User:Haughtyshoe/sandbox

Topic
Mental health in China

Ideas for improvement:


 * revamp lede
 * expansion of history section to include efforts by China to improve mental health
 * expansion of how mental health issues manifest in China vs. the West
 * e.g. depression is more about emotion, sadness in the U.S. but manifests as physical pain and soreness in China
 * expansion of cultural attitudes toward mental health
 * more statistics of prevalence
 * general cleanup of structure and copy editing

= Mental health in China = The concept of mental health in China is influenced by Confucian philosophy as well as an emphasis on family. In contrast to Western thought, the Chinese emphasize "highly personal duties and social goals" rather than the individual, and personal rights. Failing to fulfill one's duties within the family and society can lead to common symptoms of psychological distress, such as feelings of guilt and shame.Mental health is a growing issue in China with estimates of 100 million sufferers of mental illness.

History
China's first mental institutions were introduced before 1849 by Western missionaries. Missionary and doctor John Kerr opened the first psychiatric hospital in 1898, with the goal of providing care to people with mental illness 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 the Cultural Revolution.

In a 1999 meeting jointly held by Chinese ministries and the World Health Organization, the Chinese government committed to creating a mental health action plan and a national mental health law, among other measures to expand and improve care. The action plan, adopted in 2002, outlined China's priorities of enacting legislation, educating its people on mental illness and mental health resources, and developing a stable and comprehensive system of care.

In 2000, the Minority Health Disparities Research and Education Act was enacted. This act helped raised national awareness to health issues through research, health education, and data collection.

Since 2006, the government's 686 Program has worked to redevelop community mental health programs, make these centers the primary resource, instead of psychiatric hospitals, for people with mental illness. These community programs make it possible for mental health care to reach rural areas and for people in these areas to become mental health professionals, though specialists are still relatively inaccessible to rural populations. The program also emphasizes rehabilitation rather than management of symptoms.

In 2011, the legal institution of China's State Council published a draft for a new mental health law, which included new regulations concerning the right of patients not to be hospitalized against their will. The draft law also promotes transparency of patient treatment management, as many hospitals were driven by financial motives and disregarded patients' rights. The law, adopted in 2012, stipulates that a qualified psychiatrist must make the determination of mental illness; that patients can choose whether to receive treatment in most cases; and that only those at risk of harming themselves or others are eligible for compulsory inpatient treatment. However, Human Rights Watch has also criticized the law. For example, although it creates some rights for detained patients to request a second opinion from another state psychiatrist and then an independent psychiatrist, there is no right to a legal hearing such as a mental health tribunal and no guarantee of legal representation.

Since 1993, the WHO has been collaborating with China in the development of a national mental health information system.

Current
A variety of conflicting factors explain why China continues to lag behind in terms of mental health services. These factors include the balance between human rights and political control, a cultural reticence against acknowledging mental illness and the lack of qualified staff.

Prevalence of mental illness
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 illness 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 survey of 63,000 Chinese adults found that 16 percent of the population had a mood disorder, including 6 percent of people who had major depressive disorder. Thirteen percent of the population had an anxiety disorder and 9 percent had an alcohol use disorder. Women were more likely to have a mood or anxiety disorder compared to men, but men were much more likely to have an alcohol use disorder. People living in rural areas were more likely to have major depressive disorder or alcohol dependence.

In 2007, the Chief of China's National Centre for Mental Health, Liu Jin, estimated that approximately 50 percent of outpatient admissions were due to depression.

The suicide rate in China was approximately 23 per 100,000 between 1995 and 1999. Since then, the suicide rate is thought to have fallen to roughly 7 per 100,000, according to government data. The World Health Organization (WHO) states that the rate of suicide is thought to be three to four times higher in rural areas than in urban areas, which is consistent with the most common method, which is poisoning by pesticides, which accounts for 62% of incidences.

Stigma related to cultural and folk beliefs
It is estimated that 18 percent of the Chinese population, over 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 with Confucianism, Buddhism, Taoism, and shamanism. Common between all of these philosophical and religious beliefs is an emphasis on acting harmoniously with nature, with strong morals, and with a duty to family. Followers of these religions perceive behavior as being tightly connected with health; illnesses are often thought to be a result of a moral failure or insufficiently honoring one's family in a current or past life. Furthermore, an emphasis on social harmony may discourage people with mental illness from bringing attention to themselves and seeking help. They may also refuse to speak about their mental illness because of the shame it would bring upon themselves and their family members, who could also be held responsible and experience social isolation.

In addition, many of these philosophies teach followers to accept one's fate. Consequently, people with mental illness may be less inclined to seek medical treatment because they believe they should not actively try to prevent any symptoms that may manifest. They may also be less likely to question the stereotypes associated with people with mental illness, instead agreeing with others that they deserve to be ostracized.

Lack of qualified staff
China has 17,000 certified psychiatrists, which is ten 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 illness. Individuals without any academic background in mental health can obtain a license to counsel following several month of training through the National Exam for Psychological Counselors, even if most of them study psychology for their own self-help and do not pursue a career in counseling. Patients leave the clinics with false diagnoses and often do not return for follow-up treatments, detrimental to the degenerative nature of many psychiatric disorders. While many licensed psychologists lament the low professional standards of their practice, they nonetheless continue to provide short-term counseling.

