But nothing had sent a singular shockwave of concern among city government officials of this highly-urbanised city as that particular suicide case in mid- May 2021: A young man in his early 20s ended his life right inside a campus dorm room turned as one of the city government-run temporary treatment and monitoring facilities.
Already he was recuperating from moderate symptoms of the coronavirus infection, set to be released from confinement, and yet his vulnerability succumbed to self-harm at the wee hours of dawn.
With the merest of details on the circumstances of the incident, Mayor Oscar Moreno expressed condolences with the grieving family at the daily noon time press briefing hours after the incident.
“We understand he was alone in the room. We respect the need of the family for privacy as they grieve,” he added.
He later directed the local mental health board to convene and review the circumstances of the incident and suggest steps to take so as to strengthen the mental health and psychosocial support services (MHPSS) at the more than 20 isolation and treatment units sited at hotels, inns, and campuses throughout the city so that suicide prevention be better enforced.
The mental health board is a multi-stakeholder body, an innovative adjunct to the local health board mandated under the Local Government Code. The board, composed of mental health care professionals, non-government leaders, and persons with lived experience of mental illness themselves,with advisory and recommendatory tasks under the office of the local chief executive, particularly on its mental health policies. It was formed way back in 2015 through an executive order that aligned with the national government’s Mental Health Action Plan, 2015-2021 at the Department of Health, which in turn, was in consonance with the Mental Health Global Action Plan (MHGAP) of the World Health Organization (WHO).
These policies at the global and national levels of governance, seek to empower local communities and health-care professionals to do their share in sustaining a mental health service program amid a dearth of psychiatrists and psychologists in poor and developing countries like the Philippines.
That seismic one-death-too-many moment also marked a dark milestone in the Oro government’s Covid response program.
More than a year after a community quarantine was declared on March 19, 2020 in the city, and hundreds of frontliners were mobilized to prevent the spread of the virus. Hundreds of city hall employees manned barangay health centers, hospitals, ports, airports, and roadside checkpoints, as volunteers to transport individuals to isolation units, cook meals for the confined or disinfect roads and buildings.
It was also the third week of the Covid vaccination campaign targeting frontliners, senior citizens, and the immunocompromised.
As breakthrough infections rose among frontliners, community transmissions also ramped up, causing three-digit reports of infected cases. In a few weeks, the number of active cases would breach the thousandth-mark, most of whom were housed in the isolation units as the hospitals raised the code red status, meaning all beds were almost taken. In less than two months, Cagayan de Oro suffered the worst surge of Covid cases and was declared under the Enhanced Community Quarantine. At its peak, there were more than 3,000 active cases in a single day.
“Burn-out and fatigue are real, we’ve nodded off. It was a wake-up shake for us to get wide awake again,” recalled Jaymee Leonen, director of the psychosocial division of the city social welfare and development office.
As stipulated in the Bayanihan: We Heal as One National Covid Response Act, the isolation units and treatment facilities must be provided with MHPSS (mental health and psychosocial support services).
These tasks fell mainly on the shoulders of the understaffed and underfunded psychosocial division as the city health office focused on the nitty-gritty of dealing with Covid cases as well as its other health programs focusing on major diseases. Besides, the Mental Health Act (Republic Act 11036) also mandates that the City Social Welfare and Development’s psychologists and social workers must provide post-disaster stress debriefing and psychological first aid to populations hit by calamities like this disease outbreak as well as fires, earthquakes,and typhoons.
By the end of that week in May 2021, the loopholes were addressed as two dedicated hotlines were made available exclusively for those who were housed in the government facilities, including those Covid positive but asymptomatic, or exhibiting mild or moderate symptoms.
Previously, three other lines provided counselling on a sundry of mental health-related issues, including domestic violence, referrals to in-depth therapies, among others.
These lines are on top of other measures, including keeping infected persons together in wider ward-like spaces such as dormitories in groups of 10s instead of keeping single individuals solitary in separate bedrooms. Nursing staff went on monitoring rounds at night and dawn, more watchful of specific at-risk individuals like youths, the immunocompromised and those living with mental health disorders.
The WHO, along with scientists and medical professionals had warned of a spike in mental health problems, such as cases of suicidality, which had already worried officials as early as prepandemic January 2020.
Globally, 800,000 die by suicide, pre-pandemic data shows. The significance of addressing suicide-related crises is highlighted by the inclusion of suicide rate as an indicator of mental health and well-being in the Sustainability Development Goals (SDGs). Under the SDG #3, suicide rates are targeted to be reduced to a third of 2016 data by 2030.
