The medical side-effects of China's stockmarket crash

by MICHAEL WOODHEAD

Headaches, irritability, depression and most of all insomnia are the most common medical side effects of China's stockmarket crash, doctors say.

Mental health specialists at Guangzhou's prestigious Sun Yat Sen Hospital say they have seen a stream of unwell patients this week suffering from the mental effects of severe stress from the stockmarket collapse.

"Some people can not sleep at night, have difficulty falling asleep or wake up in the early hours three or four times a night.
Many people have overt physical symptoms such as palpitations, chest tightness, aches and pains, stupor and confusion," says psychiatrist Dr Wei Qinling.

Dr Wei says the worst affected people are those with a casino mentality towards the stockmarket and those with little mental resilience, who are most at risk of severe depression, mental confusion and possible suicide risk. Other common reactions are despair, alcohol abuse and loss of motivation. Some workers in the finance industry say there is nothing to work for anymore, and they have lost a reason to work. Others have lost their livelihoods altogether. Dr Wei says some have gone on extreme drunken binges to try wipe out the stress.

And in what some are calling "stocks syndrome", people suffers from sever stress from the sudden reversal from riches to destitution. This is a mix of severe anxiety, guilt, frustration and mental paralysis. Dr Wei says some people have symptoms that are so severe they may require hospital admission and antidepressant treatment.

However, at the Beijing Union Medical College Hospital Department of Psychological Medicine, Dr Li Jianzhong says some people are looking for a quick fix for symptoms such as insomnia. Some of the most difficult to treat are those who were most greedy when the market was good and became obsessed with the stockmarket. After making large gains they are now in denial and are unable to accept that they have made losses and cannot adjust to reality. Counselling may be needed, but it requires people to learn about "spiritual wealth" as well as financial wealth, he says.

Dr Li says there are two steps to treating "stock syndrome". Firstly, people must identify the cause of their symptoms and learn to manage the stressors through activities such as deep breathing and findings distractive activities such as walking or sport. Secondly, people must find an alternative to obsession with the stockmarket and focus on that.

In Shanghai, psychologist Dr Chen Gong says there has been an increase in patients with 'financial stress' but it would be an exaggeration to say his department has been overwhelmed. For him, two of the most serious consequences of mental stress from the stockmarket are cardiovascular and cerebrovascular disease. These may be triggered by severe stress, and people must learn to change their habits and behaviour to have a more balanced life, he suggests. Another problem with financial stress is its effect on the family,and relationships, he adds. He recommends that people talk openly with their family and focus more on family activities rather than being preoccupied with speculating on shares.

Dr Wei, however, warns that for some people the stockmarket has become a form of addiction, just like gambling. He warns family members to look out for signs of addiction and to recommend counselling and treatment for those who have become addicted to the stocks - and are at risk of withdrawal symptoms.

Some good news about the chaining of mentally ill patients in China, from the 686 Program

by Michael Woodhead
In recent years there have been several media articles about mentally ill people in China being chained up - usually by families - because there are no mental health services. 

The impression given by the articles is that this is a widespread practice and is going unchallenged. "This is an example of how mental disorders are dealt with in rural China" said The Independent. It is enlightening, therefore, to read that such practices are rare and have been targeted for elimination for more than a decade. In a sobering paper published in PLOS One this week, Dr Lili Guan and colleagues at the Peking University Institute of Mental Health talk abut the so-called 686 program that has been running since 2005 to provide basic mental health services and ensure human rights are upheld for people with severe mental disorders.

In their article they describe how they recruited village health workers across China to seek out and identify mentally ill people who had been chained up by families. Their program found 271 such people - some of whom had been in chains for 28 years, but most had been chained for shorter periods and intermittently as circumstances arose, rather than continuously. Cases of chaining were rare - accounting for only 0.2% of mental health patients reviewed in the program.

Most of the chained people had schizophrenia and none of them were receiving care from mental health institutions, usually because there were no such community services in their area, or the families could not afford it. The patients were restrained mostly because they were violent and abusive, causing harm to people and property.

