Dr. XIAO Shuiyuan's research interests include community mental health, mental health policy, and suicide prevention. He is the Chair of the Committee on Crisis Intervention, the Chinese Association for Mental Health; member of the International Academy of Suicide Research, the World Association of Cultural Psychiatry, and the Expert Panel on Disease Prevention and Control for the Ministry of Health, China. He received the State Council " Special Allowance Expert” Award in 2000 and the “China Medical Board Distinguished Professorship” Award in 2009.
Personal and Career Experience
Shuli: Dr. Xiao, I’m really glad to have this opportunity to talk with you. We know that mental health in China has been lagging behind other areas such as infectious diseases. What prompted you to choose mental health as your life-long career?
Dr. Xiao: During my undergraduate study of clinical medicine in Hunan Medical College (now Xiangya School of Medicine, Central South University), I was very interested in psychology and related brain science. Indeed, I did not think about that psychiatry was neither a focus area of clinical sciences nor a major public health topic. After finishing my undergraduate study, I began my graduate study in psychiatry under Dr. Desen Yang, a prestigious professor in this area. My first research project in graduate school was on social-psychological characteristics of individuals who attempted suicide. The project was discontinued halfway because of issues of cultural and political sensitivity at that time. However, Professor Yang foresaw the great need of preventive psychiatry and public mental health. I followed his advice to work in a school of public health after I graduated in 1987. When we were students, many of our generation were idealists to some extent.
Shuli: Did the study in Harvard University have any impact on your career?
Dr. Xiao: In 1990, I took an opportunity to visit and study in Department of Social Medicine at Harvard University. My mentor was Dr. Arthur Kleinman, a renowned professor of medical anthropology. Although it was only for seven months, the visit had a profound impact on my research philosophy. I understood why and how to analyze disease, especially mental illness, in a macro socio-economic context, and learnt how to analyze the experience of patients, such as psychological pain, interpersonal relationship change, financial burden, social discrimination, which are not only related to disease and functional limitation, but also depended on social culture. Also, I started to understand the impact of demographic transition, socioeconomic transition, sociocultural transition and health/epidemiological transition on global, especially China’s public health, and further understood the importance of mental health from the perspective of burden of diseases. Last, to a certain degree, I started to appreciate anthropological research in public health. After came back to China, I focused my research on suicide prevention and community mental health and did some part-time clinical work in Xiangya Hospital, to apply what I learned from Harvard to help develop the field of mental health in China.
Mental Health in China
Shuli: As a mental health expert, would you please briefly tell us the existing gaps and future direction of mental health in China?
肖教授：进入21世纪以来，中国精神卫生进入了一个较为快速的发展阶段。主要体现在这几个方面: 第一，精神卫生已被列入公共卫生范畴，重性精神障碍已被列为重大公共卫生问题。第二，社会保障体系、医疗保障体系已开始将精神病人当做弱势群体，并予以特别的关注和支持。第三，公众对精神疾病的认识和精神疾病患者的治疗率都有较大幅度的提高。第四，国家加大了对精神卫生体系的建设力度，包括精神病院和社区精神卫生网络的建设。第五，全国已有多个地方性精神卫生法律出台，国家精神卫生法草案经过多年讨论，也将于可以预见的将来通过 (编者注: 中国精神卫生法已于2012年10月26日在十一届全国人大常委会第二十九次会议经表决通过) 。
Dr. Xiao: Since 2000, mental health in China entered a phase of rapid development. First of all, mental health is now considered a public health issue; severe mental illness has been defined as one of the major public health problems in China. Second, mental patients are now considered a vulnerable group by China’s social security system and healthcare system, thus given special attention and support. Third, public awareness of mental illness and treatment rate among those with mental illness have significantly improved. Fourth, the nation has beefed up the investment on the mental health system, including psychiatric hospitals and community mental health network. Last, many local mental health ordinances have been implemented, and we can foresee the National Mental Health Legislation bill (draft) being passed in the near future. (Editor's Note: the China Mental Health Law was passed on the 29th session of the 11th Chinese National People's Congress on October 26th, 2012.)
Shuli: How was your recent visit to Thailand? Compared with other countries, what is the gap of mental health work in China?
Dr. Xiao: Mental health work received extensive attention in Thailand. It is rare, if not the only case, that a country with a population of about 60 million, and GDP per capita of roughly $5000, has within the Ministry of Health a Mental Health Bureau with more than 500 staff members. Mental health work in China is undergoing a period of rapid development, and may focus on the following urgent problems: 1) to acknowledge, understand, and support mental health work from the perspective of achieving social harmony, promoting cultural development, and national development; 2) to continue health education among the public to disseminate proper knowledge about mental illness and suicide, to understand and to reduce stigma and discrimination of mental patients; 3) to strengthen mental health system and train mental health workforce; 4) to provide basic medical services and living allowances to mental patients, and improve treatment rate /cure rate among individuals with mental illness.
Shuli: With limited resources, how to optimize resource allocation among mental patients from different subgroups such as adolescence, white-collar workers, healthcare workers, AIDS patients, etc.?
