Integrating mental health into primary care: the policy maker’s perspective and experience in China

Xin, Yu; Jin, Liu; Hong, Ma

The pathway from community-based care to tertiary care was not well-established. The deficiency was exposed during the outbreak of SARS (severe acute respiratory syndrome, which nearly became pandemic in 2002-3): because the primary healthcare system did not work as a gatekeeper, people were able to rush directly to tertiary hospitals, where they could either become infected or infect others (Hu, 2003; Li & Hu, 2004) . The government was aware of the importance of community healthcare and prepared to reform the whole system (Central People's Government, 2006) . However, the challenges were huge, especially in the case of mental health. First, primary health provision in the communities faced the twin barrier of poorly trained staff (most of them had never received any training in mental health) and poorly equipped clinics. Second, neither social security nor medical insurance covered any expenses except for medication and hospitalisation -mental health services in communities such as follow-up, day care, family support, occupational therapy and social training were not covered. Third, social stigma was the big barrier: primary clinics were reluctant to provide mental healthcare and most communities were not happy to share health resources with patients who were mentally ill (Yang et al, 1998 ).