Journal of Clinical Psychology and Neurology

Techno-Psych Serv: Technology-Based Psychological Services Applied to Selected Male and Female Adolescents and Adults with Special Needs

Marissa C Esperal* and Michelle V Ramirez

Techno-Psych Serv: Technology-Based Psychological Services Applied to Selected Male and Female Adolescents and Adults with Special Needs

Marissa C Esperal^* and Michelle V Ramirez

Southern Luzon State University, Lucban, Quezon, Philippines

^*Corresponding author
Marissa C. Esperal, Southern Luzon State University, Lucban, Quezon, Philippines.

Introduction
Face-to-face interactions have been restricted for a couple of years due to COVID-19 pandemic. It was one of the strict mitigation measures made by the Inter-Agency Task Force for Emerging Diseases (IATF) to slow down the transmission of the deadly virus. This greatly affected people regardless of age, sex, identity, and status. This caused the at-risk population to start experiencing symptoms of mental health problems like fear, doubt, boredom, frustration, anger, withdrawal, and so on. Visiting mental health clinics and offices became as scary as visiting a COVID-19 facility. This adds to the fear, anxiety, sadness, and depression of the at-risk people. It then becomes an irony that those people who need psychological assistance and services can hardly avail of them at the time they most need it. 

With the advent of technology-based interactions, this research cum extension project anchored on the IATF guidelines on the practice of health protocols, that instead of doing the assessment, counseling, and psychotherapy or any interventions face-to-face, these processes might be done virtually or through the use of telephone or via the internet. Many important services even those which are very vital like health services were transformed into technology-based processes and operations. This alternative mode of availing health services may initially appear costly due to the cost of installation of vital facilities yet in the long run, if the government would like mental health services to reach even the far-flung areas, the application of technology in assessment, counseling and therapy services for the needy clients may prove more practical and more encompassing, and hence, inclusive. The government has invested in this in education already through the introduction of online learning or flexible learning modes. The proponents believe that we have come to the point when ICT facilities become one of the easier and faster option because the safety of our people is at stake due to the pandemic. 

With the increasing need for human resources to handle cases of children and youth and the marginalized population with mental health issues and the meager financial resources to sustain the mental health services given to these types of clients and their respective families, the creation of an online structured environment and online help desk is such a good and practical alternative to deliver the mental health services that the surrounding communities need. The cost of therapy sessions with an equivalent psychotherapist range from Php 500.00 to Php 2,000.00 per session and most of the time, one session is not enough for an intervention. On the other hand, the ordinary psychological assessment may cost about Php 2,000.00 to Php 10,000.00, depending on the complexity of the syndromes experienced by the client. Some cases of mental health problems require close monitoring and supervision of a mental health professional for longer periods and sometimes, for a lifetime just like some medical conditions that require maintenance. This project, aimed at catering to the psychological services needs of a group of people in society, most of them experienced mild symptoms of anxiety and depression but for some valid reasons could not avail of the dire need for in-person psychological services.

Objectives
General Objective
This research cum extension project aimed to determine the effectiveness, relevance and applicability of the technology-based mode of delivering psychological services to selected male and female adolescents and adults with special needs.

Specific Objectives
Specifically, this project attempted to:

1. Determine the background characteristics of clients who opt for technology-based mode of delivering psychological services;
2. Assess the relevance and applicability/usefulness of technology-based psychological services to the target clients;
3. Ascertain the effectiveness of technology-based psychological services applied to the target volunteer clients;

Research Hypothesis
This study tested the hypothesis that there is no significant difference between the pre-test and post-test scores of the volunteer clients who subjected themselves to techno-based psychological services. 

Review of Literature
Advances in technology created opportunities for mental health professionals like psychologists and counselors to provide online mental health services such as assessment, counseling, and psychotherapy as an option to the ordinary face-to-face mode of delivery [1]. Online psychological services such as online counseling can be traced back to the 1970’s [2]. However, even though the application of technology-based psychological services continues to grow, critics about this distance mode of delivering mental health services have risen. Despite its current popularity around the globe, issues as to whether the advantages of online counseling surpass those of offline counseling are still in controversy [2].

The review of related literature indicated various terminologies used to refer to technology-based psychological services. These are e-therapy or e-counseling, cybertherapy or cyber counseling, online or Internet-based counseling; e-mail therapy; web counseling [3-11]. Clough, B.A. & Casey, L.M. examined the impact of adjuncts or adjunctive technologies as used to enhance psychotherapy practice [12]. Adjunctive technologies refer to mobile phones, personal digital assistants, biofeedback, and virtual reality that are oftentimes used to reduce direct therapist contact. 

In this study, the term technology-based psychological services will be used to refer to mental health services offered through the use of adjunctive technologies such as cell phones, cameras, and other gadgets, application of online psychological assessment, online counseling or tele-counseling and online intervention or tele-psychotherapy. This research anchors on the concept of Turvey and Myers about Telemental Health which is accordingly a current health imperative and a solution to the widening gap between supply and demand for mental health services [13].

Several detailed definitions of technology-based psychological services are available in the related literature [14-16]. As a whole, these are mental health services that are provided to clients from a distance, making use of electronic gadgets like cell phones, e-mails, synchronous chatting, and videoconferencing. 

Even though technology-based psychological services have opened new and promising opportunities for both practitioners and clients, several issues are being posed against its application in practice. The most salient issues raised are internet connectivity in some areas, effectiveness, and ethical and cultural issues [16]. When it comes to advantages, the ease of access is considered at the top because techno-based counseling can be done anytime and everywhere as long as both parties agree [17,18]. This makes technology-based psychological services more applicable during this time of the COVID-19 pandemic like telemedicine. Another advantage is the possibility of using websites and related links or videos to help the client in the online session. Moreover, online chat records also serve as an emotional outlet and a healing medium for the clients and at the same time, a basis for counselors’ supervision and intervention [9]. Lastly, online psychological services are cheaper than face-to-face encounters [19].

Some disadvantages of technology-based psychological services were also identified. First, is the loss of human interaction which may lead to a decrease of the depth of the therapeutic relationship due to the absence of verbal and non-verbal communication cues [3,5]. Because psychologists and counselors may not directly see when the client cries empathy is hardly expressed [6]. This may consequently lead to misunderstandings [3]. Another disadvantage is related to the fact that since it is technology-based, internet connectivity and internet accessibility, most especially in far-flung areas, is an issue [20]. Added to this issue is the level of computer literacy of users which may result in inhibition of some needy clients Lastly, in reality, it is really hard to respond to crisis situations virtually [5,19,21].

The review of related literature and studies revealed a record of online counseling that focuses on different problems [4,7,22-24]. Most of the research results indicated that online counseling and interventions have positive outcomes. Research that focused on comparing the level of effectiveness of face-to-face counseling and online counseling proved that both types are effective [25]. The rest of the researchers found that online counseling is preferred over face-to-face counseling [26].

Based on the literature, the proponents came up with several researches regarding the application of technology-based psychological services. Most of the researchers found that telephone counseling is the most preferred medium by users [27]. Castro, A. et. al. found available evidence suggesting that telephone-delivered psychotherapy may be an effective strategy to reduce depression symptoms when compared to control conditions and shows adequate treatment adherence [28]. This is due to the subscribers’ belief that technology-based psychological services in general and text counseling in particular, have strong privacy protection. It was further revealed that patients with common psychopathology tend to opt for online psychological services rather than offline consultations.

Chan sought to compare online, offline, and integrated counseling (i.e., the combined use of online and offline counseling) in therapeutic outcomes, to shed light on the significance of largely developing online counseling in youth contexts in Hong Kong [2]. Quantitative results showed that integrated counseling was perceived as achieving the best outcomes among all three forms of counseling, while online counseling was better than offline counseling. As explained by qualitative analyses, online and offline counseling had their unique advantages which were complementary to each other: While online counseling dealt with individual, and psychological issues more effectively, offline counseling helped provide more substantial support in terms of real-time company and tangible resources.

