Mental health services fall short of need
2017-12-25, WANG XIAODONG

In recent years, the number of people in China with serious mental health issues has been rising rapidly, according to statistics provided by the National Health and Family Planning Commission.

By the end of last year, 5.4 million people had been registered as having a serious mental illness, and 75 percent of them were diagnosed as schizophrenic, a rise of 300,000 compared with 2015.

However, the commission estimates that the total number of people with some form of mental illness could be more than 100 million.

In many parts of the country, people with serious mental illnesses receive preferential reimbursement through the government’s basic health insurance program, while outpatients can obtain free basic medication in cities such as Beijing, Shanghai and Changsha, in Central China’s Hunan province, according to the commission.

The treatment of about 88 percent of the 5.4 million registered patients is under the management of the health authorities, according to Wang Bin, deputy director of the commission’s disease control and prevention department.

In general, people with serious mental health issues are among the most vulnerable in the country, and more than half of them live below the poverty line, he said.

Experts said a lack of care at the community level is exacerbating the problem.

Had he not developed schizophrenia nine years ago, Zheng (who preferred not to give his full name) might have a good job and a family, like many of his former college classmates.

Instead, he is unmarried and unemployed, and regularly moves between different hospitals and clinics in Shenyang and Anshan, in the northeastern Liaoning province, and Beijing, usually accompanied by his father.

“I was first attacked by the illness when I was a college freshman in Liaoning,” he said. “It was completely unexpected.”

He is unable to remember clearly how he felt or behaved when the illness struck, but former classmates and dorm mates said he engaged in wild conversations with imaginary people. He would make outlandish claims, saying he was going to marry a movie star or that he was going to the Shaolin Temple in Central China’s Henan province to learn martial arts.

“One time I called the media in Shenyang and asked the journalists to visit me because I had some big news to tell them,” he said. “My father later told me that he had to explain to them that I was unwell. He apologized and asked them to leave.”

Zheng was forced to quit college 18 months later when his condition worsened, and he has been hospitalized at least four times since then.

His condition is stable after more than a year of treatment at Peking University Sixth Hospital in Beijing. His dearest wish is to find a job to help repay his debt to his family, whose savings have been almost entirely exhausted by treatment costs over the years.

“I feel a little disconnected from society after nine years of illness,” he said.

Ma Hong, a psychiatrist who has been treating Zheng, said the young man owes his family more than just money.

“We are thankful to his parents for their persistence in getting treatment for him. He is lucky because he is very responsive to the medication, and the required dose is decreasing. Many people with schizophrenia can be cured with proper treatment and faith shown by family and friends,” she said.

Ma, who is also deputy director of the Mental Health Center at the Chinese Center for Disease Control and Prevention, said a lack of care at the community level is the biggest obstacle to the effective treatment and rehabilitation of patients.

“One of the most serious problems is the high incidence of recurrence of the illness. About one-third of patients have a recurrence about six months after being discharged from hospital, while about 40 percent have a recurrence a year after,” she said.

Ma added that the main reason for the recurrence is that patients refuse or forget to take their medication after leaving the hospital.

“Treatment should not stop at the hospital. It should be extended to the communities in which patients live, otherwise they will continue to move between their communities and hospitals for repeated treatment,” she said.

Zhang Chong, a psychotherapist at the Haidian Tiancunlu Health Center in Beijing’s Tiancunlu subdistrict, said the number of people registered with a serious mental illness in the community of nearly 200,000 residents has risen constantly in the past few years.

“The number of registered patients exceeds 500, but the actual number may be far higher,” he said.

“We try to contact the families of patients in the community who have been diagnosed with a serious mental illness and persuade them to register the person at the health center for follow-up treatment, but some refuse because of concerns about leaks and privacy. People with these illnesses are still stigmatized by society.”

Under Beijing’s unified system for the management of serious mental health issues, each patient’s personal details are uploaded to an online platform by the doctors at certified hospitals who made the original diagnosis.

The platform, which is not open to the public, can only be accessed by community health centers, so doctors in the patients’ communities can contact them to provide follow-up treatment and management, Zhang said.

He emphasizes the role of psychotherapy, and organizes group activities such as handcrafts or storytelling sessions to help the patients recover and reintegrate with society.

Huang Xia, a volunteer who visits the health center every Thursday to guide a range of activities, such as painting, designing clothes and making bags, said most of the patients are happy to participate.

“They are able to do most things themselves, and they are also inventive, which was not what I expected,” she said.

According to Zhang, the biggest challenge for the health center is a lack of staff members. “We need at least seven or eight psychiatrists and psychotherapists to cope with so many patients, but at the moment we only have one nurse, one psychiatrist and me,” he said.

Zhang added that medical professionals at community hospitals or health centers earn much less than their peers in large hospitals, which makes it difficult to attract the best talent.

In addition, many community health centers cannot provide enough opportunities for training.

As a result, staff members sometimes have to spend large amounts of their own money on training programs to learn about the latest techniques.

“Unlike physicians, psychotherapists can never rise above the middle rank, which obviously restricts their career development,” he said.

Liu Tiebang, director of the Shenzhen Mental Health Center, in Shenzhen, South China’s Guangdong province, said treatment in the community is important to the recovery process.

He added that large hospitals and community health centers in the city are required to transfer patients with mental health issues to the community for management within three days of them being discharged from the hospital.

Moreover, there are only about 700 hospital beds for people with mental illnesses in Shenzhen, far from enough to cope with the demand, so clinical services in communities are extremely important.

In addition to inadequate facilities, the main obstacle to improving local services for patients is the lack of staff members within communities, so more training programs are needed to produce enough qualified staff, he said.

Steps are now being taken to rectify the situation, and community-based rehabilitation services should be extensively available in more than 80 percent of all counties and cities by 2025, according to a guideline released by the Ministry of Civil Affairs.

In addition, increased government spending will improve services in communities, and families will be expected to play an important role in the community-based rehabilitation of patients, the guideline stated.

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