History
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 theCurrent 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 173 million people in China have a mental disorder. Over 90 percent of people with a mental disorder have never been treated. A lack of government data on mental disorders makes it difficult to estimate the prevalence of specific mental disorders, as China has not conducted a national psychiatric survey since 1993.Conducted between 2001 and 2005, a non-governmental survey of 63,000 Chinese adults found that 16 percent of the population had aStigma 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 withLack of qualified staff
China has 17,000 certified psychiatrists, which is 10 percent of that of other developed countries per capita. China averages one psychologist for every 83,000 people, and some of these psychologists are not board-licensed or certified to diagnose illnesses. Individuals without any academic background in mental health can obtain a license to counsel, following several months of training through the National Exam for Psychological Counselors. Many psychiatrists or psychologists study psychology for personal use and do not intend to pursue a career in counseling. Patients are likely to leave clinics with false diagnoses, and often do not return for follow-up treatments, which is detrimental to the degenerative nature of many psychiatric disorders. The disparity between psychiatric services available between rural and urban areas partially contributes to this statistic, as rural areas have traditionally relied onPhysical 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
According to various scholars, China's psychiatric facilities have been manipulated by government officials in order to silence political dissidents. In addition to misuse by the state psychiatric facilities in China are also misused by powerful private individuals who use the system to advance their personal or business ends. China's legal system lacks an effective means of challenging involuntary detentions in psychiatric facilities.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. 420–4Background
Research on the mental health status of active Chinese military men began in the 1980s where psychologists investigated soldiers' experiences in the plateaus.Zhao, M., Feng, Z., Wang, F., Lai, W., Hu, F…Xia, L. (2017). Chinese military mental health at high altitude, 1993–2013: A cross-temporal meta-analysis of SCL-90. ''Acta Psychologica Sinica. 49(5),'' pp. 653–662 The change of emphasis from physical to mental health can be seen in China's four dominant military academic journals: First Military Journal, Second Military Journal, Third Military Journal, and Fourth Military Journal. In the 1980s, researchers mostly focused on the physical health of soldiers; as the troops' ability to perform their services declined, the government began looking at their mental health to provide an explanation for this trend. In the 1990s, research on it increased with the hope that by improving the mental health of soldiers, combat effectiveness improves. Mental health issue can impact active military members' effectiveness in the army, and can create lasting effects on them after they leave the military. Plateaus were an area of interest in this sense because of harsh environmental conditions and the necessity of the work done with low atmospheric pressure and intense UV radiation.Tan, Y., Li, Y., Wu, J., Chen, F., Lu, H., Lu, S., Yang, X., … Ma, X. (2018). Mental health of Automobile Transportation Troop personnel stationed in the Western Sichuan Plateau of China. ''Medicine'', ''97''(12), It was critical to place the military there to stabilize the outskirts and protect the Chinese citizens who live nearby; this made it one of the most important jobs in the army, then increasing the pressure on those who worked in the plateaus. It not only affected the body physically, like in the arteries, lungs, and back, but caused high levels of depression in soldiers because of being away from family members and with limited communication methods. Scientists found that this may impact their lives as they saw that this population had higher rates of divorce and unemployment. Comparatively, assessing the mental health status of the People's Liberation Army (PLA) is difficult, because military members work a diverse array of duties over a large landscape. Military members also play an active part in disaster relief, peacekeeping in foreign lands, protecting borders, and domestic riot control. In a study of 11,000 soldiers, researchers found that those who work as peacekeepers have higher levels of depression compared to those in the engineering and medical departments. With such diverse military roles over an area of , it is difficult to gauge its impacts on soldiers’ psyche and provide a single method to address mental health problems. Researches have