Synthesis
Technology-based psychological services have been in the mainstream of mental health services for about seven decades now since it started in the 1970s. Not all experts in the field, however, have embraced the application and incorporation of adjunctive technologies in mental health practices. This gave rise to a divided opinion among themselves; while others promote techno-based delivery of psychological services; the other group questions its effectiveness and applicability. It has always been the case throughout history because human beings have their respective phases in embracing advanced technology and making them a part of their daily lives even in their practice profession. Planetary health has long been introduced as a part of the UN Sustainable Development Goals. Yet, for some, it’s not at all easy to incorporate in our lives the sudden shift from the traditional to the modern, from the manual to the technological, from face-to-face to virtual. The occurrence of the COVID-19 pandemic unintentionally and yet, forcefully gets us to shift gears. Online classes, if not modular or flexible learning suddenly became the mainstream, virtual meetings became our regular mode; telemedicine suddenly became the requirement. Amid reservations about technology-based psychological services, we have also come to a time when the only easier and more convenient choice is just to avail of psychological services online. For this reason, this Techno-Psych Serv Project was undertaken as one way of leveling up the services that the university can provide not just to its students and personnel but can still be extended to its surrounding communities. Indeed, technology-based delivery of mental health services makes our ministry faster, more convenient, more encompassing, and thus, more inclusive because technology can traverse distances, varied terrains, different economic status, and more importantly, it can traverse through a pandemic such as COVID-19.

Figure 1 presents the research paradigm that summarizes how this research project was conceptualized and undertaken. The focus of this research are those clients who need psychological services and opt for technology-based delivery of such services. The background characteristics of these clients were determined and stored in a database through the use of Google Forms and saved in Google Drive. Upon compliance with the ethical standards related to this kind of research, the technology-based psychological services were rendered to the selected clients depending on their prevailing needs. As soon as they finished availing the services, the clients were asked to evaluate the services they availed via Google Forms. The accomplished evaluation forms served as the research data of this study and were analyzed accordingly. Based on the overall evaluation of the project, a Manual of Operation and a Proposed Policy for the Provision of Technology-based Psychological Services in the identified municipalities in Quezon shall be prepared for endorsement to the concerned authorities.

Methodology
This research cum extension project attempted to ascertain the effectiveness and determine the relevance and applicability of the technology-based mode of delivering psychological services among volunteer clients. Part of the specific objectives was to determine also the background characteristics of persons who availed of technology-based psychological services. A mixed method of quantitative and qualitative design was employed in the study where descriptive survey through the use of self-made questionnaire, pre-test-post-test analysis and brief interview were combined to gather data. Initially, promotion and information dissemination about this Techno-Psych Serv (TPS) Project was done via a Facebook page. Participation was strictly voluntary and strict compliance with the research ethics policies was ensured. To protect the identity of the participants, clients used a code name that only themselves and the attending staff and counselor were aware of. For 22 months, a total of 203 clients have signed up for the Techno-Psych Serv Facebook page and accomplished the Informed Consent and Psychological Services Contract Agreement Form. The latter is a pre-requisite for availing the free online psychological services. Through the use of the Google Meet App, online interviews and consultations, online assessments, online counseling, and online interventions or online psychotherapy were conducted by the researchers themselves who are also registered guidance counselors and one is a licensed psychologist. The researchers also used available online psychological measures such as the Beck Depression Inventory, Generalized Anxiety Disorder Test, Self-Test for Anxiety, and some other brief measures for preliminary assessment. Participants who upon evaluation, were found to need more advanced and extended psychological services that the TPS cannot provide were referred to other mental health services clinics and institutions. The majority of the clients availed of 3-5 free online sessions while some exceeded the set limit and extended up to 7 online sessions which usually took about 45 minutes to 1 hour and 15 minutes.  A couple of questionnaires (in Google Forms) were used to assess the relevance and applicability of the technology-based services that were availed by the participants. The first questionnaire, the Client Information Questionnaire was answered by the client before the first session; while the second questionnaire was given/sent to every client after the termination of the counselor-client relationship. The completed evaluation forms and the results of the pretest and post-test served as the primary data that were analyzed by the researchers. For this study, the researchers addressed the second Research Objective based on the evaluation of the services which was answered by 97 clients after availing the technology-based services. The rest of the clients, though served well, were not included as participants in the study. Out of the 97 clients/participants, only 26 had completed the pre-test and post-test for the Generalized Anxiety Disorder Test and Beck Depressive Inventory. Thus, the third Research Objective was addressed based on the analysis of 26 clients/participants only. Data gathered from the study were analyzed through the use of percentage, weighted mean and t-test for dependent means [29-35]. 

Results and Discussions
The main objective of this university-based research cum extension project was to ascertain the effectiveness and assess the relevance and applicability of the technology-based mode of delivering psychological services to selected adolescents and adults with special needs. Part of the specific objectives is to determine the background characteristics of target clients who opt for technology-based modes of delivering psychological services.