The program of 'unlocking' was focused on providing free antipsychotic medications. Patients were first admitted to psychiatric units and assessed, and then families were provided with free medications and a treatment plan. The 'unlocked' patients were then returned home to live in the community.
The good news from the program is that regular treatment rates went from 1% to 75% and most patients complied with treatment and showed great improvements. Their functioning improved and the family burden also lightened significantly. Relapse into ''locking' occurred with only 21 patients (8%), with families citing lack of adherence to medication and return to violence or harmful behaviour and lack of caretaker/financial resources to access help.

"The finding that more than 92% of those unlocked and entered into continuous treatment by the 686 Program remained free of restraints by 2012 demonstrates the feasibility of improving the human rights of persons with severe mental illness by increasing access to mental health care in the community, even with limited societal resources," the researchers said.

"Nevertheless, the failure to prevent relocking for 21 individuals suggests that considerable room for improvement of our mental health care practice still exists."

The researchers also noted that their program covered less than 1% of the population of mentally ill people in China, and said it would require more resources to allow it to cover the whole country.

"There is obviously much to be done in China to scale up the 686 Program for the whole nation and to improve quality of care. This will require substantially increased investment in mental health services. However, the success of the program in maintaining the severely ill individuals in treatment over three to seven years, and the benefits of the intervention for those who have lived for years with untreated psychosis and for their families, attests to the feasibility and social value of the “686” model."

Authors note: Restraint for people with mental illness is not uncommon practice in  western countries, particularly for elderly people in nursing homes. Medical groups in countries such as Australia have expressed concern that patients who are agitated and have challenging behaviour are sometimes restrained due to lack of staff and for convenience, rather than for their own wellbeing.

China's first mental health law - 27 years in the making, but will it change negative attitudes?

by Michael Woodhead
There is a very severe stigma about mental health in China - just try calling someone "shenjingbing" (神经病, mentally ill)  and watch the reaction. This cultural taboo about mental health  is just as strong for doctors in China - a 2012 survey found that even Chinese psychiatrists had negative and unscientific views about mental illness. Most worryingly, many psychiatrists believed that the best approach for someone with mental illness was to institutionalise them, by force, if necessary. There is still a strong belief in involuntary treatment of mental health conditions in China.

It is therefore interesting to see the reactions to the Mental Health Law that was enacted more than a year ago, in May 2013. This law had originally been proposed by the Ministry of Health back in 1985. Such was the lack of interest in change and the entrenched attitudes, it took more than 20 years to get even as far as the draft stage, when it was submitted to the State Council in 2007. After much more negotiation and consultation, the law was approved and came into effect on 1 May 2013.

To westerners, much of the law would appear unremarkable. It states that mental illness must be treated according to basic clinical guidelines, with an emphasis on prevention, treatment and rehabilitation. Where the law has proved controversial (in China at least) is on the matter of involuntary treatment. The new law states that for people with mental illness, "voluntary admission and treatment should be the priority".  It also states that involuntary admission should be based on “risk criteria", but this is a grey area that is untested in China.

In an article published this month by three psychiatrists from Shanghai's Jiaotong University School of Medicine, it is argued that the new law is flawed and will still allow mentally ill patients to be inappropriately 'committed' to an institution on flimsy pretenses. They argue that the risk criteria are too broad and open to interpretation. They say the regulations put too much weight on the opinions and wishes of the families of mentally ill people. In reality this will mean that families with 'backward' attitudes and knowledge about mental health will be able to 'get rid' of the stigma of mentally ill person in their family by having them admitted involuntarily.

The psychiatrists say the national law also lacks detail and may not be implemented at a local level. They point to local programs and treatment pathways for mental illness that have been adopted in advanced cities such as Shanghai and Beijing, and they say these should be the model for other parts of China. 

However, for the time being psychiatric treatment remains out of reach for many people with mental illness in China. There are an estimated 173 million people with psychiatric disorders in China, but only 20,000 psychiatrists and a few hundred mental hospitals and clinics. China has a long way to go in providing appropriate care for its many citizens with mental illness.

