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Mental health care for athletes in the Philippines
Article in The Lancet Psychiatry · December 2021
DOI: 10.1016/S2215-0366(21)00432-6
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5 authors, including:
Nicole Rose I Alberto
Michelle Ann Eala
University of the Philippines Manila
University of the Philippines Manila
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Katherine Donatela Manlongat
Josefina Ly-Uson
Palo Alto University
University of the Philippines Manila
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Correspondence
5
Currie A, Reardon CL, Gouttebarge V, et al.
Athlete mental health: future directions.
Br J Sports Med 2021; published online Aug 3.
https://doi.org/10.1136/bjsports-2021-104443.
Mental health care for
athletes in the
Philippines
For more on the 23rd meeting
of WHO’s Expert Committee on
Selection and Use of Essential
Medicines see https://www.
who.int/publications/i/item/
WHO-MHP-HPS-EML-2021.01
1034
During the Tokyo 2020 Olympics,
weightlifter Hidilyn Diaz became the
first Filipino to win an Olympic gold
medal. However, the journey to the
Philippines’ first Olympic gold was
not without its challenges, as Diaz
admitted to experiencing gripping
anxiety while training during the
COVID-19 pandemic.1
Mental illness is prevalent among
athletes.2 Unfortunately, the world of
competitive sports espouses the belief
that athletes should be mentally
tough, fueling the stigma of seeking
psychological support. For Filipino
athletes, this stigma is compounded
by poorly resourced mental health
care, where only 3–5% of the
country’s total health expenditure is
appropriated towards mental health,
resulting in high out-of-pocket costs.
Additionally, there is a shortage of
mental health professionals and
facilities in the country, with only
0·52 psychiatrists, 0·07 psychologists,
4·95 psychiatric hospital beds, and
0·02 community-based mental health
facilities per 100 000 people.3
Following Diaz’s historic victory in
Tokyo, Filipino athletes have received
mounting support from both public
and private sectors. As this movement
gains momentum, mental health
must be recognised as an essential
component of an athlete’s training. We
agree with The Lancet Psychiatry4 that
the mental health of athletes must be
prioritised as much as their physical
health.
Highlighting mental wellness
as a major contributor to athletic
performance, not only aiming
to reduce psychiatric symptoms,
might help circumvent athletes’
reluctance to seek professional help.5
A comprehensive and integrative
framework that is founded on holistic,
personal wellbeing, along with a
proactive approach to mental health,
must be pursued. Positive psychosocial
development should be encouraged
by teaching athletes adaptive coping
mechanisms, self-management skills,
psychological flexibility, and selfcompassion for inevitable high-stress
situations.2
Additionally, efforts must be made
to overcome barriers to accessing
mental health care in the Philippines.
Increased government funding for
mental health is key to reducing outof-pocket costs. It is likewise crucial to
train more mental health professionals
and develop more mental health
facilities across the country.
Robust support for the mental
health of athletes will spur the growing
acceptance and decreasing stigma for
mental illnesses. The passage of the
Mental Health Act in the Philippines
has paved the way for improving
mental health care nationwide, and
who better to champion mental health
than the very athletes who represent
the country on the world stage and
inspire both present and future
generations?
We declare no competing interests.
Nicole Rose I Alberto,
Michelle Ann B Eala,
Ana Beatrice D Constantino-Hernandez,
Katherine Donatela Manlongat,
*Josefina T Ly-Uson
jtlyuson@up.edu.ph
Department of Psychiatry and Behavioral Medicine
(JTL-U), and College of Medicine (NRIA, MABE,
ABDC-H), University of the Philippines, Manila,
Philippines; PGSP-Stanford PsyD Consortium,
Palo Alto, CA, USA (KDM)
1
2
3
Matel P. Hidilyn Diaz’s golden resolve proved
mental health matters in sports. ESPN. 2021.
https://www.espn.com/story/_/
id/32031828/hidilyn-diaz-gold-shows-whymental-health-matters-sports (accessed
Oct 6, 2021).
Reardon CL, Hainline B, Aron CM, et al. Mental
health in elite athletes: International Olympic
Committee consensus statement (2019).
Br J Sports Med 2019; 53: 667–99.
Lally J, Tully J, Samaniego R. Mental health
services in the Philippines. BJPsych Int 2019;
16: 62–4.
4
5
The Lancet Psychiatry. A sporting chance.
Lancet Psychiatry 2021; 8: 853.
Donohue B, Gavrilova Y, Galante M, et al.
Controlled evaluation of an optimization
approach to mental health and sport
performance. J Clin Sport Psychol 2018;
12: 234–67.
Expanding access to
long-acting
antipsychotics in
low-income and middleincome countries
At the 23rd meeting of WHO’s Expert
Committee on Selection and Use of
Essential Medicines, paliperidone
palmitate 1-monthly formulation was
added to WHO’s Essential Medicines
List. A square box symbol, next to
paliperidone palmitate, indicates
risperidone long-acting injection
as a therapeutic alternative. The
inclusion was supported by a 2021
network meta-analysis, which found
most long-acting antipsychotic
injections to be similarly acceptable
and effective to prevent relapse in
adults with schizophrenia-spectrum
disorders, with paliperidone palm­
itate (1-monthly and 3-monthly
formulation), olanzapine, and
aripiprazole showing the highest
effect sizes and certainty of
evidence. 1 Among these agents,
paliperidone palmitate was selected
for several reasons. As paliperidone
is a metabolite of risperidone, and
oral risperidone is already included
in WHO’s Essential Medicines
List, people on maintenance
treatment with oral risperidone
could easily switch to paliperidone
palmitate. Further, as opposed to
risperidone long-acting injection,
paliperidone palmitate does not
require refrigeration, and allows a
longer interval between injections,
which is of practical relevance for
constrained-resource settings. Finally,
its affordability is likely to improve in
the near future, considering that most
patents are about to expire.
www.thelancet.com/psychiatry Vol 8 December 2021
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