The succeeding tables present the data that provides the answer to the specific Research Objective 1, that is, to determine the background characteristics of clients who opt for technology-based psychological services.

Table 1 presents the sex distribution of clients who signed up and availed of the online psychological services from the Techno-Psych Serv. It became apparent that the majority, 170 or 83.74% of the clients who signed up for technology-based psychological services are female and only 33 or 16.26% of the clients are males. This suggests a few possibilities that need further investigation: It may indicate that symptoms of mental health problems are more common among females than males. It is also possible that technology-based psychological services have a stronger appeal to females than males. It may also reveal that females who experience symptoms of mental health maladjustment have higher levels of self-monitoring, self-awareness, and help-seeking behavior than males.

Table 2 shows the age distribution of clients who signed up and availed of the technology-based psychological services rendered by the Techno-Psych Serv (TPS). The majority of the clients (73 or 35.96%) who availed of the services belong to the age range of 23-27 years old. This was followed by the age range of 18-22 years old which comprises 62 or 30.54%, while the age range of 28-32 years old got 28 or 13.79%. It can be noted that as the age range increases, the percentage of clients who availed the TPS services decreases. These findings just revealed that many of the clients who entrust themselves to online psychological services are in their early adulthood years. This supports what developmental psychologist, Elizabeth Hurlock pointed out that our early adulthood stage is bombarded with adjustment issues and since this generation does not yet have enough mental health resources, they are more open to seeking help from any available source. Moreover, it has been observed by the researchers that the late adolescent years and early adulthood period are also the populations that commonly subscribe to mass media, such as Facebook. With that, they have more exposure to the use of online platforms and can risk themselves to try these non-traditional ways of availing mental health services.

Table 3 shows the gender orientation of clients who availed the technology-based psychological services. It can be noted that the majority, 136 or 67% of those who availed the services at the Techno-Psych Serv are heterosexual, while 31 or 15. 27% are bisexuals; and 26 or 12.81% are homosexuals. It can be observed in this data that the need for psychological services is not just limited to the mainstream population; it is also present even among clients of various genders. There are 67 or 33% of the participants belong to the LGBTQ++ community.

Table 4 presents the highest educational attainment of the clients who availed of the technology-based psychological services. It shows that the majority, 90 or 44.33% of the TPS clients are college graduates. This was followed by clients who are still on their college levels or college students, comprising 68 or 33.5%; and then, senior high school graduates, comprising 19 or 9.36%, and a few high school graduates, Master’s degree holders, doctoral graduates, and elementary school graduates. It is evident in this data that the majority of those who availed of the technology-based psychological services are professionals and have attained higher education.

Table 5 shows the current occupation of clients who availed of the technology-based psychological services. Consistent with the data on the highest educational attainment, the majority of the clients are professional workers, comprising 90 or 44.33%. This is followed by the population of students, with 53 or 25.62%; then, followed by non-professionals and nonworking, comprising 49 or 24.14%. This data points out that the a considerable number of of those who were served by the Techno-Psych Serv Project have professional jobs and therefore, can be assumed to be capable of paying for mental health services. However, if the population of students, non-professionals and nonworking are combined, it can be noted that their total number is greater than the professional clients. It can be deduced from the data that these are the real targets of the project, those who may not be able to pay for psychological services.

Figure 2 shows the Regional Origin of the Techno-Psych Serv clients who availed of the technology-based psychological services. It can be noted that out of 203 clients at the Techno-Psych Serv, 101 or 49.75% come from Region IVA; 53 or 26.11% come from NCR and 17 or 3.45% come from Region III. It is worth noting that a couple of clients are Overseas Foreign Workers (OFWs) - one from Qatar and one from Taiwan. It is interesting to note that the TPS Project reached the different regions of the country and even outside of it.

Figure 3 presents the distribution of clients who availed of the technology-based psychological services per province in CALABARZON. It can be noted that there was a total of 101 clients from Region IVA who availed of the online psychological services at Techno-Psych Serv. It can be noted that the majority (64 or 63.37%) of clients came from Quezon Province. Few clients are distributed from the other provinces in the region, Laguna, Batangas, Cavite, and Rizal. It is further noted that 4 clients from Quezon are 4Ps beneficiaries.

