Mental Health Care in China: Recent Changes and Future Challenges

After 1949, the communist government under Mao Zedong built strong collective health care and public health systems. While mental health care did not receive specialized attention, the overall health of Chinese citizens was improved due to the emphasis on basic health care. Within thirty years, these Chinese systems became the envy of many developing (and developed) countries struggling to provide universal access to health care at reasonable costs. However, since 1978, decreased central government support and significant policy changes have largely dismantled these comprehensive systems of public health and basic health care. During this period, policies were enacted that decentralized and privatized the health care system. Once a model for universal basic health care, the majority of Chinese citizens currently do not have insurance coverage. Moreover, decentralization has lead to large inequities between rural and urban areas, and privatization has contributed to skyrocketing costs and systemic inefficiencies. Mental health care, already in a weaker state than general medical care, has been disproportionately affected by these developments. Availability of mental health care is virtually nonexistent in rural areas and accessible only to the insured and/or wealthy in urban areas. Providers in urban areas struggle to provide services due to an unfavorable reimbursement structure and a lack of clear mental health care policies. Even in Shanghai, one of the most economically prosperous cities in China, it remains a challenge to provide