mental health

It is estimated that there are 66.3 million people suffering from various forms of mental disorder in China (Murray and Lopez 1996a, 1996b). The majority of patients in psychiatric hospitals have schizophrenia or other psychotic disorders. Depression, bi-polar disorder and obsessive-compulsive disorder tend to go undiagnosed and untreated. These sources estimate that mental illness and suicide are the most important category of disease for China and impinge more heavily on women than on men. Higher prevalence rates are reported amongst women for schizophrenia (unusual) and depression (similar to trends elsewhere). China is the only major country in the world where the suicide rate for women exceeds that for men. Treatment, where it exists, is almost exclusively based on Western psychotropic medication. ECT is used rarely but usually without anaesthetic.

There are three government ministries primarily responsible for the provision of mental health care in China: Public Health, Civil Affairs and Public Security. Public Security is in charge of the forensic psychiatric system (twenty hospitals, with 5,000 beds) with most provinces supposed to have one forensic hospital (usually in the provincial capital). Civil Affairs provides beds for veterans and the poor (known as the ‘three have-nots’: no family, no job, no means of support) and runs 200 hospitals with 30,000 beds. Public Health has traditionally sought the ‘better’ patients, i.e. those who are acutely ill and whose work units or families are able to pay the fees. They run 482 hospitals and provide 95,000 beds. The three ministries account for over 92 per cent of all psychiatric beds. The rest are provided by other ministries’ (e.g. railways and mines) psychiatric units in urban general hospitals (that have never really caught on in China although they are the preferred way of providing inpatient care in other countries)-and a small number of privately run institutions. There are approximately 1.2 psychiatric beds per 10,000 of the population.

In 1987 the government published a document entitled Some Opinions about Strengthening Mental Health Work that pointed out that 80 per cent of people requiring psychiatric treatment did not receive it and that only 5 per cent needing treatment were hospitalized. Psychiatric hospitals received only 50 per cent of the funding that the government gave to general hospitals of the same grade. It identified inadequate staff training, low pay, poor promotion prospects and little support or respect from the general public as significant deterrents to development.

Funding drives the provision of psychiatric care in China. Many people assume that because China is a socialist country medical care is provided free. This has never been true (see medical insurance). The economic reforms led to the collapse of the commune-based rural health insurance system. People in urban areas, especially women, are now infrequently covered by comprehensive health insurance. Meanwhile the government has withdrawn much of its funding for hospitals and told them that they must be self-sufficient. Hospitals have been forced to run businesses (e.g. factories, restaurants) to support themselves, and have raised hospital fees to an extent that there is now serious under-occupation of psychiatric hospital beds because families cannot afford them. Civil Affairs and Public Health hospitals are now in competition for patients who can afford to pay, and the former have lost their traditional emphasis on the poor.

Community-based treatment and rehabilitation would seem to be an answer to some of these problems. However, Shanghai is the only major city that has developed and sustained an integrated system of community care despite the fact that there is a well-articulated model consisting of ‘guardianship networks’, workstations, factory-based vocational rehabilitation programmes and ‘home beds’. The mentally ill have never been allowed to participate in the Civil Affairs-run welfare factories that are reserved for people with sensory, motor or learning disabilities. Community services, such as they are, are technically co-ordinated at all levels of local administration by cadres from Public Health, Civil Affairs, Public Security and the Federation for the Disabled. Efforts have been made to change this moribund situation, through lobbying by the China Rehabilitation Research Association for People with Mental Disabilities under the All China Federation for the Disabled. The Eighth Five Year Plan for the Psychiatrically Disabled, 1991–1995 (the first to include psychiatric illness) specified the development of community-based pilot projects in thirty-two rural and thirty-two urban sites. This was a valiant effort but largely scuppered by insufficient central and local funding.

In effect families do most of the caring for people with mental illness in China, with little help from formal or informal systems. They make the decisions about whether treatment is to be sought and how much of the family income is to be invested in it. They experience the stigma of the condition along with the patient and usually do their utmost to hide the illness from outsiders so that the marriage prospects of siblings are not badly affected.

Chinese authorities have been accused of using the psychiatric system to punish political dissidents, including the Falun gong. The World Psychiatric Association has expressed deep concern and the comparison with Russia is frequently made. Chinese psychiatrists are resentful at these accusations, saying that those few political dissidents in psychiatric hospitals are there because they are mentally ill and need treatment. In private conversations they point out that psychiatric beds are an expensive and scarce resource in China. Why would they waste them on people who do not need them when so many alternatives are available?

See also: disabilities; hospitals

Further reading

Lee, S and Kleinman, A. (2002). ‘Psychiatry in its Political and Professional Contexts’. Journal of the American Academy of Psychiatry and Law, 30:120–5.

Murray, C.J.L. and Lopez, A.D. (1996a). The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard University Press.

——(1996b). Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for over 200 Conditions. Cambridge, MA: Harvard University Press.

Pearson, V. (1995). Mental Health Care in China; State Policies, Professional Services and Family Responsibilities. London: Gaskell Press.

Phillips, M.R. (1998). ‘The Transformation of China’s Mental Health Services’. The China Journal, 39:1–36.

VERONICA PEARSON

Miao

The Miao number approximately 8 million and are mainly found in Guizhou, Yunnan, Hunan, Guangxi, Guangdong and Sichuan provinces, with some in Hainan and Hubei. They live harmoniously with the Tujia, Boyei, Dong, Zhuang, Li and Han Chinese (see Tujia, culture of; Boyei (Buyi), culture of; Dong, culture of; Zhuang, culture of; Li, culture of). Much of their areas is hilly, mountainous or drained by several big rivers. Their houses are usually built of wood. They like to eat various sour foods like pickles, sour fish and meat, and they like wine. The Miao women excel in embroidery, weaving, batik and paper-cutting. The head ornaments and decorations they wear are often made of silver, symbolizing nobility and beauty. A Roman script was introduced for their spoken language in 1956. They have a rich oral literature. Folksongs, from a few lines to over 15,000, are very popular.

The lusheng, made of bamboo pipe, is their favourite wind instrument with a reed, so are lusheng dances which focus on footwork. Their culture is diversified. Different Miao communities celebrate various festivals. Even the same festivals may fall on different dates. The Miao New Year’s Day is celebrated on ‘Rabbit Day’ or ‘Ox Day’ on the lunar calendar, including beating drums, horse-racing and bull-fighting. Of the multi-ethnic autonomous prefectures and counties, Miaos account for a larger percentage in the leadership due to their larger population. Some autonomous counties were established in the 1980s and 1990s. The railways between Guiyang and Kunming, and between Hunan and Guizhou, have boosted the development of the Miao and other ethnic groups along the routes.

Further reading

Enwall, Joakim (1995). The Myth Becomes Reality: History and Development of the Miao Written Language, 2 vols. Stockholm East Asia Monographs, 5–6. Stockholm: Institute of Oriental Languages, University of Stockholm.

Schein, Louisa (2000). Minority Rules: The Miao and the Feminine in China’s Cultural Politics. Durham: Duke University Press.

HELEN XIAOYAN WU