Mental health treatment in China: still in the dark ages?

by Michael Woodhead

Stigma and shame still feature highly in attitudes towards mental illness among the public - and even among family members of patients, a survey carried out at one of China's leading psychiatric hospitals has revealed. 

Guangzhou Psychiatric hospital was the first mental health treatment institution set up in China and is still one of the largest and most 'progressive' units in the country. Last year, researchers surveyed 87 doctors and 162 nurses at the hospital and 137 family members of people with mental illness, as well as 150 members of the public.

They found, unsurprisingly that medical staff tended to have enlightened views about mental illness - that it has biopsychosocial causes and may best be dealt with in community treatment. However, relatives of patients and the public tended to hold the traditional view that mental illness was something that should be treated in institutions and that patients do not belong in the community.

There was also support for involuntary treatment of mental illness. In rural areas there were also more superstitious beliefs that mental illness might be caused by curses, devils or bad luck.

The researchers said the negative attitudes held by family members might arise because they lived in close proximity to people with mental illness and had to cope with them in isolation as there was little community or health service support for mental illness. "Families must should much of the burden of mental illness alone,"they wrote.

"The results draw attention to the crucial issue of what has been called "family burden" the painful, often debilitating and health-endangering experience of caring for seriously mentally ill family members’ day in and day out. These experiences may be especially strong in Asian countries such as China in which the family, rather than the state or society, has a heavy burden of responsibility for mentally ill relatives, extending even to fiscal responsibility for their occasional damage of neighborhood property or criminal conduct."

The findings support provision of respite care for mentally ill people in China, "that gives family members some distance from the problems of their relatives and support in their care," the researchers concluded.

My top10 medical stories from China for Saturday 22 February

1. Smoking with a water pipe confers a 'profound' risk of chronic obstructive pulmonary disease (COPD) among people in south west China and also carries a high risk from passive smoking, researchers have shown.

2. Patients with pneumonia of unexplained origin should be promptly investigated for H7N9 risk factors such as exposure to poultry and they should also be given pre-emptive antiviral treatment such as Tamiflu, the Beijing health department has ordered.

3. About 85% of Chinese doctors experience burnout, with those who are younger, unmarried and working in emergcncy medicine having the highest risk of serious burnout, a study shows.

4. Fertility clinics in China need to become more patient-friendly as they are perceived as too impersonal and lacking in transparency and respect for patient informed consent, researchers say.

5. The stigma of mental illness in Chinese culture means that patients with schizophrenia often do not understand their medication and are unwilling to take any anti-psychotic medication, according to a study from the Guangzhou Psychiatric Hospital.

6. H. Pylori infection rates are over 90% among people in their thirties in Jiangsu, which may explain high rates of gastric cancer in the region, say researchers from Nanjing.

7. Babies in Shenyang have increased rates of neurodevelopmental deficits because their mothers were exposed to high levels of organophosphorous pesticides during pregnancy, according to a study in PLOS One.

8. Adenovirus has emerged as a significant cause of serious pneumonia in China, with a study showing that 5% of cases are attributable to the virus.

9.  People with tuberculosis are also at high risk of HIV, with rates of around 3% in groups tested in TB patients from Guangxi, Henan and Sichuan, say Chinese researchers.

10. A mediation service for patients involved in medical disputes with hospitals is to be launched in Shanghai and it will be open to patients where compensation claims exceed 30,000 yuan ($2900) regardless of whether the hospital refers them.

China's 60 million "left behind" children face neglect and poor mental health

by Michael Woodhead
More than 60 million Chinese children have been 'left behind' by rural migrants who move to cities and these children suffer from neglect and mental health problems, a new study has shown.
Research conducted by Dr Zhao Xue of the Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University has found that almost 60% of children in the rural areas were 'left behind'. This was a much higher number than expected and reflected China's "explosive growth" and shift to urban centres.
The survey of almost 1700 'left behind' children in rural Anhui found that they had higher levels of neglect, higher levels of social anxiety,  lower family function and poor quality of life compared to  children who lived with their parents. The problems were worse for girls perhaps because in Chinese society they have lower status than boys and thus get little attention, receive less physical and emotional support and have worse lives than boys, the researchers said.
However, left behind children tended to have lower rates of physical abuse than children who lived with thir parents. This might be becuse the escaped the "education by sticks" beatings from parents, the study authors suggested.
"These findings suggest that "left behind children' are currently in a relatively disadvantaged situation in Changfeng county and require more help from the local government and society to improve their life environment," they concluded.
The findings are published in Acta Paediatrica.

