This is a continued feature multi-part blog post written by our Executive Director, Alanna Hendren. Alanna will be blogging about her recent experience flying off to China as the leader of the People-to-People Psychiatric Services and Developmental Disabilities Delegation. Every Tuesday and Friday, we will be posting about her journey in China, the developmental services offered there, and the people there. To read part 7, click here.
We met Dr. Liu, the Director of the Psychology Department of Guilin 181 Hospital. He was dressed in a military uniform, as were some of his staff, because the hospital used to be a military hospital but was now open to the public and recently included children. In 1991, the hospital focused on training staff about therapeutic treatments through a partnership with some German professionals. The hospital has 46 inpatient psychiatric beds but treats most people as out-patients. Theirs is the only psychiatric unit in Guilin. Dr. Liu introduced his team, which included a counselor from the Air Force, a psychiatrist who also worked in a maternity hospital, a German-trained psychiatrist, and the Department Psychiatrist, who had decades of experience. There were also several counselors, all with post-graduate degrees. After an initial assessment, 25 to 30 days is the average stay in the hospital, then families generally take the patient home. Professionals then focus intensively on outpatient care, with follow-up visits scheduled at one week, two weeks, then more periodically, depending on how the person is doing. Guilin has over 200 mental counselors who work in schools, factories and bureaucracies to do follow-up and assist others with day-to-day problems. Hospital 181 services, including out-patient, are open 365 days per year. On in-patient wards, there is one nurse for every three patients.
The Chinese have developed their own mental status assessment software on which everyone is trained. This has also been refined through clinical application. There is no need for General Practitioners in China as people can self-refer to tertiary or specialized hospitals. Hospital 181 has ongoing communications with four universities and mental counselors can go online for information regarding virtually all psychiatric conditions.
Autism is an increasing diagnosis in China where children with autism are enrolled in early training programs. For most children with developmental disabilities, diagnosis happens through early screening. If the child also has medical problems, then these are treated first. Next they focus on physical activity and sports training. They also work on speech, provide physiotherapy, social skills training and enhance communication skills. They have a multi-disciplinary approach. About 10% of the people the system treats who have developmental disabilities also have psychiatric challenges. For autism, they use applied behavior analysis. Children with ADHD are treated separately. In China, the threshold for ADHD may be lower because children are generally much calmer in their culture, so they’ve created assessment tools that are more culturally appropriate.
When asked about substance abuse, Dr. Liu said that they treated addictions. Before 1978, there was virtually no alcoholism but since then, with more income, there’s been more alcoholism. He’d treated some who drank up to three bottles of 100 proof per day. Brain injury was a result. He felt the main problem was that, in addition to alcohol’s toxicity, alcoholics did not eat well and therefore deprived their bodies of necessary nutrition.
PTSD was a problem they treated as well, primarily as a result of earthquakes or other natural disasters. Dr. Liu was drafted to assist victims in the recent Schezhuan earthquake. As a tertiary hospital, Guilin 181 is also expected to send medical teams to small communities, donate equipment and provide some care to rural areas.
As in Canada, electroconvulsive therapy (ECT) is used in China. In the old days they used acupuncture ECT, where two needles were applied, 1 at mid-skull and another between the nose and lip. 70 millamperes were applied to the needles. General anesthesia was not used so the bodies convulsed. This treatment was used for psychosis, schizophrenia, aggression, and depression. In the West at the time, electrodes were placed like headsets just above the ears and no anesthesia was used. ECT in China today is not very common, used only if the family cannot afford prescription medications. Rural areas don’t have ECT equipment. Although medications are more affordable in Canada, ECT continues to be used for depressions that are resistant to all other treatments and as a last-resort alternative for some other psychiatric disorders.
An extremely animated, lively discussion took place as a response to a question about funding. Our interpreter/guide Riley couldn’t keep up with the translations as the discussion involved too many people, but they were basically debating the old system, where it seems everyone was covered with government funding, to the new, where people have to make a cash downpayment of 1% minimum before they can get medical care. From what I could understand, the consensus that emerged from the excited discussion was that in urban areas, the individual is responsible for about 25% of the cost and the government is responsible for 75%. In rural areas, a township clinic might be up to 85% funded, but county hospitals may have only 30% to 60% government funding. In some remote rural areas, some people are still waiting for any medical services, so they may pool money to pay for any care they can get and use traditional Chinese medicines. The discussion was foggy in translation, but it seems people can purchase supplemental insurance if they have the money.
Costs for care were dramatically lower than those in the West. The cost to stay in the hospital in Guilin is 100 yuan per day or about $18 CAN. The cost in the U.S. is about $1550 US per day. An ECT treatment costs 78 yuan, or about $14 CAN.
Wages are low because China has trade unions, but they have no rights to strike and sound more like what we would call a social club. If workers are unhappy with their wages, employment is competitive and others are waiting for their jobs.