In a healthcare system under pressure, psychiatry needs strong advocates. In China, one champion is Yang Fude, the president and chief physician at Beijing Huilongguan Hospital, a leading psychiatric teaching hospital.
Policymakers in the Chinese healthcare system must take on a huge responsibility: They have to respond to a torrent of urgent needs. There aren’t enough resources. And every decision they make affects the lives of millions.
Among experts who specialize in major diseases like cancer, heart disease or diabetes, competition for the attention of these policymakers is fierce. They try to secure whatever they can for their particular field from the scarce funding available. In this battle, psychiatry often risks coming in last. Yang Fude is the chief physician at one of the three largest psychiatric hospitals in China, and throughout his career, he has fought for the mentally ill – a group of patients he calls “underserved”.
As a government advisor, he has access to health system policymakers. And there he’s noticed a shift in the attitude toward the field of mental health. “Policymakers are increasingly aware of the suffering of psychiatric patients,” says Professor Yang. “They recognize that if these patients do not receive early treatment, the burden on the patients, their families – and society – will be even heavier.” But there’s an enormous backlog of untreated mental illness. When Professor Yang was a young psychiatrist in the late ’80s, for instance, the treatment rate for people with depression was less than 5%. The great majority of the patients he saw were the ones suffering from severe schizophrenia.
Only a systematic effort will be able to address such a heavy backlog. Professor Yang has helped draw up national guidelines, which for instance have established standards for detection rates. But what good are guidelines when there aren’t enough health professionals to implement them?
An ambitious vision
To serve its population of nearly 1.5 billion, China has about 30,000 psychiatrists at present, says Professor Yang. Only a third of them have received advanced training in psychiatry. And that is precisely the group that there’s a desperate need for. Among their other challenges, they must help retrain GPs so they will be better equipped to diagnose mental illness. Rural districts in particular are contending with a severe shortage of health professionals who are capable of recognizing the symptoms.
Policymakers have made the recruitment of skilled psychiatrists a top priority. Yet it’s difficult to recruit newly educated doctors – especially the most talented ones – to psychiatry, which still receives much less funding than specialities in physical illness. The government has set a clear target, says Professor Yang: “By 2020, we aim to increase the number of qualified psychiatric doctors to 40,000.”
But is such an ambitious vision realistic?
“We are optimistic that it’s achievable,” he replies. The government target is being supported by a series of initiatives, including the establishment of a psychiatry major at more than 30 universities. He adds, with a little smile, that once the government sets a target, it’s usually realized.
A special group
Professor Yang recounts that, during the course of his professional life, he’s been able to observe major progress in the mental health field. For example, the treatment rate for people with depression has risen to between 20% and 30%. He’s watched this change manifest itself in his clinical practice, where three quarters of the patients he now sees are suffering from depression or bipolar disorder – a proportion that better reflects the prevalence of these illnesses in the general population. The trend is headed in the right direction.
At the same time, there is still far to go. During the course of his career, Professor Yang has had the opportunity to change to other disease specialities that have more resources. Yet he says that psychiatry remains his top choice. It’s a field that continues to fascinate him professionally because of the many factors involved, social, mental and clinical. “I’ll do this work for the rest of my life,” he says.
But for Professor Yang, there’s an even more compelling reason to remain in the field – and that is the patients themselves. “They are quite a special group of patients,” he says, adding that they cannot address their condition on their own. “They’re in genuine need of care. It would be impossible for me to give up on them.”