Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Members & Subscribers
    • Benefits for CMA Members
    • CPD Credits for Members
    • Subscribe to CMAJ Print
    • Subscription Prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
News

China struggles to rebuild mental health programs

Suzanne Ma
CMAJ February 08, 2011 183 (2) E89-E90; DOI: https://doi.org/10.1503/cmaj.109-3738
Suzanne Ma
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

The anomaly is striking. At least a dozen workers leapt to their death in the same factory compound in southern China in 2010, while nearly 30 people died and 80 were injured in a spate of school stabbings.

Yet, contrary to instinct, there is little evidence to confirm that there has been a rapid rise in the rate of mental illnesses in China, and strong evidence of a dramatic drop in suicide rates over the past two decades, says Michael Phillips, director of the Suicide Research and Prevention Center at the Shanghai Medical Center.

“Westerners believe if you have suicide, you have to have mental illness,” Phillips says. “This is not the case in China. Only 65% of people who die by suicide in China have a mental illness compared to 90% to 95% in high-income countries.”

Phillips believes many of the suicides can be attributed to impulsive personality traits and poor conflict-resolution skills, rather than the stresses of modernization, the breakdown of the traditional family structure or protests against corruption, as many have speculated.

“These are people who have underlying impulsive personalities,” Phillips says. “They are people who still got married, functioned normally, but they fly off the handle really easily. Under those stressful circumstances, you have more impulsive acts.”

Whatever the cause, what has become clear through the mist of the high-profile suicides and school shootings is that China has failed to adequately address the mental health needs of the 173 million Chinese people, or 17.5% of the population, who Phillips has estimated have mental disorders (Lancet 2009; 373:2041-53). And a vast majority of those, an estimated 158 million people, have never received any kind of professional help.

That’s because help is hard to find in China — the country has just 15 000 trained psychiatrists to serve a population of 1.3 billion.

Figure

A plainclothes policeman checks the blood stains on the wall at a primary school where a man stabbed eight children to death and injured five others in Nanping, China.

Image courtesy of Reuters

In the late 1960s, Mao Zedong outlawed psychiatry during the Cultural Revolution and many mentally ill patients were taken from hospitals and sent to labour camps. Their illnesses were attributed to a lack of appreciation for the class struggle and they were labeled counter-revolutionists.

These days, there is a more capitalist rationale for Chinese doctors and patients don’t want to talk about mental health. Psychiatry isn’t glamorous and being an expert in the field doesn’t earn much in the way of salary and respect.

“It’s still quite low down on the totem pole of medical specialties in terms of income and status,” says Phillips.

Likewise, Chinese patients are ashamed to reveal they may need psychiatric help for fear of being labelled “crazy.”

In Chinese society, people “look down on those who have mental illness,” says King-Wa Fu, an assistant professor of journalism and media studies at the University of Hong Kong. “They don’t think you have the same ability in terms of working, learning and studying.”

“In China, there’s a lot of talk about ‘face’,” adds Fu, who studies the media’s influence on mental health and suicide. “If you have family members who have mental illness, you will have lost your face. So we have many people who are not willing to come out and seek help.”

There are also economic reasons why some avoid seeking help. Many sufferers, particularly those in rural area, simply cannot afford to see a psychiatrist or don’t have access to one. There’s also a fear of job loss if an employer discovers that a worker has a a mental illness.

“Mental illness is costing us not only our health … but there is an indirect cost which can be seen in labour market participation,” says Chunling Lu, senior research associate at the Harvard Initiative for Global Health in Boston, Massachusetts, and author of a recent study which found that incomes for men declines 39%, and for women 33%, after their mental health deteriorated (J Ment Health Policy Econ 2009;12:157-66)

Lu hopes that quantifying the economic losses incurred as a result of the prevalence of mental illness will motivate the government to invest in hospital psychiatric wards in hospitals and draft policies that protect workers with mental illnesses.

At the factory in southern China, safety nets were installed outside buildings and Buddhist monks and counsellors were hired to help at-risk employees. Salaries for assembly line workers were raised by about 70%. After the school stabbings, armed guards were posted at elementary schools across the country.

The government has pledged a number of long-term initiatives, including the renovation or expansion of 550 psychiatric hospitals and departments over the next two years; the creation of free mental health counseling hotlines; and the passage of mental health legislation.

Dealing with the persisting stigma attached to mental illness may be more thorny. But Fu says media attention can start a dialogue. “Sometimes even [if people] are exposed to such terrible stories, they will tend to look at the positive side: ‘If I do the same thing, I will hurt my family members. If I do the same thing, it’s not a good experience’.”

Oddly enough, while China gropes to address the mental health problem, in some cities, psychiatry seems to have developed a cult following: the theories of Freud have become fashionable.

Elise Snyder, a New York-based psychoanalyst has, for the last two years, been training some of China’s first psychotherapists through Skype conversations, while in Shanghai, workshops are offering a glimpse into the hidden realms of the unconscious.

“There’s an incredible interest in psychoanalysis here and people are making tons of money,” Phillips says. “It seems everyone wants to study Freud for some self-help, and it has consumed [people]. From a health perspective, it’s not really doing much, but it’s an indication of interest.”

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 183 (2)
CMAJ
Vol. 183, Issue 2
8 Feb 2011
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
China struggles to rebuild mental health programs
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
China struggles to rebuild mental health programs
Suzanne Ma
CMAJ Feb 2011, 183 (2) E89-E90; DOI: 10.1503/cmaj.109-3738

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
China struggles to rebuild mental health programs
Suzanne Ma
CMAJ Feb 2011, 183 (2) E89-E90; DOI: 10.1503/cmaj.109-3738
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Could bringing the hospital home expand acute care capacity?
  • Can Ontario offload surgeries to private clinics without undermining public health care?
  • Should alcohol carry a warning label?
Show more News

Similar Articles

Collections

  • Topics
    • Global health
    • Psychiatry & mental health: adult

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire