Philippine Mental Health Act of 2018

Policy, objectives, and rights framework

The State commits to promoting well-being by ensuring mental health is valued, promoted and protected; mental health conditions are treated and prevented; and that timely, affordable, high-quality, and culturally-appropriate mental health care is made available to the public (Section 2).
Mental health services must be free from coercion and accountable to service users, and persons affected by mental health conditions must exercise the full range of human rights, participate fully in society and work, and be free from stigmatization and discrimination (Section 2).
The State must comply with obligations under the United Nations Declaration of Human Rights, the Convention on the Rights of Persons with Disabilities, and other relevant international and regional human rights instruments (Section 2).
The Act expressly recognizes the applicability of Republic Act No. 7277, as amended, or the “Magna Carta for Disabled Persons,” to persons with mental health conditions as defined in the Act (Section 2).
The Act’s objectives include strengthening leadership and governance; developing a comprehensive integrated national mental health care system; protecting rights and freedoms of persons with mental health needs; strengthening information systems, evidence, and research; integrating mental health care in basic health services; and integrating mental health promotion in educational institutions, workplaces, and communities (Section 3).

Key definitions for implementation

“Confidentiality” ensures relevant information about persons with psychiatric, neurologic, and psychosocial health needs is kept safe from unauthorized access, use, or disclosure (Section 4(c)).
“Discrimination” includes any distinction, exclusion, or restriction with the purpose or effect of nullifying recognition or enjoyment of human rights and freedoms on an equal basis, including denial of reasonable accommodation; special measures for protection or advancement of persons with decision-making impairment capacity are not deemed discriminatory (Section 4(e)).
“Informed Consent” is consent voluntarily given after a full disclosure communicated in plain language, covering nature, consequences, benefits, risks, and available alternatives (Section 4(h)).
“Impairment or Temporary Loss of Decision-Making Capacity” is a medically-determined inability to provide informed consent, including inability to understand the nature of a mental health condition, consequences of decisions, treatment information (methodology, effects, side effects), or to effectively communicate consent or relevant information (Section 4(g)).
“Legal Representative” is designated by the service user, appointed by a court of competent jurisdiction, or authorized under this Act or other applicable law, and may also be appointed through an advance directive (Section 4(i)).
“Mental Health Services” cover psychosocial, psychiatric, or neurologic activities and programs across promotion, prevention, treatment, and aftercare, provided by mental health facilities and professionals (Section 4(o)).
“Service User” refers to a person with lived experience of any mental health condition, including persons who require or are undergoing psychiatric, neurologic, or psychosocial care (Section 4(t)).
“Supported Decision Making” assists a service user who is not affected by impairment or loss of decision-making capacity to express mental health-related preferences, including safeguards against undue influence, coercion, or abuse (Section 4(v)).

Service user and stakeholder rights

Service users must enjoy all constitutional and human rights protections on an equal and nondiscriminatory basis, including the right to freedom from social, economic, and political discrimination and stigmatization by public or private actors (Section 5(a)).
Service users have rights including: access to evidence-based treatment of the same standard and quality; access to affordable essential health and social services; access to mental health services at all levels of the national health care system; and access to comprehensive coordinated treatment integrating prevention, promotion, rehabilitation, care, and support (Section 5(c)–(f)).
Service users must receive psychosocial care and clinical treatment in the least restrictive environment and manner, and must be protected from humane treatment violations such as solitary confinement, torture, and other cruel, inhumane, harmful, or degrading treatment and invasive procedures not backed by scientific evidence (Section 5(g)–(h)).
Service users are entitled to aftercare and rehabilitation when possible in the community for social reintegration and inclusion (Section 5(i)).
Service users must be given adequate information about available multidisciplinary mental health services and must be able to participate in advocacy, policy planning, legislation, service provision, monitoring, research, and evaluation (Section 5(j)–(k)).
Confidentiality is protected: disclosure is prohibited without the service user’s written consent or legal representative’s consent, except for specified circumstances, including legal/court-required disclosure; expressed consent; life-threatening emergency to prevent harm; when the service user is a minor and child abuse is reasonably believed; or when needed to adjudicate issues in cases against a mental health professional or worker for negligence or breach of professional ethics (Section 5(l)(1)–(5)).
Service users have the right to give informed consent before receiving treatment or care, including the right to withdraw consent, and such consent must be recorded in the clinical record (Section 5(m)).
Service users have participatory rights in the development and formulation of the psychosocial care or clinical treatment plan, and may designate a person of legal age as legal representative in accordance with the Act (except in cases of impairment or temporary loss of decision-making capacity) (Section 5(n)–(o)).
Service users are entitled to uncensored private communication and reasonable visitor access, including service users’ legal representatives and CHR representatives (Section 5(p)).
Service users must be provided legal services through competent counsel of their choice; when they cannot afford counsel, the Public Attorney’s Office or a legal aid institution must assist (Section 5(q)).
Service users have access to their clinical records unless a mental health professional opines that disclosure would cause harm to the service user’s health or put others at risk; withheld records may be contested with the internal review board or the Commission on Human Rights (CHR) (Section 5(r)).
Service users must receive information on their rights within twenty-four (24) hours of admission in a form and language understood by the service user (Section 5(s)).
Service users may file complaints with the appropriate agency about improprieties, abuses in mental health care, violations of rights, and to seek investigation and action against those who authorized illegal or unlawful involuntary treatment or confinement and other violations (Section 5(t)).
Family members, carers, and duly designated or appointed legal representatives have rights to receive appropriate psychosocial support from government agencies, participate (with the service user’s consent) in the individualized treatment plan, apply for release and transfer to an appropriate facility, and participate in advocacy, policy planning, legislation, service provision, monitoring, research, and evaluation (Section 6(a)–(d)).

