Mental health in China

The concept of mental health in China is influenced by Confucian ideology as well as an emphasis on family.^[1] In contrast to Western thought, the Chinese emphasize "highly personal duties and social goals" rather than the individual, and personal rights.^[1] Failing to fulfill one's duties within the family and society can lead to common symptoms of psychological distress, such as feelings of guilt and shame.^[1] Mental health is a growing issue in China with estimates of 100 million sufferers of mental illness. ^[2]

History

China's first mental institutions were introduced before 1849 by Western missionaries. After the establishment of the People's Republic of China in 1949, the treatment model was indigenized during 1949-1963. During the Cultural Revolution (1964–1976) strong political control governed diagnosis and treatment as well as detention and discharge of mental patients. Later, due to the modernization and reform advocated by Deng Xiaoping, western models of treatment and rehabilitation were gradually introduced by psychiatrists. After more than 25 years of planning and fundraising, American medical missionaries opened the first mental hospital in China in 1898. In 19th century China, the mentally ill were usually confined by their families in a dark room of the house, essentially neglected. If left to wander in the streets, they were often mocked and laughed at, and sometimes stoned. If they did anything wrong, they could be arrested and thrown into prison. Because the mentally ill were largely invisible, some missionaries argued that mental illness was not as prevalent in China as in Europe or the United States. John G. Kerr, MD (1824–1901), an American Presbyterian medical missionary, disagreed-and he worked long and hard to change the treatment of the mentally ill. When he opened his Refuge for the Insane, Kerr declared some new principles: first, insane patients were ill and should not be blamed for their actions; second, they were in a hospital, not a prison; and third, they must be treated as human beings, not as animals. He pledged to conduct a course of treatment based on persuasion rather than force, on freedom rather than restraint, and on a healthy outdoor life with a maximum of rest, warm baths, and kindness. He also wanted to provide patients with gainful employment wherever possible. The directors of the Canton refuge worked closely with local Chinese officials and local police, who did not know how to handle insane people and were glad to refer them in large numbers to the refuge. 6 Chinese officials paid the refuge an annual allowance for taking care of the patients. Local families also brought in patients, and some were sent from Hong Kong by the British authorities. The hospital was eventually expanded to 500 beds, and it operated with considerable success until it finally closed in 1937.^[3]

Current

Currently, dilemmas such as human rights versus political control, community integration versus community control, diversity versus centrally, huge demand but inadequate services seem to challenge the further development of the mental health service in the PRC.

China has 17,000 certified psychologists, which is ten percent of that of other developed countries per capita.^[4] Some 100 million Chinese have mental illnesses, with varying degrees of intensity.^[4]

In 2007 the Chief of China's National Centre for Mental Health, Dr Liu Jin estimated that approximately 50% of outpatient admissions were due to depression.^[5] And while issues surrounding living conditions in rural areas have been a known contributor to this, another issue is that of high levels of competition in all levels of schooling. One specific area of concern is that of the suicide rate in China, which stands at approximately 20 per 100,000.^[6] The World Health Organisation state that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas, which is consistent with the most common method, which is poisoning by pesticides, which accounts for 62% of incidences.^[6]

On June 10, 2011, the legal institution of China's State Council published a draft for a new 'mental health law', which includes new regulations concerning the right of patients not to be hospitalized against their will.^[7] The draft law promotes the transparency of patient treatment management. Currently, many cases exist in which hospitals are led by financial motives and patients' rights are disregarded. On October 26, 2012 China adopted the law. The law stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment.^[8][9] However, although described as significant, Human Rights Watch has also criticised the new law. For example although it creates some rights for detained patients to request a second opinion from another state psychiatrist and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.^[10]

Collaboration

Since 1993, the WHO has been collaborating with China in the development of a national mental health information system. These efforts included adapting the NKI/WHO Mental Health Information System to the needs of China, training visiting scientists, and providing continuous support to the project. In January 1995, the Center was notified that the System has been approved by the Ministry of Health for use nationwide .

See also

• Chinese Society of Psychiatry
• Nathan Kline Institute for Psychiatric Research

References

Further reading

• Normal and Abnormal Behavior in Chinese Culture (1981) edited by Arthur Kleinman and Tsung-yi Lin
• Chinese Societies and Mental Health (1995) edited by Tsung-yi Lin, Wen-shing Tseng, and Eng-kung Yeh
• Mental health care in China (1995) By Veronica Pearson
• Narcotic Culture - A History of Drugs in China (2004) by Frank Dikötter, Lars Laamann and Zhou Xun

External links

• Chinese Mental Health Network (中华精神卫生网) (Chinese)

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