarely or never able to work, and 75% believed that
they are rarely capable of building a family and living
Moreover, self-stigma presents as a danger to self-
esteem. Because of their condition, people with mental
illness may believe that they are less appreciated and less
respected by others. These negative feelings may lead to
demoralization and decreased self-worth and self-efficacy
. Those who disclosed their mental illness to a greater
extent have been found to experience significantly higher
damaging effects on their self-esteem. Social interactions
are also affected by self-stigma. People with mental illness
tend to have negative expectations from other people and
so they are likely to act defensively when interacting but
appears to have less self-assurance .
Stigma affects the willingness of people with mental
illness to seek help . A study in the the U.S. by Alvidrez et
al.  found that 32% of its participants did not initially
recognize the need to seek help for their mental problems
because of stigma. Furthermore, Cooper et al.  stated
that stigma influences people in considering other
alternatives of help seeking, such as informal sources.
Similarly, the effects of stigma persist not only in initiating
help seeking but as well as when treatment has already
started. Studies by Sirey, et al.  found that stigma affects
antidepressant medication noncompliance and premature
treatment discontinuation, particularly among older
clients. Underutilization of mental health services is
influenced by stigmatization even in countries where
services are offered free of charge . Family shame also
serves as a significant predictor of treatment avoidance .
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Mental Health Stigma Among Filipinos
Stigma presents as a barrier in all the levels of prevention
of public health. It serves as an obstacle to acquiring
information about mental health problems . Current data
is needed in order to address the persisting mental health
issues in the country. However, there is definitely a lack of
accurate and relevant information that will assist the
government in formulating comprehensive mental health
policies (primordial level of prevention). Moreover, stigma
can affect the willingness of policy makers in investing in
mental health. In turn, it leads to lower prioritization in the
allocation of government funds for mental health and
subsequently resulting to poor delivery of services.
Furthermore, stigma may affect the eagerness of the public
to participate in awareness and promotional campaigns
(primary prevention) about mental health which are
designed to minimize the onset of mental health illness in
the public. Likewise, when there are already mental illness
cases involved, stigma serves as a barrier to the utilization of
programs that aim early case detection and management
(secondary prevention), as well as to the continued
participation in treatments to lessen severity of illness
(tertiary prevention) .
Interventions addressing stigma
Byrne  points out that the starting point for all target
groups at every level of intervention is education. He said
that education in the form of research helps the public,
particularly the professionals, in understanding the
complexities of stigma. It also provokes discussions among
scientific communities which, in turn, results to even more
investigations on the subject matter. Studies on the
interaction of varying aspects of self-stigma and care
seeking can be done, as well as conducting regular surveys
on the public attitudes to mental health, mental well-being
and me ntal illness es whic h may serve as basel ine
information to other studies and as reference for future
policies . Interactions with people having mental illness
further supplement educational approaches [17,18].
Contact may be direct, face-to-face interaction, or indirect,
through watching video interviews.
Anti-stigma campaigns have already been introduced
from around the world, mostly from developed countries.
Some campaigns target mental hea lth stigma and
discrimination in general for all groups like the See Me
campaign of Scotland , the Time to Change of U.K. ,
and Elephant in the Room of Canada ; while other
campaigns are more directed to a particular mental
disorder like the Beyond Blue campaign of Australia which
targets depression and anxiety , and the Open the Doors
campaign, an international movement started by the World
Psychiatric Association (WPA) focused on reducing stigma
among schizophrenia patients . An awareness campaign
in Australia was conducted to improve mental health
literacy and help-seeking attitudes among young people.
The campaign had a significant impact on self-identified
depression, increased awareness of suicide risks, improved
help-seeking behaviors, and reduced perceived barriers to
According to Lauber , targeted interventions may be
more effective because the objectives and messages are
more specific. Targeted groups can be workplaces, schools,
police as well as mental health professionals. The labor
agency of the government must work with the human rights
commission in assuring that the rights of mentally ill persons
are lawfully maintained. Employers can offer possible
working arrangements with mentally ill employees like
working from home or giving additional time to finish their
tasks. Meanwhile, increasing awareness in the school
setting can be done through educational workshops and
watching video interviews, documentaries or movies about
mental illness. Interventions among police officers may
include training seminars on dealing with mentally ill
persons, on being cautious and more careful in interacting
Mental health professionals are encouraged to go
beyond educating within the confines of their clinics to
participating in programs of public education. According to
Byrne, every intervention must convey the importance of
stigma and discrimination, challenge the stereotypes within
ourselves, and continue to explain the nature of prejudice
. In the U.S., the National Alliance of the Mentally Ill
(NAMI) has pushed for better legal protection in terms of
housing and working conditions for people with mental
illness through education. The group has also been
successful in pointing out negative representations of
mentally ill people in the media .
