Mental health system in China: History, recent service reform and future challenges

Peking University Institute of Mental Health, Beijing, China.
World psychiatry: official journal of the World Psychiatric Association (WPA) (Impact Factor: 14.23). 10/2011; 10(3):210-6. DOI: 10.1002/j.2051-5545.2011.tb00059.x
Source: PubMed


This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

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Available from: Wei Hao, Jan 15, 2014
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    • "Through understanding the nature of the policy and the processes of policy changes we could gain new insights that help to explain how health systems actors and the relationships of power and trust among them influence health systems performance. Health systems and sub-systems research includes health systems frameworks [60,61], health systems management [62,63], health systems strengthening [13,17,21], health systems evaluation [48,64], accessibility, equality and efficiency of health systems [65-67], primary care system [68], public health systems [69-71], and mental health systems [72-74]. Healthcare and services research (i.e., Brazil) include accessibility, equality and efficiency of healthcare [75,76], primary healthcare and mental healthcare [49,73,74,77-79], managed care and integrated care [80-82], healthcare innovation [83,84], health care delivery models [85,86], responsiveness to health services [53,87], influencing demand for care [88,89], financial question of healthcare [48,90]. "
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    ABSTRACT: Background In the last few decades, health systems research (HSR) has garnered much attention with a rapid increase in the related literature. This study aims to review and evaluate the global progress in HSR and assess the current quantitative trends. Methods Based on data from the Web of Science database, scientometric methods and knowledge visualization techniques were applied to evaluate global scientific production and develop trends of HSR from 1900 to 2012. Results HSR has increased rapidly over the past 20 years. Currently, there are 28,787 research articles published in 3,674 journals that are listed in 140 Web of Science subject categories. The research in this field has mainly focused on public, environmental and occupational health (6,178, 21.46%), health care sciences and services (5,840, 20.29%), and general and internal medicine (3,783, 13.14%). The top 10 journals had published 2,969 (10.31%) articles and received 5,229 local citations and 40,271 global citations. The top 20 authors together contributed 628 papers, which accounted for a 2.18% share in the cumulative worldwide publications. The most productive author was McKee, from the London School of Hygiene & Tropical Medicine, with 48 articles. In addition, USA and American institutions ranked the first in health system research productivity, with high citation times, followed by the UK and Canada. Conclusions HSR is an interdisciplinary area. Organization for Economic Co-operation and Development countries showed they are the leading nations in HSR. Meanwhile, American and Canadian institutions and the World Health Organization play a dominant role in the production, collaboration, and citation of high quality articles. Moreover, health policy and analysis research, health systems and sub-systems research, healthcare and services research, health, epidemiology and economics of communicable and non-communicable diseases, primary care research, health economics and health costs, and pharmacy of hospital have been identified as the mainstream topics in HSR fields. These findings will provide evidence of the current status and trends in HSR all over the world, as well as clues to the impact of this popular topic; thus, helping scientific researchers and policy makers understand the panorama of HSR and predict the dynamic directions of research.
    Full-text · Article · Jun 2014 · Health Research Policy and Systems
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    • "Apart from the increasing mental health burden, China, like many developing countries, is facing a severe shortage of skilled mental health professionals and bed provisions [8]. Before 2011, there were 20,914 licensed psychiatrists and assistant psychiatric practitioners (1.55/100,000 population) and 38,907 licensed psychiatric nurses (2.89/100,000 population) [9], far below the global average of 4.15 psychiatrists and 12.97 psychiatric nurses per 100,000 population [10,11], and also farther below the Africa average of 10.5 psychiatrists and 34.5 psychiatric nurses and the South East Asia average of 4.54 psychiatrists and 9.3 psychiatric nurses, per 100,000 population [10]. Only 1% of the one million total medical graduates in China took up a career as a psychiatrist [12]. "
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    ABSTRACT: Pathway studies highlight the help-seeking behaviors of patients with physical and mental illnesses. A number of studies in this field have been completed in various parts of the world. The purpose of this study is to explore the characteristics of the help-seeking pathways of patients with mental illness from urban north China at Mental Health Professional (MHP). The pathway diagrams, which accounted for more than five percent of patients, were documented for 441 subjects using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns and durations of care-seeking were analyzed in different diagnostic groups. The chi2-test and the Mann-Whitney U test were employed, as needed. Respondents visited the MHP through a variety of pathways. Approximately three-quarters of the patients took an indirect pathway (74.8% vs 25.2%, chi2 = 108.8, p < 0.0001), and on average, each patient consulted 3.4 caregivers. The vast majority of patients first visited local tertiary general hospitals (56.4% vs 4.1%, chi2 = 138.3, p < 0.0001) or local secondary general hospitals (24.8% vs 4.1%, chi2 = 40.96, p < 0.0001). However, only 9.6% of patients were diagnosed with mental disorders for the patients who first visited non-psychiatric hospitals. Of the patients who first contacted with psychiatry hospital, 55.6% received a professional diagnosis and finally reached the MHP because of the poor treatment or high-cost medical care. The majority of patients seek other pathways than to go to MHP directly and this may be due to stigma, and/or lack of knowledge. The study gives emphasis on the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders in the community health centers, the general hospitals system and by private practitioners. The pathway described by this study may be helpful while preparing mental health programs in the future.
    Full-text · Article · Sep 2013 · International Journal of Mental Health Systems
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    • "Unfortunately, mental health services in China are insufficient to respond to the extensive mental disorders prevalent in the country. The shortage of skilled mental health professionals is a major problem: In 2004, the total number of licensed psychiatrists in China was 16,103 (1.24 psychiatrists per100,000 people), which is significantly lower than the global average of 4.15 psychiatrists per100,000 people [3]. The number of mental health institutions and doctors lags far behind the need for mental health services. "
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    ABSTRACT: To understand the attitudes among medical students in China toward different medical specialties and to find the factors that influenced their choice of career in psychiatry. A questionnaire was developed and administered to 287 medical students at the Xiangya Medical College, Central South University in Changsha, China. All the students were asked to rate the importance of five possible factors in choosing a specialty as a vocation: the ability to help patients, interesting and challenging work, lifestyle factors, financial reward, and prestige. Students reported negative perceptions of psychiatry in regard to all five possible factors that were important in choosing a specialty as a vocation, especially in financial reward and prestige. Medical students in China have negative attitudes toward psychiatry as a career. Some negative beliefs about psychiatry seem to be due to erroneous or insufficient knowledge that could be corrected during the course of medical education. Some negative attitudes were unlikely to be completely changed until the mental health system in China improves.
    Full-text · Article · Sep 2013 · PLoS ONE
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