In an article in The Journal of Public Health, Jeff Clyde CORPUZ, a professor at De La Salle University, rang alarm bells as historically suicide rates rose during disease outbreaks as the 1918-19 influenza epidemic in the USA and the 2003 severe acute respiratory syndrome (SARS) outbreak in Hongkong.
Corpuz also wrote that the Philippine Statistics Authority (PSA) saw a 25.7 percent rise in deaths by self-harm in 2020,the start of the pandemic, as compared to data in 2019.
Suicide rates in Oro increased slightly, from 2.3 in 2020 (18 cases), to 2.45 (19 cases) in 2021, data gathered by the Cswd show.
In Northern Mindanao, with 123 cases in 2021, suicide rate was calculated at 2.5, an increase of point 5 from the previous year’s 2.0.
The PSA however has noted that the country’s suicide rate remained at 2.2, from 2016 to 2019.
“The trends (in Cagayan de Oro) show that they are getting younger. Ga kabanata, the youngest is a nine-year-old,” said Leonen, at a forum in September 2021.
Her insight presaged the WHO findings that suicidal behaviors among children and young adolescents (aged 20 years and below) were on the rise globally even as global suicide rates are stable during the early part of the pandemic.
Dr. Ginger Ramirez, who monitored youth suicides in the country also saw a sharp rise (58 per cent) in the number of youth suicides, from January to October 2020, as compared to 2021 data of the same period.
(Kids in the neighborhood gather to watch some funny videos on Youtube from a single smart phone connected to a WiFi signal from a nearby Internet cafe. According to the World Health Organization, there is evidence that self-harm among children and adolescents are on the rise during the Covid-19 pandemic. In the Philippines, cases of deaths by self-harm among the youths rose by 57 percent. Photo by LSReyes)
But according to a WHO briefing paper issued in March 2022 available national data from several countries showed that no increase in suicide rates ensued in the early months of the pandemic though prevalence is on the rise among the young.
Meanwhile, a critic of the city government’s Covid-19 response strategies, however insisted that these are only stopgap measures and “the real faultline lies in the use of private commercial establishments as hotels instead of empowering barangays and neighborhoods to establish community-based facilities as envisaged in the Bayanihan Act.”
“We are not used to leave our sick and ill alone. That is so Westernized. Our culture is more of a caregiving culture. Isolating the sick like this in a strange environment invites despair and depression, and alienation and anomie. We give them(the sick) attention and presence which are denied those pandemic due to the viral contagion,”she said,adding that Covid funds were centrally handled by city hall, leaving most barangays empty-handed and disempowered throughout the pandemic.
According to Leonen, the trends in the previous years indicate that more children as young as 9 years old are reporting suicide ideation.
Leonen attributed it to the pandemic impact on family life and social relationships.”Distressed parents begets distressed children.”
Meanwhile, awareness of the exclusive crisis hotlines were further enhanced by placing the contact phone numbers in leaflets handed out to clients as they checked into facilities.
Not for long though these lifelines were however disrupted around late July till early September when these lines were burned to communicate with cash-strapped families competing to receive cash grants to stave off hunger as the local economy was on a standstill because of the ECQ status.
The cellular phone lines were then flooded with calls and text messages from thousands of angry citizens who felt discriminated and excluded from the controversy-ridden distribution of the cash grants.
Leonen begged for sobriety and compassion for the caregivers as surreally, the phone messages turned into online abuse, filled with obscenities and threats, which spilled into the discussion threads of the psychosocial division’s Facebook posts.
As this was happening, those confined at the isolation rooms and wards could no longer avail of the counselling services.
“I kept on calling the numbers since day one but someone would have pushed the end button. It happened for days,” Rowena Taperla, 28, recalled her experience when she was confined for 10 days at an isolation unit.
Despite their unavailability, the exclusive lines were still announced and shared for several weeks during the daily briefings. Obviously there was a disconnect between the CSWD and the information staff hosting the briefings as the latter was not informed of the disruption of services.
The mixed-up would be corrected only in September.
Asked for suggestions on how to improve the lifeline, the young woman professional said that the service, and so must the other hospital-based telehealth services, must be made available 24 hours a day, 7 days a week. Presently, telehealth services however are only available during office hours, 8 am-5 pm, Mondays to Fridays.
Under the Mental Health Act (RA 11036) , suicide prevention hotlines are mandated to follow this 24/7 dictum.
