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East Asia's mental health

16th October 2006

yinandyangAsian nations have great need for mental health services but often have least to offer those in distress.

As the World Health Organization (WHO) promotes suicide prevention on World Mental Health Day 2006, experts say the solution lies with low-cost community-based interventions.

Rapid economic growth, coupled with growing social and economic pressures, has prompted increasing numbers of people in East Asia to seek help for mental distress. But their governments are far from meeting that demand.

According to the WHO Mental Health Atlas 2005, mental health services in developing countries in East Asia fell pitifully below those of developed economies.

Lack of trained professionals

China, where the psychiatric profession has seen a resurgence in the last 20 years, can boast just 1.06 psychiatric beds per 10,000 people, compared with 13.80 in developed South Korea.

This compares with 0.63 beds per 10,000 in Vietnam and 0.55 in Burma and 0.07 in Laos, with psychiatric in-patient care in Cambodia virtually non-existent.

In Southeast Asia as a whole, there are just 0.2 psychiatrists per 100,000 people, compared with 11 per 100,000 in the United Kingdom and 13.7 per 100,000 in the United States.

Chinese psychiatrists say their limited mental health services are already overstretched, and the profession is growing at a rapid rate to try to keep up, especially amid an alarming rise in suicides.

Meanwhile, awareness of mental health problems, even among medical professionals, lags far behind.

"When older people are hit with mood disorders such as depression and anxiety...they tend not to come to us. They go to the general hospital to seek treatment. Then they are passed around from pillar to post before they finally end up at our hospital," psychologist Sun Ping at the Zibo City Psychiatric Hospital in the eastern province of Shandong told RFA's Mandarin service.

Burden of mental distress

She added: "Things are a little better among the younger generation. They seem to have a little more understanding of psychological treatment and psychological counselling. For example, students will sometimes seek us out for counselling or treatment if they are experiencing anxiety over their studies."

Psychologist Zhan Chuhua, who has worked on the Kangning Mental Health Hotline in the southern city of Guangzhou for many years, warned listeners that depression which was allowed to progress without treatment could turn into a life-threatening condition.

"Firstly, the person themselves is suffering. Then there's the burden on their family. Some patients will spend their whole lives seeking medical not psychological treatment, taking all sorts of different medications in an attempt to get well again, and of course that puts a great strain on the family budget," Zhan said.

"The other major factor is that people are much less able to work when depressed, because they suffer from a lack of motivation. These are all very serious effects of depression, and it has a major impact."

Chinese blame politics

About 250,000 Chinese die of suicide each year, making suicide a leading cause of death for Chinese people, according to WHO figures.

Callers to RFA Mandarin listener hotlines put the problem down to social pressures.

"It's not just that life is hard and fast-paced, but there are also constant conflicts between what people have to say and what they do," a Shanghai-based public security officer surnamed Wang said.

"The newspapers and media are filled with ideological empty talk that does not apply in real life. I don’t know how to teach my children about how to act in the society," he added.

"Only rich people can afford to see a psychiatrist...Ordinary people, the unemployed, and the disadvantaged face mental breakdown but have no help. Many of them numb themselves with alcohol."

An electrician from the eastern province of Jiangsu surnamed Qian agreed.

"Some say that mental diseases are hereditary but I believe they are mostly caused by the social environment," he said. "Most of those who suffer mental problems around me had a very painful past. The society that we live in has to do with why there are so many people with mental problems. This is what the government needs to reflect on."

New solution needed

Zhang, a teacher from the eastern province of Shandong, said the rise in mental health problems was due to political reasons. "The Communist Party has launched continual political campaigns ever since our so-called liberation. First there was the sons and daughters of capitalist roaders, of rightists...the stinking ninth category of intellectuals, and so on."

"So all these years have been passed under intolerable pressure. These people couldn't even get married. Of course it has had a massive impact on their mental state. That is why there are so many people with mental health problems in China," he said.

Whatever the causes, international experts say the solution to East Asia's growing mental health challenge lies in a more innovative approach to mental health care in countries with strong family structures and large rural populations who can't afford traditional psychiatric treatment.

The second edition of the Disease Control Priorities in Developing Countries (DCP2), an exhaustive guide to public health launched in Beijing in April 2006, urges governments to train primary care doctors serving rural areas to recognize symptoms of mental disorders and treat them with generic antidepressant and antipsychotic drugs.

It recommends boosting the ranks of social workers and psychiatric nurses to provide counseling to patients and their families, and working with local non-government groups and volunteers to help plan and implement community-based mental health programs.

DCP2 researchers found that every U.S.$1 million invested in such a grass-roots mental health package could buy up to 700 years of healthy life.

With the right training, more than 80 percent of mental disorders could be handled in primary care settings, it said.

Original reporting in Mandarin by Bai Fan. RFA Mandarin service director: Jennifer Chou. Translated and written for the Web in English by Luisetta Mudie. Edited by Sarah Jackson-Han.

This article appears courtesy of Radio Free Asia.


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