Build a "protective fence" for national mental health (Health New Journey ⑤)
The report of the 20th National Congress of the Communist Party of China proposed to pay attention to mental health and mental hygiene.
Why the specific emphasis on mental health and mental hygiene?
What is the status quo of mental health and mental health development in my country?
What short boards still exist?
In which areas should efforts be made in the future?
In response to these issues, our reporter interviewed Lu Lin, academician of the Chinese Academy of Sciences and president of Peking University Sixth Hospital.
More than 90% of patients with severe mental disorders receive care
According to the definition of the World Health Organization, health not only refers to physical health, but also mental health, which is also very important.
"Mental health and mental hygiene are related to the happiness and well-being of the masses." Lu Lin introduced that in the past ten years, with the strong support of the party and the state, departments at all levels have made a series of major deployments to protect the mental health of the public. The construction of the mental health system and the mental health system have provided a solid policy guarantee, the mental health work has entered the track of rule of law, the social mental health service system has been continuously improved, and the mental health medical service system has also been greatly improved.
At the same time, China has launched management services for severe mental disorders, and implemented a registration and reporting system for patients with severe mental disorders.
According to Lu Lin, by the end of 2021, there will be 6.6 million patients with severe mental disorders registered in the national database. At present, the standardized management rate of registered patients has reached 92%.
In other words, more than 90% of patients with severe mental disorders have received care and treatment.
Why so much emphasis on mental health and mental health work?
"In recent years, with the rapid development of my country's economy and society, people's pace of life and work pressure have increased significantly, and the number of people with psychological and behavioral problems and mental disorders has gradually increased, and the mental health problems of the masses have become increasingly prominent," Lu Lin said. , although the incidence of mental illness in my country is lower than that in developed countries, it still needs to be given great attention.
The latest survey data show that the lifetime prevalence of various mental illnesses (excluding dementia) among Chinese adults is 16.6%, and the prevalence of mood disorders and anxiety disorders, mainly depression, is on the rise.
In China, the disease burden due to mental disorders accounts for 13% of all noncommunicable disease burdens.
Under the new crown pneumonia epidemic, the incidence of psychological and mental disorders has increased significantly.
According to surveys, about 1/3 of the public has symptoms such as anxiety, depression, and insomnia.
"Due to the public's lack of correct understanding of mental illness, ignorance or misunderstanding of psychiatric treatment, the number of patients with mental illness receiving treatment does not exceed 20% of all patients." Lu Lin pointed out that my country's mental health industry started late, and mental illness The low diagnosis rate may be related to the low rate of patients visiting the clinic, misdiagnosis or missed diagnosis caused by doctors in other departments not having knowledge of mental diseases, and lack of consultation and examination skills related to mental diseases among clinicians.
Studies have shown that the incidence of depression among people over the age of 15 in China is 4%-8%, but the recognition rate of depression in hospitals above the prefecture and city level nationwide is less than 20%, and less than 10% of patients with depression have received formal treatment .
At the end of 2021, the National Center for Mental Health and Mental Hygiene Prevention and Control will be established to coordinate and carry out mental health-related work at the national level.
In July this year, the National Health Commission decided to set up national medical centers for mental illness in Beijing, Shanghai and Hunan province.
"my country's mental health discipline started relatively late. Although it has developed rapidly in recent years with the attention of the state and the promotion of various departments, and the public's increasing understanding of mental health, compared with countries in the world where psychiatry developed earlier , there is still a certain gap.” Lu Lin said that in the face of the increasing burden of mental disorders, the uneven distribution of mental health resources, and the current situation of many difficulties in the prevention and treatment of mental disorders, it is necessary to take multiple measures to promote the coordination of psychological services and mental health systems in various regions. Coordinated development, serving to improve the mental health and happiness of the masses.
Improving the mental health service system for mental health
From what aspects should efforts be made to carry out mental health and mental hygiene work?
"To put it simply, the 'system, people, money, and things' can be used as the starting point for the development of mental health, and the national mental health 'protection fence' can be built." Lu Lin pointed out.
At the institutional level, it is necessary to improve the top-level design of the mental health and mental health service system, improve the utilization efficiency of mental health resources, expand the coverage of the grassroots mental disorder rehabilitation system, balance the distribution of medical resources in different regions, and improve the ability of mental and mental health services.
At the same time, policies and regulations related to mental health need to be improved.
On the one hand, standardize mental health diagnosis and treatment services and protect the legitimate rights and interests of patients with mental disorders; on the other hand, improve the community's ability to prevent and manage severe mental illnesses, and reduce patients' accidents and disasters and their negative impacts.
In terms of people, it is necessary to improve the training of mental health professionals, improve the training system and assessment standards for psychiatrists, clinical psychotherapists, and vocational rehabilitation practitioners, and improve the clinical diagnosis and treatment skills, comprehensive quality, knowledge reserve, and employment of mental health practitioners. Salary and social recognition.
