Integrated National Mental Health Policy Act

Policy, purpose, and objectives

Section 2 affirms the basic right of all Filipinos to mental health and the fundamental rights of persons who require mental health services.
Section 2 commits the State to ensure that mental health is valued, promoted and protected; mental health conditions are treated and prevented; and timely, affordable, high-quality, and culturally-appropriate mental health care is made available to the public.
Section 2 requires mental health services to be free from coercion and accountable to service users.
Section 2 requires persons affected by mental health conditions to exercise the full range of human rights and participate fully in society and at work, free from stigmatization and discrimination.
Section 3 directs the Act toward these objectives: strengthening mental health leadership and governance; establishing a comprehensive, integrated national mental health system responsive to psychiatric, neurologic, and psychosocial needs; protecting rights and freedoms of persons with mental health needs; strengthening information systems, evidence, and research; integrating mental health care into basic health services; and integrating mental health promotion strategies in educational institutions, the workplace, and communities.
Section 2 mandates strict State compliance with obligations under the United Nations Universal Declaration of Human Rights, the Convention on the Rights of Persons with Disabilities, and other relevant international and regional human rights conventions and declarations.
Section 2 expressly recognizes the applicability of Republic Act No. 7277, as amended, “Magna Carta for Disabled Persons,” to persons with mental health conditions as defined in the Act.

Core definitions

Section 4 defines “Addiction” as a primary chronic relapsing disease of brain reward, motivation, memory, and related circuitry, characterized by inability to consistently abstain, impaired behavioral control, craving, diminished recognition of significant problems, and dysfunctional emotional response.
Section 4 defines “Carer” as a person who maintains a close personal relationship and manifests concern for the welfare of the patient, whether or not the carer is the patient’s next-of-kin or relative.
Section 4 defines “Confidentiality” as keeping relevant information safe from access, use, or disclosure by persons or entities not authorized to access, use, or possess it.
Section 4 defines “Deinstitutionalization” as transitioning service users from institutional and other segregated settings to community-based settings enabling social participation, recovery-based approaches, and individualized care in accordance with the service user’s will and preference.
Section 4 defines “Discrimination” to include denial of reasonable accommodation and special measures solely to protect the rights or secure advancement of persons with decision-making impairment capacity.
Section 4 defines “Drug Rehabilitation” to include medical or psychotherapeutic treatment for dependency on psychoactive substances pursuant to Republic Act No. 9165 and may include diagnosed behavioral addictions such as gambling, internet, and sexual addictions.
Section 4 defines “Impairment or Temporary Loss of Decision-Making Capacity” as medically-determined inability to provide informed consent, including inability to: understand the nature of a mental health condition; understand consequences of decisions and actions; understand information about proposed treatment (methodology, direct effects, possible side effects); and effectively communicate consent for treatment or hospitalization.
Section 4 defines “Informed Consent” as consent voluntarily given after full disclosure in plain language by the attending mental health service provider of the nature, consequences, benefits, risks, and available alternatives.
Section 4 defines “Legal Representative” as a person designated by the service user, appointed by a court of competent jurisdiction, or authorized by the Act or other applicable law to act on the service user’s behalf, including by advance directive.
Section 4 defines “Mental Health Condition”, “Mental Health Facility,” “Mental Health Professional,” “Mental Health Service Provider,” “Mental Health Services,” “Mental Health Worker,” “Psychiatric or Neurologic Emergency,” “Psychosocial Problem,” “Recovery-Based Approach,” “Service User,” and “Support” and “Supported Decision Making” in the terms stated in the Act, including the detail that supported decision making is assistance for a service user who is not affected by impairment or loss of decision-making capacity to express mental health-related preferences, with safeguards against undue influence, coercion, or abuse.

