Experts have estimated that about 130 million adults living in the People's Republic of China are suffering from a mental disorder. It is estimated that one in six people in the country will eventually have to deal with mental health issues. The desire to seek treatment is largely hindered by China's strict social norms (and subsequent stigmas), as well as religious and cultural beliefs regarding personal reputation and social harmony.
History As everything is ineluctably influenced by a complicated web of qi-dynamics, ancient Chinese philosopher–physicians never focused specifically on mental illness as a distinct category. According to mainstream Confucian ethical thought, anyone suffering from a mental disorder would be seen as an anomaly within the otherwise normal order of things. Mainland China's first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John G. Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental health issues, and treating them in a more humane way.
In 1949, the country began developing its mental health resources by building psychiatric hospitals and facilities for training mental health professionals. However, many community programs were discontinued during the Cultural Revolution.
In a meeting jointly held by Chinese ministries and the World Health Organization in 1999, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.
In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped in raising national awareness on health issues through research, health education, and data collection.
Since 2006, the government's 686 Program has worked to redevelop community mental health programs and make these the primary resource, instead of psychiatric hospitals, for people with mental illnesses. These community programs make it possible for mental health care to reach rural areas, and for people in these areas to become mental health professionals. However, despite the improvement in access to professional treatment, mental health specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation, rather than the management of symptoms.
In 2011, the legal institution of China's State Council published a draft for a new mental health law, which includes new regulations concerning the rights of patients not to be hospitalized against their will. The draft law also promotes the transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, 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. However, Human Rights Watch has criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrists 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.China: End Arbitrary Detention in Mental Health Institutions Human Rights Watch, May 3, 2013
Since 1993, WHO has been collaborating with China in the development of a national mental health information system.
Current situation Though China continues to develop its mental health services, it still has a large number of untreated and undiagnosed people with mental illnesses. The aforementioned intense stigma associated with mental illness, a lack of mental health professionals and specialists, and culturally-specific expressions of mental illness may play a role in the disparity.
Prevalence of mental disorders Researchers estimate that roughly 130 million people in China over the age of 18 suffer from mental illness in any given year.
Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6 percent of people with major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were significantly more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.
In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.
There is a disproportionate impact on the quality of life for people with bipolar disorder in China and other East Asian countries.
The suicide rate in China was approximately 23 per 100,000 people between 1995 and 1999. Since then, the rate is thought to have fallen to roughly 7 per 100,000 people, according to government data. WHO states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas. The most common method, poisoning by pesticides, accounts for 62 percent of incidences.
Stigma related to cultural and folk beliefs It is estimated that 18 percent of the Chinese population, about 244 million people, believe in Buddhism. Another 22 percent of the population, roughly 294 million, people believe in folk religions which are a group of beliefs that share characteristics with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of moral failure or insufficiently honoring one's family in current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.
Also, reputation might be a factor that prevents individuals from seeking professional help. Good reputations are highly valued. In a Chinese household, every individual shares the responsibility of maintaining and raising the family's reputation. It is believed that mental health will hinder individuals from achieving the standards and goals—whether academic, social, career-based, or other—expected from parents. Without reaching these expectations, individuals are anticipated to bring shame to the family, which will affect the family's overall reputation. Therefore, mental health issues are seen as an unacceptable weakness. This perception of mental health disorders causes individuals to internalize their mental health problems, possibly worsening them, and making it difficult to seek treatment. Eventually, it becomes ignored and overlooked by families.
In addition, many of these philosophies teach followers to accept one's fate. Consequently, people with mental disorders may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, and instead agree with others that they deserve to be ostracized.
Lack of qualified staff By the end of 2019, there were 40,850 licensed psychiatrists and psychiatric registrars, averaging 2.9 per 100,000 population, compared to the average in developed countries of 6.6 per 100,000. Individuals without preliminary experience can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors.Huang, Hsuan-Ying. (2015). "From psychotherapy to psycho-boom: a historical overview of psychotherapy in China". Psychoanalysis & Psychotherapy in China. 1: 1–30. Due to limited knowledge about psychiatry, low salary, high workload and stigma towards mental illness, very few medical graduates choose to specialize in psychiatry.Hizi, Gil. (2017). "'Developmental' Therapy for a 'Modernised' Society: The Sociopolitical Meanings of Psychology in Urban China". China: An International Journal. 15(2): 98–119.
A study in 2015 reported that two-thirds of counties in China lacked any psychiatrists.
Physical symptoms Multiple studies have found that Chinese patients with mental illness report more physical symptoms compared to Western patients, who tend to report more psychological symptoms. For example, Chinese patients with depression are more likely to report feelings of fatigue and muscle aches instead of feelings of depression. However, it is unclear whether this occurs because they feel more comfortable reporting physical symptoms or if depression manifests in a more physical way among Chinese people.
Misuse There have been multiple accusations that China's psychiatric facilities have been used by government officials to silence political dissidents. Prior to China's implementation to the National Mental Health Law in May 2013, involuntary admission was the most common type of admission for patients with psychotic disorders and required only informed consent signed by family members. Involuntary admission under the reform is only allowed if patients to pose a clear threat to themselves or others, determined through initial assessment by a registered psychiatrist. Despite the law, a 2017 national survey showed that fewer than 50% of involuntarily admitted individuals met the criteria for involuntary admission, with the number of involuntary psychiatric admissions remaining high in China.
Chinese military mental health Overview Military mental health has recently become an area of focus and improvement, particularly in Western countries. For example, in the United States, it is estimated that about twenty-five percent of active military members suffer from a mental health problem, such as PTSD, Traumatic Brain Injury, and depression. Currently, there are no clear initiatives from the government about mental health treatment towards military personnel in China. Specifically, China has been investing in resources towards researching and understanding how the mental health needs of military members and producing policies to reinforce the research results.Wang Y., Zhang, L., Chen, C., Yao, G. (2012) Application of Chinese Military Health Scale in screening mental health of new recruits. Medical and Health Research Foundation of PLA. 37(5) pp. 420–4
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