The media serves as a highly influential instrument in
reframing public perception of mental illnesses. Hostile and
violent representations of people with mental illness should
be discontinued. Instead, media should focus on reporting
accurate descriptions and explanations of mental illnesses.
In addition, the media should not only focus on the illness
itself but also on ways of coping with the illness and assisting
support groups . Guidelines on reporting mental
illnesses can be developed to ensure responsible journalism
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Mental Health Stigma Among Filipinos
among news agencies. Media prizes and awards may be
given to media outlets showing positive and innovative
representations of people with mental health problems
Culture and arts can also be incorporated in anti-stigma
awareness campaigns. Concerts, theater performances and
art exhibits focusing on mental illnesses are organized in
different parts of the world, all with the same goal of
diminishing stigma and discrimination. The World Health
Organization (WHO) compiled these efforts in a report on
global advocacy campaigns to end mental health stigma.
Some of the activities mentioned in the report were the Indian
theater play entitled, Mind Matters, which portrayed a
journey through a person's mind, and The Hidden Artist art
exhibition which showcased the paintings of persons with
mental illness from Israel. Events like these were included in
mental health festivals or fairs, wherein free diagnosis and
consultation services were also provided . In the
Philippines, a free art exhibit organized by the nonprofit
organization, NoBox Transitions Foundation, Inc., entitled Still
Life, featured the works of local artists with drug use and
addiction as the subject .
Other strategies done in the Philippines were mostly
spearheaded by private individuals and non-government
organizations. Students of the University of the Philippines
Manila College of Nursing initiated a fundraising event for
their psychiatric patients at the National Center for Mental
Health (NCMH); this event later prompted the students in
organizing other activities such as a symposium on mental
health awareness and a socializing event for the patients of
NCMH . According to a report by Corrales , the
Janssen Pharmaceutical Companies of Johnson & Johnson
has collaborated with the National Institutes of Health,
University of the Philippines Manila (NIH-UPM) and the
Foundation for the Advancement of Clinical Epidemiology,
Inc. (FACE) in creating the country's first integrated mental
health information system; this collaboration is a product of
the Into the Light project of Janssen aimed to promote
awareness and eliminate stigma towards mental illness. As
stated in the report, Prof. Maria Lourdes Amarillo, the project
leader of the mental health information system, said that the
identification of the magnitude of mental illness will be the
first step in ending stigma, thus, gathering baseline data will
result in the creation of effective solutions that will address
the needs of people with mental illnesses . The Philippine
Psychiatric Association (PPA) released awareness videos and
started the petition #MHACTNOW to encourage the public to
support the Philippine Mental Health Act of 2014 .
The mere avoidance of people in engaging in discussions
on mental illnesses has a lot to say about how it is perceived
by the public. There is undeniably high stigma associated
with mental illnesses in the country. These stigmatizing views
are translated in the way the public uses offensive labels in
describing mentally ill persons, as well as in equating them
with people, particularly politicians, who the public
considers dishonorable and undesirable. Moreover, media
reports of people with mental illness who are involved in
crimes are almost always overemphasized and lacking in the
information needed that will, at the least, attempt to explain
the rationale for their conduct. As a result, people with
mental illnesses are faced with enduring stigmatizing
attitudes and responses from the public which may further
exacerbate their mental well-being and compromise their
physical conditions and social relations.
Interventions which aim to reduce stigma can be
integrated in the community, school, workplace and other
settings. Promotion and education strategies are considered
effective and efficient means of increasing awareness of the
public on mental health problems. Targeted interventions
are b e lieve d t o b e m o re succe s sful due to the i r
responsiveness to individual needs. Creating events which
incorporate culture and arts is a more enjoyable and
interactive way of increasing awareness on mental illnesses.
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