Professional rights and treatment consent rules

Mental health professionals have rights including a safe and supportive work environment, continuous professional development participation, involvement in planning and management of mental health services, participation in development and regular review of standards, participation in mental health policy and service delivery guidelines, and (except in emergency situations) managing and controlling aspects of practice including whether to accept or decline a service user (Section 7(a)–(e), (f)).
Mental health professionals must be able to advocate for service users’ rights when the service user’s wishes conflict with family or legal representative wishes (Section 7(g)).
Service users must provide informed consent in writing prior to implementation of any plan or program of therapy or treatment, including physical or chemical restraint, by mental health professionals, workers, and other service providers (Section 8).
All persons—including service users, persons with disabilities, and minors—are presumed to possess legal capacity for purposes of the Act or any other applicable law, regardless of the nature or effects of their mental health condition or disability (Section 8).
Children have the right to express views on matters affecting themselves, and those views must be given due consideration based on age and maturity (Section 8).
A service user may set treatment preferences through a signed, dated, and notarized advance directive, and an advance directive may be revoked by a new advance directive or by a notarized revocation (Section 9).
A service user may designate a legal representative through a notarized document (Section 10).
A legal representative must (1) provide support and help, represent interests, and receive medical information under the Act; (2) act as substitute decision maker when the service user is assessed to have temporary impairment of decision-making capacity; (3) assist in exercising rights under the Act; and (4) be consulted regarding treatment or therapy (Section 10(a)(1)–(4)).
The appointment of a legal representative may be revoked by appointing a new legal representative or by a notarized revocation (Section 10(a)).
A person appointed as legal representative may decline to act, but must take reasonable steps to inform the service user and the attending mental health professional or worker of the decision (Section 10(b)).
If the service user fails to appoint a legal representative, the legal representative acts in this order: spouse (unless permanently separated by court decree, or unless spouse has abandoned/was abandoned for a period not yet ended), non-minor children, either parent by mutual consent if the service user is a minor, chief/administrator/medical director of a mental health care facility, or a person appointed by the court (Section 10(c)(1)–(5)).
A service user may designate up to three (3) supporters for supported decision making, including the legal representative; supporters may access medical information, consult with the service user regarding proposed treatment, and be present during appointments and consultations during treatment or therapy (Section 11).

Emergency exceptions and internal review boards

During psychiatric or neurologic emergencies, or when impairment or temporary loss of decision-making capacity exists, treatment, restraint, or confinement may be administered or implemented under Section 13’s safeguards (Section 13).
In applying emergency exceptions, compliance with available advance directives is required unless doing so poses an immediate risk of serious harm to the patient or another person (Section 13(a)).
Involuntary treatment or restraint may be used only to the extent necessary and only while the emergency or impairment/temporary loss of capacity exists or persists (Section 13(b)).
The attending mental health professional must order the intervention, and the order must be reviewed by the internal review board within fifteen (15) days from issuance and every fifteen (15) days thereafter while intervention continues (Section 13(c)).
Involuntary treatment or restraint must follow guidelines approved by the appropriate authorities containing clear criteria for application and termination and must be fully documented and subject to regular external independent monitoring, review, and audit by internal review boards (Section 13(d)).
Public and private health facilities must create internal review boards to expeditiously review cases, disputes, and controversies involving treatment, restraint, or confinement of service users within their facilities (Section 12).
Each internal review board includes: a DOH representative; a CHR representative; a person nominated by an accredited organization representing service users and their families through the Philippine Council for Mental Health; and other designated members as determined under IRR (Section 12(a)(1)–(4)).
Internal review boards must (1) regularly review, monitor, and audit cases involving treatment, confinement, or restraint; (2) inspect facilities to ensure service users are not subjected to cruel, inhumane, or degrading conditions or treatment; (3) investigate on its own initiative or upon written complaint/petition by a service user or immediate family/legal representative involuntary treatment, confinement, or restraint cases; and (4) take necessary action to rectify violations, including recommending administrative, civil, or criminal filing (Section 12(b)(1)–(4)).

