Providing Free Treatment for Severe Mental Disorders in China

By Zhu, Yi; Zhang, Weibo et al. | Shanghai Archives of Psychiatry, April 2014 | Go to article overview

Providing Free Treatment for Severe Mental Disorders in China


Zhu, Yi, Zhang, Weibo, Wang, Yanfeng, Cai, Jun, Shanghai Archives of Psychiatry


Following the SARS outbreak in 2003 the Chinese government substantially strengthened its public health infrastructure. One of the new programs was the 'Central Government Support for the Local Management and Treatment of Severe Mental Illnesses Project'. Initially funded in December 2004 with 6.86 million Renminbi (829,000 in 2004 US$), the ongoing project has subsequently been referred to as the '686 Project'. The aims of the project include establishing an effective system to control and prevent violent behaviors by individuals with severe mental disorder, increasing care-seeking by persons with severe mental illnesses and disseminating knowledge about mental health. The main activities conducted under the auspices of the program are: a) the registration and evaluation of individuals with severe mental disorders, b) the identification and follow-up of persons with severe mental disorders who are considered at risk of violence, and c) the provision of free outpatient, inpatient and emergency treatment to persons with severe mental disorders who are living in poverty. In most locations the program is coordinated by the local public health department with varying levels of participation by mental health institutions. [1]

This project has played an important role in the transformation of mental health services in China. It has moved China closer to the long-term goals of reducing the financial burden to individuals and families of severe mental disorders, of increasing care-seeking and treatment adherence, and--ultimately--of decreasing the relapses and chronic disability associated with severe mental disorders" By the end of 2012 the program had expanded to cover approximately 60% of the population in 1578 districts and counties around China. Three million people with severe mental disorders had been registered, among whom 249,000 had received free treatment and over 41,000 had received free inpatient care. Over this period the reimbursement limit of medications has increased from 500 to 700 Renminbi per person per year (about 110 US$) and the reimbursement limit for inpatient treatment has increased from 1,500 to 2,000 Renminbi per hospitalization (about 330 US$).

Despite these considerable achievements, there is still a huge unmet need for services among persons with severe mental illnesses. Given the size of the population and the rapidly rising cost of health services the 686 project is only dealing with a small part of the problem. According to data from the Chinese Center for Disease Control and Prevention, there are more than 16 million people with severe mental disorders in China and the majority of them (57%) live under the official poverty line, primarily because of the disability and subsequent poverty that is associated with chronic mental disorders. The need for long-term treatment, the frequent relapses, and the high costs of medications impose a tremendous financial burden on individuals with serious mental disorders and their families. In many cases these cost limit care-seeking and treatment adherence. [3] A secondary burden associated with under-treatment of individuals with serious mental disorders is the greatly increased risk of harm to self or others among untreated individuals, problems that can undermine social stability and harmony.

The public health system--which runs the 686 program--does not identify all individuals who need free treatment and, in any case, the 686 project does not have the funds to provide free treatment to all such individuals. To address this unmet need, national and local governments need to substantially increase financial support for the 686 program and more effectively integrate the program with other mental health services. For example, in Shanghai mental health facilities have integrated the '686' project into the regular mental health service system. This has made it possible to institute standard protocols for the evaluation of patients, the determination of eligibility for free treatment, and the regular follow-up of patients to monitor safety and medication adherence. …

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