Grand Challenges Facing China’s Mental Health Care Infrastructure
China is facing tremendous mental health challenges. Current studies indicate that one-month prevalence of any mental disorder in China is around 17.5%. The 2010 global burden of disease (GBD) study reported that mental and behavioral disorders account for approximately 9.5% of all disability adjusted life years (DALY’s) and 23.6% of all years lived with disability (YLD) in China.
In contrast, a mere 5% of the individuals experiencing mental illnesses have been seen by a mental health professional. A variety of barriers and challenges contribute to this limited mental health service access, including but not limited to: disproportionate concentration of psychiatric hospitals in urban areas, limited mental health training for general physicians and community health workers, low level of mental health awareness among patients and their family members, stigma against mental illnesses, and financial burden associated with often costly mental health care.
In order to address these grand challenges, it is imperative to produce and evaluate innovative solutions that would result in overall health system strengthening through service integration, as well as improved access to evidence-based packages of care through task-shifting. Evidence for effective and affordable treatment for common mental disorders has been well represented in the WHO Mental Health Gap Action Programme (mhGAP), which specified treatment packages and priority task conditions, and promoted task shifting to aid non-specialists in providing mental health services. This would effectively empower the mentally ill in the service system, and expand the mental health services to reach vulnerable populations, such as migrants and the elderly.
The recent implementation of China’s first national mental health legislation aims to meet the grand challenges facing its mental health landscape by transforming the service infrastructure through quality improvement and community mental health service expansion.
The tremendous successes from the Chinese National Continuing Management and Intervention Program for Psychoses (the “686″ program) represents an emerging paradigm, and could be expanded to include more care pathways, essential skill packages, and worker matching options for an evolving mental health service system.
However, due to the regional disparity and situational complexity in China, local context and resources for scaling up mental health and psychosocial services in rural and underdeveloped areas differ greatly from those of urban areas. This calls for a successful mechanism of contextualization, which would integrate treatment packages with local resources and skill sets, provide feedback input to the legislative processes, in order to address the ongoing service barriers. Country or region-specific contextualization of the mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings (mhGAP-IG) would be instrumental to meet this challenge.
Finally, experiences accumulated among the global mental health community would help to map a coherent strategy for China’s efforts in scaling up its mental health and psychosocial services. Strategies to alleviate existing structural barriers would include broadening diagnostic privileges and priority tasks, as well as expanding coverage for vulnerable populations. These strategies would be essential in maximizing the efficacy of scale-up efforts. Without which, a mental health service system in development would risk continued redundancy and limited follow through in the face of demand pressures.