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Abstract: Program of implementation research on mental health legislative issues in China

The following abstract was presented at the Implementation Science and Global Health satellite meeting on March 17, 2010 at Bethesda, Maryland.

Presenter

Zhiguo Wu, MD
Attending Psychiatrist
Shanghai Mental Health Center
Shanhai Jia Tong University

Co-Authors

  • Dr. Bin Xie, Harvard Medical School
  • Dr. Yang Shao, Harvard Medical School
  • Dr. Yanling He, Harvard Medical School
  • Dr.  Hong Ma, Harvard Medical School
  • Dr. Jianyin Qiu, Harvard Medical School
  • Dr. Mingyuan Zhang, Harvard Medical School

FIC Award

Overview

Although efforts to develop a national mental health law for China were launched in 1985, to date a national law has not been passed. The Chinese government is concerned that there are not enough mental health resources to support a promise of providing mental health care to all citizens. There remain unresolved controversies on detailed procedures and provisions of the legislation.  The national government is often hesitant to institute programs that are perceived as being experimental, preferring to pass responsibility for managing the problem to the local level.

During the last 10 years, a research team at Shanghai Mental Health Center, including 6 key members who have been trained through the Fogarty ICOHRTA program at Harvard Medical School, has been conducting a program of implementation science studies which focus on promoting the process of mental health legislation on both district and national level. This article introduces the main work done by our team.

Studies of mental health services and manpower: First, the team has evaluated mental health services capacity across China, investigating distribution, functioning, and utilization of 969 psychiatric institutions, 134,200 psychiatric beds in 31 provinces, outpatient/inpatient service status of 39 psychiatric institutions, and distribution of mental health human resources. The group provided analysis of probable distribution of psychiatric and psychological human resources for 2010 to 2015, providing a planning frame for the next 5-10 years in China. Findings of these studies, which suggest that legislation calling for mental health services to be made available throughout China is feasible, have been presented to the national legislature.

Studies of regulatory and legal issues: Our team has reviewed controversial legal issues concerning rights of autonomy, privacy and confidentiality, restriction and seclusion, standardized admission, and discharge. We have developed and piloted assessment instruments for psychiatric services in China, including a Semi-Structured Inventory Competence Assessment (SSICA) for mentally ill patients. We investigated admission of 2333 psychiatric patients in 17 cities across China and found low voluntary admission rates (18.5%). Another study found that most escorts of 500 first contact outpatients were not their legal guardians. Based on those, the team proposed a Medical Protection model as a compliment to current guardianship networks that were found not to be working well for mentally ill patients.

Contributions to local and national mental health legislation: Our team contributed to the enactment of the Shanghai Municipality Regulations on Mental Health (2002), the first local mental health legislation in China, and to subsequent mental health legislation in four other municipalities. Research is currently evaluating the implementation of this legislation in routine clinical practice. We continue to evaluate current legal frameworks for key issues (e.g. voluntary and involuntary admission, medical protection and guardianship) according to international standards, and to advocate for improvement in legislation and implementation. The main researchers of this team play a leading role in developing evidence-based reference and advocacy reports for a national mental health draft law, which has been submitted to Legislative Affairs Office of the State Council P.R. China.

Updated May 2010

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