Michael Phillips: Mental Health Is A Global Challenge

Asiancountries need to put more resources in the field of mental health to solve theproblem of lack of resources and the burden of mental illness. However, due tovarious reasons, mental health has always be neglected, which has caused thedifficulties in matching the resources.

Reporter: Qiu Meifang

Reporter: At the very beginning, the topic that you submitted toShanghai Forum is “Mental Health Challenge in Asia-Pacific Region”. Why did youuse the word “challenge”? Is it because mental health in Asia-Pacific region a seriousissue?

Michael Phillips: Mental health is a global challenge. WHO recentlyreleased its global mental health action plan, which states that mental healthis a global problem but is not taken seriously. Asian countries are differentfrom Latin American countries and African countries, where epidemics like Aidsare still the most pressing problems. After decades of development, epidemicsin Asian countries are under control while chronical diseases are major burdernof diseases, and mental illness is a big part of it. Asian countries need toput more resources in the field of mental health to solve the problem of thelack of resources and burden of mental illness. However, due to variousreasons, mental health has always be neglected, which has caused thedifficulties in matching the resources.

Reporter: Why mental health is not takenseriously? Why don’t Asian countries put more resources in it?

Michael Phillips: Historically, epidemicshas the largest potion in the burdern of diseases in Asia. In the last thirtyyears, epidemics has been well curbed, 60% to 70% of the burden of diseases are now chronic diseases. In thepast, cancer and cardovascular diseases drew a lot of attention, but mentalhealth was never taken seriously. To divert the attention requres a lot oftime.

It is until these years that the importanceof mental health is gradually recognized  by the health management offices and securityoffices. But at the same time, the clinical departments still won’t acknowledgethe relative importance of mental health. Clinicians’ discrimination upon mentalhealth is deep rooted, which has much to do with the distribution ofdisciplines and curriculum in the medical schools. When the medical schoolswere first established, psychiatry was a small branch of neurology departmentand had very few courses. Even now, during the five years of undergraduatemedical education in China, the training in psychiatry only has forty hours.Because of discrimination, mental health department gets very limited resourcesin the ditribution of medical resources in the hospital. Other departments  won’t be happy to see the cut of theirresources. These factors restrict the input of resources in mental health inAsian countries.

Reporter: What is the outlook of mental health in Asian countries inyour opinion?

Michael Phillips: The newly-released global health plan mentionsthat in the past 20 years, the suicide rate in Korea has increased 3 timeswhile the suicide rate in China is 50% less. Both are Asian countries but thesuicide rate differs so much. In this past 20 years, Asian countries havedifferent input in mental health and the mental health services they providedare also different. In terms of how to improve the awareness of mental health,the problems and solutions for each Asian country are different. There is nomode which suits all countries. If one wants to have a drastic improvement, thesolution has to be tailor-made.

Thailand acknowledged the situation mentioned in WTO’s report ondisease burden very early and distributed its resources as the portion ofdisease burden. Since the mental health gets enough attention, the situation isimproved. China is in the process of acknowledging the report, but does notdistribute the resources as the report. Now not all Ascian countiresacknowledge the report, If all these countries are willing to distribute theresources according to the disease burdern data, the mental health situationwill be much improved.

From the viewpoint sof research, in mental health, Asian countriesneed more interdisciplinary reasearches to adjust the mechanism of mentalhealth services and prevention of discrimiation. These researches require morefunding and talents.

Reporter: On May 1,MentalHealth Law of People’s Republic of Chinatook effect officially. What doyou see the purpose and meaning of this law? What can be improved?

Michael Phillips: China’s Mental Health Law finally came to forceafter 27 years of revision. It will no doubt boost the development of mentalhealth. It also shows that the related governmental offices has realized theimportance of mental health.

But many details of this law can be improved. For example, in theterms about “unwilling hospitalization”, we need to define “major mentalillness” and “great harm to the society” in a more detailed and clearerfashion. The law advocates community services, but no specific approaches arementioned. I’m worried about the implementation of the law.

China needs to put more resources in the evaluation of the effects ofthe law. I think the relative govenmental offices need to do a very detailedevaluation on the mental health situation in China, and five years later, do anotherone, then compare the results of evaluation, so that they know well the resultof implementation and then revise it. The evaluation has to be as specific aspossible. Fore example, they need to investigate what the attitude toward mentalhealth in different regions, who provides the mental health services, how theservice people are trained, the coverage and the funding. The evaluatioinmechanism has to be well implemented, instead of bureaucratic, we can’t justtell people how good the law is.

Reporter: These years China looks more at mental health. Is itbecause the problem is more serious?

Michael Phillips: I don’t think so. Though some reports show thatthe rate of mental health has increased, but it’s not true. Recent years,people are more sensitive to depression and anxiety, and are more willing toreveal their own psychological problems. In the past, the patients chose to hidethe illness, so reports at that time show an extrodinary low rate of mental illness.The reason why the problem is considered more serious is because the data isnot accurate, or some other reasons. In fact, except for the problem of alcoholabuse, mental illness rate is not so much higher.

The suicide of Foxconn employees drew more attention on the mentalhealth of immigrant workers, but the quality of study is not good, and the problemis not properly analyzed. It’s good that we pay more attention to mental health,we definitely need more input of resources.

Reporter:  In the1990’s, the suicide rate in the Chinesecountryside is three times of that in the cities. Is there a change now?

Michael Phillips: It has been changed. First of all, the suiciderate is half of before now, secondly, the suicide rate in the countryside istwo times of that in the cities. But we need to think about the mobility ofpopulation. Twenty years ago, the mobile population was far less than nowadays.Now more farmers have immigated to the cities. It’s hard to catagorize a caseof suicide to countryside or to city.

In the past, the suicide rate of women is 25% higher than that ofman, now it’s almost 1:1, similar to most Asian countries. Among the womensuiciders, women in the countryside are the majority. In the past, drinkingpesicide is the way of suicide, now the rate has decreased but is still quitehigh. On the one hand, the usage of pesicide is strictly controled, on theother hand, when most farmers become immigrant workers, it’s not that easy toget access to pesticide.

Reporter: How is the community services for mental health now? Whatare the problems to establish and improve the community services in Shanghai?

Michael Phillips: The Chinese mental health doctors are not willingto work in the community hospitals, especially the countryside clinics. Thetask falls upon the shoulder of the community doctors in the generaldepartment, whereas they already have a lot of work. Without enough specialtraining, they can’t do the job satisfyingly. The new law has no detailedregulation on the implementation.

The resources, funding and talents are suffient in Shanghai. Tobuild up complete community service mechanism, two problems have to be solved.Firstly, we need to regulate the practice of doctors in the community clinics.Shanghai provides training for the community doctors, but there is nosupervision on their practice. Many patients don’t have early treatment in thecommunity. Secondly, we need to change people’s perception in the mental healthservices in the community clinics. We need to enourage them to go to thecommunity clinics instead of comprehensive hospitals and A level hospitals.They should have no hesitation to see the doctors when they have mentalproblems instead of feeling ashamed.

What’s more, I hope that we can set up some community organizationswhere the families of the mental health patients can have a say, so that thereis less discrimination and more precautions.

Introduction:

MichaelPhillips is Canadian, consultant of China Mental Health of WHO, ChinaRepresentative and Finance Secretary of Internaitonal Association of SuicidePrevention, Consultant of China Medical Board, Director of Shanghai MentalHealth Center Crisis Prevention Research Lab