Hubei group protest forced psychiatric treatment of people without mental illness

People who complain against the government are being forced into mental institutions and given forced treatment with antipsychotics and electroconvulsive therapy, a human rights group in Hubei has told Radio Free Asia.. Liu Feiyue, a spokesman for the Civil Rights and Livelihood Watch says the psychiatric hospital system is being abused and there have been 40-50 cases of forced treatment of healthy people during 2013, in contravention of China's new Mental Health Law, which came into effect in 2013 but is not being implemented on the ground.

Recommended reading: Zhang Lijia on the mental health of migrant workers

Migrant workers suffer from a wide range of mental disorders, caused by their working situation, according to Zhang Lijia at the CNN-website. Her findings are based on recent research by Yu Cheng,Sun Yat-sen University, Guangzhou. "We just have to pay more attention to mental diseases as they can lead to suicide," said Cheng.
He recommends compulsory mental health testing in the workplace and a practice he calls "positive psychological intervention" -- setting up hotlines and counseling services and providing workers with more opportunities to socialize.
China Herald.

Autism numbers on the rise in China

More children are being diagnosed with autism, prompting the establishment of a new research center in Shanghai and more efforts to detect the disorder in infants. Wang Hongyi reports in Shanghai.
The "children of the stars", as autistic people are called in China, live with slow language development, an unwillingness to communicate and narrow interest ranges. Autism is a neurological disorder that affects normal brain function. It usually emerges in the first three years of life. The number of children with autism has been rising in recent years, drawing more attention to the condition, according to Du Yasong, a professor at Shanghai Mental Health Center, who is also an expert on autism. Du and his peers are still trying to determine why the numbers are up.
"There are not sufficient psychological counselors and professional medical staff for rehabilitation training for children. Much work needs to be done," Du says. Shanghai's Fudan University Autism Treatment and Clinical Research Center will establish the country's largest research network for identifying autism in children and treating it. The center will carry out a large epidemiological study among 120,000 autistic children aged between 6 and 12 by teaming up with universities and medical bodies from eight provinces. Under the three-year project, about 1,200 biological samples from autistic children will be collected to study the incidence of the disease and the factors causing it in China. Experts estimate that one in 100 children are being diagnosed with an autism, far higher than other diseases, such as cancer (1/1,500) and diabetes (1/500). In developed countries, about one in 110 children are diagnosed with autism.
"There has not yet been a large-scale epidemiologic investigation of the disease, but data from Guangzhou, Tianjin and some places show that about one in 120 children are diagnosed with the disease," says Wang Yi, vice-president of Shanghai Children's Hospital of Fudan University where the research center is located.
Source: China Daily

Shanghai pioneers mental health laboratory

Shanghai has set up a key mental health research laboratory to intensify efforts to diagnose and treat severe mental illnesses, which affect nearly 1 percent of China's population.
"Over the past 20 years, there has been little progress in the field," Xu Yifeng, president of the Shanghai Mental Health Center, said in a recent interview.
"The question of how to combine basic science and clinical research has not been solved."
The new lab, opened in November, will focus on solving a bottleneck in the study of severe mental illnesses through a combination of multiple disciplines, such as molecular and cell biology, brain imaging and bioinformatics, a method for processing biological data using computer science and mathematics.

