AT A GLANCE:

• Experts say the number of suicide cases and students with mental illnesses has risen drastically in the last two years with at least one suicide referral made each day
• Increased risk factors such as  breakdown of relationships coupled with a decrease in protective factors such as health lifestyles and rest can leave children increasingly exposed to mental health issues and vulnerable to suicide
• Urgent attention is needed to address the rise in mental illnesses and suicide cases among the youth

Part 1 of 2

MANILA, Philippines – “I would feel suffocated, then I felt like ants were crawling on my skin and on to my head, then I wouldn’t be able to stop crying. I resorted to pinching my arms just to distract myself from what was going on in my head,” recalled 22-year-old Bettina Jose.

“It was the only thing that reminded me that I was still breathing because I could still feel the pain in my forearms,” she added. 

Bettina was just 20 when she first attempted suicide. When the thought first entered her head, it was as though something had snapped. No weapons involved, she said, but the compulsion to commit suicide was intense.

That first time, she had come from an 8 am class presentation. Her mother found her 9 hours after she left home for school, lying in the university chapel. 

Nearly two years later, after much prodding and convincing from her family, Bettina sought treatment for anxiety and post-traumatic stress disorder. For almost two years, she battled with the anxiety attacks on her own. They only became worse over time.

“I was really convinced I was managing them and handling them well enough but my attacks never really went away and I would get so stuck in my head it would be much harder to do things I normally had no problems with in the past,” Bettina said. 

Sometimes the attacks would have triggers, other times they would not. But each time she ended up with the same kind of anxiety attack.

Even with treatment, Bettina admitted having entertained suicidal thoughts since that first attempt. Oftentimes, it was masked as having a grave and intense need to disappear.  

“In the times I’ve experienced that, I’m usually pushed by an intense feeling of isolation and desperation,” she said. 

To this day, Bettina said dealing with her mental illness remains a struggle. But creating her own mental health group, which she called Spring, gave her the courage and the community she needs.

“I’m not sure if it’s also the looming fear that it could go back to the way things were,” she said. 

Like Bettina, many students struggle with mental illness. Often, they can come as unknown desperate cries for help. 

Over the last 4 years, psychiatrist Dr Dinah Nadera, would receive urgent calls and messages from students asking to meet. Not holding regular clinic, Nadera had no idea how students got hold of her number. But one thing she knew: they needed help and had no one else to turn to. 

For the students, it was worth a chance: a message to an unknown number could lead them to someone who could listen and maybe guide them.

Nadera recalled some who contacted her felt pressured with school or had scholarships on the line. Other times, they had been referred to psychiatrists but with appointments scheduled months away. (READ: Student’s wish: More guidance counselors in school)

More often than not, students felt as though they were reaching a point where they had run out of options. So as long as they were at least 18 years old, Nadera would meet them – be it at a Jollibee branch or somewhere on campus. 

It was enough to prompt Nadera to move on from her work in public health and research to take on a new role as a psychiatrist at the University of the Philippines Diliman. 

“(That’s) the reason why I wanted to be here even if I would leave my other work. It’s because there is really a felt need,” she said. 

Nadera’s experience does not stand alone. It’s one echoed across the field of mental health practitioners in the Philippines. 

Psychiatrists, psychologists, and life coaches Rappler spoke to attested to the fact that in the last few years, suicide cases and mental illnesses among the youth have drastically increased.  

“At least one per day would come in the emergency room for a suicide attempt, one young person,” said Dr Constantine Chua, chief resident of the Philippine General Hospital (PGH) Department of Psychiatry and Behavioral Medicine in an interview with Rappler. 

Child psychiatrist Dr Norieta Balderrama from the PGH Child Protection Unit also said that she and roughly 80 child psychiatrists in the country have shared anecdotes from their practice indicating an increase in young patients who have suicidal thoughts or have attempted suicide. 

Many of them, she said, experienced depression.

Balderrama and other child psychiatrists noticed this as several schools would refer students who admitted to dealing with mental health issues. 