Rights of service users and stakeholders

Section 5 provides that service users enjoy, on an equal and non-discriminatory basis, all rights guaranteed by the Constitution and rights recognized under relevant international and regional human rights instruments.
Section 5 expressly recognizes service users’ right to freedom from social, economic, and political discrimination and stigmatization by public or private actors.
Section 5 expressly recognizes service users’ right to exercise inherent civil, political, economic, social, religious, educational, and cultural rights without discrimination on specified grounds including physical disability, age, gender, sexual orientation, race, color, language, religion, nationality, ethnic or social origin.
Section 5 expressly recognizes service users’ right to access evidence-based treatment of the same standard and quality regardless of age, sex, socioeconomic status, race, ethnicity, or sexual orientation.
Section 5 expressly recognizes service users’ right to access mental health services at all levels of the national health care system and to comprehensive, coordinated treatment integrating holistic prevention, promotion, rehabilitation, care, and support through a multidisciplinary, user-driven treatment and recovery plan.
Section 5 expressly recognizes service users’ right to psychosocial care and clinical treatment in the least restrictive environment and manner, and humane treatment free from solitary confinement, torture, and other cruel, inhumane, harmful, degrading treatment, and invasive procedures not backed by scientific evidence.
Section 5 expressly recognizes service users’ right to aftercare and rehabilitation when possible in the community for social reintegration and inclusion; right to adequate information about available services; and right to participate in mental health advocacy, policy planning, legislation, service provision, monitoring, research, and evaluation.
Section 5 expressly recognizes service users’ right to confidentiality of information, communications, and records in any form or medium, with disclosure allowed only in the circumstances enumerated in Section 5(l).
Section 5 provides that service users must receive informed consent before treatment or care, including the right to withdraw consent, and that such consent must be recorded in the clinical record.
Section 5 provides service users’ rights to participate in development of the psychosocial care or clinical treatment plan; designate a legal representative (except where impairment or temporary loss of decision-making capacity applies); send or receive uncensored private communications and receive visitors at reasonable times (including the legal representative and Commission on Human Rights (CHR) representatives).
Section 5 provides that service users have a right to legal services through competent counsel of their choice, and where the service user cannot afford counsel, assistance is provided through the Public Attorney’s Office or a legal aid institution of the service user or representative’s choice.
Section 5 provides a right to access clinical records unless, in the opinion of the attending mental health professional, disclosure would cause harm to the service user’s health or put the safety of others at risk; it also provides the right to contest withholding through the internal review board or the CHR.
Section 5 provides that within twenty-four (24) hours of admission to a mental health facility, service users must be informed of the enumerated rights in a form and language understood.
Section 5 provides the right to file complaints of improprieties, abuses, and violations of rights, and to initiate investigations and actions against those who authorized illegal or unlawful involuntary treatment or confinement and other violations.
Section 6 provides rights of family members, carers, and duly designated or appointed legal representatives to receive appropriate psychosocial support; to participate (with service user consent) in individualized treatment plan formulation and implementation; to apply for release and transfer to an appropriate facility; and to participate in advocacy, planning, legislation, service provision, monitoring, research, and evaluation.
Section 7 provides rights of mental health professionals to a safe and supportive work environment; continuous professional development; participation in planning, development, and management of mental health services; contribution to standards for evaluating services; participation in development and review of policy and guidelines; control of practice aspects except in emergency situations; and advocacy for service users where the service user’s wishes conflict with those of family or legal representatives.

Treatment consent, directives, and decision support

Section 8 requires service users to provide informed consent in writing prior to implementation of any therapy or treatment plan (including physical or chemical restraint) by mental health professionals, workers, and other service providers.
Section 8 provides that 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 irrespective of the nature or effects of mental health condition or disability.
Section 8 provides children the right to express views on matters affecting themselves and to have such views given due consideration according to age and maturity.
Section 9 allows a service user to execute a signed, dated, and notarized advance directive setting out treatment preferences.
Section 9 provides that an advance directive may be revoked by a new advance directive or by a notarized revocation.
Section 10 allows a service user to designate a legal representative through a notarized document.
Section 10(a) requires a legal representative to provide support and help; represent interests; receive medical information in accordance with the Act; act as substitute decision maker when assessed to have temporary impairment of decision-making capacity; assist in exercising rights under the Act; and be consulted regarding treatment or therapy received.
Section 10(a) provides that appointment of a legal representative may be revoked by appointing a new legal representative or through a notarized revocation.
Section 10(b) permits a legal representative to decline to act; it requires a person who declines to take reasonable steps to inform the service user and the attending mental health professional or worker.
Section 10(c) provides the order of default legal representation if the service user fails to appoint one: spouse (unless permanently separated or has abandoned/been abandoned for an ongoing period); non-minor children; either parent by mutual consent if the service user is a minor; chief, administrator, or medical director of a mental health care facility; and a person appointed by the court.
Section 11 allows a service user to designate up to three (3) persons as supporters for supported decision making, including the legal representative, with authority to access medical information, consult on proposed treatment or therapy, and be present during appointments and consultations.
Section 12 mandates internal review boards in every public and private health facility to expeditiously review cases, disputes, and controversies involving treatment, restraint, or confinement.
Section 12(a) provides internal review board composition: a representative from DOH; a representative from CHR; a person nominated by an organization representing service users and their families accredited by the Philippine Council for Mental Health; and other designated members under implementing rules.
Section 12(b) gives internal review boards powers to review, monitor, and audit; inspect facilities; investigate upon receipt of a written complaint or petition filed by a service user or immediate family or legal representative, or motu proprio; and take necessary action to rectify or remedy violations, including recommending administrative, civil, or criminal case filing by the appropriate agency.
Section 13 establishes exceptions to informed consent during psychiatric or neurologic emergencies, or when the service user has impairment or temporary loss of decision-making capacity, permitting involuntary treatment or restraint subject to safeguards:
- In compliance with available advance directives unless doing so poses immediate risk of serious harm.
- Only to the extent necessary, and only while the emergency or impairment persists.
- Only upon the order of the attending mental health professional, reviewed by the internal review board within fifteen (15) days from issuance and every fifteen (15) days thereafter while continued.
- In strict accordance with guidelines approved by appropriate authorities containing clear criteria for application and termination, and with fully documented and regularly monitored, reviewed, and audited external-independent monitoring by the internal review boards.

