QuestionsQuestions (Republic Act No. 11036)
The Act is known as the “Mental Health Act.” It establishes a national mental health policy to enhance delivery of integrated mental health services, promote and protect the rights of persons using psychiatric, neurologic, and psychosocial health services, and appropriates funds therefor.
Informed consent is consent voluntarily given by a service user to a plan for treatment after full disclosure in plain language of the nature, consequences, benefits, and risks of the proposed treatment, including available alternatives.
Service users have, among others, rights to freedom from discrimination and stigmatization, evidence-based treatment, access to affordable essential mental health services, treatment in the least restrictive environment, humane treatment, aftercare and community rehabilitation when possible, confidentiality, informed consent (including right to withdraw), access to clinical records (with limits), information of rights within 24 hours of admission, and to file complaints and seek investigations for violations and unlawful involuntary treatment.
Disclosure is allowed when: (1) required by law or court order; (2) the service user consents; (3) life-threatening emergency exists and disclosure is necessary to prevent harm; (4) the service user is a minor and the attending professional reasonably believes the minor is a victim of child abuse; or (5) disclosure is needed in an administrative, civil, or criminal case against a mental health professional/worker for negligence or breach of professional ethics to the extent necessary to adjudicate the issue.
All persons, including service users, persons with disabilities, and minors, are presumed to possess legal capacity for purposes of the Act regardless of the nature or effects of their mental health condition or disability.
During psychiatric or neurologic emergencies, or when the service user has impairment or temporary loss of decision-making capacity, treatment/restraint/confinement may be implemented under strict safeguards and only to the extent necessary while the emergency or impairment persists.
It must comply with the advance directive if available (unless immediate risk of serious harm), must be only as necessary and only while the emergency/impairment exists, must be ordered by the attending mental health professional and reviewed by the internal review board within 15 days and every 15 days thereafter while it continues, and must follow guidelines approved by appropriate authorities with clear criteria for application and termination and full documentation subject to regular external independent monitoring, review, and audit.
A signed, dated, and notarized advance directive sets the service user’s treatment preferences. It may be revoked by a new advance directive or by a notarized revocation.
A legal representative is designated by the service user, appointed by court, or authorized by the Act/law to act on the service user’s behalf. Functions include providing support and receiving medical information; acting as substitute decision-maker when temporary impairment is assessed; assisting the service user in exercising rights under the Act; and being consulted regarding any treatment/therapy received.
In order: spouse (unless permanently separated by decree, or abandoned/abandoned and such period has not ended); non-minor children; either parent by mutual consent if the service user is a minor; chief/administrator/medical director of a mental health facility; and a person appointed by the court.
Supported decision-making is assisting a service user who is not affected by impairment/loss of decision-making capacity in expressing mental-health-related preference/intention/decision. It includes safeguards against undue influence/coercion/abuse. Substitute decision-making occurs only when the service user has temporary impairment assessed, where the legal representative acts for the service user.
Purpose: to expeditiously review cases/disputes/controversies involving treatment, restraint, or confinement within facilities. Composition includes DOH representative, CHR representative, an accredited organization representing service users/families, and other designated members under the IRR.
It conducts regular review/monitoring/audit of restraint, confinement, or treatment cases; inspects facilities to ensure humane, non-degrading conditions; investigates involuntary treatment/confine/constraint cases motu proprio or upon written complaint/petition; and recommends/initiates necessary actions to rectify violations, including recommending filing of administrative/civil/criminal cases.
They must provide: short-term inpatient hospital care in a small psychiatric/neurologic ward; partial hospital care; outpatient services in collaboration with primary care mental health programs; home care services for special needs; coordination with drug rehabilitation centers; and referral systems with other public/private health and social welfare providers.
Facilities must: establish policies/guidelines/protocols minimizing restrictive care/involuntary treatment; inform service users of their rights; provide complete information regarding the treatment plan (including for voluntary admission); ensure informed consent prior to procedures/plan except in exceptions; maintain a register of treatments/procedures administered; and ensure legal representatives are designated/appointed only after Act requirements are followed while respecting autonomy/preferences as far as possible.
DOH develops general standards and guidelines with stakeholders; LGUs integrate responsive primary mental health services into basic health services, create local programs consistent with general guidelines, and coordinate with concerned agencies/private sector. DOH also funds/assists in establishing and operating community-based mental health care facilities with needed complement of professionals and support staff to provide appropriate services and rights-based care.
Imprisonment of not less than six months but not more than two years, or a fine of not less than P10,000 but not more than P200,000, or both, for acts such as: failure to secure informed consent (unless under Section 13 exceptions); violation of confidentiality; discrimination against persons with mental health conditions; and administering inhumane/cruel/degrading/harmful treatment not based on medical/scientific evidence.