Harvard to collaborate in China on program to train psychiatrists

Psychiatrist Yao Xueyang says he has been overloaded with work ever since he started at Yichang Mental Health Center six years ago.

"We have about 30 doctors here, with four to five working in the outpatient department. They receive an average of 100 patients each day," he said, adding with a sigh: "The physical pain patients inflict on doctors and nurses, severe or not, can be seen every day."

There are only about 40 psychiatrists in all of Yichang, a city in Central China's Hubei province with a population of about 4 million. That means one psychiatrist for every 100,000 people.

In Western countries, such as the United States, Britain and Germany, there are more than 11 psychiatrists serving 100,000 people.

"The personnel shortage has existed at my clinic for years, not to mention lower-level hospitals," Yao said. "Because of the high risk of being hurt by patients, low pay and wide social stigma, very few people want to enter the field of psychiatry when they graduate from medical school, let alone work in less-developed areas of China."

China has had a serious lack of qualified psychiatrists for a long time, particularly in central and western areas. Figures from the Ministry of Health showed that in 2010 there were only about 20,000 psychiatrists to serve the country's population of 1.3 billion, about one-fourth of the international level.

Statistics from China's National Center for Mental Health said in 2009 about 170 million people had some sort of mental illness, and the number of patients with severe mental health problems exceeded 16 million.

The distribution of mental health medical staff is also extremely uneven. Most mental health medical staff work in big cities in eastern areas, with about 29 percent in central regions and less than 23 percent in western areas.

In addition, more than 80 percent of mental health specialists are working at psychiatric hospitals and less than 20 percent are working at general hospitals, county-level and community hospitals, according to the Health Ministry.

"In medical schools, psychiatry is not as popular as cardiology or endocrine medicine. Students have fewer periods for psychiatric study," said Wu Yuefeng, a doctor at Xi'an Mental Health Center in Northwest China's Shaanxi province. "When they graduate, students prefer to work or study further in eastern areas, where rich psychiatric resources are concentrated."

Take the Guangxi Zhuang autonomous region as an example. From 2008 to 2012, psychiatric hospitals in the area recruited 160 professional psychiatric medical staff, while 54 quit.

Of them, 39 had worked for less than three years, a source with the local health department said.

To make things worse, social stigma makes few people who suffer from mental illness willing to seek medical treatment.

For a long time, mental illness was taboo in China, though the situation has improved in recent years.

"Even patients that have fully recovered often face the prospect of losing their jobs, housing and marriage. Mental problems are always seen as a source of shame to a person and his or her entire family," said Xie Bin, professor of forensic psychiatry at Shanghai Mental Health Center.

"Psychiatry's marginalization in both medical school and society means that general doctors, especially those at community hospitals, often are ignorant of mental disorders and consequently fail to diagnose or treat them."

Mental problems also exist in big cities like Beijing and Shanghai, though they have much better medical infrastructure.

A dramatic growth in the amount of psychobehavioral problems has been seen among children, adolescents and the elderly in urban areas due to the fast pace of social change.

Recognizing the severity of the situation, the government has in recent years scaled up programs and policies to remedy the lack of psychiatric services.

In Shanghai, mental health has been prioritized by public health departments in a new round of healthcare reforms.

"With the fast development of society and the economy, people are facing increasing pressure from work and life," said Xu Jianguang, director of the city's health bureau, who added that Shanghai will boost investment in mental health services, especially for the elderly.

Shanghai is the first city in the country to have an ageing population. It is predicted that about one-third of Shanghai residents will be older than 60 by 2020.

Meanwhile, mental health experts and institutions are also exploring more effective and innovative ways to improve the country's mental health services.

A five-year training program focused on building research capacity and improving mental health among all age groups in China was launched on Monday. It will improve the skills of medical staff, especially those from the country's central and western areas, Xie said.

Sponsored by the Fogarty International Center of the US National Institute of Health, the program was initiated by the department of global health and social medicine of Harvard Medical School, the Shanghai Mental Health Center and the Peking University Institute of Mental Health.

Under the program, a total of 40 researchers, doctoral-level students and post-doctoral fellows from Shanghai and Beijing will receive rigorous training from professionals from these three institutes. In addition, 80 clinical psychiatrists from other areas of China will be trained in Beijing and Shanghai.

"Trainees in this program will play a leading role in mental health research across China," Xie said.

"The main task of promoting mental health development is to reconstruct the country's mental health service system. Over the past few years, the medical staff and resources have been mainly concentrated in the psychiatric hospitals. But now the mental health service should move from institution-based treatment to community-based care," Xiao Zeping, deputy director of Shanghai municipal health bureau, said at the Harvard-China Fogarty Conference, which discussed mental health care in China, including research, implementation and policy. The conference was held at the Harvard Shanghai Center on Monday.

It's estimated that about 300,000 people have already received national licenses to work as psychological counselors.

"This reflects that there is huge demand for psychological counseling. Using this method, some people want to solve their own psychological problems, while some want to provide psychological help to others," said Xu Kaiwen, associate professor of clinical psychology at Peking University.

But Xu added that those granted licenses are usually far from meeting the requirements of a professional clinical psychologist.

"People with different educational backgrounds can easily get the licenses after about half a year of part-time study. But more professional training should be given before they can work as psychological counselors."

"We must enable psychologists and social workers to play their parts to the fullest extent. Psychiatrists provide the treatment after mental illness occurs. Probably a more fundamental way to solve the problem is to prevent mental illnesses from the very beginning through community service, where psychologists and social workers play an important role," Xiao said.

In addition to psychiatrists, the development of mental health needs the collaboration of various participants, such as sociologists, psychologists, mental health social workers, public health experts and anthropologists, Byron Good, professor of medical anthropology at Harvard University, said at the conference on Monday.

Contact the writer at wanghongyi@chinadaily.com.cn