Figure 4 presents the psychological services availed by the clients. The highest number of clients, 85 or 41.87% availed of consultation; 70 or 34.48% availed of tele-counseling, and/or psychotherapy services, while 58, or 28.57% availed of psychological assessment. It is noted that the majority of the clients who availed of online consultation with the counselors/psychologists availed of the other services as well. The usual starting point is consultation, then, followed by psychological assessment, and finally, tele-counseling or tele-psychotherapy.

Figure 5 presents the referral sources of the clients. Data shows that the majority, 79 or 38.92% of the respondents learned about the services via Facebook Post; while 68 or 33.50% learned about the services from friends; then, 21 or 10.34% are referrals from family members.

Figure 6 presents the chief complaints of the clients. It can be noted that anxiety and panic attacks, with a frequency of 74 or 36.5% topped the list. This was followed by depression, with 39 or 19.2%, emotional breakdown, with 34 or 16.7%, mental instability and sleeping problems, which both got 24 or 11.8%, and then, suicidal thoughts or suicidal ideation with 20 or 9.85%. The research findings support what the World Health Organization (WHO, 2022) reported that anxiety and depression are two of the most common mental health problems that prevailed during the pandemic and post-pandemic period. It can be further noticed that the top 6 chief complaints of the clients are interrelated and those fall into only 2 mental health issues which are either anxiety or depression.

To answer the specific Research Objective 2, a post-evaluation was conducted among the clients as soon as they ended their sessions with the Techno-Psych Serv. 

Range
0-0.75 Strongly Disagree 0.76-1.5 Disagree 1.60-2.25 Agree        2.26-3.0 Strongly Agree

Table 6 presents the summary of the evaluation of the clients on the services they availed at the Techno-Psych Serv. With an overall weighted mean of 2.80 (n=97), it can be deduced that the clients strongly agree with all the evaluation statements. They strongly agree that the online psychological services rendered to them by the TPS have helped them in their current situation, and gave them a sense of relief and relative healing. Moreover, it is accordingly as effective as traditional face-to-face counseling, it gives them insights that enable them to survive and overcome their troubles; it brings positive outcomes in their whole being; and inspires them to face the daily challenges in their life with hope and cheer. those are relevant and useful at present, most practical way nowadays, applicable to many clients, “in” to individuals. Finally, the respondents believed that it should be upheld and supported to ensure its sustainability. Finally, they recommend the TPS to relatives and friends whom they know need such services.

To answer Research Objective 3 and test the Null Hypothesis in this study, the Paired Samples Test of Differences was used for the analysis of the Pre-Test and Post-test data derived from the Generalized Anxiety Disorder (GAD) Test and the Beck Depression Inventory (BDI). This analysis is just based on the 26 participants who have completed the pre-tests and post-tests.

Samples Statistics Based on the Generalized Anxiety Disorder (GAD) and Beck Depression Inventory (BDI). As shown in the table above, the mean scores revealed that pre-test scores and post-scores are far different from each other by more than 5 units in both tests. The pre-test score means are greater than those of the post-test score means. However, standard deviations are very close. This means that the two variables have approximately the same level of dispersion or variation [36-37]. 

Table 8 presents the Paired Samples Correlations of the Pre-test and Post-test Scores in the Two Tests. The first test (GAD) correlation coefficient indicates that the pre-test scores and post-test scores are significantly positively associated. With a correlation coefficient equal to 0.683, it implies that the two variables have moderate to strong associations at 0.01 level of significance. On the other hand, the second test (BDI) correlation coefficient indicates that the pre-test scores and post-test scores are significantly positively associated. With a correlation coefficient equal to 0.395, it implies that the two variables have moderate to strong associations at 0.05 level of significance.

Table 9 presents the Paired Samples Tests of Difference in the pre-test and post-test data from GAD and BDI. As presented in the table above, there are significant average differences between pre-test scores and post-test scores in both tests (p<0.001). This means that there is a significant improvement of scores from pre-test evaluation to post-test evaluation in both tests. This just indicates that there is a noted effectiveness of the interventions given via online counseling and online psychotherapy when applied to clients experiencing symptoms of anxiety and depression.

Finally, to further see the relevance or applicability of technology-based psychological services, clients were requested to give their overall descriptive evaluation of the services they availed. Three general themes came out from their responses and these are presented in Table 10.

