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| | General Hospital Psychiatry in China | | 2005-5-10 20:42:34 Shanghai Tongji hospital, Tongji Univers Wu Wenyuan, M.D. |  General hospital psychiatry in China usually refers to mental disorders which are encountered in daily clinical practice and are managed by psychiatrists or clinical psychologists in general hospital. For example, it includes such conditions: 1) psychological problems in patients with medical diseases; 2) psychological problems caused by diagnosis, treatment or operation of medical diseases; 3) Psychosomatic diseases in which psychological factors play an important role in etiology, treatment and prognosis; 4) functional symptoms, eg. somatoform disorder; 5) Neurosis; 6) Disorders related to ill behavior or life styles; 7) Personality disorders; 8) psychotic patient with medical disease, etc.
The modern history of psychiatry in general hospitals started in 1980s. Some teaching general hospitals in big cities such as Beijing, Shanghai, Nanjing, Changsha, Chengdu and Kunming, began to set up psychiatry clinic service in general hospital since 1980s. In 1992, Tongji Hospital of Tongji University, Shanghai, opened the first psychosomatic medicine ward in general hospital in China. It provides a more acceptable approach to patients with neurosis, emotion disorders and other psychological related disorders than local mental health center (or psychiatric hospital), which was previous major provider of mental health service. Simultaneously, patients with psychosomatic diseases were paid much more attention on account of the transform in medicine education from bio-medicine model to bio-psycho-social model. A few hospitals founded psychosomatic medicine or psychiatric wards in general hospitals in some big cities in China. There is no exact statistical data yet.
There are some continuing medical education (CME) courses on general hospital psychiatry for doctors and nurses in general hospital every year. Its a required curriculum CME course in some big cities. A psychosomatic skill training program has been carried out in Shanghai Tongji Hospital of Tongji University since 2003, it was collaborated with the Department of Psychosomatic Medicine and Psychotherapy, Freiburg University, German. It will be supported by Asia-Link Project (Postgraduate Psychosocial Training for Medical Doctors, the ASIA-LINK-Program is funded by the European Community) in 2005. The main objective of the project is to improve the health care systems of PR-China and Southeastasian (Vietnam-SR, Laos-PDR) countries by enhancing the psychosocial competence and supporting international networking in the field of psychosomatic medicine. The specific objective of the project is to introduce, develop and sustain psychosocial competence in the postgraduate medical training of particular groups of medical doctors in three Asian countries.
Consultation liaison psychiatry (CLP) in China
CLP is a new area of general hospital psychiatry in China. It bridges between physicians and psychiatrists in order to provide more mental health service for patients with various medical diseases. The CLP attends the clinical rounds besides consultation. But there are few general hospitals in China can provide really CLP activities in the daily clinical practice. CLP could provide liaison and consultation service to clinical doctors as well as enhance communication and collaboration between them so that patients with mental disorders in clinical practice could be well recognized and treated. Besides, CLP takes responsibility of education for medical students and clinical doctors about some essential psychiatric knowledge. We believe that CLP must be quickly improved with the development of new medical model in the soon future.
According to one investigation within Tongji Hospital of Tongji University, incidence of mental illnesses was as high as two-third among all the inpatients population, among which emotional problem(depression or anxiety) constitutes the majority. So, general hospital more and more urgently calls for mental health service. But current psychiatry services including CLP provided by general hospital are far from meeting the demands. In China, it is much lower than average level of the world on the ability of recognizing and treating psychiatric disorders among physicians in general medical settings. A few studies has made investigation about status of mental health service of general hospitals in certain cities, while the statistical data in whole China is still absent. Here we introduce the results of investigation in Shanghai just because it is the most comprehensive and latest study among all reported ones(Yu DH, Wu WY and Zhang MY, 2004). It should be helpful to get a hint of the whole country although levels of Shanghai could not represent that of the whole China.
This study covered all of the municipal districts of Shanghai, included 15 IIIa general hospitals and 14 IIa hospitals*. Content of investigation included hospital scale and medical resources, settings of mental service organization, psychiatric personnel and consultation as well as liaison service of each hospital. Among all of 29 general hospitals, 17 (59%) included 12 (80%) IIIa and 5 (36%) IIa hospitals set up mental health department. In those having set up mental health department (group A), rate of applying for psychiatry consultation was 0.63% and that of in those not setting up mental health department (group B) was only 0.10%. In group A, most common causes of applying consultation were mental disorders caused by medical conditions (48%), emotional disorder (21%), and sleeping disorder (14%); in group B, first two reasons were mental disorders caused by medical conditions (84%), sleeping disorder (14%). Main diagnosis after consultation in group A were mental problem caused by organic brain diseases (34%), psychological reaction to physical diseases (23%) and neurosis (17%); in group B were mental problems caused by organic brain diseases (41%), psychological reaction to physical diseases (24%) and neurosis (13%). Consultation liaison group composed of psychiatrists and clinical doctors had not existed in any of them while in hospitals of group A, psychiatrists attended ward inspection or clinic work of other departments in different rates: in 5 hospitals (17%) they attended 3 times or more per week, in 8 hospitals (28%) 1 to 2 times per week and in 8 hospitals (55%) occasionally or never attended. There was significant difference on further training and education of psychiatry between two groups.
Numerous studies have proved psychiatric disorders existing in different departments of general hospitals. Above investigation indicates that mental health service in general hospital has been paid more and more importance in Shanghai. But even in hospitals with relatively more psychiatric or psychological consultation, it could not meet the requirement of clinical work. China has not yet evolved a suited CLP model while in general hospital psychiatrists are more and more taking part in clinical work.
Expectation
Mental health service in general hospital has been enhanced by Chinese government. A document named as "Guideline of improving Chinese mental health service" has been signed by Ministry of Health, Ministry of Education, Ministry of Public Security, Ministry of Civil Affairs, Ministry of Justice, Ministry of Finance and China Disabled Persons Federation in August 2004. It definitely pointed that proportion of identification and treatment of depression should be improved in primary health organizations. Identification rates in municipal or higher level hospitals should reach at 40%, in country hospitals reach at 30% till 2005, and these rates should be 60% and 50% respectively till 2010. Synchronously, approach of mental health service should be much broadened. It is required that till 2005, 70% municipalities should have at least one general hospital providing psychiatry service and 50% country hospitals could have such a general hospital till 2010.
So with the more and more attention of government and participation of the whole society, we have every reason to believe that a bright and effective mental health system of China would present in the world psychiatry arena.
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Ministry of Health, (2003) No.013
ICP:No.040657