Four million Chinese have untreated mental disability

News findings from a Chinese study indicate there is huge unmet needs for mental health services among Chinese adults with mental disabilities, as well as socioeconomic inequalities in use.
In a study of almost 2 million adults, the prevalence rate of mental disability was 0.81%. From this, it was estimated that about half, or more than 4.2 million adults with a mental disability had never used a mental health service.
People were less likely to use mental health services if they lived in rural areas, had less education and were poor.
Dr Li Ning and co- researchers from Beijing University say mental disability in China has become a significant public health problem. However, few studies have examined utilization of mental health services in China among people with mental disabilities.  "Strategies are needed for enhancing community mental health service systems and reducing barriers to mental health service use in China," they conclude.
Source: Psychiatry Online

All-of-life care policy needed for people with autism

Shanghai needs to provide life-long care for people with autism, according to a political adviser. At present they are only covered by a special education and training network until the age of 18.
Life-long care would offer proper support and help to people with autism and their parents, who worry about their children's future after they are gone, said Yao Jianjian, a member of the Shanghai committee of the Chinese People's Political Consultative Conference.
Yao said there are at least 10,000 people with autism in the city. Autism is the result of a neurological disorder that affects the development of a person's communication and social interaction skills.
Yao said the current legal system only allows for nine years of compulsory education for children with autism from seven years to 16 years old.
There is another two years of vocational training available for those with mild autism.
"After 18, all autism patients have to stay at home, since there is no follow-up care and training for this special group of people, who can't communicate with others properly," Yao said. "Until death, they almost have no social welfare."
Yao said Shanghai has the ability to set up a welfare system covering the whole life of people with autism. "Developed countries such as Japan and Canada ... all have special education and training plans for people with autism, whose welfare continues to improve," he said.
Yao suggests that the city government carry out a detailed study on autism and set up a life-long social service welfare system covering early diagnosis and intervention, rehabilitation, education, employment and care throughout adulthood.
The government should also offer subsidies to the carers of people with autism and give favorable policies to non-governmental organizations involving in the care of such people.
Source: Shanghai Daily

Global mental health centre opens in Shanghai

China's first academic cooperative body that focuses on global mental health issues was launched in Shanghai on Monday.
The Collective Center for Global Mental Health was jointly established by the Shanghai Mental Health Center and Emory University in the US.
It will work as a global platform for exchange and communication in the field of mental health research and training, and further promote the development of mental health in China.
"Many developed countries have had their own centers focus on global mental health, but it's very rare in developing countries," said Michael Phillips, who has pioneered research on Chinese suicide for more than two decades. He is also the director of the Suicide Research and Prevention Center of the Shanghai Mental Health Center.
"The center provides opportunities for mutual study, where China and other countries can learn more from each other," he said.
The center's first program will start with India, which has accumulated a lot of positive experiences in promoting mental health in local communities.
"India has a similar conditions to China. It has carried out metal health projects among local communities very early, and China could learn from the experiences," he said.
The center will also carry out some basic research in mental health with experts from Emory University.
Source: China Daily

Government requires mental health education for schools

New guidelines require psychological counselling be made available in all Chinese schools

China's Ministry of Education on Monday urged more efforts to provide qualified mental health education and services to students in primary and middle schools.
Local education authorities and schools should strictly implement a newly revised guideline on mental health education, according to a circular published on the ministry's website on Monday.
The circular stresses systematic arrangements for mental health-related curriculum and accessible in-school psychological counseling. It also pledged to include mental health education in the overall evaluation of a school's performance.
In-school counseling should be strengthened in order to prevent and resolve students' mental health issues, says the circular.
It also highlights the guideline's requirement that each school should have at least one mental health teacher.
The guideline also introduces an examination procedure for all textbooks to be used in mental health classes from the spring semester of next year.
A previous version of the guideline was adopted in 2002.
In 2010, China's total enrollment at regular primary schools and junior secondary schools was 152.2 million, according to the ministry.
Source: Shanghai Daily

