Qian Jiwei
National University of Singapore, Singapore.
J Ment Health Policy Econ. 2012 Dec;15(4):179-86.
Mental health in China is a great concern given the large number of patients and huge social and economic costs. The one-month prevalence rate of adult mental disorder in China is about 17.5%. Over 170 million adults have one or more types of mental disorder. Of this, 16 million people are estimated to have serious mental diseases. Over 90% of patients with serious mental diseases in China have not been given proper medical treatment. Over 60% of suicide cases in China are associated with mental disorders and suicide is the most significant reason for death between 19 and 34 years old in China.
This paper reviews the mental health care condition in China and discusses policy implications, given current import issues for mental health care.
We review research literature for mental health care in China and collect reports from various published sources.
Under-supply of the mental health services is the most pivotal issue for policymakers. The utilization of mental health care services in China has increased by double digits in recent years. In 2011, outpatient visits for mental health care were over 27 million. The situation is aggravated by the lack of qualified doctors and the shortage of physical infrastructures such as wards and equipment, leading to many patients with mental disorders being under-treated and under-reported. There are only 1.46 psychiatrists per 100,000 people and 15 beds per 100,000 people. Current government input for mental health in China accounts for less than 1% of total health expenditure. According to the 12th Five-Year Program (2011-2015), the Chinese government will increase its spending on the prevention and treatment of mental health care. The mental health law has been passed by the National People's Congress in October, 2012 and will come into effect on May 1st, 2013. The financial coverage of patients with mental diseases and relevant regulations for involuntary admission are still being debated.
Three more issues are discussed. First, the lack of provision of mental health care for vulnerable groups is serious. Second, the opportunistic behavior of both patients and suppliers of mental health care should be addressed. Thirdly, the extraordinary high share of involuntarily admitted patients should be reduced.
Mental health care provided in primary care clinics and community is both complement and substitutable for hospital care and should be supported for government to relieve the undersupply condition.
First, government should increase financial support for mental health care provision. Second, mental health care provided at community level should be supported and carefully designed by government.
Future research should focus on two issues. First, how mental health care services can be provided more efficiently at community level? Second, how can a national mental health care law be helpful to reduce the number of involuntarily admitted patients?
鉴于中国精神疾病患者数量庞大以及巨大的社会经济成本，心理健康问题备受关注。中国成人精神障碍的1个月患病率约为17.5%。超过1.7亿成年人患有一种或多种精神障碍。其中，估计有1600万人患有严重精神疾病。中国超过90%的严重精神疾病患者未得到适当治疗。中国超过60%的自杀案例与精神障碍有关，自杀是中国19至34岁人群中最重要的死亡原因。
鉴于当前心理健康护理的重要问题，本文回顾中国的心理健康护理状况并讨论政策影响。
我们回顾中国心理健康护理的研究文献，并从各种已发表来源收集报告。
心理健康服务供应不足是政策制定者面临的最关键问题。近年来，中国心理健康护理服务的利用率以两位数增长。2011年，心理健康护理门诊就诊量超过2700万。合格医生的缺乏以及病房和设备等物理基础设施的短缺使情况更加恶化，导致许多精神障碍患者治疗不足且报告不充分。每10万人中仅有1.46名精神科医生和15张床位。中国目前政府对心理健康的投入占卫生总支出的比例不到1%。根据“十二五”规划（2011 - 2015年），中国政府将增加心理健康预防和治疗的支出。《精神卫生法》已于2012年10月由全国人民代表大会通过，并将于2013年5月1日生效。精神疾病患者的财政覆盖范围以及非自愿入院的相关规定仍在讨论中。
还讨论了另外三个问题。第一，弱势群体心理健康护理的提供严重不足。第二，患者和心理健康护理提供者双方的机会主义行为都应得到解决。第三，非自愿入院患者的异常高比例应降低。
基层医疗诊所和社区提供的心理健康护理既是医院护理的补充也是替代，政府应支持其以缓解供应不足状况。
第一，政府应增加对心理健康护理提供的财政支持。第二，政府应支持并精心设计社区层面提供的心理健康护理。
未来研究应关注两个问题。第一，如何在社区层面更高效地提供心理健康护理服务？第二，国家精神卫生保健法如何有助于减少非自愿入院患者的数量？
