Mental health in China: From Tang to today

By Will Wu, August 4, 2015

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Mental health. It’s not an easy topic to broach in China, despite the fact that the nation has long acknowledged its existence.

The earliest recorded form of care for the mentally ill can be traced back to the Tang Dynasty (AD 618-907), during which a monk-administrated charity facility called Bei Tian Fang took up the role of aiding the homeless, widows, orphans and those with psychoses. However, it wasn’t until 1898 that the country’s first specialized psychiatric hospital, Refuge for the Insane, was established in Guangzhou.

John G. Kerr, an American medical missionary who built and ran the establishment, introduced a brand-new approach to treating mental patients. Instead of neglecting or confining them, the devout Presbyterian pledged to conduct therapies that focused on autonomy and encouraged the public to view the mentally ill as human beings. His early methods cast a revolutionary light on the problem in the then isolated Middle Kingdom.

After the founding of the People’s Republic of China in 1949, psychiatric hospitals sprang up in every province, shouldering the responsibility of maintaining social stability. The first National Mental Health Meeting was held in 1958, bringing the country’s psychiatric services to another level – community-based initiatives commenced in Beijing, Shanghai, Hunan and Sichuan, and a modernized training system for professionals was developed and put into use.

Yet the 10-year Cultural Revolution and fiscal reforms begun in the late 1970s stunted the country’s mental health-care development. The former suspended community programs, while the latter forced financially dependent psychiatric hospitals and rehabilitation centers to close due to their failure to make profits in the new market economy.

The number of people suffering from mental disorders, however, did not decrease. Amid the rapid economic and social changes that unfolded in a nation stressing personal duties and communal goals, those who failed to fulfill their role became easy victims of distress and anxiety. Gradually, mental illnesses such as depression, panic disorder and schizophrenia became widespread. Prevalence of mental illness in people aged 18 or above increased from 2.7 percent in the 1950s to 5.4 percent in the 1970s.

A decade later, the figure had doubled to 11.1 percent, before reaching 13.47 percent in the 1990s. By 1998, mental disorders had surpassed cardiovascular disease, respiratory conditions and cancer to become the country’s top disease burden, according to data presented by the World Health Organization.

To put it another way, for every 100,000 Chinese, there were only 1.24 doctors and 1.91 nurses trained to treat behavioral health.

The dawn of China’s modern mental health-care policies occurred in April 2002, when the first National Mental Health Plan (2002-2010) was signed by the ministries of health, public security and civil affairs together with the China Disabled Persons’ Federation. Detailed targets were listed, including establishing an effective psychiatric system led by the government, accelerating the process of mental health legislation, improving knowledge and raising awareness of mental disorders, developing human resources for handling said disorders and enhancing existing psychiatric hospitals.

The plan sparked the renowned 686 Program, implemented in 2004, which focused on creating an integrated hospital-community treatment model and assembling a qualified workforce. At the time, there were only 16,103 licensed psychiatrists and 24,793 licensed psychiatric nurses in China. To put it another way, for every 100,000 Chinese, there were only 1.24 doctors and 1.91 nurses trained to treat behavioral health.

Although 686 successfully helped to incorporate mental illness care into the country’s public health system, it was unable to adequately recruit medical personnel in the face of an ever-growing number of patients. By the end of 2009, the body of licensed psychiatrists had expanded to 19,000 – an increase of fewer than 3,000 in five years. On the other hand, 16 million people had been diagnosed with a major mental illness, meaning one psychiatrist had to handle 842 patients – a statistic that reflected the ultimate failure of the ambitious 686 Program.

Many attributed the lack of success to scant laws and regulations supporting the relatively new medical field. Finally, on May 1, 2013, China’s first Mental Health Law – which took no less than 27 years to prepare and formulate – was put into effect. Calling for the respect of a patient’s will and privacy, the law was viewed as a giant step forward in addressing longstanding problems in China’s mental health-care system, such as insufficient medical facilities, low insurance coverage and a dearth of doctors and nurses.

The road ahead is still awash with challenges. Currently, more than 100 million people in China suffer from mental disorders. They can seek succor from a mere 1,650 professional hospitals and organizations, primarily located in the developed southern and eastern regions of China. Ignorance about mental health problems is widespread – an estimated 70 percent of individuals with a psychiatric illness are unaware of the seriousness of their condition and refuse to seek help.

The World Health Organization has warned that by 2020, the financial burden arising from mental disorders in China will constitute a quarter of the total outlay for disease treatment on the mainland. The personal expense of mental illnesses left untreated, however, will prove even greater.

 

// Click here to view more stories from our mental health series.

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