As reported by state media, China adopted new national mental health law last Friday to protect the rights of mental health patients and strengthen mental health infrastructure and services nationwide. The actual law document can be found on the National People’s Congress website here. The new national mental health law is set to take effect in May 2013.
The law has attracted attention from major news outlets (WSJ, CBS, and NYTimes) who have covered this legislation primarily from a human rights perspective. Before getting into the health-related implications of the Party’s new legislation, it is worth noting that China has had a history of politically motivated, compulsory admittance of citizens into mental institutions. Prior to approval by the Standing Committee of the 11th National People’s Congress, China has had no mechanism to prevent compulsory admission to mental health clinics and hospitals. In 2010, the term 被精神病 (lit. “being psychiatrized”) gained popularity as a buzzword for being admitted for ulterior motivations. Furthermore, employers or family members due to wage or property disputes may also admit people, without needing proper medical assessments. The law stipulates that patients themselves should now determine admission to a psychiatric hospital. This is now a voluntary process unless the prospective patient is considered a danger to themselves or others. However, it is not well understood what constitutes as a danger to self or the public. In the event of a disagreement with the original diagnosis, any qualified institution may be requested to conduct an independent medical assessment. It is still difficult to say that all mental health practitioners will be impervious to Chinese officials’ influence. Moreover, psychiatric hospitals have enjoyed economic incentives for keeping high occupancy in inpatient wards.
China’s mental health establishment has been unhealthy for several decades. Cultural stigma for seeking care dates back to the Cultural Revolution when mental illness was declared a bourgeois self-delusion and the sick were treated with readings from Chairman Mao.
As a country, China has faced severe economic and societal changes including urban migration, the one-child policy, intense competition for jobs, education pressures, and the deterioration of traditional family structure. While demand for mental services has been on the rise, primarily in urban areas, stigma still exists. The new law aims to protect patient privacy by preventing disclosure of personal information like name, address, and employer.
China’s National CDC estimates that nearly 100 million Chinese suffer from one form of mental disorder or another with varying intensity. Independent reports have suggested that upwards of 173 million adults in the country have a mental disorder, 158 million of which have never sought professional help. Prevalence of at least one current mental disorder in adults was greater than 17% in 2001-2005. Chinese Psychiatrists’ Association estimates that there are only about 20,000 certified psychiatrists in China, just one-tenth that of developed countries when accounting for population. The law aims to train new medical workers; however, beyond the call for more doctors is a necessity to provide robust, non-medical services. China has weak training programs for clinical psychologists, social workers, occupational therapists, and other non-medical professionals. Well-designed programs and capital needs to be committed in order to make sure that workers are well prepared and competent as well as motivated through defined career pathways.
Additionally, as stated by Xinhua, most general hospitals do not have clinics specializing in mental illnesses. The law specifies that general hospitals, under the guidance of government health departments, must set up mental illness clinics. With a dearth a qualified mental health workers, adequate staffing will be a concern for these hospital clinics moving forward. Furthermore, the mental services offered by general hospitals are being standardized. This also creates a question of whether clinics and hospitals will be able to provide all of the services that are required of them at acceptable quality standards.
No institutions are in need of more improvement than those in rural China. While urban areas have enjoyed considerable investment in healthcare and a less stigmatizing view of mental health services over the years, rural counterparts are still struggling with basic infrastructure problems. Compounded on capital and human resource constraints, one can make a convincing argument that mental health issues are more prevalent in rural China. Rural Chinese are faced with harsh living conditions and few options for education and employment among other unfavorable issue. The that suicide rates in rural China are three to four times higher than those in urban China. Unfortunately, most health services are concentrated in urban areas. Mental health services should be expanded as medical care becomes more accessible in rural China. As the New Cooperative Medical Scheme continues to develop, it will be particularly beneficial to include mental health services in benefit package design.
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