“We have a lot of this….One consultant said in one clinic day he has 5 children who are suicidal… in one clinic day, so it can go as high as (5), 2 to 3…one every day,” she said, adding that the past two years have been the busiest in her more than 20-year practice. 

For life coach Myke Celis, this turnaround was apparent in those who have sought his help – from those aged 25 or older, Celis said the majority of those he coaches are now aged 13 to 25 years old. 

Many of them experienced depression and anxiety, with some having entertained suicidal thoughts. 

Behind the rise

In the Philippines, the rise in the number of suicide cases and youth with mental health issues is brought about by a mix of social and biological factors.  (READ: How does the PH fare in mental health?)

However, a common theme stands out: disconnectedness and deterioration of relationships brought about by social media and technology. Experts said young people today tend to be more disconnected despite the internet supposedly opening up the world to everyone. 

“With all the social media, there’s just too many things to do; too many things to prove….Young people today tend to be very pressured, very stressed, live very complicated lives, and tend to be socially disconnected,” Chua said.

The lack of connectedness can often lead to a breakdown in relationships, which are crucial in fostering good mental health. A recent 2017 study published in the Association for Psychological Science also found that adolescents who spent more time online – such as social media – were more likely to report mental health issues.

“That sense of lack of social connectedness is very, very prevalent….They’re connected but they can’t seem to have a trusted person,” Nadera said.

This was echoed by Celis who observed that children nowadays do not always understand the difference between “true friendship” and belonging. “There’s a need to fit in and there’s a need to stand out and you tend to forget what really matters,” he said.

The breakdown in connectedness is often seen in high school and college students but Balderrama said it had already been observed even among elementary students.  

Meanwhile, relationships at home may not always be better either. Experts said many Filipino children also have parents who work abroad. Some of them experience increased busyness themselves, too.  

In addition, experts said children nowadays are also often exposed to events and information that older generations might have encountered at a later stage. For instance, Nadera highlighted the case of children who have gone through traumatic events such as armed conflict, sexual abuse, and even exposure to a more “chaotic” world.  

Coupled with high levels of stress from increased competition and school, these can have an impact on how children learn to cope as brain development may not be at a stage where one would know how to deal with changes and heightened expectations.  

Experts also observed this has often led to children with low self-esteem and high self-expectations. 

High risk  

While there is no one factor that causes these, the rise in mental illnesses and suicide cases can also be explained by what Chua described as a simultaneous increase in “risk factors” like social disconnection and weakened “protective factors” such as genuine relationships and healthy lifestyles. 

“If that happens for a long time then the mental health tends to be not so good, leading to different kinds of mental health conditions, which, of course, would predispose to suicide,” he said.  

Globally, the World Health Organization reported an average of 3,000 people who die by suicide daily – this translates to one suicide every 40 seconds. Suicide is also listed as the second highest cause of death among people between the ages of 15 and 29.  

Locally, there is no one figure for mental health and suicide cases as data is often scattered in different government agencies, and varies across years. Latest available data on the Philippines recorded by the WHO, however, reported over 2,000 cases of suicide from 2000 to 2012 with majority of individuals dying by suicide also aged between 15 to 29 years old. 

But beyond the numbers, experts said paying attention to mental illnesses among the youth remains urgent. 

“You also know it’s on the rise if you feel and see one person suffering and that story isn’t very different from others. You know it can happen to anyone,” Nadera said. 

Experts added the problem is not hard to fathom, with majority of people knowing at least one person who may be dealing with a mental health illness or even unstable mental health.

Balderamma added, “There’s always somebody we know. We communicate it as urgent because it cuts all strata and it cuts all professions.” – Rappler.com

READ: Conclusion | Is the Philippines ready to address mental health?

In the Philippines, the Natasha Goulbourn Foundation has a depression and suicide prevention hotline to help those secretly suffering from depression. The numbers to call are ‎804-4673 and ‎0917-558-4673. Globe and TM subscribers may call the toll-free number 2919. More information is available on its website.