The state of mental health care in China

Xu, Ziyan; Gahr, Maximilian; Xiang, Yu‐Tao; Kingdon, David; Rüsch, Nicolas; Wang, Gang

doi:10.1016/j.ajp.2021.102975

Cited by 48 publications

(29 citation statements)

References 45 publications

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“…This may not only impact treatment adherence but also infringe human rights by coercive measures, such as forced hospitalization and/or medication, seclusion, and/or restraint (Mohr et al, 2018). Consequently, more comprehensive and practical guidelines are needed to improve compliance with the criteria for IA, which can also protect the freedom and rights of patients with schizophrenia (Xu et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study

Wang

et al. 2023

Int J Soc Psychiatry

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Background: Patients with schizophrenia in rural areas of China face severe delays in getting appropriate treatment due to poverty, transportation, and limited availability of mental healthcare services. However, the experiences of care-seeking among patients with delayed diagnosis and treatment in rural areas remain poorly understood, and it remains unclear how these experiences influence patients’ medical mistrust or expectations of care. This study aims to fill that void. Methods: We applied a qualitative phenomenological method. Patients were recruited through purposive sampling at a psychiatric hospital in Harbin, China. Semi-structured, one-to-one interviews were conducted, guided by an interview outline. Thematic analysis was performed using Colaizzi’s seven-step method. Results: Data saturation was achieved after interviewing 13 participants aged 21 to 53 years. Three themes with eight subthemes were identified: (i) Barriers to seeking care, (ii) Feelings for psychiatric treatment, and (iii) Demand for mental healthcare. Several factors that may impede the timely diagnosis and treatment were identified, including patients, physicians, and institutions. The participants described their feelings of adverse treatment experiences, as well as expectations arising from this process. It predominantly covers awareness of the disease, supportive access to care, and geographic accessibility of services. Conclusion: Patients with delayed diagnosis and treatment in rural areas often have negative experiences and various needs for mental health services in the pursuit of effective treatments. Policymakers and health planners should seriously consider the current challenges in rural mental healthcare to develop comprehensive strategies for improving prehospital delays and medical experience for this group of patients.

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Section: Discussionmentioning

confidence: 99%

Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study

Wang

et al. 2023

Int J Soc Psychiatry

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“…Chen, Wu et al, 2020). Meanwhile, the National Mental Health Working Plan (2015Plan ( -2020 has set goals of lowering out-of-pocket expenditures for mental healthcare by extending health insurance coverage (Xu et al, 2022). The Implementation Scheme of the National Project of Specialty-Transfer Training to be Psychiatrists and Guidance on Strengthening Mental Health Services have provided solutions of scaling up mental health resources and workforce (R. Z.…”

Section: Discussionmentioning

confidence: 99%

Understanding components and predictors of delay of first treatment for mental health problems: A hospital-based study in China

Xie

Zhou

Xiao

et al. 2023

Int J Soc Psychiatry

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Background: Understanding components and predictors of delay of first treatment for mental health problems are crucial to inform interventions for earlier treatment. However, Chinese-context knowledge of this theme is still limited. Methods: We conducted an inpatient survey among 206 patients with various mental disorders in China. Delay of first utilization of mental healthcare (Delay-Total) and its two components of help-seeking delay (Delay-H) and referral delay (Delay-R) were assessed in terms of occurrence and duration. Binary logistic regression was performed to test predictors of Delay-Total, Delay-H and Delay-R, and multiple linear regression was used to test predictors of delay durations. Results: Overall, 66.0% patients experienced Delay-Total, with a duration range of 0 to 353 months; 49.5% patients had Delay-H (duration range = 0–207 months) and 29.6% with Delay-R (duration range = 0–323 months). Multivariate logistic regression analysis found that the diagnosis of severe mental disorders was a consistent predictor for a reduced chance of Delay-Total, Delay-H and Delay-R. Multiple linear regression analysis demonstrated that younger age of disorder onset and disorder onset before 2016 were significantly associated with longer delay. Conclusions: Delay of first treatment for mental health problems is still common in China. However, the development of mental health policy and services promotes shorter treatment delay. The diagnosis of common mental disorders and younger age of onset are risk factors of the occurrence and duration of delay, respectively. Thus, education of the public and non-mental-healthcare professionals are needed for better disorder recognition and more efforts should be inputted to support youngsters’ utilization of mental healthcare.

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“…Community-based management programs of mental health have been piloted, such as establishing community mental health facilities and training of community health care professionals. The mental health service has been incorporated as part of the public health program which is focused on managing people with psychotic disorders (Liu et al, 2011), including follow-up of cases with a mild to moderate degree of psychotic disorders in the community by primary care physicians following a diagnosis by psychiatrists (Sun et al, 2023;Xu et al, 2022). Apart from managing psychotic disorders, there is a strong need for expanding community mental health care services to include depression and anxiety disorders, which are highly prevalent among the general public and have increasingly become a public health concern since the beginning of the COVID-19 pandemic (Shi, Lu, et al, 2020;Shi, Shen, et al, 2020;Zhang et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use

Sun,

Lam,

et al. 2024

Transcult Psychiatry

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Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients’ help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health.

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The state of mental health care in China

Cited by 48 publications

References 45 publications

Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study

Experiences of care-seeking by schizophrenia patients with delayed diagnosis and treatment in rural China: A qualitative study

Understanding components and predictors of delay of first treatment for mental health problems: A hospital-based study in China

A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use

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