Mental health services in China.

Neuropsychiatric conditions in China pose a huge and growing public health problem that is unrecognized by policy makers, the health care establishment, and the public. The Global Burden of Disease project (Murray & Lopez, 1996a, b) estimates that in 1990 over 5% of the Chinese population (66 million individuals) suffered from mental disorders and that by 2020 neuropsychiatric conditions and suicide will account for 15.0% of the total burden of illness for men and 26.8% of the total burden of illness for women. The most important problems are depression, suicide, bipolar disorder, schizophrenia, obsessive-compulsive disorder, dementia, and alcohol abuse; in 1998 depression was the second most important health problem in the country (accounting for 6.9% of all DALYs lost), and suicide was the fourth most important problem (accounting for 4.2% of all DALYs lost) (WHO, 1999). Like in other resource-poor countries, most persons in China suffering from neuropsychiatric conditions do not receive necessary treatment. The Global Burden of Disease study estimates that in 1990 only 5% of persons suffering from depression or bipolar disorder received treatment (versus 35% in developed countries) and only 30% of persons suffering from schizophrenia received treatment (versus 80% in developed countries). Moreover, China's recent economic reforms have dramatically altered the provision of health care and led to decreased comprehensiveness and accessibility of mental health services. New initiatives are urgently needed to increase awareness of the importance of neuropsychiatric problems to overall health and to mobilize the political will needed to undertake major reforms in the structure and financing of mental health services.