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September 23, 2009

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Suicide hotline paves way for better mental health services

DESPERATE callers to a suicide-prevention hotline are the tip of the iceberg for China's fledgling mental health services. The challenge lies in delivering effective treatment. Talking people out of committing suicide is an important part of Meng Mei's work.

Working on a suicide prevention hotline in Beijing for eight years, she has a record of success in helping those afflicted with various types of mental problems but refuses to use the word "save."

"I am not God. I cannot save anyone but only help them with their problems," Meng says.

Mental disorders span various light mood and anxiety disorders, such as clinical depression, panic attacks and obsessive-compulsive disorder. They can also develop into more serious problems such as bipolar disorder (previously called manic depression) and schizophrenia.

The hotline Meng works for is run by the government-funded Beijing Suicide Research and Prevention Center (BSRPC) at Huilongguan Hospital, which specializes in mental illness.

The hotline, which takes calls 24 hours a day seven days a week, has received more than 570,000 calls since it started in 2003.

"Based on my experience, many people who want to attempt suicide are suffering from mental problems to different degrees but do not realize it," Meng says. The number of calls often peaks just after midnight.

Research on suicide levels in China carried out by doctors at the center in 2007 found a high correlation between suicide and mental illness - out of 287,000 people who committed suicide each year, 63 percent suffered mental disorders.

In this sense, the hotline provides a screening service by evaluating callers' mental health. Operators try to help the mildly affected, but severe cases will be referred for hospital treatment.

There are 173 million people in China estimated to be suffering from mental disorders, roughly one in every seven people, according to a research report put together by a BSRPC team headed by Michael Phillips, the center's executive director.

The team conducted random sampling of 113 million individuals aged above 18, about 12 percent of China's adult population, from 2001 to 2005.

They concluded the prevalence of any mental disorder in China was 17.5 percent, substantially higher than the 7 percent announced by the Ministry of Health earlier this year.

Their report was published on the June 13 issue of the prestigious international medical journal The Lancet.

Treatable illness

But only 8 percent of these people ever sought professional help and only 5 percent had ever consulted a mental health professional, the report said.

"Many patients didn't recognize their mental illness in the first place," says Zhang Yanping, associate director of the BSRPC. "They thought it was no big deal and they were just feeling a bit low."

"Sufferers are unaware the problem is usually an illness that can be treated," the report said.

Even among those who sought help, Zhang says, many were too ashamed to see mental health doctors. Fearing discrimination, they went to general hospitals instead to have physical complications treated. "Such fears are deeply rooted."

Other people are inclined to regard the mentally ill as bad people, Zhang says. "Today in some remote countryside areas, there still lingers the superstition that mental health patients have been possessed by demons."

Lack of mental health services is another problem. Because of limited staff, only 37 percent of incoming calls to the BSRPC hotline are answered, Zhang says.

"Now we have five operators on each shift. To answer all the phone calls from Beijing there should be at least 12. To answer every call from Beijing and the rest of China there should more than 30," she says.

According to a 2005 World Health Organization report, only 2.35 percent of the government's health budget in China was spent on mental health and less than 15 percent of the population had health insurance covering mental disorders.

Moreover, China's mental health sector is understaffed. According to a commentary in the August 22 Lancet issue, there are just 14,000 psychiatrists and psychologists to serve China's 1.3 billion population.

The situation is worse in rural areas, where mental health services are extremely under-resourced, lacking both professional staff and medicines, but mental disorders are more prevalent in these areas. According to the BSRPC 2007 report, 79 percent of people who committed suicide had been living in rural areas.

There is, however, a growing awareness of the problem in both government and public sectors.

Last year the Beijing health department invested 2.7 million yuan (US$395,289) in the BSRPC suicide hotline.

With more resources at its command, the center plans to install more telephone lines and hire more operators, Zhang says.

As well, mental health is now covered in a plan mapped out by the Ministry of Health whose goal is to provide universal access to basic medical services, including mental health services, by the year 2020.

"More and more people are turning to us for help," says Zhang. She attributes the increase to greater media publicity and growing awareness in society.

Professional institutions such as the BSRPC are also stepping up to tackle the problems. The center is planning programs on various aspects of mental health, such as education on the topic for normal university students, China's future teachers.

Compared with specialist hospitals, other institutions in the field play unique roles, especially by way of hotline services.

"Callers feel safe and less embarrassed talking over the phone because it's anonymous, and we never, ever release their profiles," says Meng.

To those who fear discrimination, hotlines have become major emotional release valves that also provide potential gateways to professional help.

Meng is proud of her work but realizes what she does is only a drop in the bucket.

"Callers place high hopes on hotlines, but it really takes more than us to make a difference," she says.


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