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

Abstract

Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

Prevalence, awareness, and treatment of depressive symptoms among the middle‐aged and elderly in China from 2008 to 2015

“…China still has a long way to go in developing its mental health care provision system. Additionally, social stigma associated with seeking mental care may also explain the low treatment rate of depressive symptoms, while there is usually no such stigma for other typical chronic diseases. Future detailed investigation is needed as to understand why and how the continuous government efforts in China do not turn into actual effects of depression management.…”

“…China has also implemented a series of guidelines, regulations, and policies on mental health to effectuate these plans. Among them, the most significant event is the introduction of China's first mental health law in 2012, which formalizes the legal rights of people with mental problems …”

Peer Review #1 of "Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study (v0.2)"

“…Although primary care is a promising setting for addressing psychosocial problems of Chinese older adults, there are still barriers to providing integrated mental health services in primary care settings of China. One of the most challenging barriers was PCPs' insufficient capacity to manage psychosocial problems in China (Liang et al 2018). Specialized educational and training programs are warranted to strengthen PCPs' ability to recognize, diagnose, manage and refer older patients with psychosocial problems and mental disorders.…”

“…Although the bio-psychosocial model has dominated medical practice for many years, medical services provided by primary care in contemporary China are still quite basic and largely limited to disease treatment (Liang et al 2018). Late life is a period when increasing numbers of PeerJ reviewing PDF | (2019:01:34439:2:0:NEW 21 Mar 2019)…”

Assessing perceived quality of primary care under hospital‐township health centre integration: A cross‐sectional study in China

“…Some studies have examined the impact of integrated intervention on access and care coordination at the patient level in Henan Province and at the system level in Qinghai Province . We also found studies targeting chronic diseases, including mental diseases, hypertension, diabetes, and stroke, that explored whether the integration intervention was successful in different local contexts . To date, very few studies have focused on assessing the perceived quality of primary care in tight integration and loose collaboration to provide evidence for the ongoing reform.…”