Mental health system in China: history, recent service reform and future challenges

Jin, Liu; Ma, Hong; He, Yulong; Xie, Bin; Xu, Yifeng; Tang, Haibo; Li, Ming; Hao, Wei; Wang, Xiangdong; Zhang, Mingyuan; Ng, Chee H.; Goding, Margaret; Fraser, Julia; Herrman, Helen; Chiu, Helen F. K.; Chan, Sandra S. M.; Chiu, Edmond; Yu, Xinguang

doi:10.1002/j.2051-5545.2011.tb00059.x

Cited by 237 publications

(239 citation statements)

References 14 publications

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“…Although there are undoubtedly many contributory factors, the establishment of policy and guidelines to move from institutional care to community mental health services is an important driver. 25 Assertive community treatment is one of the specialised models being introduced for this purpose 26,27 in recognition of the need for assertive engagement of a subgroup of patients. 28 However, 'diluted' models are also appearing here due to scarce resources and, given the lack of evidence for these models, their implementation may turn out to be a false economy.…”

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confidence: 99%

Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs

2013

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was established in England, The Lancet published an article entitled 'Clinical specialism', 1 which explored the tensions between medical generalists and specialists. It suggested that specialisation evolved as an appropriate consequence of 'the growth of knowledge and the mastery of technique', but warned of its potential to limit the cross-fertilisation of ideas and collaborative working, and to generate areas of expertise that were more focused on the self-serving needs of the clinician than on the needs of patients. It advocated more specialised services where needed, with a better balance between generalised and specialised services, while fostering collegial, congenial and collaborative relations between them all. The article probably reflected widely held anxieties about the consequences of the radical reorganisation of health services in the UK at the time and the shift from a private to a publicly funded system. In the current international context of economic turbulence, where health priorities compete for investment within different public/private funding systems, the generalist v. specialist debate remains highly topical.

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confidence: 99%

Specialisation and marginalisation: how the assertive community treatment debate affects individuals with complex mental health needs

2013

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“…Actually, severe misdistribution does not exist only between surgeons and anaesthesiologists, but also exists in other specialties in China, such as family doctors, paediatricians and psychiatrists (25)(26)(27)(28). Historically, China did not have a national needs-based resident recruitment system to keep a reasonable balance between different specialties.…”

Section: Discussionmentioning

confidence: 99%

“…The infrastructure of this system should include continued data collection and comprehensive assessment about the current shortage and surplus for all medical specialties, dynamic healthcare needs and demandbased analyses and projection of the future medical service needs and supply (30), allowing medical graduates to do multiple applications for different specialties, an effective recruitment match system for different economical regions, sized hospitals and medical specialties. China, the most populous country with about 20% of doctors in the world (27), recently completed a rapid transition from a low income country to an upper middle income country. China's experiences in medical reform, lessons on maldistribution and imbalance of healthcare workforce and workload should be, to some degree, valuable references for other developing countries those are making the transition from low or lower middle income countries to lower middle or upper middle income countries.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Workforce and Workload in China: A National Survey

Yang¹,

Zhu²,

Li³

et al. 2017

J Anesth Perioper Med

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Background: With the economy growth and medical reform, anaesthesia workforce and workload, as well as for other medical specialties in China changed dramatically, but the detail information have not been presented. A national off-line survey was designed to learn the current status for anaesthesiology, to analyze the related issues for medicine and to make suggestions for government to improve equity and quality of healthcare in China. Methods: From Mar 1 to Jun 30 in 2015, Chinese Society of Anaesthesiologits (CSA) released questionnaires containing hospital general information, anaesthesia-related information and surgical-related information to all the anaesthesiology departments in mainland China, except Hong Kong, Macao and Taiwan of China. Other relative data sources were searched from publications or website. Results: A total of 16280 questionnaires were released and 14076 copies (86.5% ) were retrieved. There were 13489 copies (82.9%) identified as anaesthesia related data copies (ARDC) and 7026 copies (43.2% ) identified as surgical related data copies (SRDC). In 2014, there were 77926 anaesthesiologists and its density was 5.7 per 100,000 population, 27.66 million inside operating room (OR) anaesthesia cases and 11.47 million outside OR anaesthesia cases were done. GDP per capita in each province was positively correlated with densities of physicians, anaesthesiologists and anaesthesia cases. One attending anaesthesiologist covered 634 inside OR and 263 outside OR anaesthesia cases in 2014. In SRDC, attending surgeons to attending anaesthesiologists ratio was 7.5 to 1. Each attending surgeon had 0.93 operation day per week and performed 86 operations in 2014. Generally, the higher-level and largersized hospitals had higher surgeons to anaesthesiologists ratio, higher surgeons to ORs ratio, less operation day per week for one surgeon, more operations and anesthesia cases done by one surgeon and one anaesthesiologist. Conclusions: China has the biggest number of anaesthesiologists in the world, but is still in shortage of anaesthesiologists. Economic level was positively correlated with anaesthesia workforce and anaesthesia service for all provinces in China. Significant misdistribution and imbalance in different provinces, sized hospitals and medical specialties were found in this survey. A national needs-based resident recruitment system along with the set-up of compulsory standardized resident training system should be taken into consideration and action.

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“…Due to various reasons, China has faced major deficits in mental health resources in the past decades. For example, in 2004 there were only 16,103 licensed psychiatrists and psychiatric registrars (1.24 per 100,000 population), 24,793 psychiatric nurses (1.91 per 100,000), and 557 psychiatric hospitals with 129,314 psychiatric beds (9.95 per 100,000) nationwide 1 . , the proportion of psychiatrists in 2014 was 0.3 per 100,000 in India, 0.87 per 100,000 in Thailand, and 20.1 per 100,000 in Japan.…”

Section: Rethinking Progress and Challenges Of Mental Health Care Inmentioning

confidence: 99%

“…Psychotic experiences as an independent risk factor for angina pectoris in 48 low-and middle-income countries People with schizophrenia are known to have a life expectancy reduced by 10-20 years compared to the general population 1 , which is largely attributable to their increased risk for cardiovascular diseases (CVDs) 2 . There is some evidence that people with psychotic experiences (PEs) who do not reach the clinical threshold for a psychosis diagnosis are also at higher risk of premature mortality (by 5 years) 3 , which likewise may be explained by a higher likelihood of CVDs 4,5 .…”

mentioning

confidence: 99%