After his girlfriend publicly turned him out, a Shanghai university student began suffering anxiety and nightmares so intense he had to drop out. His parents took him to a hospital, where he received drugs that made him gain weight and did nothing to alleviate the stress. So instead he sought out his own solution, one not recognized by the Ministry of Health, and began seeing counselor Tony Leung. After a couple of months in therapy, talking through the childhood trauma that seeded his anxiety, he returned to school.
It’s a story with a happy ending as Leung tells it, but also one that illustrates the deficiencies of Shanghai’s mental health system. From the spate of kindergarten stabbings to the fact Chinese women have the world’s highest suicide rate – there’s a large, uncontested volume of evidence China desperately needs better mental health care. But stories played out in international media overlook the fact that even Shanghai, which has some of the nation’s best care, lacks resources.
Shanghai Mental Health Center is one of the nation’s top facilities (officials there declined an interview), offering a variety of clinical departments staffed by well-trained psychiatrists and psychotherapists. However, not every hospital in the city has psychiatric service. And the shortage of psychiatrists in general hospitals means face time is typically brief, often only 10 minutes.
The Ministry of Health doesn’t offer certification to psychologists. People who don’t need pills but do need therapy must pick from a sea of practitioners with disparate standards and credentials. Therapies seen as dated in the West are widely used.
Psychologists say hospitals overmedicate. Psychiatrists say private clinics lack standards. Most agree that laws are needed to close the gap between demand and delivery. But for now, choices remain limited.
The Counseling Center
Situated in a Xujiahui residential tower, Milkyway Tree Clinic has a lobby that looks like it belongs in a creative start-up. One wall is decorated with a black-stenciled mural – bats, a posse of men in suits, a gladiator. At reception there’s a shelf displaying Zen Miracle whitening products and slimming teas.
“Most people don’t know the difference between what we do here and what they do at the hospital,” says Tony Leung, who has worked in therapy for four years. His qualifications include a sociology degree and a six-month training program, which earned him a license from the Labor Bureau. “Sometimes I feel disappointed. People think a counselor is just like a garbage sack, just someone who suffers someone else’s complaints.”
Leung is one of five full-time counselors at the clinic. There are about 15 parttimers including a lawyer, professor, teacher and business developer. Legally, nothing distinguishes them from someone with a graduate degree in psychology.
Leung’s patients all pay him out of their own pocket. He charges between RMB300–500 per hour. About 70 percent of his 300 clients are women. “Women like to talk,” he explains.
Like many in his field, Leung saw a big upturn in business after the 2008 Sichuan earthquake. The devastation reverberated on the national psyche in such a way that officials all the way up to General Secretary Hu Jintao acknowledged the need for greater care, but legislation remains stalled.
There is one anomalous clinic in town with a license from the City Bureau of Health – Xin Chao Psychology Consultation Center. It’s helmed by Gordon Gu, known for his program on Hunan Satellite TV, Brother Gu Looks at the Heart of the News (顾哥看心 闻), where he analyzes psychological issues in current events.
Gu’s celebrity means he can charge RMB1,500 per hour. He started his working life as a lawyer. It was lucrative, but the job entailed repossessing property and sometimes people became violent. Gu says he suffered post-traumatic stress, but at the time there were no counseling centers, so he went back to school and earned his second masters in psychology.
After a decade in the industry, Gu says he mainly does cognitive behavioral therapy. In addition, he conducts Freudian analysis – a process increasingly popular here, though seen in the West as only useful to those with time and money for therapy several times a week. Gu also performs hypnosis.
Gu describes a time when he hypnotized a woman who had a chicken feather phobia. Under hypnosis, she unearthed a memory of being beaten by her mother with a stick covered in feathers. Gu says he changed the memory while she was under hypnosis – instructing that her mother was just playing a game – and she was cured.
“I hope in the future the government will focus on employing legitimate psychologists in community hospitals,” says Gu. “But right now they aren’t very open-minded.”
Community Hospital Psychiatry
Psychiatrist Shan Huaihai has been working in Shanghai mental health care for 30 years. “Our procedures are very good, they haven’t changed during my career,” he says. “What’s changed is how many drugs have become available.”
Shan spends about 30 minutes with each patient before offering diagnosis and treatment. While that might sound cursory, Shan points out it’s much longer than most others offer. Plus, with a shortage of doctors, there isn’t much else he can do. He says he prescribes psychiatric drugs to about 70 percent of his patients.
“I’m proud of my profession and being able to serve people,” he says. “The difficult part is that the demand is so high and there are so few of us.”
Shan says he wishes more people would just come to the hospital instead of private clinics – the treatment is standardized and, starting at RMB100 a session, more economical.
The availability of drugs isn’t the only sign of progress, he says. Shan works at a mental health center housed within Xuhui Community Hospital – a decade prior you wouldn’t have seen a psychiatric ward in a general hospital, he says. As he steps outside the central lobby, a motorcyclist zips by with a cigarette hanging off his lip.
“Let me show you,” Shan says, walking around the corner the driver came from. He stops in front of a small unassuming plaque, marking the entrance to the hospital’s methadone clinic.
“Ten years ago you wouldn’t have seen this either. Our healthcare system is very progressive.”
The Future of Care
The breakdown between getting medicated and getting counseling isn’t unique to China.
“Even in the West we have a vicious cycle,” says Dr. Tim Kelly, an American clinical psychologist at ParkwayHealth Medical Centers who has been working in China off and on for six years. Kelly authored the book Healing the Broken Mind: America’s Failed Mental Health System.
The difference is that psychological counseling halted during the Cultural Revolution. Mental illness was dismissed as a phony foreign construct, and treatment didn’t resume for another 28 years.
Zhao Xudong, Director of Psychosomatic Medicine at Shanghai East Hospital, started college before psychology classes were offered. He became interested in the field after a philosophy professor mentioned it in a lecture, so he studied neurology and psychiatry, and later went to Heidelberg to study psychotherapy.
In the late 1980s Zhao helped establish an open psychiatric ward at Yunnan University Hospital, the first of its kind.
“The old physicians were afraid, but we insisted,” he says.
It was a success. Several years later they received a grant for the first in-hospital psychotherapy room in China. Zhao worked his way up the management ranks, eventually becoming president – yet another indicator of growing acceptance of his specialty. Today, families in Shanghai wait up to eight months to see him for therapy.
“I’m very optimistic,” he says, citing improved attitudes toward therapy, the growing number of graduate-level psychology programs and the fact the government is drafting mental health care laws.
But when asked when he thinks the draft will be finished he smiles and looks away. In its present incarnation, national mental health law has gone through 10 revisions since 1985,