China on the Couch: Psychologists Struggle To Meet Demand

Anxious Shanghai parents wait outside the school at exam time. Competition in education is a major source of stress for Chinese families. Photos: AFP/Mark Ralston

HONG KONG—China's stunning economic growth and deepening social inequalities are ramping up stress across the population, with urban white-collar workers, high-flyers, and young people all seeking psychological help in unprecendented numbers, mental health professionals say.

"One doctor will see seven or eight patients in the course of a day's work here," Zhan Chunhua, a psychological counselor at the Kangning Counseling Hotline in the southern city of Guangzhou, told RFA's Mandarin service.

"We have more than 20 doctors working here. Some of our clients continue to see us for one or two years, or even four or five years," Zhan said.

Huge demand for counseling

Hotlines such as Zhan's are proliferating rapidly in major cities across China, and frequently advertise their services online, with names like "The Soul's Home," "Kind Hearts," or "A Burden Halved."

As understanding of psychological issues becomes deeper in China, and demand increases, he added, China's mental health professionals are only going to get busier.

More and more people are gaining an understanding of counseling, and are beginning to understand that this isn't a disease. Most of our clients are able to seek help of their own accord nowadays, and that's a big improvement.

"There really is a huge demand for these services...The psychological profession will be very important in the promotion of mental health in the future," he told "Investigative Report."

According to the World Health Organization (WHO), there is a greater incidence of mental health and psychological problems among developing countries than in the developed world. But there is a huge shortfall in the number of doctors and treatment options available in those countries.

According to WHO figures for 2005, the average number of psychiatrists available per 100,000 head of population in the developed world is 10.5, while psychologists number 14 per 100,000. But China can offer only 0.05 psychiatrists and 0.04 psychologists per 100,000 people.

China, with its population of 1.3 billion, is home to just 14,000 psychiatrists and psychologists, the same number as France, with its population of 60 million.

Thousands are in training

But the profession is growing as fast as it can. Wu Jinghua is a psychological expert at the Tianlang Psychological Clinic in the northeastern city of Shenyang.

When he started in the business a few years back, there were only two such clinics in Shenyang. But he has witnessed an explosion in his profession, with the Psychological Counseling Institute in Shenyang training around 1,400 new professionals annually.

Wu said that he currently sees three or four patients a day, and that many of them are very young.

"There are three types. The first is primary school students worried about their relationships with classmates or with their teacher, those trying to get used to the psychological environment of primary school," he said.

Changing attitudes

"Another type is the older junior high school students and the high school students. They are mostly concerned about relationships with their peers, and by that age there are some love issues there too. And the third type are mature adults concerned about relationships in the workplace."

Zhang, 28, is a medical doctor trained in Western medicine. He works at the Jingshi Huixin Psychological Clinic in Beijing. He told RFA that he was able to establish a rapport with the many young people who came to him as clients at the center because he was quite close in age to them.

Zhang said older people tended still to be quite suspicious of counselling, while younger people were happy to attend the clinic.

"Mostly we don't refer to people as patients, but as guests or clients. People are worried that if they are regarded as patients, then other people will think there is something wrong with them," he told reporter Bai Fan.

"Many people think that to undergo psychological difficulties is the same as being ill. But things are getting much better in this regard. More and more people are gaining an understanding of counselling, and are beginning to understand that this isn't a disease. Most of our clients are able to seek help of their own accord nowadays, and that's a big improvement. "

In the West, a psychological counsellor must undergo many years of training. But in China there are a lot of very young people coming into the profession.

Profession in its infancy

Zhang said: "Right now there is a huge demand. So it's the best that can be done to meet it. There are benefits to being younger, as well as advantages to being older. If you have very young counselors they might actually find it easier to strike up a rapport with younger clients, like high school students, for example."

The strain on the country's nascent mental health services is immense.

"We are really too busy," one psychiatrist at the Kangyuan Hospital in the northeastern province of Heilongjiang said. "The conditions that we treat, for example depression and anxiety, have really got out of hand. But what can we do? We have to treat them."

Psychologist Sun Ping at the Zibo City Psychiatric Hospital in the eastern province of Shandong said there was also a problem with the quality of trained counselors in China at the moment.

"Psychological work has only been going on in this country for the past 10-20 years," she said. "That's when it really started to develop. It is reasonably well developed in the big cities like Beijing, Shanghai, and Guangzhou, but it's still a long way behind in other parts of the country."

"Actually, the majority of psychology professionals are still concentrated in the big psychiatric hospitals and in the teaching hospitals, or in specialist counseling clinics."

Suicide a leading cause of death

"In the majority of counseling centers across the country, the psychologists working there have had only the briefest training, compared with the very intensive and formal training that the others get. In fact, even within the psychiatric units there aren't that many people who have really undergone a proper psychological training. Things are very chaotic here at the moment," she added.

Sun said the government should tighten up regulation of the profession. However, Dr. Zhang from Beijing thought that market forces would regulate the profession better than the government ever could.

"The entire system is very piecemeal at the moment. At the moment the best judge of performance in this field is the client themselves," he said. "If a therapist is doing a good job then they will have a lot of clients. If not, then no-one will seek them out for help."

China's Communist Party has traditionally regarded the psychological profession as an imported form of Western-influenced bourgeois decadence.

Even the medically-based psychiatric profession was virtually non-existent until well after the Cultural Revolution (1966-76) had ended, and psychologists were almost unheard of until about a decade ago.

For now, however, only a small sector of relatively well-to-do Chinese will ever get anywhere near a therapist.

Currently, fees for an hour's psychotherapy in China range from 200-500 yuan (U.S.$25-62), well out of the reach of any of the country's 900 million rural residents, among whom suicide rates for women are alarmingly high.

About 250,000 Chinese die of suicide each year, making suicide a leading cause of death for Chinese people, a WHO expert said recently.

Suicide is the number one cause of death for Chinese people aged between 15 and 34, said Michael R. Philips, China representative of the International Association for Suicide Prevention and a consultant with the Mental Health Department of the WHO.

And at least two million patients go to a hospital each year after being injured in an attempted suicide, Philips said. Only 10 percent of them have previously received professional psychiatric treatment.

Original reporting in Mandarin by Bai Fan. RFA Mandarin service director: Jennifer Chou. Translated and written for the Web in English by Luisetta Mudie. Edited by Sarah Jackson-Han.


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