Table 10 presents the overall descriptive evaluation of the clients about the services they availed at the TPS Project. Responses of the clients were predominantly leading to the theme of gratitude and appreciation, 44.62% (29/65). Most common responses were “Thank you…”, “I appreciate…” and similar statements. Gratitude and appreciation are followed by positive testimonies like, “TPS gave so much effort to help me and my family”, “Therapy sessions were great!”, “something to look forward to”. Someone attested that she improved so well. The third theme presents the well wishes of the clients for the TPS such as “Keep up the good work…” and “God bless you and more power!”

Summary
The main focus of this research cum extension endeavor was to determine the effectiveness, relevance, and applicability of technology-based psychological services to people who might be needing such services for free. Part of the research objective was to determine as well the background characteristics of clients who avail of technology-based psychological services. A mixed method of quantitative and qualitative design was employed in the study where descriptive survey through the use of self-made questionnaire, pre-test-post-test analysis and brief interview were combined to gather data. For 22 months, a total of 203 clients have signed up for the Techno-Psych Serv Facebook page and availed of the services offered by the TPS. A couple of questionnaires (both in Google Forms) were used to evaluate the relevance and applicability of the technology-based services that were availed by the participants. The completed evaluation forms and the results of the pretest and posttest served as the primary data that were analyzed by the researchers using percentage, weighted mean and the t-test for dependent means. Findings revealed that the technology-based psychological services offered to the public were able to capture a multisectoral population. Majority of the clients served were females, 23-27 years old, and heterosexuals. It is important to note, however, that the TPS Project was able to capture a significant number of clients belonging to the LGBTQ++. In terms of education, fifty percent of the clients have finished college education, with the majority of them currently engaged in their respective professional jobs. The TPS Project has catered to a significant number of students and non-professionals as clients, who are the main targets of the projects. Fifty percent of the clients came from Region IVA and the rest of the clients were distributed to other regions in the country. Out of the number of clients from Region IVA, the majority are from the Quezon Province where the Southern Luzon State University is located. Thus, the TPS Project has captured its target population to serve. It was further noted in the survey that the majority of the clients availed almost all of the services offered. It turned out that the most common source of information about the TPS was the TPS Facebook page itself, as well as referrals from friends and families. Upon evaluation of the services rendered to the clients, it was found that the clients perceived that the services they availed are relevant and applicable to their varied circumstances and conditions. The pre-test-post-test analysis of data gathered from the respondents noted the effectiveness of the interventions given via online counseling and online psychotherapy when applied to clients experiencing symptoms of anxiety and depression. Finally, data gathered from the brief interview supports the findings of the analysis of the quantitative data that brought out three major themes: gratitude and appreciation for the services rendered, positive testimonies and good wishes for the Techno-Psych Serv Project.

Conclusion
Based on the findings of the study, it is concluded that the technology-based psychological services rendered by the Techno-Psych Serv Project have served its target population and have accomplished its mission. On top of that, the technology-based psychological services rendered to the clients were effective, relevant, and applicable to the people they served.

Recommendations

1. Partnership and Collaboration – For a more successful implementation of technology-based psychological services to adolescents and young adults with special needs, partnership and collaboration with the Local Government Units through the Municipal Social Welfare and Development Office should be considered. The latter shall be of good help in looking for prospective clients in the community who might be in dire need of mental health services. The LGU may assist prospective clients by providing a venue for virtual sessions with the clients. Proper endorsement of the TPS Project to and from the Office of the Provincial Governor is necessary to accomplish this. 
2. Funding and Support – For the continuous operation of the Techno-Psych Serv Project, it is important to seek adequate funding and support from different sectors.
3. Psychoeducation and Mental Health Promotion - There is still a need for psychoeducation and mental health promotion among the marginalized sectors and the intended population. The importance of increasing their self-seeking behavior may be an emphasis to be taken seriously. Although the TPS Project has captured its target clientele, it has not yet been maximized. Thus, promotion and endorsement of the TPS services to the target groups still need to be intensified.
4. Mental Health Services Facility - If mental health services are extended to the community of marginalized groups, providing in-person psychological services remains a good choice for more serious cases of mental health problems and minor clients. Thus, it is recommended that LGUs consider establishing visible mental health services facilities to cater to this need.
5. Future Researchers - Further investigation is needed considering clients with other mental health issues. A comprehensive survey on the mental health status and mental health services in Quezon is also recommended. Future researchers may consider measuring the help-seeking behavior of prospective clients/participants.

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