Mental health service standards and delivery

Section 14 requires mental health services to be based on medical and scientific research findings; responsive to clinical, gender, cultural, ethnic, and other special needs; provided in the most appropriate and least restrictive setting; age-appropriate; and delivered by mental health professionals and workers in a way ensuring accountability.
Section 15 requires development and integration of responsive primary mental health services as part of basic health services at city, municipal, and barangay levels, with standards determined by DOH in consultation with stakeholders based on current evidence.
Section 15 requires every Local Government Unit (LGU) and academic institution to create its own program in accordance with the general guidelines set by the Philippine Council for Mental Health, and requires coordination among LGUs, academic institutions, and concerned agencies and the private sector.
Section 16 requires the national government through DOH to fund establishment and assist operation of community-based mental health care facilities in provinces, cities, and clusters of municipalities based on population needs, to provide appropriate services and enhance a rights-based approach.
Section 16 requires each community-based facility to have adequate room, office or clinic, a complement of professionals and allied professionals, support staff, trained barangay health workers (BHWs), volunteer family members, basic equipment and supplies, and adequate stocks of medicines appropriate at that level.
Section 17 requires LGUs, through health offices, to submit quarterly reports to the Philippine Council for Mental Health through DOH, including numbers of patients/service users attended and/or served, kinds of mental illness or disability, duration and results of treatment, and ages, genders, educational attainment, and employment, without disclosing identities.
Section 18 requires all regional, provincial, and tertiary hospitals (including private hospitals rendering services to paying patients) to provide psychiatric, psychosocial, and neurologic services including:
- short-term in-patient care in a small psychiatric or neurologic ward for acute symptoms;
- partial hospital care for psychiatric symptoms or difficulties tied to personal and family circumstances;
- out-patient services in close collaboration with existing mental health programs at primary health care centers;
- home care for special needs from long-term hospitalization, noncompliance or inadequacy of treatment, and absence of immediate family;
- coordination with drug rehabilitation centers for care, treatment, and rehabilitation of persons suffering from addiction and other substance-induced mental health conditions; and
- a referral system with other public and private health and social welfare providers to expand prevention and risk-management access.
Section 19 requires mental health facilities to establish policies and protocols minimizing restrictive care and involuntary treatment; inform service users of rights; provide admitted service users complete information about the treatment plan; ensure informed consent before medical procedures or treatment plans except for emergencies or impairment/temporary loss of decision-making capacity; maintain a register of all medical treatments and procedures administered; and ensure legal representatives are designated or appointed only after required observance of Act requirements and procedures respecting autonomy and preferences as far as possible.
Section 20 requires each local health care facility to be capable of conducting drug screening consistent with treating drug dependency as a mental health issue.
Section 21 requires mental health services to include mechanisms for suicide intervention, prevention, and response strategies with particular attention to youth, and requires twenty-four seven (24/7) hotlines for assistance to individuals with mental health conditions—especially those at risk of committing suicide—and strengthens existing hotlines.
Section 22 requires DOH and LGUs to initiate and sustain a heightened nationwide multimedia campaign to raise public awareness on mental health protection and promotion and rights, including elements such as mental health and nutrition, stress handling, guidance and counseling, and other mental health elements.

