Destigmatizing Mental Health in China, Slowly But Surely
The Chinese government is making efforts to recognize mental illness as a public health issue, but progress has been slow.
Compared to other countries, China has a much lower per capita number of mental health professionals. China had roughly 23,000 psychiatrists in 2014, with 1.7 for every 100,000 people, according to the World Health Organization. Conversely, for every 100,000 people in the United States, there were 12 psychiatrists.
When I was working at Stanford University, a mentor was diagnosed with cancer. He returned to work after the first round of chemotherapy and described the whole experience as a challenge. “But I love challenges in my life,” he told me.
I was struck deeply by his tenacity, so when the news of my father’s diagnosis of gallbladder cancer came months later, and my mother asked if we should tell him the truth, I categorically said yes.
However, I underestimated the risk of his physical ailment affecting his mental health.
It is estimated that 15% to 25% of cancer patients suffer from depression. Recent research revealed that the majority of cancer patients identified with depression didn’t receive any form of treatment.
My father was given less than two years to live, which he didn’t yet know. I flew back to China to be with him. After researching online about the cancer, he was convinced that he was living on borrowed time. He got restless and started to miss his radiotherapy appointments.
He walked out of every psychotherapy session I scheduled for him. When he hit the point of refusing to eat or sleep, close family members were still reluctant to help take him for mental health care. As a last resort, my mother called the local community association (juweihui). One staff member helped take my father to a psychiatric hospital for medication. He was calm for a few weeks until the cancer spread. He passed away six months later.
Priority: tackling stigma to seek care
My heartbreaking experience with mental health stigma in China — socially and personally — was five years ago. Since then, China passed its first national mental health law (in late 2012), a law that was 27 years in the making.
In December 2016, the State Council issued China’s inaugural policy document to strengthen mental health services, calling for a multi-sectoral approach to addressing mental health disorders.
Despite the government’s ongoing efforts, tackling stigma and discrimination in Chinese society has a long way to go.
Dr. Fenglan Li of Central China Normal University surveyed 2,222 adults across China and found that the general public had a negative perception of mental health patients, because “they had strange and unpredictable behaviors, and were bad on the whole; the causes of their illness were complicated; the damage inflicted on these people was severe; it was hard to handle mental health problems; and they were harmful to the society.”
The majority of those surveyed felt for people with mental disorders. However, people often discriminated against, avoided and rejected those with mental health issues, the research paper revealed.
In a 2016 report about China’s mental-health awareness and psychological counseling industry, co-authored by the Beijing-based mobile internet startup MyTherapist and the Psychological Counseling and Treatment Center at Peking University, 26% of the 1,291 people surveyed said only those with severe mental disorders would need counseling, and close to one fifth (19.8%) thought seeking psychotherapy showed one’s weakness.
Stigma associated with mental illness is certainly a universal issue. “I’m not convinced it’s worse in China,” says Michael Phillips, director of the Suicide Research and Prevention Center of Shanghai Mental Health Center at Shanghai Jiaotong University School of Medicine. But the perception of mental health is different in China. “Mental health” has been associated with psychoses, and people often think that psychological problems, like depression and anxiety, can be healed without treatment.
Language choice could help decrease the stigma against getting help, says Jack Chen, founder and CEO of Cognitive Leap, a U.S. and China-based company aiming to destigmatize and alleviate China’s mental health problems by using virtual reality and mindfulness training. Chen believes that “mental traits,” “training” and “brain health” are better accepted in the Chinese language than “mental disorders,” “treatment,” and “mental health.”
The Chinese government aims to encourage more people to go to community clinics, particularly in rural areas, says Dr. Phillips, who has been doing mental health research in China for the past three decades. At the moment, proposed plans “are more aspirational than real,” he notes.
Access to quality mental health services at a community level and free medications will take a long time, but close monitoring of China’s mental health law implementation can be useful to other developing, even developed countries.