Editorial - Journal Clinical Psychiatry and Cognitive Psychology (2018) Volume 1, Issue 1
Where would we find enough psychiatrists to serve in the new buildings in China?Yuping CAO*
Mental Health Institute of the Second Xiangya Hospital, Central South University, China
- *Corresponding Author:
- Yuping CAO
Mental Health Institute of the Second Xiangya
Hospital, Central South University
The China National Clinical Research Center for
Mental Health Disorders
National Technology Institute of Psychiatry
Key Laboratory of Psychiatry and Mental Health of
139 Renmin Road
E-mail: [email protected]
Accepted date: October 24, 2017
Citation: Yuping CAO. Where would we find enough psychiatrists to serve in the new buildings in China? J Clin Psychiatry Cog Psychol. 2017;1(1):5-6.
In contemporary China, mental health problems are growing fast with the rapid economic development and intense social competition taking place today. An estimated 173 million Chinese suffer from psychiatric disorders. Mental illness has become top ranked and accounts for about 20% of the total burden of diseases. It will be up to 25% in the coming 20 years in China. It has become a major medical, public health and social problem.
In contemporary China, mental health problems are growing fast with the rapid economic development and intense social competition taking place today. An estimated 173 million Chinese suffer from psychiatric disorders . Mental illness has become top ranked and accounts for about 20% of the total burden of diseases. It will be up to 25% in the coming 20 years in China . It has become a major medical, public health and social problem. Fortunately, it has been given much attention by the Chinese government in recent decades, especially after the Wenchuan earthquake in 2008. In 2010, the government had given financial support to the mental health services, and initiated the building of 550 psychiatric hospitals and also psychological units in general hospitals by 2012 . As of present, these new buildings have been completed. “Where would we find enough psychiatrists?” Ms. Wang Liying, the new director of Mental Health Division of National Health and Family Planning Commission, asked when she visited our institute the year before. “Psychiatry has the most shortage of medical professionals in China today”; “Xiangya (referring to our institute, Xiangya Medical College of Central South University) as the biggest psychiatric education and training base in China, should do the best to take responsibility for recruiting and training.” Ms. Wang said.
China nowadays has approximately 27 733 registered psychiatrists , there is less than 1.5 psychiatrists per hundred thousand population . Doctor-patient ratio is far below the global average. “Professional psychiatrists in China are precious like pandas”, Dr. Zhang Yalin, a former vice director of our institute, told the New York Times . The principals of mental health services, especially in the non-capital cities and rural areas, always complain that it is difficult to recruit professional psychiatrists.
Why does such a shortage of psychiatrists remain? This might be related to several problems and challenges that persist in China.
Firstly, there are only 17 medical colleges with the psychiatric specialty set to recruit medical students through the college entrance examination nationwide nowadays; and the recruitments are not that many. For example, our institute, as the famous mental health institute and the key university which enrolls for the specialty of psychiatry, feels the impact from a lack of successors. There are less than 30 students applying for the specialty of psychiatry every year, only 3 in 2009. Because of the negative attitudes and bias towards psychiatry [7,8] or with a gloomy picture of the medical career , some of students would transfer into other disciplines before graduating, or into non-medical professions. Stigma also makes medical students eschew the specialty of psychiatry. Some students/psychiatrists may also have experienced the following: If someone asks “what do you do?” you may answer “I’m a psychologist!” or “I’m a physician!” However, if you do answer “I’m a psychiatrist!” you may be deemed as a strange person, or may be the subject of ridicule in jokes. Dr. Yu Xin, the former director of Mental Health Institute of Peking University, said that almost all of the psychiatrists in his institute didn’t choose the psychiatric specialty originally and voluntarily. Secondly, psychiatry is a profession that is extremely stressful and one exposed to high risk [10,11]. Even more so than other doctors, psychiatrists are under the constant threat of intimidation and violence, on an almost every day basis. More than 10% of psychiatrists have been attacked by patients . Thirdly psychiatrists gain lower incomes when compared to other doctors in the general hospitals. Although the salary is basically the same standard according to the national regulation, the bonuses are widely different. Psychiatrists tend to do fewer examinations and prescribe relatively less medications; whilst making more observations, doing more communicating and nursing care, and charging less money. In China, interviews and consultations are very cheap in hospitals. For example, in our institute, the price per 45 min consultation with a senior psychiatrist/psychologist only affords two hamburgers (60 Yuan or an amount of $9.1). Although there is a subsidy policy in place, it is 30 Yuan (an amount of $4.8) per month for psychiatric staff in some services  Psychiatrists do not get adequate recompense in comparison to what they contribute.
China’s first National Mental Health Law launched in 2013, has a special regulation on encouraging and strengthening the training of professionals. However, how does one manage to attract “new blood” into psychiatry? Considerable admission priority and resources for medical students’ psychiatric education is needed. While it is not enough to merely depend on the medical colleges and psychiatry departments exclusively. In the recent two years, the Chinese government has launched a transition training project for psychiatrists, which is an effective approach to foster the talent in this area. Physicians such as neurologists, cardiologists, gastroenterologists, and general practitioners were chosen from primary care. They were given the standardized training in psychiatry, in a qualified psychiatric department for one year (including theoretical and clinical training). Once they pass the examination, they would be awarded with psychiatric practicing certificates. After that, they would go back to serve in their primary care settings. “The transition training may help to cope with the lack of psychiatric practitioners in primary care and remote areas in China”, underscored Mr. Wangbin, the vice director of the division of Disease Control of the National Health and Family Planning Commission .
The issue of an insufficient number of psychiatrists in China is being improved through the transition training project; while some problems still need perfecting, such as the knowledge about mental health, that ought to be popularized to ensure a decreased stigma towards these illnesses, for the psychiatrist also; the salary of psychiatric practitioners need to be elevated; the qualification of the transition psychiatric practitioner also needs to be improved.
Conflict of Interest
I declare that I have no conflicts of interest.
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