The disparity between psychiatric services available between rural and urban areas partially contributes to this statistic, as rural areas have traditionally relied on barefoot doctors since the 1970s for medical advice. These doctors, one of the few modes of healthcare able to reach isolated parts of rural China, are unable to obtain modern medical equipment, much less provide reliable diagnoses for psychiatric illness. Furthermore, the nearest psychiatric clinic may be hundreds of kilometers away, and families may be unable to afford professional psychiatric treatment for the afflicted.

Political infringement on human rights
Practices enacted during the Communist Era prevented mental health violations from being exposed[citation needed]. Historically, Maoist and Marxist writings denounced mental illness as a "capitalist evil" that should not exist in a socialist state. Similar misinformed statements were made by the vice minister of public health during the early 1980s, Tan Yunhe, and by workers at the Beijing branch of the Chinese Medical Association. The view of mental illness as a political evil rather than a disease with very human aspects prevents developments in psychiatry, psychotherapy and other integrative healing techniques present in the West. It took 27 years to pass the Mental Health Code in 2013, which prevented patients from being hospitalized against their will. From 1995 to 1999, leadership over developing the law was passed from academic circles to the Ministry of Health (China), consisting primarily of psychiatrists, legal experts and public health experts. This meant that other factions, such as professional groups and individuals involved with the mentally ill had no say in the law. The division of responsibility from academia to government institution shows that only uppermost factions have influence in swaying legislation regarding mental health and is also disorganized since the issue is passed around between organizations until one takes responsibility. Currently, government censorship of dissenting opinions remains a problem because the majority of abuses in psychiatric hospitals remains in secret. Human rights organizations in the United States have reported abuse within China's hospital system[citation needed]. Although China's government has taken action to prioritize mental health by legislation such as the 686 Rule and Mental Health Code, the results of implementing these statutes comes over time.

Cultural reticence
The Chinese reluctance to address mental illness and psychiatry stems from the limited extent to which health care professionals and public health officials are involved with the issue. The US Rural Health Systems Delegation's 1978 visit to a rural inpatient teaching institution revealed patients bound in locked isolation rooms by their legs and hands; when asked about the social nature of mental illness, workers claimed that psychiatry is a purely biological discipline independent of social wellbeing. The workers' attitudes view mental illness merely as neurosis, reflecting the perception that diseases of the mind do not need to be treated holistically in a communal context. That neurosis, a diagnosis of a mild mental illness not caused by disease, is still used as a classification for most anxiety, factitious, and somatoform disorders in China shows that the standards of diagnosis for mental illness have not been updated.

Physical 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.

Misc info
The map of disability-adjusted life years shows the disproportionate impact on quality of life for persons with bipolar disorder in China and other East Asian countries.

Also, the income and education level in rural China averages to be less than that of urban China. This makes it difficult for the rural populace to comprehend mental disorders enough to seek treatment.

nd while issues surrounding living conditions in rural areas have been a known contributor to high depression rates, another issue is that of high levels of competition in all levels of schooling.

To delete
Chinese culture emphasizes stoicism, internal confidence, humility, hard work and diligence. These characteristics may make it difficult to be vulnerable or to admit to having a psychiatric illness. Patients have already taken a big leap of faith when they admit to having a psychiatric disorder, yet those that do take the first step to obtain treatment are not in luck, either.

"These efforts included adapting the NKI/WHO Mental Health Information System to the needs of China, training visiting scientists, and providing continuous support to the project. In January 1995, the Center was notified that the System has been approved by the Ministry of Health for use nationwide."

China's first mental institutions were introduced before 1849 by Western missionaries. After the establishment of the People's Republic of China in 1949, the treatment model was indigenized during 1949–1963. During the Cultural Revolution (1964–1976) strong political control governed diagnosis and treatment as well as detention and discharge of mental patients. Later, due to the modernization and reform advocated by Deng Xiaoping, western models of treatment and rehabilitation were gradually introduced by psychiatrists. After more than 25 years of planning and fundraising, American medical missionaries opened the first mental hospital in China in 1898. In 19th century China, the mentally ill were usually confined by their families in a dark room of the house, essentially neglected. If left to wander in the streets, they were often mocked and laughed at, and sometimes stoned. If they did anything wrong, they could be arrested and thrown into prison. Because the mentally ill were largely invisible, some missionaries argued that mental illness was not as prevalent in China as in Europe or the United States. John G. Kerr, MD (1824–1901), an American Presbyterian medical missionary, disagreed – and he worked long and hard to change the treatment of the mentally ill. When he opened his Refuge for the Insane, Kerr declared some new principles: first, insane patients were ill and should not be blamed for their actions; second, they were in a hospital, not a prison; and third, they must be treated as human beings, not as animals. He pledged to conduct a course of treatment based on persuasion rather than force, on freedom rather than restraint, and on a healthy outdoor life with a maximum of rest, warm baths, and kindness. He also wanted to provide patients with gainful employment wherever possible. The directors of the Canton refuge worked closely with local Chinese officials and local police, who did not know how to handle insane people and were glad to refer them in large numbers to the refuge. 6 Chinese officials paid the refuge an annual allowance for taking care of the patients. Local families also brought in patients, and some were sent from Hong Kong by the British authorities. The hospital was eventually expanded to 500 beds, and it operated with considerable success until it finally closed in 1937.

They tend to blame patients' "cultural conservativeness" and concerns of "face" for their flexible application of therapeutic methods.