"We know that it is not easy to train a doctor, and it is even more difficult to train a well-trained psychiatrist. In the past ten years, our country has done a lot of work in this area." Lu Lin introduced that at present, there are 5,936 mental health medical service institutions across the country , compared with 2010, an increase of 205%.
There are more than 50,000 registered psychiatric doctors nationwide, an increase of 144% compared with 10 years ago, but there is still a large gap.
"In the medical field, psychiatry is an unpopular specialty with low social recognition and high occupational risks, which makes it less attractive to outstanding medical students. Statistics show that less than 100% of Chinese medical school graduates choose to work in psychiatry. %, which is very detrimental to the long-term development of psychiatry.” Lu Lin said that relevant departments should increase financial investment, improve the treatment of mental health professionals, and fundamentally solve the problem of follow-up weakness faced by psychiatric medical personnel.
In terms of finance, more investment is needed to enhance scientific research and innovation in the field of mental health.
Lu Lin introduced that the etiology of mental disorders is very complex and has not yet been fully elucidated.
At present, the treatment methods for mental illness include drug therapy, psychotherapy and physical therapy, but there are still many problems.
To this end, cooperation between different departments should be advocated, regular academic exchanges should be carried out, the scientific research awareness of psychiatrists should be improved, and the development of psychiatric scientific research technology should be promoted.
At the physical level, it is necessary to strengthen the construction of relevant departments and hardware facilities.
"Most tertiary hospitals in China mainly focus on the physical health of patients and do not pay enough attention to mental health. Some general hospitals do not even have a psychiatric department, and some provinces and cities do not have mental health centers and psychiatric hospitals. Nearly 50% of county hospitals have no mental health. Health professional institutions, psychiatric beds or psychiatrists, mental health resources in rural and remote areas are relatively weak." Lu Lin suggested that in the future, a psychiatric medical center should be set up in each province (autonomous region, city). The above general hospitals set up psychiatric departments.
At the same time, build consortiums and alliances of specialized mental health hospitals, make full use of the Internet and big data platforms, actively carry out remote consultations, and promote the hierarchical diagnosis and treatment model of first diagnosis at the grassroots level, two-way referral, emergency and slow treatment, and linkage between upper and lower levels, so as to improve the ability of diagnosis and treatment at the grassroots level , so that people in remote areas can seek medical treatment nearby when they encounter psychological problems.
Improving the ability to cope with psychological intervention in emergencies
"At present, there are still many misunderstandings in the public's understanding of mental and psychological problems. It is necessary to eliminate the stigma of mental disorders and form a social atmosphere that cares for patients with mental disorders." Lu Lin pointed out that many people equate mental illness with "weakness of will". ", thinking that mental illness is "hypocritical" and "squeamish", and thinking that "it will pass after a while".
There are also some people who have a one-sided understanding of mental illness and believe that mental illness is "curable".
Under such circumstances, many patients with mental disorders have a "sense of stigma" and are afraid of being labeled as mentally ill. They are afraid or unwilling to seek professional help, which often leads to delays in their treatment.
"Take depression, which has received the most attention in recent years, as an example. In fact, depression is just a common disease. The scientific community has concluded that depression, like high blood pressure and diabetes, has its biological basis. It is the brain's The neurotransmitters have changed, and there is no shame or embarrassment, and the treatment effect of most patients is very good.” Lu Lin emphasized that depression itself is not terrible, what is terrible is that it cannot be faced squarely, and professional treatment and treatment cannot be obtained in time. help.
In recent years, the global pandemic of the new crown pneumonia epidemic has had a certain impact on the mental health of some people.
For such public health emergencies, what targeted psychological intervention measures should the country take?
"In the past ten years, my country's psychological intervention work on emergencies has gone through a process of establishing rules and regulations from scratch. Laws and systems such as the Mental Health Law and the Law on Basic Medical Health and Health Promotion have stipulated and guaranteed the prevention of emergencies. The incident will carry out psychological rescue work." Lu Lin pointed out that after the outbreak of the new crown pneumonia epidemic, the state set up a special prevention and treatment psychological service team and set up more than 660 psychological assistance hotlines.
"For the mental and psychological problems caused by public health emergencies, we should formulate scientific and reasonable emergency psychological plans, and be prepared for danger in times of peace." Lu Lin pointed out that every locality can reserve a psychological rescue team to strengthen daily emergency psychological counseling training , Strengthen drills, improve the psychological rescue capabilities of emergency teams, and ensure that the contingency plan can be implemented smoothly in emergencies through repeated drills.
When a public health emergency occurs, the first to understand and join the frontline work are often medical staff.
Therefore, the mental health knowledge training system for ordinary medical staff should be strengthened to improve their ability to identify and deal with mental and psychological problems.
At the same time, psychiatric hospitals should improve their own scheduling capabilities, so that they can quickly deploy personnel and materials to quickly and accurately resolve emergencies without affecting normal outpatient ward services.
Wang Meihua