Lack of psychologists in gov’t hospitals hampers healing of abused children

Ella (not her real name) was brought to the child protection unit of the Philippine General Hospital (PGH) after a jeepney driver raped her when she was five years old. She was abused inside the jeepney where she and her family slept at night. A neighbor caught her abuser in the act.

Social workers immediately placed Ella in a shelter, which became her home in the next five years. There she was given therapy and provided counseling.

Based on assessments, Ella had delays in cognitive development. The social worker involved in Ella’s case said she repeated Grade 1 several times and eventually dropped out of school after her sophomore year because she couldn’t keep up with her classmates.

Ella lived with her grandmother after she left the shelter. Her mother then diligently accompanied her to counseling sessions. Fifteen years after the abuse, Ella, now 20, still attends sessions with her psychologists.

In many cases, management of an abused child’s mental and emotional well-being is a longterm engagement.

Ella’s plight underscores the importance of mental health interventions for abused children. But not all victims of child abuse get to have the same treatment. In government hospitals, the lack of mental health professionals specializing in child psychology hampers the effective treatment of children who have undergone trauma caused by abuse.

At the Child Protection Unit of the Philippine General Hospital ( CPU-PGH), scheduling an abused child for therapy may take anywhere from three to six months. As of late, there are a total of 460 patients waitlisted to be seen by the unit’s psychologists and psychiatrists, according to triage officer Jennalyn Casapao. (Triage is where patients are sorted according to the urgency of care required.) On average, CPU-PGH psychologists see 21 patients in a week, while the unit’s psychiatrists handle 16 patients weekly for counseling and therapy.

According to the World Health Organization, there are only two mental health professionals per 100,000 population in the Philippines.

Child psychologist Jason Barlaan says he is scheduled to see patients until March of this year. The same goes for one of his colleagues at the Mental Health and Wellness section of the CPU-PGH.

“At least we have a purpose for the new year. We already have something to do,” says Barlaan, who handles about four patients a day and spends an average of two hours per patient.

“If you’re dealing with kids, you’re also dealing with their parents,” he adds.

The unit’s psychologists and psychiatrists are the last persons to see an abused child after a social worker, police, and physician have examined the case. It is only then that the child undergoes psychological screening and is scheduled for counseling and therapy.

When a child is first brought to the CPU-PGH— usually by referral from the police, social welfare office of a local government unit (LGU), barangay officials, and private physicians—a social worker conducts an in-take assessment to get the basic details of the child and a safety assessment, which determines, among other things, whether or not it is safe for the child to go back home.

The doctor performs a medico-legal examination of the child to see if, for instance, the child contracted a sexually transmitted infection (STI). Depending on the findings, the doctor and social worker will commence a debriefing or safety planning, which includes medical follow-ups and psychological screening schedules. For highrisk cases—such as when a child exhibits risk-taking behavior or if the parents lack the capacity to protect the child—the social worker conducts a home visit within the next five days.

The entire process should take only one day from the time the child is initially brought to the CPU, says Annaliza Macababbad, supervising social worker at the CPU-PGH. With two doctors and two social workers, the CPUPGH receives an average of five cases of child abuse per day. On some days, the number can go up to 10.

Macababbad says the CPU adjusts schedules on a case-to-case basis. If the child is considered highrisk based on initial assessments, such as if the abuse happened within the past 24 hours or if the perpetrator still has access to the child, then he or she will be given priority.

CPUs use a toolkit called PTAQ, or Psychological Trauma Assessment Questionnaire, to determine who needs immediate psychiatric evaluation and those who can be given psycho-education, which even non-psychologists or non-psychiatrists can provide. During psycho-education, patients are told that it is not their fault. They are taught deep breathing exercises to help them relax. Doctors say this helps victims of child abuse begin to recover.

For other patients, the wait to see a counselor is too long. Macababbad says that there are some whose schedules are so far off, they’ve already forgotten about it by the time their turn came along. They simply don’t show up at all, while some parents don’t see the need for their children to undergo therapy anymore.