China has a complex history in the treatment of the mentally ill. In 1849, the first mental institutions in the country were founded by Western missionaries. One of them, Dr. John G. Kerr, instituted some principles which are even valid today. Among those principles were the following: mentally ill patients shouldn’t be blamed for their actions; those that were hospitalized were not in a prison but in a hospital and should be treated as human beings, not as animals.
During the Cultural Revolution there were changes that lead to strong political control, over-diagnosis and treatment, a change that overshadowed patients’ real needs. Many mentally-ill patients were sent to labor camps because of their ‘counterrevolutionary behavior’. Western models of treatment were gradually introduced only after the reforms advocated by Den Xiaoping. Today, however, serious problems remain such as the high number of untreated mentally ill patients, inadequate services, and lack of trained personnel.
The spectrum of mental illness is broad, and includes minor conditions such as anxiety to depression, obsessive-compulsive disorder and other problems that may lead to drug addiction and serious crimes. In 2009, the World Health Organization (WHO) stated that mental illness –which affected seven percent of the population- had overtaken heart disease and cancer as the biggest burden on China’s health care system.
According to a study by The Lancet, roughly 173 million Chinese suffer from a mental health disorder. 158 million of those have never received professional help for their disease. Despite this high number, China averages only one psychiatrist for every 83,000 people –approximately one twelfth the ratio in the United States and other industrialized countries. This led one professional psychiatrist to remark, “We are like pandas. There are only a few thousand of us.”
The need for psychiatrists, however, is growing. According The Lancet, the incidence of mental disorders had increased more than 50 percent between 2003 and 2008. Although some of these cases can be due to improved diagnosis, most cases can result from more stressful life conditions. These conditions may be one of the causes for the increasing number of individual who commit violent crimes.
Depression is China’s second most commonly diagnosed disease, and has a huge economic cost in terms of lost work days and medical expenses. In recent years, depression has replaced schizophrenia as the most common mental disease at China’s top mental health facility, Beijing’s Anding Hospital.
According to some estimates, more than 260 million people were struggling with at least mild depression in 2011, and depression-related deaths such as suicides even exceed traffic fatalities. In 2007, China’s Medical Association estimated that two-thirds of depression sufferers had harbored suicidal thoughts at least once, and 15 to 25 percent ended their lives on their own.
As the number of mentally ill people increase in China, efforts to expand insurance coverage haven’t kept pace. According to some statistics, in recent years only 45,000 people have been covered for free outpatient treatment and 7,000 for free inpatient care. This is a vastly inadequate response to a most serious problem. In Beijing, almost 90 percent of mental patients do no receive inpatient treatment, either because it is too expensive or because hospitals do not have enough room for them.
Huge needs in the treatment of the mentally ill have led to an increase of unregistered and inadequately trained psychologists who are unable to provide proper diagnosis and treatment to the patients. As a result, many patients end up with a worsening of their symptoms.
The lack of professionals in medicine and psychology should be urgently addressed. The Ministry of Human Resources and Social Security is now expanding the country’s professional ranks by modifying criteria to certify mental health counselors. These counselors can treat patients suffering from minor depression symptoms and thus alleviate the work of psychologists and medical doctors who could address more severe cases.
Additional steps should be taken, however. They include bringing foreign doctors to help train local students on mental health’s most pressing issues and sending more Chinese students for specialization overseas. At the same time, the government should build more mental health facilities and improve insurance policies to help those patients in greater need. The Chinese government should treat mental health needs as the emergency it truly is.
Cesar Chelala, MD, PhD, is an international medical consultant and a winner of an Overseas Press Club of America award.