Mental health services and community delivery

Mental health services must be based on medical and scientific research findings; responsive to clinical, gender, cultural, ethnic, and other special needs; delivered in the most appropriate and least restrictive setting; age appropriate; and provided by professionals and workers in a manner ensuring accountability (Section 14(a)–(e)).
Primary mental health services must be integrated into basic health services at appropriate levels, particularly city, municipal, and barangay; DOH sets standards in consultation with stakeholders based on current evidence (Section 15).
LGUs and academic institutions must create their own program in accordance with general guidelines set by the Philippine Council for Mental Health and coordinate with relevant government agencies and the private sector for implementation (Section 15).
The national government through DOH must fund the establishment and assist in operation of community-based mental health care facilities in provinces, cities, and clusters of municipalities nationwide based on population needs to provide appropriate services and enhance rights-based mental health care (Section 16).
Each community-based mental health care facility must have adequate rooms/offices/clinics and a complement of mental health professionals, allied professionals, support staff, trained barangay health workers (BHWs), volunteer family members of patients or service users, basic equipment and supplies, and adequate stock of medicines appropriate for that level (Section 16).
LGUs through their health offices must submit quarterly reports to the Philippine Council for Mental Health through the DOH, including numbers of patients/service users attended and/or served, kinds of mental illness or disability, duration and results of treatment, and patients’/service users’ age, gender, educational attainment, and employment—without disclosing identities to maintain confidentiality (Section 17).
Regional, provincial, and tertiary hospitals must provide psychiatric, psychosocial, and neurologic services, including short-term inpatient care in a small ward for acute symptoms; partial hospital care for those with psychiatric symptoms/difficulties; outpatient services in collaboration with mental health programs at primary health care centers; and home care services for special needs due to factors including long-term hospitalization, noncompliance or inadequacy of treatment, or absence of immediate family (Section 18(a)–(d)).
Hospitals must also provide coordination with drug rehabilitation centers for care, treatment, and rehabilitation of persons suffering from addiction and other substance-induced mental health conditions (Section 18(e)).
Hospitals must implement a referral system involving other public and private health and social welfare providers to expand access to programs preventing mental illness and managing risks of developing mental, neurologic, and psychosocial problems (Section 18(f)).
Mental health facilities must: establish policies/guidelines/protocols minimizing restrictive care and involuntary treatment; inform service users of rights under the Act and other pertinent laws and regulations; provide complete information on the treatment plan to every service user (including voluntary admissions); ensure informed consent is obtained before any medical procedure or plan of treatment or care except during psychiatric or neurologic emergencies or when decision-making capacity is impaired/temporarily lost; maintain a register of all medical treatments and procedures administered; and designate legal representatives only after complying with the Act’s requirements and procedures respecting autonomy and preferences as far as possible (Section 19(a)–(f)).
Each local health care facility must be capable of conducting drug screening as part of its mental health services duty and in line with treating drug dependency as a mental health issue (Section 20).
Mental health services must include mechanisms for suicide intervention, prevention, and response strategies with particular attention to youth, and must set up 24/7 hotlines for assistance to individuals with mental health conditions, especially those at risk of committing suicide, and must strengthen existing hotlines (Section 21).
DOH and LGUs must initiate and sustain a heightened nationwide multimedia campaign to raise awareness on protection and promotion of mental health and rights, including mental health and nutrition, stress handling, guidance and counselling, and other elements of mental health (Section 22).

