Mental Health in China: A Tsunami Brewing?

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“Mental health is currently a major problem in China, and will become an ever greater problem unless effective interventions are put in place.”

 

Mental Health has Long Been a Serious Problem in China

 

The most populous nation in the world is said by some to be “in the throes of a mental health crisis” given the ever-increasing number of patients with mental health disorders, coupled with the inadequate healthcare system to support them, especially when compared to other developed economies.

 

Prevalence and cost of mental health disorders are substantial.

 

By some estimates, as many as 280 million Chinese may be impacted by some form of mental illness. Mental illness here refers to the compilation of psychiatric disorders (depression, schizophrenia, etc.), neurological diseases (Alzheimer’s disease, Parkinson’s disease, etc.), and substance abuse (alcoholism, etc.).

 

One such disorder, depression, is a serious problem in China, with over 54 million sufferers, representing over 4% of the country’s population according to the World Health Organization (WHO). Moreover, depression-related deaths such as suicides exceed deaths caused by traffic accidents. Some estimates of suicide are as high as 13 per 100,000, making it the fifth leading cause of death in China, accounting for over one-quarter of suicides worldwide.

 

The economic cost of mental illness is also substantial. For example, depression costs China an estimated $7.6 billion US every year in lost workdays, medical expenses and funeral expenses. Between 2012 and 2030, these conditions will slow productivity in China by more than $9 trillion US.

 

Current challenges in China’s system are myriad.

 

Inadequate number of trained mental healthcare professionals. For every 100,000 psychiatric patients, there are fewer than two psychiatrists, a stark contrast to Japan and US where there are 20 and 12, respectively. Of licensed psychological counsellors, 90% are not employed in the mental health industry.

 

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Figure 1. Psychiatrists per 100,000 people in various countries (cited from Economist).

 

Insufficient mental health service capacity. The financial investment per capita from the Chinese government for psychiatric hospitals is just over $1 US, which is far lower than $35 US in high-income countries during the same period. Hospital psychiatric beds in China per 10,000 population is 3.2, compared to 7.1 beds in high-income countries.

 

Unbalanced and lack of treatment standardization. Even when services are present, there are inconsistent level of performance of providers across the country, with severe lack of standardization. Exacerbating this is the vastness of the country and the divide between the rural and urban areas. The mental health status of the rural population is generally worse than that of the urban population. Yet the distribution of mental health hospitals and professionals are concentrated in the more urban areas.

 

Lack of awareness and social stigma leading to underdiagnosis. As a conservative society, a major challenge is social stigma and the government’s historical passiveness in developing awareness, with resulting underdiagnosis of mental disorders. According to the WHO, the recognition rate of global mental disorders is around 50%, and the rate in China is far below the world average. Taking depression as an example, its recognition rate is only 21% in Shanghai. Moreover, one report states that less than 9% of depressed patients sought professional help in China.

 

China has Begun to Tackle Mental Health Disorders with Urgency

The Chinese government, understanding the past inadequate attention given to mental disorders, has begun to implement various programs to better understand mental illnesses in their population, strengthen the research, services and management of treatment, and protect the rights of patients. For example, the first National Mental Health Plan (2002-2010) was implemented in 2002; the China Mental Health Survey was introduced in 2012; the Mental Health Law providing laws and rules for research and treatment was implemented in 2013 and updated in 2018; the National Clinical Research Center for Mental Disorders, to raise mental health issues to the national strategic level for the first time was established in 2014; and more recently announced initiatives includes the National Mental Health Work Plan 2015– 2020, China’s Long-Term Plan for Prevention and Treatment of Chronic Diseases 2017–2025, and Healthy China 2030: A Vision for Health Care. The National Mental Health Work Plan 2015– 2020 report in particular, outlines aggressive goals and objectives to address China’s mental health crisis.

 

China’s Solutions Must Incorporate Digital Therapeutics and Data Science

Mental health poses a daunting challenge for China, which must be met with the latest technological innovations. As an example, let us discuss a solution for treating major depressive disorder (MDD) that will enhance its treatment and management, and remove barriers to care posed by scarcity of therapists and geographic isolation, all problems that are endemic to China. This solution comprises three separate systems integrated under a single platform: (1) Digital therapeutics, (2) Mental health EHR system, and (3) Integrated database & predictive analytics.

 

The digital health platform can use mobile applications to collect passive data (location, social media usage, etc.) and active data (questions uniquely directed to monitor states, voice and speech samples, etc.) outside of clinic visits. This platform will be an online assessment and monitoring tool that collects information and uses predictive algorithms to process and provide insights into the patient’s state, mental health state over time, risk of deterioration, etc. It will be able to track depressive symptoms, suicide risk, life functionality, adverse effects of the drugs treatments, and treatment adherence. The wealth of digital data can be combined with the EHR system data collected from clinic visits to form a gestalt view of the patients. Data analytics driven by artificial intelligence will analyse the combined data to draw predictive insights to anticipate potential depressive episodes based on the pattern of data and to inform better treatment decision making for both patients and clinicians. Ultimately, this system will provide patient-centric digital health solution to improve the quality and personalization of care delivery and treatment outcomes of patients suffering from MDD.

 

“If necessity is the mother of invention, then resourcefulness is the father. The challenges in mental health that lies ahead for China can be met with invention and resourcefulness from technological innovations.”

 

 

References

 

China wakes up to its mental-health problems.

https://www.economist.com/china/2017/01/28/china-wakes-up-to-its-mental-health-problems

 

Chinese mental health services falling short: report.

http://chinaplus.cri.cn/news/china/9/20190225/253543.html

 

Development and challenges of mental health in China.

https://gpsych.bmj.com/content/gpsych/32/1/e100053.full.pdf

 

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2818%2932279-7

 

Healthy China 2030: A Vision for Health Care.

https://www.ispor.org/docs/default-source/publications/newsletter/commentary_health-care_china_2030.pdf?sfvrsn=3b155d92_0

 

How Digital Technology Can Enhance Mental Health.

https://www.psychologytoday.com/us/blog/culture-shrink/201806/how-digital-technology-can-enhance-mental-health

 

Integrated mental health services in China: challenges and planning for the future.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Integrated+mental+health+services+in+China%3A+challenges+and+planning+for+the+future

 

Outline of the Healthy China 2030 Plan.

https://www.sahealth.sa.gov.au/wps/wcm/connect/d39abd8041032c76a711ff1afc50ebfc/1645+Ning+Zhuang.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-d39abd8041032c76a711ff1afc50ebfc-mKO1wtS

 

Prevalence of mental disorders in China: a cross-sectional epidemiological study.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30511-X/fulltext

 

Tackling China’s mental health challenges.

http://www.chinadaily.com.cn/a/201812/21/WS5c1c8d23a3107d4c3a002244.html

 

The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30590-6/fulltext

 

The Incredible Ways Artificial Intelligence Is Now Used In Mental Health.

https://www.forbes.com/sites/bernardmarr/2019/05/03/the-incredible-ways-artificial-intelligence-is-now-used-in-mental-health/#42f0d08dd02e.

 

Mental Health.

https://ourworldindata.org/mental-health

 

The Mental Healthcare Industry in China.

https://www.china-briefing.com/news/mental-healthcare-industry-china/

 

Translated and annotated version of the 2015-2020 National Mental Health Work Plan of the People’s Republic of China.

https://www.ncbi.nlm.nih.gov/pubmed/27688639

 

Understanding the public’s profile of mental health literacy in China: a nationwide study.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1980-8

 

World Health Organization.

https://www.who.int

 

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