As a large country with a population of over 1.3 billion people, China has been widely recognized for its roles in economic development and for its participation in global governance. However, China’s efforts in domestic social governance receive both praise and blame. On one hand, the management of a large country that has 18% of the world population, is worth 15.5% of the world economic gross, and is made up of 56 ethnic groups would be a serious challenge to any government or social organization. In the globalization and internet age there is no international experience that can be entirely replicated. China possesses the quality of trial and error from policy design to practice and , if China’s reforms in the development of social governance are successful, the immediate and longterm effects are both likely to be significantly adds to the complexity is that there are larger economic, social, and cultural gaps between the different regions within China than there are even between China and other countries at a similar economic level. These factors result in the need for a comprehensive design,omni-directional design, and multi-level testing before national policy adjustment, reform or so-called “ideal” or “instructive” paradigm on the international stage could possibly take root in the soil of reality or could likely survive.

1. The basis of mental health work

In the realm of mental health, China’s situation is particularly unique. Stigmatization and discrimination during a long period of history has caused the mental health services to lag behind in China’s economic and social development. The real rapid advancement began around 2000. [1-2] Before the introduction of the National Mental Health Work Plan for 2015-2020 (the New Plan for short [3]) which was referred to by Professor Xiangdong Wang and formulated by 10 departments,the management and services of mental health in China had essentially experienced 3 mutually distinctive and overlapping developmental stages in the past 15 stages were: (a) improving specialized services, (b)integrating with community management services, and(c) improving the mechanism of social coordination.

From 2010 to 2012, China invested 9.1 billion RMB Yuan in the expansion of buildings and operations for the 550 mental health institutions in the country and 1.45 billion RMB Yuan into purchasing equipment necessary for specialized services. Meanwhile, starting with the improvement of patients’ protection through the adjustment of the policies such as financial subsidies and health insurance, there was a rise the specialized medical services’ financing level and indirectly an improvement in treatment service. In order to enhance the professional proficiency of psychiatric teams, there were standardized trainings for physicians and later resident physicians in all 4 zones of China.[4] The above mentioned measures laid the foundation for the mental health service system construct that regarded psychiatric hospitals as the main body.

Taking the development of the Mental Health Center for Disease Control and Prevention and the community management program for severe mental disorders as hallmarks, the community-based mental health service network basically has had its main framework since 2010. This has resulted in the upgrading of community based treatment (originally considered a pilot program)[5,6] and the initial steps in laying the foundation from the National Mental Health Comprehensive Management Pilot, which began in 2015. With the central government establishing the Mental Health Joint Conference in 2007, two rounds of special planning in mental health began, one round from 2002-2010 and the other from 2008 to 2015. It was during this time that various departments and social groups began to form the rough framework for mental health management and services in terms of division of tasks and cooperation between groups. The national mental health law and a number of mental health policies in the past 10 years have also benefited from the formation of this framework.

2. Existing resources and conditions

In China, the current status of services demand and utilization is the following: although the lifetime prevalence of all mental disorders is 17% and severe mental illness is 1%,[7] patients registered in the public health information system[8] as having severe mental illness was less than 0.5% of the total population in most regions. This means that approximately 50% of individuals with severe mental illness were unable or unwilling to receive community based treatment provided by the government.

Though the full picture of services utilization and demand has not yet come out, we can say that the service resources in most places are seriously inadequate and mode of services is often outdated and homogenous. As of 2015, in China there were 949 specialized mental health institutions, 27,733 practicing (including assistants) psychiatrists(2.02/100,000 people), 57,591 psychiatric nurses(4.19/100,000 people), and 339,306 psychiatric inpatient beds (24.68/100,000 people). The annual number of outpatient and emergency visits was 40,051,027 (2,914/100,000 people) and the annual number of hospital discharges was 1,987,534(145/100,000 people).[9] Resources per capita and the quantity of services has increased significantly since 2000 and the numbers have even exceeded the median of the other countries with a similar income level(see table 1).[9-10] However, the gap between resources and needs is still large. For example, according to one study there is still an estimated need for at least 13,000 more psychiatrists in China. [3] Furthermore, the overall pattern of large disparities, both in terms of terms of resources and staff capability, between China’s regions has not changed in recent years. [11] Psychiatric resources are mainly concentrated in developed areas and in medium and large-sized cities. Rural areas, as well as large portions of central and western China lag far behind in availability of services (see table 2,3). In addition, China’s mental health system is mostlyfocused on psychiatry and inpatient services, whereas non-medical support staff, such as psychologists and social workers, are few and far between (see table 4).