Depression a "time bomb" for China's wife-less young men

China's increasing numbers of unmarried men are prone to depression, suicidal feelings and aggression

by Michael Woodhead
China's sex ratio imbalance is producing an increasing number of unmarried men who have a high risk of depression, suicidal ideation, lower self-esteem and greater propensity to aggression, a Hangzhou study has shown.
Dr Zhou Xudong and researchers at the Institute of Social and Family Medicine of  Zhejiang University,  Hangzhou, studied psychiatric characteristics of 1,059 never-married men and 1,066 married men aged 30–40. They found that never-married men were poorer, less well educated and had lower self-esteem than married men. Never-married men were also much more likely to have depression symptoms, higher levels of aggression and were more likely to have suicidal thoughts or wishes  than married men.
The researchers say China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. They say their study is one of the first to show that this sex imbalance is having an impact on the psychological well-being of the large numbers of men who will never marry.
"The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services," they say.
"Our results present evidence for a potential mental health timebomb in rural large areas of rural China," they add.
They say the immediate question is what can be done to support the millions of men who, through no fault of their own, will be unable to marry and have children, and who, as a consequence have high rates of depression and suicidal tendencies.
"The challenge here is the virtual non-existence of mental health services in most of rural China. There are 1.3 psychiatrists and two psychiatric nurses per 100,000 people in China, but the overwhelming majority are in urban areas."
According to the researchers few men with depression are diagnosed or treated because of the lack of trained mental health professional in rural China.
"It would be straightforward and feasible to train rural doctors to identify key symptoms and signs of mental illness, or simply to administer a mental well-being check list as a screening tool for referral. The problem of depression is not of course confined to older unmarried men and such screening would identify vulnerable married men and women as well. This would of course require a major strengthening of mental health services at county level and above. But with mental health now rising on the health agenda and more resources available for health services as a result of the health reforms in China, there is a real opportunity now to address this," they conclude.
Source: Social Psychiatry

Shanghai's new suicide hotline receives hundreds of calls

Shanghai's new suicide hotline offers counselling day and night

by Wang Hongyi
Shanghai's first 24-hour suicide-intervention hotline received more than 200 calls during its first week of operation.
The free hotline at 021-5161-9995, launched on Dec 3, is run by the Life Education and Crisis Intervention Center, a nonprofit organization.
Compared with other similar hotlines in the city, this new line extends its psychological service into late nights and early mornings, peak times for people to reach out for mental comfort, according to the hotline operator.
"We received a lot of phone calls after the hotline was launched. This reflects that many people are needing the psychological and mental health aid," says psychological expert Lin Kunhui, the founder, who is also the secretary-general of the Taiwan Suicide Prevention and Cure Association.
During the first week, a total of 201 calls were received. Among them, 137 calls were "ordinary" psychological counseling calls while 64 required crisis intervention.
The psychological crises were divided into seven degrees by the center; degree five and above are considered serious and needing urgent intervention.
Among the 64 calls that required crisis intervention, 22 were urgent, according to the center.
When receiving the most serious calls, Lin says, "the immediate thing for our staff member to do is to manage to lower the callers' degree of crisis".
Volunteers will contact the 110 or 120 emergency hotlines immediately if they suspect a life may be in danger, he adds.
So far, about 100 volunteers have been trained, and they work in shifts for the 24-hour service.
According to statistics by the center, most phone calls were received between 10 pm and 8 am. Peak times for psychological crisis occurred on Wednesday, Thursday and Sunday.
"So far, we have only mastered one week's figures. After several weeks' operation, we will sort and analyze the data, and identify the peak periods when people most need psychological crisis intervention," Lin says.
The World Health Organization said that each year about 287,000 people kill themselves in China, while about 2 million more attempt suicide.
The first suicide intervention hotline on the Chinese mainland was opened in Beijing in 2002. Since then, similar hotlines have opened across the country, such as in Guangzhou in Guangdong province, Hangzhou in Zhejiang province and Nanjing in Jiangsu province.
"In Taiwan, a 24-hour suicide intervention hotline can receive as many as 100,000 calls each year on average. But on the Chinese mainland, the number is still lagging behind," Lin says. "In this regard, psychological aid and crisis intervention need to be widely publicized."
In addition to enrolling volunteers citywide, Life Education and Crisis Intervention Center will also organize public education and training activities at local schools, communities and companies.
An online platform for psychological health guidance and suicide intervention is also expected to be operating within three to six months.
Source: China Daily

China's new mental health law - what's changed?