Education, workplace, research, and capacity building

The State must integrate mental health into the educational system by requiring age-appropriate curriculum content at all educational levels and requiring psychiatry and neurology as subjects in all medical and allied health courses, including post-graduate courses in health (Section 23(a)–(b)).
Educational institutions must develop policies and programs designed to raise awareness on mental health issues, identify and provide support and services for at-risk individuals, and facilitate access and referral to treatment and psychosocial support (Section 24).
All public and private educational institutions must have a complement of mental health professionals (Section 24).
Employers must develop workplace policies and programs designed to raise awareness, correct stigma and discrimination, identify and support at-risk individuals, and facilitate access to treatment and psychosocial support (Section 25).
Mental health professionals, workers, and other service providers must undergo capacity building, reorientation, and training to deliver evidence-based, gender-sensitive, culturally-appropriate, and human rights-oriented mental health services, with emphasis on community and public health aspects (Section 26).
DOH must disseminate information and provide training programs to LGUs; LGUs with DOH technical assistance must train BHWs and other barangay volunteers on mental health promotion; and DOH must assist LGUs with medical supplies and equipment for effective BHW functions (Section 27).
Research and development must be undertaken with academic institutions, psychiatric/neurologic associations, and NGOs to produce evidence for a culturally-relevant national mental health program incorporating indigenous concepts and practices (Section 28).
Mental health research must meet high ethical standards: only with free and informed consent; researchers must not receive privileges or remuneration for recruiting participants; potentially harmful or dangerous research must not be undertaken; and all research must be approved by an independent ethics committee under applicable law (Section 28).
Research and development must also cover nonmedical, traditional, or alternative practices (Section 28).
The National Center for Mental Health (NCMH), formerly the National Mental Hospital, must expand capacity as the DOH’s premiere training and research center for interventions on mental and neurological services in the country (Section 29).

Government agency duties and Philippine Council structure

DOH must: formulate/develop/implement a national mental health program; coordinate a Mental Health Awareness Program framework; regulate, license, monitor, and assess mental health facilities and ensure safe therapeutic hygienic environments with sufficient privacy; integrate mental health into routine health information systems and use disaggregated mental health data including completed and attempted suicides; improve research capacity and academic collaboration including centers of excellence; ensure protection against torture or cruel/inhu mane/degrading treatment; coordinate with PhilHealth to ensure insurance packages equivalent to physical disorders comparable in impact measured by Disability-Adjusted Life Year or other methodologies; prohibit forced or inadequately remunerated labor in mental health facilities unless justified as therapeutic treatment program; provide support services for families/co-workers and for professionals/workers; develop alternatives to institutionalization, especially community recovery-based approaches; ensure internal review boards are established and promulgate rules for disposition of matters referred to or reviewed by such boards; establish balanced community-based and hospital-based services across levels; and ensure human rights trainings for health workers (Section 30(a)–(l)).
CHR must: establish mechanisms to investigate and act upon complaints of impropriety and abuse in involuntary mental health treatment/care; inspect mental health facilities; investigate all involuntary treatment/confinement/care cases for compliance with domestic and international standards; and appoint a focal commissioner for mental health to protect rights of service users and other persons using mental health services and to protect mental health professionals/workers, with authority to take necessary actions to rectify violations including recommending administrative, civil, or criminal cases (Section 31(a)–(d)).
CHR’s investigative role is limited to violations of human rights involving civil and political rights consistent with CHR powers under Section 18 of Article XIII of the Constitution (Section 32).
DOH, CHR, and DOJ must receive complaints of improprieties and abuses in mental health care and initiate appropriate investigations; CHR must inspect places where psychiatric service users are held for involuntary treatment and may file complaints motu proprio against noncompliant institutions based on investigations (Section 33).
DepED, CHED, and TESDA must integrate age-appropriate mental health curriculum content; develop guidelines and standards for age-appropriate evidence-based programs for public and private institutions; pursue strategies promoting mental health well-being in educational institutions; and ensure mental health promotions are adequately complemented with qualified mental health professionals (Section 34(a)–(d)).
DOLE and CSC must develop guidelines and standards for workplace evidence-based mental health programs and develop policies promoting workplace mental health and addressing stigma and discrimination suffered by persons with mental health conditions (Section 35(a)–(b)).
DSWD must refer service users to appropriate mental health services; provide or facilitate access to housing facilities, counselling, therapy, livelihood training, and skills development programs; and coordinate with LGUs and DOH to formulate and implement community resilience and psychosocial well-being training including psychosocial support during and after natural disasters and calamities (Section 36(a)–(c)).
LGUs must: review/formulate/develop regulations and guidelines for effective mental health care and wellness policy, including local ordinances consistent with national policies; integrate mental health services in basic health services and ensure services in primary health care facilities and hospitals; establish training programs to enhance providers’ capacity; promote deinstitutionalization and recovery-based approaches; establish/reorient/modernize mental health care facilities; provide or facilitate access to public housing, vocational training, disability or pension benefits where independent living is not available; refer service users to care; and establish a multisectoral stakeholder network for identification, management, and prevention of mental health conditions (Section 37(a)–(h)).
Each LGU, upon determining necessity using well-supported data from its local health office, must establish or upgrade hospitals and facilities with adequate qualified personnel/equipment/supplies for mental health services and addressing psychiatric emergencies, and must ensure equal access for people in geographically isolated and/or highly populated and depressed areas through means such as home visits or mobile clinics; the national government must provide additional funding and assistance for effective implementation (Section 38).
The Philippine Council for Mental Health is established as a policy-making, planning, coordinating, and advisory body attached to DOH to oversee Act implementation, particularly rights protection and delivery of rational unified integrated services (Section 39).
The Council must develop and periodically update a national multi-sectoral strategic plan; monitor implementation and undertake mid-term assessments and evaluations; ensure implementation of Act policies and issue orders or recommendations; coordinate mental health promotion among agencies and stakeholders; coordinate with foreign/international organizations regarding data collection, research, and treatment modalities for psychiatric/neurologic and substance use disorders and other addictions; coordinate joint planning and budgeting so funds are included in annual budgets; call upon agencies and stakeholders for data; and perform other functions necessary (Section 40(a)–(h)).
The Council consists of DOH Secretary as Chairperson; DepED Secretary; DOLE Secretary; DILG Secretary; CHR Chairperson; CHED Chairperson; and one representative each from academe/research, from medical or health professional organizations, and from NGOs involved in mental health issues (Section 41(a)–(i)).
Government members may designate permanent authorized representatives (Section 41).
Within thirty (30) days from Act effectivity, the President appoints academe/research, private sector, and NGO members from a list of three nominees submitted by organizations and endorsed by the Council (Section 41).
Those non-government members serve a term of three (3) years, and vacancies are filled for the unexpired term (Section 41).
A Mental Health Division must be created within the DOH under the Disease Prevention and Control Bureau, staffed with qualified specialists and support staff with permanent appointments and an adequate yearly budget, serving as secretariat of the Council and implementing the National Mental Health Program (Section 42).

