The People's Republic of China is no different from any other country in having a significant number of mentally ill citizens. The most extensive epidemiological study done in China found that the prevalence of schizophrenia is 6.06 per 1,000 in urban China and 3.42 per 1,000 in rural China (Research Coordinating Group, 1986), a total of approximately 4,500,000 people. Only about 2 percent of these individuals are hospitalized at any one time; over 90 percent of them are cared for by their families (Phillips, 1993). In contrast, only an estimated 40 percent of people with schizophrenia in the United States are cared for by their families (Torrey, 1988), and in the United Kingdom, 60 percent of those suffering their first episode of schizophrenia are cared for by their families (Perring, Twigg, & Atkin, 1990).
China has few community-based services to provide for the needs of mentally ill individuals and their families. Over the past decade some services such as work therapy stations (Xia, Yan, & Wang, 1987), factory liaison projects (Jiang, 1988), mobile psychiatric care units (Xia et al., 1987), and home programs (Leung, 1978; Shen, 1983, 1985) have evolved in the major urban centers, but these services reach only a tiny proportion of mentally ill people (Pearson, 1992). Moreover, the network of voluntary nongovernment agencies that provide ancillary services for mentally ill clients in Western countries does not exist in China.
The preponderance of family-based care and the lack of community facilities indicate that psychiatric social workers could provide needed services to mentally ill patients and their families in China. It would, however, be inadvisable to assume that because social work has demonstrated usefulness in Western cultures it will automatically be useful in a very different culture. This article discusses the practical and idealogical problems of introducing this Western profession into the Chinese setting. We hope to show that there is a potential role for psychiatric social work but that such practice would inevitably assume Chinese characteristics.
History of Social Work in China
According to Fu (1983), who wholeheartedly supported the development of social work in psychiatric settings in China, several Chinese universities and medical schools had set up social work departments before the 1949 Revolution. Yanjing University in Beijing was the first to introduce social work in 1925, although not of a specifically psychiatric nature (Nann, He, & Leung, 1990). Some people were sent abroad to train as social workers. However, after 1949 psychiatric practice came under the influence of the Russian school of psychiatry, which was biologically oriented. Social sciences and sociology in particular fell into disrepute and social work with them. As Fu said, "It was considered that under the supreme socialist system social problems did not exist". The Cultural Revolution (1966 to 1976) took this view to even more extreme lengths.
It has taken four decades for this position to be seriously reviewed and for the authorities in the People's Republic to reach a more realistic appraisal of the human condition and the problems inherent in living. At the meeting of the Asia and Pacific Association of Social Work Education (APSWE) held in Beijing in December 1988, it was announced that the State Education Commission had decided to approve general social work studies in four universities (APSWE and Department of Sociology, Beijing University, 1988). Zhongshan University in Guangzhou, in conjunction with Hong Kong University's Department of Social Work and Social Administration, offered courses in social work in its Sociology Department in the 1986-87 school year (Nann et al., 1990).
In 1992, 35 delegates from China attended the first international conference on social work in Chinese communities held in Hong Kong. Also in 1992, the Chinese Ministry of Civil Affairs produced the first government "white paper" on social welfare in China. …