The new Mental Health Law does little to help those with mental illness lead an independent life and be accepted by society.

by Elizabeth M. Lynch
After 25 years of discussion, and two rounds of very vocal public comments in the past year, on October 26, 2012, the Standing Committee of the National People’s Congress finally passed its Mental Health Law.
One of the major improvements to the law since earlier drafts is the removal of the provision that specifically permitted involuntary commitment if the individual’s behavior was deemed to be “disturbing public order” or “endangering public safety”. Earlier drafts which included that clause were vigorously attacked by both Chinese and foreign experts noting that such a provision would give carte blanche to the police to involuntarily commit anyone who expressed a dissenting view.  As Chinese Human Rights Defenders (“CHRD”) highlighted in its seminal report on China’s mental hospitals, The Darkest Corners: Abuses of Involuntary Psychiatric Commitment in China, some of China’s many mental hospital “patients” are in fact dissidents who were involuntarily committed outside of any court process for expressing their dissenting views.
Deletion of this provision is certainly a step forward there are still aspects of the adopted law that make it far less than ideal and demonstrates the continued need for better protections for the mentally ill in China.
However, family members are still able to commit an individual against his or her will
In addition to voluntary commitment, Article 28 of the Mental Health Law still permits family members to involuntarily commit an individual that the family member suspects has a mental illness.  In effect, the Mental Health Law places the family in a separate sphere that assumes that family will not abuse the process.

In reality, the Mental Health Law does little to foster an environment where those with mental illness can lead an independent life and be accepted by society. Furthermore, although the law discusses the very real (and dire) need to increase the number of mental health professionals in China, that has remained aspirational. As of yet, the Chinese government has remained silent on how much money and what incentives it will provide to achieve that goal. Providing adequate and sufficient medical assistance for those suffering from mental illness is just as important to making sure that those individuals will be able to lead a full life.
Read more: China Law and Policy

Suicidality more common in Chinese women

 by Michael Woodhead
Women are more likely to attempt suicide than men, a study carried out in the emergency departments of Shenyang has found.
A review of 239 patients who were treated at a Shenyang hospital fro attempted suicide found that 22% were men, and 78% were women.
Men were more likely to be drug users, more likely to be icing with family and less likely to be living alone or co-habitating. Women were more likely to express suicide ideation compared with men. About 70% of both men and women who attempted suicide had   had mental illness.
The unique, gender-specific characteristics pertaining to suicide attempters in urban China emphasizes the need for gender-specific interventions in future clinical treatment.
Read more: General Hospital Psychiatry

News in brief ...

Cholera becoming resistant to antibiotics in China

Antibiotic resistance is observed with increasing frequency among epidemic Vibrio cholerae strains in China, researchers from Beijing have warned.
Since the 1990s strains of V. cholerae have shown a rapid increase in the prevalence of resistance to antibiotics such as  nalidixic acid, tetracycline and trimethoprim/sulfamethoxazole.
This study serves as a warning of the rapid dissemination of resistance in the past 20 years," say researchers from the State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing.
Read more: International Journal of Antimicrobial Agents.

China's medical demand for helium creates world shortage

A shortage of helium caused by increasing demand for MRI machines in China is beginning to affect other countries - and even Disneyland balloons.
Tokyo Disney Resort has suspended sales of Disney-character balloons, and at least one hospital in the country has suspended use of MRI because of a lack of helium .
In hospitals, liquid helium is used to cool electromagnets inside MRI machines
However gas wholesalers say helium stock have run out as demand for helium for hospital use has increased mainly in emerging countries such as China. This has resulted in an at least threefold increase in helium prices in the last decade, greatly increasing the cost of semiconductor production, which relies heavily on helium.
Furthermore, due to an accident at a helium production facility in the United States, the supply-demand balance has been very tight since July, according to an Iwatani division chief. The situation may not improve until next spring at the earliest, observers say.
Read more: Daily Yomiuri

Elderly Chinese suffer from untreated depression

Depression is a common condition among older patients attending primary care clinics in Beijing, and most people do not receive treatment, a study. has found.
 A study of 1275 adults aged over 60 years at a primary care clinic in urban China found that 11% had major depression, with depression more likely to occur in older people, females and those with a  lower educational level or living alone.
Less than 1% of these patients received treatments and yet more than 60% of patients with depression initially remained depressed throughout the 12-month follow-up period.
Read more: Journal of Affective Disorders.