Drug dependents and penalties

Persons who voluntarily submit under drug-related provisions and persons charged pursuant to Republic Act No. 9165, the “Comprehensive Dangerous Drugs Act of 2002,” must undergo examination for mental health conditions, and if found with such conditions, must be covered by the Act’s provisions (Section 43).

Penalty clause, IRR, appropriations, and clauses

Any person convicted by final judgment for committing any of the acts in Section 44 is punished by imprisonment of not less than six (6) months but not more than two (2) years, or a fine of not less than PHP 10,000 but not more than PHP 200,000, or both, at the court’s discretion (Section 44).
Punishable acts include: failure to secure informed consent (except for exceptions under Section 13); violation of confidentiality of information; discrimination against a person with a mental health condition; and administering inhumane, cruel, degrading, or harmful treatment not based on medical or scientific evidence (Section 44(a)–(d)).
If the violation is committed by a juridical person, the penalty is imposed upon directors, officers, employees, other officials, or persons responsible (Section 44).
If the violation is committed by an alien, the alien offender must be immediately deported after service of sentence without need of further proceedings (Section 44).
The penalties are without prejudice to administrative or civil liability of the offender, or the facility where the violation occurred (Section 44).
Funding for initial implementation is charged to the 2018 appropriations of the DOH for maintenance and other operating expenses of the national mental health program, capital outlay for development of psychiatric facilities among selected DOH hospitals, and formulation of the strategic plan for mental health (Section 45).
For succeeding years, funding for mental health in the DOH budget and other agencies with mandates under the Act is hashed on the Council’s strategic plan, its coordination with stakeholders, and included in the National Expenditure Program (NEP) as basis for the General Appropriations Bill (GAB) (Section 45).
The Secretary of Health must issue the Implementing Rules and Regulations (IRR) in coordination with CHR, DSWD, DILG, DepED, CHED, TESDA, DOLE, CSC, and with associations representing service users and mental professionals/workers, within one hundred twenty (120) days from Act effectivity (Section 46).
A separability clause preserves the validity of remaining provisions if any part is declared unconstitutional or invalid (Section 47).
A repealing clause modifies, supersedes, or repeals all inconsistent laws, decrees, executive orders, department or memorandum orders, and other administrative issuances or parts thereof (Section 48).