Mental health in education and workplace

Section 23 requires integration of mental health into the educational system by including age-appropriate mental health content in curricula 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 24 requires educational institutions to develop policies and programs for students, educators, and employees to raise awareness, identify and provide support and services for individuals at risk, and facilitate access including referral mechanisms for individuals with mental health conditions to treatment and psychosocial support.
Section 24 requires all public and private educational institutions to have a complement of mental health professionals.
Section 25 requires employers to develop appropriate workplace policies and programs to raise awareness, correct stigma and discrimination, identify and provide support for individuals at risk, and facilitate access to treatment and psychosocial support for individuals with mental health conditions.

Capacity building, research, and NCMH

Section 26 requires capacity building, reorientation, and training of mental health professionals, workers, and other service providers to develop ability to deliver evidence-based, gender-sensitive, culturally-appropriate, human rights-oriented mental health services emphasizing community and public health aspects.
Section 27 makes DOH responsible for disseminating information and providing training programs to LGUs, while LGUs with technical assistance from DOH train BHWs and other barangay volunteers on promotion of mental health, with DOH providing assistance on medical supplies and equipment needed for effective BHW functions.
Section 28 requires research and development in collaboration with academic institutions, psychiatric, neurologic, and related associations, and non-government organizations to produce information, data, and evidence for a culturally-relevant national mental health program incorporating indigenous concepts and practices.
Section 28 requires high ethical standards: research only with free and informed consent; researchers do not receive privileges, compensation, or remuneration for encouraging or recruiting participants; potentially harmful or dangerous research is not undertaken; and all research is approved by an independent ethics committee in accordance with applicable law.
Section 28 includes research and development relating to nonmedical, traditional, or alternative practices.
Section 29 requires expansion of the National Center for Mental Health (NCMH)—formerly the National Mental Hospital—as the DOH premiere training and research center for research and development of interventions on mental and neurological services.

Government duties and the Philippine Council

Section 30 requires DOH to: formulate, develop, and implement a national mental health program and create a framework for a Mental Health Awareness Program; regulate, license, monitor, and assess mental health facilities to ensure safe, therapeutic, hygienic environments and sufficient privacy; integrate mental health into routine health information systems with data disaggregated by sex and age and health outcomes including completed and attempted suicides; improve research capacity and academic collaboration including centers of excellence; ensure mental institutions uphold the right to protection against torture or cruel, inhumane, degrading treatment; coordinate with PhilHealth to ensure insurance packages equivalent to those covering physical disorders of comparable impact as measured by Disability-Adjusted Life Year or other methodologies; prohibit forced or inadequately remunerated labor unless justified as accepted therapeutic treatment; provide support services for families and co-workers and for service providers; develop alternatives to institutionalization; ensure internal review boards exist and that DOH promulgates rules for efficient disposition of proceedings; establish a balanced system of community-based and hospital-based mental health services from barangay to national levels; and ensure all health workers undergo human rights trainings.
Section 31 requires CHR to establish mechanisms to investigate, address, and act upon complaints of impropriety and abuse, especially involuntary treatment; inspect facilities; investigate involuntary treatment, confinement, or care cases for strict compliance with domestic and international standards; and appoint a focal commissioner for mental health empowered to protect rights of service users and those utilizing mental health services and to take necessary actions to rectify violations, including recommending administrative, civil, or criminal case filing.
Section 32 limits CHR investigative role to violations of human rights involving civil and political rights consistent with CHR powers and functions under Section 18 of Article XIII of the Constitution.
Section 33 requires DOH, CHR, and the Department of Justice (DOJ) to receive complaints and initiate appropriate investigation and action, and requires CHR to inspect places where psychiatric service users are held for involuntary treatment to ensure compliance with legal basis, quality of medical care, and living standards; it authorizes CHR to motu proprio file complaints against noncompliant institutions based on investigations.
Section 34 requires DepED, CHED, and TESDA to integrate age-appropriate mental health content, develop guidelines and standards for evidence-based mental health programs, pursue strategies promoting realization of mental health and well-being in educational institutions, and ensure mental health promotion is complemented by qualified mental health professionals.
Section 35 requires DOLE and CSC to develop evidence-based workplace mental health guidelines and policies addressing stigma and discrimination.
Section 36 requires DSWD to refer service users for appropriate care, provide or facilitate housing, counseling, therapy, livelihood training, and skills development programs, and—coordinating with LGUs and DOH—formulate and implement community resilience and psychosocial well-being training including psychosocial support during and after natural disasters and calamities.
Section 37 requires LGUs to review and develop regulations and guidelines for mental health within territorial jurisdiction including local ordinance consistent with national policy; integrate mental health into basic health services and ensure mental health is provided in primary health care facilities and hospitals; establish training programs for mental health service provider capacity; promote deinstitutionalization and recovery-based approaches; establish, reorient, and modernize mental health care facilities; provide or facilitate access to public housing, vocational and skills programs, and disability or pension benefits where independent living is not available; refer service users for care; and establish a multi-sectoral stakeholder network for identification, management, and prevention.
Section 38 requires each LGU, based on necessity supported by data from its local health office, to establish or upgrade hospitals and facilities with adequate and qualified personnel, equipment, and supplies for mental health services and addressing psychiatric emergencies, ensuring equal access in geographically isolated and/or highly populated and depressed areas through means such as home visits or mobile health care clinics as needed, and provides that national government shall provide additional funding and necessary assistance.

