Abstract
Background
High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country’s mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China.
Methods
This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis.
Results
Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (β = − 0.88), self-experience (β = − 0.59) and professional supervision (β = − 1.26) significantly influenced psychotherapy capacity (P<0.001).
Conclusions
Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.
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Introduction
The global burden of mental disorders has risen in all countries, increasing by 13.5% between 2007 and 2017 [1, 2]. In 2016, mental disorders affected more than 1 billion people worldwide [3]. It was the leading cause of years lived with disability (YLDs), accounting for 32.4% [4]. It is projected that the estimated economic cost will increase to six trillion dollars by 2030 [5]. In China, most mental disorders have become more common in the past 30 years. The lifetime prevalence of mental disorders was 16.6% [6]. This disease burden reflects characteristics of mental disorders with high prevalence and high severity [7].
Despite the growing public health burden of mental disorders, there is still widespread neglect of the human workforce for mental health care in low- and middle-income countries (LMICs) [8]. China, as one of the two most populous countries in the world, has improved greatly in psychiatric human resources in the context of the World Health Organization (WHO) Comprehensive Mental Health Action Plan (2013–2020) and its National Mental Health Plan (2015–2020) [9]. However, the available evidence still highlights an alarming scarcity and inequitable distribution of professionals available, especially a severe lack of nonpsychiatric mental health professionals such as psychotherapists [9, 6) may also apply to other LMICs similar to the Chinese situation in psychotherapy.
Several limitations of this study should be noted. First, we used a cross-sectional design and a convenience sampling method. Although the sample covered three major regions of the country, the sample size in some provinces is still small, which limited our ability to find more specific characteristics of different regions and to generalize the results to similar countries. Second, quantitative research was employed in the study, and more detailed information might be missing; thus, a combination of quantitative and qualitative research is needed in the future. Third, the questionnaire in the present study was established and modified based on the WHO-AIMS [22, 33]. More structured tools and models should be applied to estimate the mental health workforce.
Conclusions
Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy mental health workforce in China. Although these are very promising policies and programs, challenges for community mental health sectors and western China are likely to continue for some time. If China was able to address its unmeet mental health workforce needs, this will have substantial implications, not only for a large portion of the worldwide population but also as an inspiration for other LMICs.
Availability of data and materials
The datasets generated during the current study are available from the corresponding author on reasonable request.
Abbreviations
- YLDs:
-
Years Lived with Disability
- LMICs:
-
Low- and Middle-Income Countries
- WHO:
-
World Health Organization
- SPSS:
-
Statistical Package for the Social Sciences
- VIF:
-
Variance Inflation Factor
- WHO-AIMS:
-
WHO Assessment Instrument for Mental Health Systems
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** with the completion of the study.
Funding
This work was supported by the National Natural Science Foundation of China (grant numbers 82001400 and 81800482).
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**g-Li Yue and Hong-Qiang Sun developed the research question and study design. **g-Li Yue, Na Li and Jian-Yu Que oversaw the data analysis. **g-Li Yue and Na Li contributed to data interpretation and writing of the report. Jia-Hui Deng, Si-Fan Hu, Na-Na **ong, Jie Shi, and Hong-Qiang Sun revised the report. Ning Ma, Rui Chi and Si-Wei Sun managed data collection. All authors revised and approved the final report.
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We declare that this study was approved by the Ethical Committee of the Peking University Sixth Hospital. All subjects gave their informed consent for inclusion before participating in the survey.
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Supplementary Information
Additional file 1: Table S1
. Training Situation of Participants by Different Workforces. Table S2. Training Situation of Participants by Different Hospital Levels. Table S3. Competence in Psychological Counseling/Psychotherapy by Different Workforces. Table S4. Competence in Psychological Counseling/Psychotherapy by Different Hospital Levels. Table S5. Correlations among training situations and competency.
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Yue, JL., Li, N., Que, JY. et al. Workforce situation of the Chinese mental health care system: results from a cross-sectional study. BMC Psychiatry 22, 562 (2022). https://doi.org/10.1186/s12888-022-04204-7
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DOI: https://doi.org/10.1186/s12888-022-04204-7