Strengthening Community-Based Mental Health Through Local Governance and Barangays in the Philippines

Abstract

The Slovenian experience of establishing community-based mental health (CBMH) services, including expanding CBMH centers, securing funding, enhancing training, and involving mental health workers, offers a valuable example for the Philippines and other LMICs. It shows that community-based mental health reform needs professionals, empowered communities, and capable local leaders. This paper emphasizes the applicability of Slovenian insights in LMICs, using the Philippines as an example. It highlights the roles of barangay officials and BHWs in implementing CBMH, as they can bridge policy and practice, clinic and community, and stigma and understanding. Their effectiveness depends on clear mandates, ongoing funding, and culturally sensitive training that respects local beliefs and evidence-based care. Overall, the future of community mental health in the Philippines and other LMICs could involve transforming community resources, such as barangays, into recovery centers in which mental well-being is integrated into governance, culture, and community life.

Introduction

Mihevc and Galof ¹ provide insights into establishing community-based mental health (CBMH) services in Slovenia, such as expanding CBMH centers, sustaining funding, enhancing training, and ensuring the participation of mental health workers. Their insights offer guidance for countries transitioning from hospital-centered to community-focused care, ¹ including low- and middle-income countries (LMICs) like the Philippines. However, while the Slovenian context emphasizes structural and professional issues related to integration, ¹ LMIC settings introduce a unique cultural, economic, and governance layer. For example, in the Philippines, barangay (village), the smallest government administrative unit, leaders can serve as both the backbone and the bottleneck of community healthcare reform.^2,3

Community-Based Mental Health in the Philippines

CBMH marks a change toward greater accessibility, inclusion, and recovery-focused care.^2,3 In LMICs, this change is not just about clinical practices but also social and developmental aspects. The WHO highlights that mental health systems in resource-poor settings should be built on primary care and community networks, where people live and work. ⁴ In the Philippines, this strategy aligns with the Mental Health Act of 2018, which calls for integrating mental health services into the barangays.^{5 -7} Yet, despite this law, implementation remains inconsistent due to limited funding and resources, with many rural communities still depending on overburdened or inadequately trained barangay health workers (BHWs), the primary health workers of barangays, for psychosocial help.^{2,3,5 -7}

The Slovenian study highlights 3 issues, including defining the Occupational Therapists’ (OT) role, forming interdisciplinary teams, and obtaining sustainable funding. ¹ These issues reflect conditions in LMICs like the Philippines, though with fewer resources. In both settings, healthcare workers struggle with unclear responsibilities within newly formed CBMH teams.^{1,5 -7} However, the Philippines needs to expand this analysis beyond professionals to include lay governance actors, such as barangay captains (village leaders), barangay kagawads (village council members), and BHWs, who often serve as the first contact for residents in distress.^2,3,8 These barangay officials can hold dual roles as administrative leaders and informal health advocates. For example, they may also be tasked to promote vaccination in their communities.^2,3,8 Likewise, in practice, barangay officials’ endorsement can determine whether a mental health program succeeds or stalls. ⁹ For example, in Quezon City’s CBMH Program, barangay leaders who collaborated with local professionals achieved higher referral rates and reduced stigma through awareness campaigns and peer-support groups. ¹⁰ Conversely, in barangays where leadership views mental disorders as moral or spiritual issues rather than health concerns,^9,11 programs may struggle to maintain participation. This highlights how cultural beliefs and leadership attitudes significantly influence the success of CBMH.

The importance of integrating CBMH at the barangay level stems from its alignment with Filipino communal values like bayanihan (collective action) and malasakit (shared concern).^12,13 These cultural foundations can empower communities to offer mutual psychosocial support outside formal institutions.^12,13 BHWs often act as trusted intermediaries between families and the health system,^2,3,9 enabling them to identify individuals in distress, facilitate outreach, and reduce stigma through personal relationships rather than formal diagnoses.

Furthermore, including consultations with mental health professionals in barangay-level teams provides an opportunity to adapt international models effectively.^2,3,14 For example, OTs’ focus on meaningful activities and daily functioning complements the barangay’s close understanding of residents’ lives. ¹⁵ Together, they can develop interventions grounded in practical community practices, such as urban gardening for coping and social connection, livelihood projects for reintegration, and household-based therapy models that fit Filipino culture and family structures.^2,3,14,15

Challenges and Pathways Forward

However, challenges can hinder the integration of CBMH into the barangays. The first is role ambiguity. Just as Slovenian OTs struggle to define their roles within community teams, ¹ Philippine barangay officials may lack a clear framework for mental healthcare involvement.^2,3,9,16 Their usual mandates focus on peace, disaster response, and sanitation, while emerging mental health roles might be seen as additional tasks.^2,3,9,16 Without job descriptions, barangay captains and BHWs may either overstep (eg, providing untrained counseling) or withdraw completely, leaving residents with unmet needs.

The second issue is capacity and training. BHWs may receive limited orientation on mental health, often confined to brief lectures during Department of Health (DOH) seminars.^2,3,9,16 Unlike OTs or psychologists, they may lack the clinical grounding in assessment or intervention planning.^2,3,9,16 This gap can lead to inconsistent care or unhelpful practices such as forced confinement or reliance on faith healers, both of which are reported in the country’s rural communities. While Slovenia faces professional integration challenges, ¹ LMICs face a shortage of professionals in many localities. For example, there are only about 500 psychiatrists nationwide, serving more than 110 million Filipinos.^6,7

Third, funding and sustainability often remain difficult. Community mental health projects in the Philippines may depend on short-term grants from local governments or NGOs.^{17 -19} This situation is worsened by the historically small budget for mental health, which has only received around 5% of the country’s total public healthcare spending in the previous years.^{5 -7} Likewise, local governments have to balance competing priorities like disaster preparedness and maternal health, often placing mental health at the financial margins.^9,20 As a result, once funds run out, trained volunteers may return to their previous roles, and services may cease. Therefore, as the country moves toward CBMH, it is essential to establish policies that define the specific roles of barangay officials, provide culturally appropriate, comprehensive training, and allocate a greater share of the health budget to mental healthcare.

Nonetheless, some local governments demonstrate potential pathways forward that other barangays can replicate and adopt. For example, the National Center for Mental Health’s Mental Health Caravan trains officials, teachers, and students in basic screening, psychoeducation, and referrals in Palawan. ²¹ Meanwhile, in Quezon City’s CBMH Program, barangay leaders who partnered with local professionals continue their training for referrals and reduced stigma through awareness and peer-support initiatives. ¹⁰

Conclusion

Overall, this paper demonstrates how programs in the Philippines show how local governance, when supported by training and technical partnerships, can help implement community mental health initiatives. They embody the interdisciplinary and participatory ethos emphasized by Mihevc and Galof, adapted to a culturally distinct and resource-limited LMIC context. Such programs can serve as models for integrating culturally appropriate, resource-conscious CBMH in other LMICs.