Philippine Council for Mental Health

Section 39 establishes the Philippine Council for Mental Health attached to DOH as a policy-making, planning, coordinating, and advisory body to oversee implementation of the Act, focusing on protection of rights and freedom of persons with psychiatric, neurologic, and psychosocial needs and delivery of rational, unified, and integrated mental health services responsive to Filipino needs.
Section 40 directs the Council to develop and periodically update a national multi-sectoral strategic plan; monitor rule implementation and conduct mid-term assessments and evaluations; ensure implementation of Act policies and issue orders or make recommendations; coordinate mental health promotion activities across agencies; coordinate data collection and research with foreign/international organizations; coordinate joint planning and budgeting; call upon agencies and stakeholders to provide data and information; and perform other necessary duties.
Section 41 provides Council composition: Secretary of DOH (Chairperson), Secretary of DepED, Secretary of DOLE, Secretary of DILG, Chairperson of CHR, Chairperson of CHED, one representative from the academe/research, one representative from medical or health professional organizations, and one representative from NGOs involved in mental health issues.
Section 41 provides that government members may designate permanent authorized representatives.
Section 41 requires that within thirty (30) days from effectivity, the President appoints academe/research, private sector, and NGOs members from a list of three nominees submitted by the organizations, as endorsed by the Council.
Section 41 sets terms of Council members representing the academe/research and private sector/NGOs at three (3) years, and provides that any replacement due to vacancy serves only the unexpired term.
Section 42 creates a Mental Health Division in the DOH under the Disease Prevention and Control Bureau, staffed with qualified mental health specialists and support staff with permanent appointments and adequate yearly budget, which implements the National Mental Health Program and serves as the secretariat of the Council.

Drug dependency and voluntary submission

Section 43 provides that persons who voluntarily submit for confinement, treatment, and rehabilitation under the voluntary submission provision and persons charged pursuant to Republic Act No. 9165 shall undergo examination for mental health conditions.
Section 43 provides that if found to have mental health conditions, such persons are covered by the provisions of the Act.

Penalties, liabilities, and enforcement

Section 44 imposes criminal penalties on any person who, upon conviction by final judgment, commits any of the following:
- failure to secure informed consent of the service user unless covered by the exceptions in Section 13;
- violation of confidentiality of information as defined under Section 4(c) / Section 1(e) as referenced in the penalty provision;
- discrimination against a person with a mental health condition as defined in the Act;
- administering inhumane, cruel, degrading, or harmful treatment not based on medical or scientific evidence as indicated in Section 5(b) as referenced in the penalty provision.
Section 44 provides the penalty range: imprisonment of not less than six (6) months but not more than two (2) years, or a fine of not less than Ten thousand pesos (P10,000.00) but not more than Two hundred thousand pesos (P200,000.00), or both, at the discretion of the court.
Section 44 provides that if the violation is committed by a juridical person, the penalty is imposed upon the directors, officers, employees, or other officials or persons responsible for the offense.
Section 44 provides that if the violation is committed by an alien, the alien offender shall be immediately deported after service of sentence without need of further proceedings.
Section 44 provides that the criminal penalties are without prejudice to the administrative or civil liability of the offender or the facility where the violation occurred.

Appropriations, IRR, separability, and repeal

Section 45 charges the initial implementation cost against 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 provides that for succeeding years, mental health amounts in the DOH budget and other agencies’ budgets with specific mandates are hashed on the Council’s strategic plan and coordination with stakeholders, and included in the National Expenditure Program (NEP) as basis for the General Appropriations Bill (GAB).
Section 46 requires the Secretary of Health to issue the Implementing Rules and Regulations (IRR) within one hundred twenty (120) days from effectivity, in coordination with