中国精神卫生政策研究资源中心

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Jun 21st
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Mental health in China is a great concern given the large number of patients and huge social and economic costs. Over 170 million adults have one or more types of mental disorder. Over 90% of 16 million patients with serious mental diseases have not been given proper medical treatment. This paper reviews the mental health care condition in China and discusses policy implications.Undersupply of the mental health services is the most pivotal issue for policymakers. There are only 1.46 psychiatrists per 100,000 people and 15 beds per 100,000 people. Current government input for mental health accounts for less than 1% of total health expenditures. The Chinese government will increase its spending on the prevention and treatment of mental health care. Mental health care provided at community level will be supported by government. However, a draft of the National Mental Health Law has yet to be endorsed by the National People's Congress.

中国精神卫生保健:为治疗不足的患者提供服务

BACKGROUND:Mental health in China is a great concern given the large number of patients and huge social and economic costs. The one-month prevalence rate of adult mental disorder in China is about 17.5%. Over 170 million adults have one or more types of mental disorder. Of this, 16 million people are estimated to have serious mental diseases. Over 90% of patients with serious mental diseases in China have not been given proper medical treatment. Over 60% of suicide cases in China are associated with mental disorders and suicide is the most significant reason for death between 19 and 34 years old in China.

AIMS OF THE STUDY:This paper reviews the mental health care condition in China and discusses policy implications, given current import issues for mental health care.

METHOD:We review research literature for mental health care in China and collect reports from various published sources.

RESULTS:Under-supply of the mental health services is the most pivotal issue for policymakers. The utilization of mental health care services in China has increased by double digits in recent years. In 2011, outpatient visits for mental health care were over 27 million. The situation is aggravated by the lack of qualified doctors and the shortage of physical infrastructures such as wards and equipment, leading to many patients with mental disorders being under-treated and under-reported. There are only 1.46 psychiatrists per 100,000 people and 15 beds per 100,000 people. Current government input for mental health in China accounts for less than 1% of total health expenditure. According to the 12th Five-Year Program (2011-2015), the Chinese government will increase its spending on the prevention and treatment of mental health care. The mental health law has been passed by the National People's Congress in October, 2012 and will come into effect on May 1st, 2013. The financial coverage of patients with mental diseases and relevant regulations for involuntary admission are still being debated.

DISCUSSION:Three more issues are discussed. First, the lack of provision of mental health care for vulnerable groups is serious. Second, the opportunistic behavior of both patients and suppliers of mental health care should be addressed. Thirdly, the extraordinary high share of involuntarily admitted patients should be reduced.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Mental health care provided in primary care clinics and community is both complement and substitutable for hospital care and should be supported for government to relieve the undersupply condition.

IMPLICATIONS FOR HEALTH POLICIES:First, government should increase financial support for mental health care provision. Second, mental health care provided at community level should be supported and carefully designed by government. IMPLICATION FOR FURTHER RESEARCH: Future research should focus on two issues. First, how mental health care services can be provided more efficiently at community level? Second, how can a national mental health care law be helpful to reduce the number of involuntarily admitted patients?

政策角度的全球精神卫生

Mental health is a critically important issue in global health today and yet does not receive due policy attention. This report characterises mental health as a policy issue, and draws upon the experience of different social movements across global health to provide lessons for this field. It presents an array of engagement strategies to specifically inform how the Mental Health Innovation Network (MHIN) can best help to improve policy influence across aspects of the global mental health community.

摘要: 公共卫生领域中开展了实施性研究,旨在改善干预措施的普及率,这已表明发挥一定的作用,但是尚未普及到许多本应从中获益的人群。 研究人员确定公共卫生项目所面临的实际问题并且努力寻找改善卫生状况的解决方案。 在操作性研究中,我们使用定期收集的项目数据来揭示提供更加有效、高效和公平的医疗保健的途径。 由于实施性研究可以解决许多类型的问题,因而多种研究设计可能都是适合的。现存的报告指南部分涵盖了实施性和操作性研究中所采用的方法,因此我们通过世界卫生组织 (WHO)、卫生政策与卫生体制研究联盟 (AHPSR)、热带疾病研究特别行动规划 (TDR) 开展了一项咨询并且制定了指南,旨在为此类研究提供经费、实施、评审和发表支持。我们的目的是为实施性和操作性研究的资助者、研究人员、政策制定者、执行者、评审者和编辑人员提供切实可行的参考。 这是一个不断发展的领域,因此我们计划监测这些指南的使用情况并根据需要制定出新的版本。

Abstract: In public health, implementation research is done to improve access to interventions that have been shown to work but have notreached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.

各省、自治区、直辖市卫生计生委、党委宣传部、综治办、发展改革委、教育厅(委、局)、科技厅(委)、公安厅(局)、民政厅(局)、司法厅(局)、财政厅(局)、人力资源社会保障厅(局)、文化厅(局)、工商局、新闻出版广电局、科学院、中医药局、工会、共青团省委、妇联、科协、残联、老龄办,新疆生产建设兵团卫生局、党委宣传部、综治办、发展改革委、教育局、科技局、公安局、民政局、司法局、财政局、人力资源社会保障局、文化局、工商局、新闻出版广电局、工会、共青团团委、妇联、科协、残联、老龄办;教育部各直属高校:
心理健康是影响经济社会发展的重大公共卫生问题和社会问题。为深入贯彻落实党的十八届五中全会和习近平总书记在全国卫生与健康大会上关于加强心理健康服务的要求,根据《精神卫生法》《“健康中国2030”规划纲要》和相关政策,现就加强心理健康服务、健全社会心理服务体系提出如下指导意见。

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