“The night makes people more vulnerable,” the former cultural worker explained when asked why she thought night duty is necessary.
Quoting the writer Diane Ackerman who volunteered for the night shift of a suicide prevention center in the 1990s, she further said,” As Ackerman observed, ‘people are most alone at night. They drink until they fill their minds with darkness FOREVER. PThey have the pre-dawn crazies…If they can just get through till daybreak, the gloom might just break a little, and familiar people and routines offer hope.”
Fortunately, other private volunteer groups are filling the gaps by providing telehealth services via social media like The Cagayan de Oro Mental Health Hour and Kamusta Youth Online Chat.
So far, only the DOH Kamusta Ka Hotline phone and social media lines are truly 24/7.
Three shifts of trained counsellors are manning three lines. By September 2021, the latest data indicated that around 15,000 calls had been received by the service, or around 25 calls per day, which could last for at least 5 minutes to an hour.
But Maria Dolores Mercado, DOH 10 regional coordinator on mental health, also urged that family members and friends can become lifelines themselves, as force multipliers, to be listeners and witnesses so that sufferers may not rely on crises lifelines. “If we cultivate the art of listening to these people, the call lines should serve as only the last resort,” she said.
“Usually these people would tell people their stories, their fears, their problems. They need a listening ear.”
“If any of your friends or a family member, would tell you they are suicidal, take them seriously. Do not dismiss them as ka-dramahan or just a mere joke. You must listen without judgment. Give them options, show and convince them they are not alone,” she suggested.
Another aspect that needs to be addressed is postvention, an activity that reduces the risk of suicide and debriefs the surviving and grieving family and friends in the aftershock of a sudden completed suicide. Or also, individuals whose attempt to end their lives did not succeed might also need support to process their lives.
As licensed social worker Ken Norton quoted, “It is said that a suicide dies but once and yet the survivors of the lost lives die a thousand deaths in the aftershocks of grief, guilt and shame.”
Postvention is considered “the third leg to the 3-legged stool of addressing a suicide crisis” , aside from prevention and direct intervention but it is rarely included in programs such as this.
At present, primary vaccinations in the city has reached beyond 100 per cent for the target sectors. Booster shots continue to be administered to target groups. The schools have re- opened for face-to- face, in-person classes.
The isolation units and temporary treatment facilities have reverted back to back-to-normal business, serving tourists and travellers as hotels and inns. But the city’s infirmary in Barangay Lumbia, the JR Borja General Hospital and Treatment Facility in Barangay San Simon–built and or refurbished with pandemic funds, and other private hospitals had all increased bedspaces, in preparation for another surge in the future.
The daily Covid- positives are either zero or in low single digits. There are barely a 100 active cases, mostly in isolation in their homes.
Also, as pointed by Leonen, the Sanggunian had approved, as its swan song, before their term ended in June, the much-awaited Mental Health Ordinance, which is a community-based service delivery program with the City Health Office at its helm.
The ordinance operationalizes the policies for local government’s roles laid out in the RA 11036.
With the imprimatur of the legislative body comes appropriate funding for more staff, more counsellors to man the lifelines and serve the communities. This, as well as funding for training barangay health workers on psychological first aid and suicide prevention, and building facilities for the mentally ill in barangays as well as free psychotropic medicines and mental health-care insurance.
The implementation of the Mandanas ruling this year heralds a bigger budgetary hoard for the LGU, and ensures that its mental health projects are funded.
But this September, ironically, suicide cases clustered during and after Suicide Prevention Awareness Day, Sept 9th.
A rash of 8 completed suicide incidents and 2 attempts within a week brought mid- year incidences at 16, with 10 attempted cases. With three more months to go before the year ends, it is predicted that the number of suicides in 2022 will far exceed last year’s 19 cases.
Leonen and Mercado both agree however that an ongoing challenge remains that of reining in the media as their coverages of suicide cases, especially of radio stations, become more of a sensatinalized feeding frenzy that violates ethical protocols and this risks social contagion or copycat cases.
But Leonen trusts that sooner, with frequent reminders from mental health advocates, the media will fulfill its essential role to carry on its tasks to rally people to choose #hawidlaum: holding on to hope.
Part 2: Radio’s role in suicide prevention and risk reduction.
This story was produced with a Health and Governance fellowship from the Philippine Press Institute (PPI) under the auspices of the Hanns Seidel Foundation-Philippines (HSFP). The contents of this story are the full responsibility of the reporter and do not reflect that of the publisher, PPI nor of HSFP.