Rural areas urgently need newborn hearing screening

Urgent measures should be taken by the Chinese government to promote newborn hearing screening in the rural areas, researchers say.
Newborn hearing screening has been successfully implemented in Chinese cities , but not in rural areas, according to the authors of a new report.
Researchers screened for hearing problems in 11,568 babies born in five rural areas of Hubei. Overall, about 92%  newborns had normal hearing but 8% had a high-risk of hearing loss. While 71% newborns passed the initial screening test, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% .
Read more: International Journal of Pediatric Otolaryngology

Spinal fractures increasingly common in elderly Chinese

There has been a five fold increase in spinal fractures among older people over the let decade, new findings from Sichuan show.
Doctors from the Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing reviewed hospital records on all patients who was 60 years of age or older with spinal fracture at two university-affiliated hospitals between January 2001 and May 2011.  A total of 996 patients with spinal fractures were identified, of whom 35% were males. The annual incidence of spinal fractures among the elderly rose from 24 to 130 cases per 100,000 hospital admissions between 2001 and 2010.
The causes of spinal fractures include traumatic spinal fractures (72%), osteoporotic fracture with no specific cause (27%) and spinal fracture caused by tumour and tuberculosis (2%).
The lumbar region was the most common region of spinal fracture, followed by the thoracic and the cervical regions. Lumbar spinal fractures and thoracic spinal fractures were more commonly seen as a result of accidental falls from low heights and osteoporotic spinal fractures respectively. Spinal fractures usually occur outdoors causing by accidental falls from low heights, most frequently happen on the road.
Read more: Injury

Hospitals tricked into buying shoddy dentures

An unlicensed denture processing factory in Beijing has been ordered to suspend production for allegedly using recycled metal materials to make dentures.
The Beijing Jingjiayi Denture Processing Centre is also accused of using illegal cleansing cream to whiten the dentures to meet the requirement of hospitals and clinics.
The factory, in the city's Tongzhou District, has been ordered to suspend production after a local law enforcement team found it had no license following an undercover investigation by the newspaper.
The investigation found the factory melted recycled residue of metal materials to make dentures and used shoe polish and furniture cleansing products to whiten and brighten the dentures.
Since the purity of the metal was lower, the dentures would unavoidably have small holes on them. The poorly-made dentures were also likely to cause irritation in the mouth and other oral diseases if they were not disinfected under strict conditions, according to Shao Dongsheng, a former prosthodontist with Beijing Stomatological Hospital.
The unlicensed dentures and false teeth were sold to small- and medium-sized hospitals and dental clinics in Beijing at low prices.
Read more: Shanghai Daily

Vitamin B deficiency linked to depression in Chinese people

Thiamine deficiency linked to three-fold higher risk of depression

by Michael Woodhead 

People with low levels of the vitamin B component thiamine have a three-fold higher risk of depression, Shanghai researchers have shown.
According to researchers from the Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences at the Shanghai Institutes for Biological Sciences, thiamine has been hypothesized to play an important role in mental health; however, few studies have investigated the association between thiamine nutritional status and depression in the Chinese population.
Therefore they conducted a trial to examine levels of thiamine and its phosphate esters [thiamine monophosphate (TMP) and thiamine diphosphate (TDP)] in erythrocytes of 1587 Chinese men and women.
They found that just over 11% of people had depressive symptoms, and that lower concentrations of all three thiamine biomarkers were associated with a higher prevalence of depressive symptoms.  People with the lowest thiamine levels had a 3-3.5 time higher risk of depressive symptoms compared to people with higher levels of thiamine.
"In conclusion, poorer thiamine nutritional status and higher odds of depressive symptoms were associated among older Chinese adults. This finding should be further investigated in prospective or interventional studies," the researchers say.
Read more: Journal of Nutrition