The University of Nottingham is justly proud of its links with China. One of its two overseas campuses is at Ningbo, just outside Shanghai. Playing its part in this, the Institute of Mental Health (IMH), where I am based has been building links with China, specifically with contacts in Shanghai, for several years. So when the possibility of a visit arose, I was very keen to join the visiting group.
The main purposes of our visit were to explore the possibility of the IMH contributing to an international centre for mental health in China, that would be able to provide services for expatriates living or working in China, and also to plan the agenda for a high level conference next year to review the operation of the Chinese Mental Health Law, which came into operation earlier this year (translation).
England has had laws around mental health since the 19th century and the current legal framework can be traced through the 20th, with significant Mental Health Acts being passed in 1959 and 1983. These have set the framework not just for compulsory admissions but also informal care, the interface between the criminal justice system and mental health, and other issues such as consent. As a result, it is easy not to realise that many countries don’t have such laws, or rely on local regulations for their approach to mental illness. Such was the case in China until 2013. The new law not only sets out the procedure for assessment and compulsory admissions, but it also goes into quite radical territory. For example, it outlaws stigma and discrimination against people with mental disorders, it sets out a responsibility to provide rehabilitation for mental health patients, and it explicitly sets a framework for greater use of psychological treatments and the regulation of practitioners in this area. It was clear from our meetings with psychiatrists in Shanghai that the law will bring about major changes in practice. At least initially, the biggest change may be that compulsory admission can only be used if there is risk of harm to the person or others, so a proportion of patients who were admitted in the past may not choose to accept this now.
Mental health provision is still very hospital orientated and although some facilities are very large – the Shanghai Mental Health Centre has 2000 beds at its two sites – nonetheless the number of beds per capita is lower than the UK. There are relatively small numbers of mental health professionals and these include a larger proportion of doctors than in the UK. An initial appointment would be about 15 minutes on average and the clinics that are held see very large numbers of patients, so medication is generally the only treatment.
The Chinese government is well aware that it needs to change services for mental health. As well as this, China faces extraordinary pressure with an ageing population. The single child policy means that the balance of numbers is tilting rapidly with increasing numbers of old people, who are of course at risk of dementia. This is exacerbated by the pattern of rural to urban migration. Therefore there is much interest in different approaches to care and especially the use of appropriate technology to support older people and their families in the coming years.
It won’t solve the problems of China but during my visit my colleagues and I did manage to submit a grant application for a technology related project. As these things often do, it went to the wire, and the bid was sent with less than two hours to spare. Whew!
Professor Tom Dening
Professor of Dementia Research
Faculty of Medicine & Health Sciences
University of Nottingham