Mental health on the ground

By Herman M. Lagon

Some jobs are so woven into community life that we hardly notice them—until a crisis hits. Across the country’s barangays, Barangay Health Workers (BHWs) are the neighbors you know—dropping by to check your blood pressure, bring vitamins, or remind you about the kids’ vaccines.

In my recent presentation at the International Social Sciences and Humanities Conference (ISSHCON 2025) in Metrocentre Hotel in Tagbilaran City, Bohol, I argued that BHWs are more than just providers of basic health services. They’re also frontliners in a quieter battle—addressing the mental health struggles of women, struggles often invisible yet carried daily in the mind and body. The WHO notes that women globally face higher risks of mental health disorders, not just from biology but from economic pressure, social expectations, and environmental stressors. In the Philippines, these can mean caring for children and elderly parents while stretching a budget that’s never enough.

In Iloilo’s rural areas, where our study with ISUFST and DLSU JRIG partners Dr. Francisco Magno and Ms. Danela Dagdag focused, stressors multiply as jobs are scarce and social services thin. BHWs here aren’t distant professionals in white coats—they’re neighbors and friends who notice when a woman skips gatherings or grows unusually quiet. Sometimes the first sign emerges over small talk at a sari-sari store. One BHW recalled spotting “may mabigat” in a mother’s demeanor at a feeding program—a burden that turned out to be domestic violence. Without that safe ear, the woman might never have sought help.

Yet mental health is just one of many duties BHWs juggle—alongside TB tracking, dengue prevention, family planning, and even organizing summer circumcisions. All on modest, often delayed honoraria of ₱3,000–₱5,000. The irony is clear: we ask them to champion mental health while they themselves face constant stress.

Training is another challenge. While laws like the Mental Health Act, Iloilo’s Mental Health Ordinance, and the Magna Carta of BHWs mandate integration and benefits, the reality is patchy. Many sessions are one-off lectures with little focus on practical skills like psychological first aid or trauma-informed care. One BHW admitted she still wouldn’t know what to say if someone shared suicidal thoughts—her hesitation born not from apathy but from lack of tools.

And yet, resilience shows. Some keep informal “mental health logs,” drop by unannounced when concerned, or simply listen over coffee. These may seem small, but community health research shows such early, empathetic engagement can change outcomes. Applying Elinor Ostrom’s Institutional Analysis and Development Framework, we found that BHWs, when trusted to adapt, devise solutions suited to their community’s realities.

But goodwill alone can’t fix structural barriers: delayed pay, outdated materials, lack of technological support, and lingering stigma. Cultural norms still frame emotional distress as a private matter, and many women hesitate to seek help. Most BHWs are women too, carrying a “double burden” of community service and unpaid domestic work—making them both empathetic and vulnerable to burnout.

Strengthening this frontline requires timely pay, practical training, and tools for tracking and referral. Other countries offer models—India’s ASHA program, Ghana’s mobile midwife initiative—showing that investing in grassroots health yields real gains. The Philippines has its own promising pilots, like Mindanao’s integration of mental health into BHW training. For BHWs, like teachers, do transformative work in unmeasurable moments—a timely visit, a word of encouragement, a listening ear.

The question then isn’t whether BHWs can deliver gender-sensitive mental health care—they already do, often with little to work with. The real challenge is whether we will meet their dedication with equal support. This isn’t charity—it’s fairness. If we value community health, we must value the people who protect it through proper training, enough time, and fair pay.

So what can we do? We can’t just praise them while leaving them with outdated skills, delayed pay, and crushing workloads. We need to act.

First, pass and enforce real policies with funding and accountability. Second, make training practical, local, and gender-sensitive. Third, give them timely pay, manageable tasks, and mental health protection of their own.

Because in the end, this work isn’t about manuals—it’s about people: who delivers the care, how they’re trained, and the support they get.

In the end, BHWs are a mismanaged but deeply promising resource in building a fairer, more responsive mental health system. They already carry the trust of their communities and understand the struggles of those they serve. Now we must give them what they have long earned—training that works, support they can count on, and respect that matches their worth. Do that, and we give them more than the tools to care; we give them the power to transform lives, one quiet act at a time.

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Doc H fondly describes himself as a “student of and for life” who, like many others, aspires to a life-giving and why-driven world grounded in social justice and the pursuit of happiness. His views do not necessarily reflect those of the institutions he is employed or connected with.