Filling the Void: Mental Health Care in China

Aug 18, 2016 by

Tom Watkins –

Much of what gets written and discussed about China revolves around economics and commerce between our two countries. Yet there are several areas outside of the economic realm where both China and the U.S. should be building bridges that would pay significant human dividends for us all.

One issue that carries universal shame in both countries and costs hundreds of millions of dollars in lost productivity and human potential is mental health care. Within Chinese culture, as in America, people with these disabilities have been stigmatized and devalued. This needs to change.

Ironically, while I have spent a good part of my adult life building cultural, economic and educational bridges between America and China, it was around mental health issues that I met the first person from the People’s Republic of China (PRC) in 1988. This led to a 3-week tour of China’s mental health care system in 1989.

While serving as Michigan’s State Mental Health Director in 1988, the department organized an international mental health conference that attracted participants from more than half the United States and professionals from as far away as Guam, Africa, Europe and the PRC. Slightly 10 years beyond the tumultuous Cultural Revolution, when Western thought and medicine were considered dangerous even to think aloud, let alone practice, four Chinese mental health scholars presented at the conference. They graciously invited us to China the following year to see their re-building of a rudimentary mental health system.

Even in as advanced a nation as ours, with high income and a developed health care system, the U.S. is woefully inadequate when it comes to treating mental illness. There are far too many persons going untreated, living on the streets or incarcerated in jails and prisons rather than being treated in hospitals and their own communities. This is a universal human rights issue.

We know that mental illness impacts 1 in 4 individuals and skips not a single zip code. We also know that with proper diagnosis, treatment and support, recovery and a meaningful life is possible. 

Then and Now 

The first Chinese mental “hospital” was opened in 1898 by American missionaries backgrounds in medicine.

Fast forward to the late 1970’s with Deng Xiaoping in power. China was not only opened to the rest of the world, but the country also opened up to renewed ideas that were now allowed after Mao’s reign of terror when politics, not psychiatry, could get one locked up. Imagine having “Capitalist Roader” added to the DSM-5 diagnosis criteria as established by the American psychiatric Association – this was China during the Cultural Revolution.

Recent research from The Lancet Psychiatry suggests that by 2025, 39.6 million years of healthy life will be lost to mental illness in China. Less than 6% of people with common mental health disorders (mood or anxiety disorders), substance abuse disorders, dementia and epilepsy seek treatment. Forty percent of people with psychotic disorders have never sought treatment from mental health professionals.

If gone untreated, this will be a drain on a nation that has seen remarkable growth and development over the past 40 years – a country that has pulled over 400 million of its citizens out of abject poverty and into the middle class.

To address these concerns, mental health professionals know that community engagement and increased support for community health workers are key factors in providing more accessible, affordable, acceptable and accountable mental health care.  

Learning Is Not a One-Way Street

There is much we can learn from China’s historic “Barefoot doctors” from the blending of traditional Western medicine and alternative therapy to yoga, massage therapy and traditional Chinese medical techniques using herbs and acupuncture.

While far from perfect, Michigan and America has much to offer the Chinese when it comes to mental health. President Kennedy, only months before his assassination in 1963, passed the “Community Mental Health Act.” This bold action, later coupled with the passage of Medicare and Medicaid funding and the Affordable Care Act, or ‘Obamacare’, has drastically altered the delivery of community mental health services.

The 1963 law led to the establishment of comprehensive community mental health centers throughout the country. It began to unlock cells where persons with mental illnesses were “warehoused” in out-of-sight and out-of-mind hospitals and institutions. New modes of care and support were created so people could return to their communities and live a self-directed life. 

Market Opportunity for Reform

The breakdown of traditional family structures, urbanization, scattered families, economic pressures and other changes in China’s rapid modernization have brought an increase in emotional strain to its people. These rapid changes have wrecked the traditional framework of appropriate social behavior, ethics and morality, and have left people groping for new support.

Forbes magazine recently reported that mental health care is an explosive new market in China: “If China’s balky economy is looking for growth in its service sector, here’s a market with great potential: There are thought to be at least 180 million potential customers, 4.3 million of them in desperate need. Yet only some 20,000 qualified specialists are in force to meet the demand.” 

Forbes finds, “Private psychiatric care in China grew at a compounded 20% annually to 2014, largely to treat common disorders like anxiety, depression, substance abuse and psychosis.” The need in China for quality mental health care for the ‘walking worried’ to persons with serious mental illness is huge.

China could help transition its economy from low wage manufacturing exports to a service economy by returning the societal support of a new day “iron rice bowl.” Providing a social safety net and freeing people from constant worry of a personal or family calamity might unleash massive consumer savings into consumer spending.

Could President Xi Jinping, the General Secretary of the Communist Party of China and President, be the 21st century equivalent to President Kennedy by mandating that China will no longer allow its citizens with serious mental illness to go unnoticed and untreated?  Might he create the Chinese version of Social Security, Medicare and Medicaid as a national funding mechanism for meaningful health and behavioral health care reform – a sort of “Xi-Care”?

China’s entrepreneurs are sensing a new market emerging to meet the pent up demand for high quality mental health care for the expanding middle class.  Equally important, the Communist Party must strive to meet the same expectations of a bulging underclass getting more and more aggressive about having their general welfare and health care needs met.

As the need and demand for quality mental health becomes apparent throughout China, a major concern is the scant professional resources currently available. Opportunity exists for collaboration around research, training and program development.

China can learn and benefit from our mistakes and successes in developing a successful community engagement approach. They might also reach back to its own past, re-evaluating its village and community assets and including the cultural and family strengths once devalued as ‘feudal.”  A re-direct to Buddhism, Taoism and Confucianism as a living, contemporary spiritual power that influences people directly or indirectly and places ethical and social demands on the individual, may be the foundation upon which to build.

America’s and specifically Michigan’s community mental health system, hospitals and universities can help build on the latent strengths of China and address their growing mental health void. Together, we can expand and improve the community based, quality mental health care with Chinese characteristics.

Source: Filling the Void: Mental Health Care in China – China-US Focus

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