increased over the last two decades, but the studies still lack a sense of comprehensiveness and reliability. In over 73 studies that together included 53,424 military members, some research shows that there is gradual improvement in mental health at high altitudes, such as mountain tops; other researchers found that depressive symptoms can worsen. These research studies demonstrate how difficult it is to assess and treat the mental illness that occurs in the army and how there are inconsistent results. Studies of the military population focus on the men of the military and exclude women, even though the number of women that are joining the military has increased in the last two decades.Chen H.H., Phillips, M.R., Cheng, H., Chen, Q.Q, Chen, X.D…Bueber, M. (2012) Mental Health Law of the People’s Republic of China''. Shanghai Arch Psychiatry 24(6)''pg. 305–321 Chinese researchers try to provide solutions that are preventative and reactive, such as implementing early mental health training,Yan J , Wang LJ , Cheng Q , Miao D.M., Zhang L.Y…Pan, Y. (2008) Estimated mental health and analysis of relative factors for new Chinese recruits. ''Mil Med 173(10)'' pp. 1031 – 4. or mental health assessments to help service members understand their mental health state, and how to combat these feelings themselves.Xu, X., Li, X., Zhang, J., Wang, W., (2018) Mental Health-Related Stigma in China. ''Issues in Mental Health Nursing. 37(2)'' pp. 126–134 Researchers also suggest to improve the mental health of the military members, programs should include psychoeducation, psychological training, and attention to physical health to employ timely intervention.Implementation
In 2006, the People's Republic Minister for National Defense began mental health vetting at the beginning of the military recruitment process. A Chinese military study consisting of 2500 male military personnel found that some members are more predisposed to mental illness. The study measured levels of anxious behaviors, symptoms of depression, sensitivity to traumatic events, resilience and emotional intelligence of existing personnel to aid the screening of new recruits. Similar research has been conducted into the external factors that impact a person's mental fortitude, including single-child status, urban or rural environment, and education level. Subsequently, the government has incorporated mental illness coping techniques into their training manual. In 2013 leak by the Tibetan Center for Human Rights of a small portion of the People's Liberation Army training manual from 2008, specifically concerned how military personnel could combat PTSD and depression while on peacekeeping missions in Tibet. The manual suggested that soldiers should:“...close heireyes and imagine zooming in on the scene like a camera hen experiencing PTSD It may feel uncomfortable. Then zoom all the way out until you cannot see anything. Then tell yourself the flashback is gone.”Moore, M. (2013, May). Chinese troops suffering post-traumatic stress disorder in Tibet. ''The Telegraph.'' Retrieved fromIn 2012, the government specifically addressed military mental health in a legal document for the first time. In article 84 of the Mental Health Law of the People's Republic of China, it stated, “''The State Council and the Central Military Committee will formulate regulations based on this law to manage mental health work in the military.''" Besides screening, assessments and an excerpt of the manual, not much is known about the services that are provided to active military members and veterans. Analysis of more than 45 different studies, moreover, has deemed that the level of anxiety in current and ex-military personnel has increased despite efforts of the People's Republic due to economic conditions, lack of social connects and the feeling of a threat to military livelihood.Yang, Z., Cao, F., Lu, H., Zhu, X., Miao, D. (2014) Changes of anxiety in Chinese Military personnel over time: a cross-temporal meta-analysis. ''International Journal of Mental Health Systems. 8'' This growing anxiety manifested in both 2016 and 2018, as Chinese veterans demonstrated their satisfaction with the system via protests across China.Buckley, C. (2018, June). Marching Across China, Army Veterans Join Ranks of Protesters. ''NY Times.'' Retrieved fromhttps://www.telegraph.co.uk/news/worldnews/asia/tibet/10071121/Chinese-troops-suffering-post-traumatic-stress-disorder-in-Tibet.html
See also
* Chinese Society of Psychiatry *References
Further reading
* Normal and Abnormal Behavior in Chinese Culture (1981) edited by Arthur Kleinman and Tsung-yi Lin * Chinese Societies and Mental Health (1995) edited by Tsung-yi Lin, Wen-shing Tseng, and Eng-kung Yeh * Mental health care in China (1995) By Veronica Pearson * Narcotic Culture – A History of Drugs in China (2004) by Frank Dikötter, Lars Laamann and Zhou Xun {{Asia topic, Mental health in China