Facing the huge demand but very limited supply of mental health services in PRC, a much more centralized, comprehensive, and efficient mental health policy was extremely requested. In 2002, the three leading governmental ministries including Ministry of Public Health, Ministry of Civil Affairs, and Ministry of Public Security together with the China Federation of Disabled People (CFDP) formulated and published an important guiding document, China Mental Health Work Plan (2002-2010). This served as the main mental health policy directing the mental health services from 2002 to 2010, and it had large influence on shaping the policies within those years.
In this document, it estimated that there were around sixteen million persons with mental illness that necessitate long-term treatment and rehabilitation, thirty million adolescents with behavioral and emotional problems, six million persons with epilepsy and numerous elderly persons with mental health problems like Alzheimer's disease (ä¸åœ‹æ®˜ç-¾äººè¯åˆæœƒ, 2002). It set the overall goal and focus of future development during the period as primary prevention, integration of treatment and rehabilitation, intensive intervention, wide coverage and centralized legislation and policy. To make it more precise, five focuses and aims were addressed. Firstly, to establish a mental health system, organizational management, and coordinating mechanism under the leadership of government, cooperation of various ministries, and participation of social groups. Second, to stimulate the process of formulating related mental health laws, regulations, and policies, forming a mental health security system coping with the current national economy and social development. Thirdly, to strengthen the promotion and education of mental health, improving the recognition of importance for mental health work, improving the mental health level of the people. The fourth one was to consolidate the intervention for those with severe mental illness, improving the treatment and rehabilitation services and preventing the increasing trend of mental health illness. The last goal was to build a comprehensive mental health service system and network, consummating the existing function and improving the quality and ability of mental health team to basically meet the need of the masses.
Under the above guidance, mental health has been gradually included in the national public health reform program. Since October 2003, there had been many applications of specialized public health projects supported by the Ministry of Public Health for the investment and funding from the Ministry of Finance. After a serious selection, a delegation led by Guihua Xu (Vice Director of China Centre for Disease Control) and three psychiatrists from Peking University Institute of Mental Health, visited Melbourne to study a suitable and practical model for the PRC, ending with a suggestion of the patient-centered approach that was community-based, seamless, function-oriented and multi-disciplinary (Liu et al., 2011). In September 2004, the program for mental health service reform, as the only non-communicable disease program, was included in the China's national public health plan, representing a major historical milestone for China when mental health became officially included into public health.
In the late 2004, the mental health reform, named the 686 Program after the government funding of 6.86 million RMB, was formally approved by the Ministry of Finance and soon put into practice. By early 2005, sixty demonstration sites, locating in one urban and one rural area in each of 30 provinces, were established, covering around 43 million people. The plan attempted to extend aspects of care that were found to be reasonably successful in the PRC (Zhang, Yan, & Phillips, 1994). These sites initially helped with the two-level training model from nation-level to the provincial-level, in order to build up a capable mental health workforce. This was something that the Chinese authorities had not carried out for several years (Lin & Eisenberg, 1985).
One year later, with the help of the National Continuing Management and Intervention Program for Psychoses, an intervention and treatment program was incorporated in the 686 Program for providing continuous care for four types of mental illness patients: schizophrenia, bipolar disorder, delusional disorder, and schizoaffective disorder. As a result, in 2009, a total of 34,861 facilities participated in this program, including 44 provincial hospitals, 92 municipal hospitals, 168 district/county-level hospitals, 986 urban community health centers, 2,748 urban community health stations, 1,136 township clinics, 11,480 village clinics, 5,660 urban neighborhood committees and 12,547 village committees (Liu et al., 2011).
689 Program not only enhanced the mental health professional training and treatment approaches, it also stimulated policy reforms, followed by five vital national polices on mental health: the Guiding Compendium on Development of National Mental Health Work System (aimed to improve inter-ministerial coordination); the Government Work Report (when the mental illness was first addressed in the annual report of the Central Government); the Short-term Strategy of Health System Reform (psychiatric hospitals should be included in the overall aim at improving public health service capacity building); the Opinions on Improving Gradual Equity of Basic Public Health Services (in which the management of mental illness was included as one of nine national basic public health service domains); and the Working Criteria on Management of Psychoses (in which responsibility of different sectors in the management of mental illness were defined and classified).
Satisfied with the outcomes of previous reforms while still accounting the unappeasable demand of mental health services, the four agencies - Ministry of Public Health, Ministry of Civil Affairs, Ministry of Public Security, and China Disabled Persons' Federation - again jointly drafted the China Mental Health Work Plan (2012 -2015) and issued for public opinion in 2012. In this document, five goals, which were similar with the previous plan from 2002-2010, were set more specifically in detail (ä¸è¯äººæ°‘共和國衛生部, 2012).
(2) Decentralized Authority under the Western Influence and Financial Requirement
Although there have been persistent efforts of the government and Party to improve the comprehensiveness and effectiveness of mental health policy, at the same time, the government in fact has correspondingly decreased its commitment to provide the health services, especially in terms of funding and insurance. Influenced by the economic liberalism of pragmatic reformers, mental health services have inclined towards economically self-sufficient (Phillips, 1998). This can be significantly reflected in the virtual elimination of the rural cooperative medical insurance system that previously provided basic medical care to the majority of China's huge rural population (Gu, Bloom, & Tang, 1993). As the reforms continue, the decentralized authority, self-determination and individualism had indirect but powerful effects on the provision of social welfare and mental health in various regions. For instance, the allocation of funding for health resources will be more susceptible to local influence peddling: powerful urban centers gradually gained an increasing proportion of the available resources and mental health services; whereas those less influential localities would receive a decreasing proportion of available government funds.
Besides, the distribution of mental health services were largely by the policies promoting increased self-determination and job mobility. Under the intensive emphasis on financial benefit, there have been less and less people mobilized by the local cadres to participate in neighborhood mutual help programs. This change will undermine the continued viability of the previously innovative 'guardianship networks', sheltered workshops, and operational centers that support the community mental health care through volunteering (Pearson, 1992a). In terms of vocational factors, as more medical and nursing students got the chance for choosing their jobs, fewer become psychiatrists and psychiatric nurses for the low salary and low status of psychiatric and psychological works compared to other medical specialties, not to mention the clinical social workers for mental illness persons.
As a result of less governmental commitment and psychiatric professions, the drift influenced by Western individualism caused a gradual shift in the focus or caring responsibilities of the mentally ill to the family. However, the governmental-sponsored health insurance had been decreased on the one hand; on the other, trapped with the stigma of mental illness as dangerous sources, more families are reluctant to re-accept mentally ill relatives back home after an acute hospitalization. Besides, as the Chinese Mental Health Law is still under evaluation, currently the decision to hospitalize the mental illness patients lied on the will of their families and their consultation with local psychiatrists, which caused the frequent cases for hospitalization by forces in the PRC these years (Phillips, 1998).
