China Mental Health Reform - perspective about psychiatric nursing assistants
- 1. Mental Health Institute of the Second Xiangya Hospital, Central South University, Hunan, People’s Republic of China
- 2. Changde Convalescent Hospital, Hunan, People’s Republic of China
Citation
Zhong Q, Yan H, Wu R, Tan Y, Tang H, Huang J, Chen J (2017) China Mental Health Reform - perspective about psychiatric nursing assistants. J Prev Med Healthc 1(1): 1002
INTRODUCTION
In May of 2016, a video clip showing a female patient being violently beaten for approximately forty seconds by a psychiatric nursing assistant in a Chinese rural psychiatric hospital was widely viewed among major websites such as Phoenix New Media and the Daily Mail [1,2]. Although few of such incidents have been reported before, the occurrence of this incident still brings up serious managerial concerns regarding Chinese psychiatric hospitals.
These violent assaults could be attributed in part to the inadequate and uneven distribution of mental health professionals in China. The ratios of psychiatric nurses (2.65 per 100,000 people) in China is much lower than the globally median ratio (5.8 per 100,000 people) [3]. The distribution of mental health professionals across the country is also imbalanced [4]. Compared to urban areas, mental health resources are very limited in rural areas [5]. Take one rural psychiatric hospital in one of the authors’ hometown - Changde, Hunan, for example, five nurses from one ward need to take care of more than 120 patients each day, sometimes even 150. By distributing questionnaires to 21 psychiatric nursing assistants, we investigated the status quo of psychiatric nurse assistants from a rural hospital in Changde, Hunan, including their education level, previous contact, knowledge, and impression on psychiatric patients, as well as their attitude toward this job. The results indicate that 90.5% of these psychiatric nursing assistants have only primary education qualifications, and all of them responded that becoming a psychiatric nurse assistant was their last career choice. In addition, due to the lack of medical background and standardized pre-service training, most psychiatric nursing assistants in our study do not have good insight on mental illness, compared to professional licensed doctors and nurses. The psychiatric nurse assistants' insights are rather limited to the violent impression based on long-held stereotypes cultivated by the media. Given the disparity between lack of training, commitment and relatively high demands for these positions, along with stigma and discrimination, it is not surprising to see the occurrence of this type of violence toward psychiatric patients.
In recent years, an increasing number of psychiatric hospitals have been established under the support of the Chinese government. As a result, more and more mental illness patients have been receiving treatment and management [6]. However, the demand for qualified mental health professionals cannot be met in a short time. By interviewing three vice presidents from three rural hospitals in Changde, Hunan, we found that in response to the shortage of professionals, hospitals are recruiting more and more less qualified psychiatric nursing assistants into wards to carry out nursing and supervisory duties, which in the eyes of many hospital administrators are cheap labors. Moreover, since their job is regarded as less demanding compared to licensed nurses, hospitals see no need to invest time and resources into training them. Right after the occurrence of this violent attack, we managed to follow closely to the process of this incident, since two of our authors came from the same city in which this incident occurred. We found that before local government’s formal investigation, the psychiatric nursing assistant in the video was not subjected to any kind of disciplinary action from the employer. This lack of concern from the part of hospital administrators also demonstrates a callous attitude towards patients who are no less worthy of respect than their counterparts who are receiving other forms of medical care.
In June 2015, the National Health and Family Planning Commission of the People’s Republic of China published the “National Mental Health Work Plan (2015-2020)” [7]. One of the overall targets of this plan is to “build a social milieu of understanding, acceptance, and caring for individuals with mental illnesses”. This plan represents a collective effort of all relevant government bodies and specific implementation strategies on this goal were designed [8]. However, this violent incident captured on video indicates that the discriminatory attitude towards people with mental illnesses still remains a problem. While the Chinese government is emphasizing timely detection, better treatment and management of patients with mental illness, more specific strategies should be developed to address disparities in the distribution of mental health resources in urban and rural areas. Furthermore, more measures should be taken to cultivate professionalism and compassion among all mental health practitioners to enable their patients to live with the dignity that every human being deserves.
ACKNOWLEDGEMENT
All authors have contributed to this article and have approved the final manuscript. We are also very grateful to two anonymous reviewers for their comments and peer-review.
DISCLOSURE
The authors declare no conflicts of interest.
REFERENCES
1. Daily Mail. Shocking footage shows paramedic beating a female patient. Published 11 May 2016.
3. WHO. Mental health atlas 2011. Geneva: WHO. 2011.
7. Xiong W, Phillips MR. Translated and annotated version of the 2015- 2020 National Mental Health Work Plan of the People’s Republic of China. Shanghai Arch Psychiatry. 2016; 28: 4-17.
8. The Lancet. Mental health in China: what will be achieved by 2020? Lancet. 2015; 385: 2548.
About the Corresponding Author
Dr. Jindong Chen
Summary of background:
PhD, MD, Professor. Director of Mental Health Institute of the Second Xiangya Hospital, Central South University, Hunan, People’s Republic of China.
Laboratory detail: The China National Clinical Research Center for Mental Health Disorders; National Technology Institute of Psychiatry; Key Laboratory of Psychiatry and Mental Health of Hunan Province, People’s Republic of China.
Current research focus:
• Clinical psychopharmacology, mainly on metabolism related areas
• Drawing psychology
• Social psychiatry
Permanent e-mail address: chenjd269@163.com
Ms. Yuxi Tan
Summary of background:
Graduate student of Mental Health Institute of the Second Xiangya Hospital, Central South University, Hunan, People’s Republic of China.
Laboratory detail: The China National Clinical Research Center for Mental Health Disorders; National Technology Institute of Psychiatry; Key Laboratory of Psychiatry and Mental Health of Hunan Province, People’s Republic of China.
Current research focus:
• Social psychiatry
• Community mental health, especially on the recovery of mental illness
• Drawing psychology
Permanent e-mail address: yuxitan321@163.com
