Background: In recent years, both mental health (MH) and substance use (SU) have emerged as important issues among Filipinos. Not all clients need specialized services and can be treated in non-specialized settings. However, no previous study has examined integration of MH and SU in the Philippines. Objectives: This qualitative study explored the current practices, gaps, and potential for integration of MH and SU treatment in communities. Methodology: In-depth interviews were conducted among eight subject matter experts from five Department of Health (DOH) Centers for Health Development and three local government units. Data was analyzed using Framework analysis and the SAMHSA-HRSA Framework. Results: Findings suggest very low levels of integration of mental health and substance use services given inadequate resources and divergent policies and governance structures. However, findings show the potential for integration of community-based drug rehabilitation (CBDR) and community-based mental health (CBMH) especially for low and moderate risk clients. Conclusion: CBDR programs appear to be a promising model for care and lay the groundwork for implementation of CBMH. However, policy changes are needed to decriminalize drug use and implement an integrated flow for MH and SU. In addition, incorporating screening and early interventions in primary care are key to decreasing mental health inequity in the Philippines.
Diagnosis, Dual (Psychiatry) ; Philippines

OBJECTIVES: The objective of this study was to explore the explanatory factors on the length of stay of psychiatric patients in various mental health-related facilities. METHODS: Subjects in this study were consisted of 1,028 psychiatric patients staying in 22 mental health-related facilities randomly sampled after proportional stratification by regions. The subjects in 22 mental health-related facilities including psychiatric hospitals/clinics, psychiatric welfare facilities, welfare facilities for homeless, and illegal institutions were interviewed by psychiatrists and social workers with clinical experience. Demographic characteristics, socioeconomic support, diagnosis/history of illness, clinical symptom/functional disability and type of facilities were investigated and included in the multiple regression models to examine their influence on the length of stay. RESULTS: Two thirds of total variance of length of stay were explained by the independent variables in this study, and the type of facilities had the most explanatory power. In addition to type of facilities, sex, age, economic status, type of medical security, familial support, living condition before admission, diagnosis, dual diagnosis, age of onset of illness and number of admissions were significant explanatory factors. CONCLUSION: This study provides bases for specific strategies to develop efficient mental health facilities and community mental health system by disclosing the important explanatory factors for length of stay.
Age of Onset ; Diagnosis ; Diagnosis, Dual (Psychiatry) ; Humans ; Length of Stay* ; Mental Health ; Psychiatry ; Social Conditions ; Social Workers

Although obsessive-compulsive disorder (OCD) is recognized as a major psychiatric illness, few studies have investigated obsessive-compulsive symptoms in patients with schizophrenia. Recent increases in dual diagnosis due to changes to the DSMIV diagnostic criteria, findings of obsessive-compulsive symptoms (OCS) after administration of atypical antipsychotics, increased reports of co-occurrence of schizophrenia and OCD have increased the interest in OCS in schizophrenia. The incidence of OCS in patients with schizophrenia is reported to be 3-59%; however, the rate of progression to schizophrenia from OCD is not higher than in the general population. Level of insight, which differentiates obsessions from delusions, can be confounded by the specifier 'with poor insight' in OCD. OCD with schizotypal personality disorder or poor insight differs from pure OCD in that it responds poorly to treatment, has a poor prognosis, leads to deficits in cognitive functioning similar to those observed in schizophrenia, and responds well to low-dose antipsychotics. In the past, it was believed that OCS could prevent or delay the deteriorative course of schizophrenia. However, recent studies have shown that co-occurrence of OCD and schizophrenia increases the severity of symptoms, delays the treatment response, and reduces socio-occupational functions. Schizophrenia and OCD share the same pathophysiology in that both diseases have defects in the fronto-basal functional circuitry of the brain. The use of serotonin and dopamine has been addressed in schizophrenia due to the use of atypical antipsychotics in patients with schizophrenia. The finding of drug-induced OCS suggested that the two diseases share a similar pathogenesis involving neurotransmitters. Further studies are needed to make an exact diagnosis between the two diseases and to determine the common pathophysiology between OCD and schizophrenia.
Antipsychotic Agents ; Anxiety ; Brain ; Delusions ; Diagnosis, Dual (Psychiatry) ; Dopamine ; Humans ; Incidence ; Neurotransmitter Agents ; Obsessive Behavior ; Obsessive-Compulsive Disorder ; Prognosis ; Schizophrenia ; Schizotypal Personality Disorder ; Serotonin

PURPOSE: The aim of the study was to investigate associations of spiritual well-being, attitude toward death, and quality of life among Alcoholics Anonymous (AA). METHODS: This study was cross-sectional and descriptive in design. The data was collected from August to September 2018 with 133 AA members drawn from two provinces of South Korea. The data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Turkey tests, Pearson's correlation coefficients, and hierarchical multiple linear regression analyses using SPSS/WIN 20.0 program. RESULTS: The existential spiritual well-being (β=.52, p<.001), attitude toward death (β=.24, p<.001), dual diagnosis (β=−.17, p=.003), occupation (β=.12, p=.035) of the participants were significant factors, which explained 63.7% of the variance of quality of life. CONCLUSION: The study findings highlight the need to develop psychological nursing strategies to enhance the spiritual well-being and improve a positive attitude toward death based on the job and dual diagnosis among AA members to improve their better quality of life.
Alcohol-Related Disorders ; Alcoholics Anonymous ; Alcoholics ; Attitude to Death ; Diagnosis, Dual (Psychiatry) ; Humans ; Korea ; Linear Models ; Nursing ; Occupations ; Quality of Life ; Spirituality ; Turkey