Dr. Xiao: Public mental health work has four major objectives: promotion of mental health, prevention of mental illness, treatment of mental illness, and rehabilitation of mental patients. I have to emphasize that, mental health is a social problem, thus improving population mental health requires societal efforts. There are two things to consider in optimizing resource allocation: one is to address those common mental health problems that affect population health, such as psychotic disorder and depression; another is to pay attention to the vulnerable groups. AIDS patients are considered as the most vulnerable among vulnerable populations due to social discrimination, exclusion, economic burden, HIV invasion of the central nervous system and many other reasons. Studies showed that AIDS patients have much higher rates of anxiety, depression and suicide compared with the general population. At the same time, mental health issues affect patients’ help-seeking behavior, following doctors’ instructions, and psychological status, which may worsen the treatment of AIDS. Unfortunately, few programs, not even to mention about a systematic approach in China, tend to address the mental health problems among AIDS patients.
Shuli: In some rural areas, many mental patients are reluctant to visit a doctor due to lack of self-awareness of their mental illnesses. Is that the biggest barrier to promote mental health in China? What should we do to change this?
Dr. Xiao: Lack of self-awareness of suffering from a mental health issue is common among people with psychotic disorders. The biggest problem is, due to lack of knowledge about mental health or fear of stigma and social discrimination, family members of patients are unable or unwilling to send patients for treatment at the early stage, or they decide to discontinue the treatment after a moderate improvement; or after treatment and gaining of self-awareness, patients may relapse after discontinuing treatment because of discrimination and drug side effects. This situation also exists in developed areas and among highly educated population. In addition, most mental illnesses require a long-term, continuous treatment. An example of such treatments is hospitalization, which however, might cause social isolation of patients and hinder the recovery of his/her social function. In the 1960s, western countries, particularly the United States launched the deinstitutionalization and community mental health movement, which enabled patients to continue treatment and rehabilitation in the community. Overall, it is necessary to popularize mental health knowledge through various strategies, to protect legal rights of mental patients, and to reduce social discrimination. In the meantime, to develop community mental health system and allow mental patients to receive continues and systematic treatment and rehabilitation in the community.
Public Health Emergency Preparedness
Shuli: China had several public health emergencies in recent years. Misinformation or misconstruing of the information often immediately results in collective irrational responses, among which the most cited example is the ‘panic salt-buying’ after the Japanese nuclear leak in 2011. What do you think are the underlying factors? How should we deal with that?
Dr. Xiao: Four factors are mostly accountable for the collective irrational responses. 1) The public’s lack of scientific knowledge; 2) delayed and insufficient official information release; 3) ordinary people’s lack of critical thinking, which could easily lead to herd mentality; 4) misinformation and rumors distributed when an emergency happens. To prevent collective irrationality and its spread, we need to improve the public’s scientific and mental health knowledge; the government and experts need to distribute related information responsibly, timely and effectively. We also need to promote critical thinking among adolescence, and to take legal action against those who irresponsibly disseminate misinformation and rumors.
Shuli: Do you have any good suggestion to build an efficient psychological crisis intervention system for public health emergencies?
Dr. Xiao: Psychological crisis intervention is an integral part to construct of emergency response system dealing with public health emergencies. In public health emergencies, we not only need a professional psychological crisis intervention team, but also require all the field personnel to have basic knowledge and skills of psychological crisis intervention. Training, exercise, and field intervention should be coordinated and arranged by public health emergency response agencies.
Mental Health Legislation
Shuli: The Mental Health Legislation bill (draft) recently released by the State Council lead to a lot of discussions. One of the most controversial issues was, while guaranteeing the treatment of mental patients, how to prevent the risk of forcing healthy citizens into psychiatric hospitals to receive “compulsory mental health treatment” in many complicated situations? Whether or not there are any supervising and regulating agencies to ensure justice and fairness in the implementation of the law?
Dr. Xiao: “Compulsory mental health treatment” is not a public health problem, but a legal problem. The main purpose of mental health legislation is to ensure the basic human rights of mental patients, such as fundamental existence condition and the opportunity to access basic treatment. Cracking down “Compulsory mental health treatment” is not, and should not be, the main propose of mental health legislation. Regardless of motivation, deliberately labeling people with mental illness is a crime comparable to defamation and libel, and should be resolved by suitable legal actions.
Shuli: What do you think is the greatest challenge for China’s mental health legislation?
Dr. Xiao: The greatest challenge is not the legislation itself, but to ensure the law being enforced effectively after the legislation. I believe that the mental health legislation in China will be improved gradually along with the social progress. However, I won’t be so naive to think that a bill solves all mental health problems.
Words to CHPAMS
Shuli: CHPAMS is a fast-growing professional community. Do you have any words to share with CHPAMS members and readers of China Health Review?
Dr. Xiao: Mental illness accounts for a great proportion of total disease burden in China, with depression ranked the second. I am very much appreciate CHPAMS’s effort to promote public health in China, and hope all the CHPAMS members and readers of China Health Review can work together to promote public health in China and globally, particularly in area of mental health policy and health system development.