China Needs to Build Community Mental Health Structure
Abstract
Now that China’s first national mental health law has taken effect, a major challenge will be to build a community mental health infrastructure where none exists.
On May 1, China’s first National Mental Health Law—something that had been in the works for 27 years—went into effect.
Michael Phillips, M.D., an American psychiatrist and China mental health expert, and colleagues wrote April 29 in AJP in Advance that “this new law is a high-water mark for Chinese psychiatry, and potentially for global mental health.” The new law eliminates most forms of involuntary treatment, puts strict limits on seclusion and restraints, and bans the use of treatment as a form of punishment (Psychiatric News, June 7).
Now that China has a national mental health law, the challenge is to make community mental health services available to villages such as this one—a village in Guanxi, an autonomous region in southern China.
And now that the law is being implemented, it is time to make community mental health services in China a reality, Chinese mental health professionals pointed out in a paper to be published in the July Psychiatric Services.
The leading commentator is Samson Tse, Ph.D., an associate professor of social work at the University of Hong Kong who is currently working at Yale University.
The new law “has highlighted the urgent need to properly develop a community mental health service,” Tse and his colleagues said. They contend that a mental health reform initiative used in China since 2004 called the “686 Project” might be the way to go.
The project is based on a World Health Organization model that integrates hospital-based services with community mental health services. “People with mental illness and their families are often frustrated at being offered treatment by different providers who do not communicate with each other and then having to negotiate the many gaps by themselves,” they explained. Moreover, the initiative has already received a generous investment from the Chinese government and, as of November 2011, had led to the treatment of almost 2 million Chinese with severe mental illness and had covered 766 sites in 170 cities with a total catchment population of 43 million.
Tse and his colleagues also proposed that psychiatrists and other mental health workers providing community mental health services be educated in a mental illness recovery approach. “The recovery approach,” they asserted, “is highly consistent with the values embedded within the 686 Project, such as paying more attention to the person’s level of functioning and strengths, rather than disabilities and psychopathology.”
Furthermore, recovery strategies are based on three decades’ worth of studies and clinical evidence, “most of which has been collected in the United States, the United Kingdom, Australia, and more recently, Hong Kong,” they noted.
And the recovery approach, which focuses on hope, empowerment, self-determination, and illness management, “resonates strongly with traditional Chinese culture in terms of hardiness and the amazing resilience the Chinese people have displayed during wars and the Cultural Revolution as they have struggled to survive,” Tse told Psychiatric News.
In addition to providing community mental health services guided by a mental illness recovery philosophy, the families of individuals with severe mental illness also need to be supported and guided, Tse and colleagues maintained. “Up to 80 percent of individuals with mental illness in China (especially in rural areas) are looked after by family members at home, by choice or otherwise,” they said. “This figure will increase as the National Mental Health Law is implemented.”
They also pointed out that the Internet, smart phones, and social media in China can be used to “promote self-help and reduce stigma associated with severe mental illness,” especially among younger Chinese.
A critical question, of course, is how much money the Chinese government will be willing to pay for such service expansions, Tse and his colleagues said. An encouraging sign, though, is that “the government is planning to increase the mental health budget from 3 to 4 percent of the total national health budget in 2010 to 7 to 8 percent by 2015.”
Samuel Law, M.D., an assistant professor of psychiatry at the University of Toronto who is helping develop the first Assertive Community Treatment (ACT) team in China, commented on the report by Tse and colleagues for Psychiatric News.
“It is well researched,” he said. “I think the information is current and that the recent mental health reforms in China have substance—they are not just another empty political campaign.... I would add that there is tremendous energy in some mental health sectors in China today. I work with some of them and am impressed by their commitment and ambition.”
However, Law does have a criticism of the current thrust to create community mental health care in China. “One cannot have meaningful community mental health care without social safety-net reform. China has no unemployment security; the current health insurance is woefully not in keeping with actual medical care costs, and welfare for the indigent is still a remote idea. Thus mentally ill individuals are not likely to spend precious time and resources to seek or secure care.” ■
“The Urgency of Now: Building a Recovery-Oriented, Community Mental Health Service in China” is posted at http://ps.psychiatryonline.org. The report also constitutes a new column in Psychiatric Services called “Mental Health Reforms in Asia.”
