China's new approaches to an old problem

Graham W.MELLSOP

Waikato Clinical School，University of Auckland，New Zealand.

*E-mail：graham.mellsop@waikatodhb.health.nz

China's new approaches to an old problem

Graham W.MELLSOP

Waikato Clinical School，University of Auckland，New Zealand.

*E-mail：graham.mellsop@waikatodhb.health.nz

Many countries have grappled with the problem of how to increase the rate of treatment for people with mental disorders when the disorder itself impairs patients'desire or capacity to voluntarily seek or accept treatment.Two particular issues are the most debated.

The first issue is arriving at a culturally acceptable balance between two opposing approaches：the‘concerned paternalism'approach that restricts patients'self-determination and leaves decisions about whether or not to treat and the manner of treatment up to well-informed clinicians versus the‘rights'driven approach that aims to maximize patient autonomy by preserving patients'right to make all decisions about treatment even if they remain unwell.There is no consensus on this issue so the relevant legislation and practices vary tremendously;in many developed countries the approach is quite different in different regions within the same country.

The second issue regards the form of compulsory treatment that should be available.Different jurisdictionsspecifydifferentregulationsabout where involuntary treatment should be provided，about the criteria for deciding who should be required to accept treatment，about who should make the decision about whether or not an individual requires treatment，about how long the treatment should last，and so forth.

China's proposed mental health law considers these and other issues that are internationally recognized as core components of modern mental health legislation.For example，the law includes an effective appeal mechanism if individuals or their guardians wish to reverse a recommendation for involuntary treatment and specification of the training requirements，skills，and obligations of those who provide services to the mentally ill.

The proposed law also has some unique features.The interest in prevention and the broad scope envisaged in the proposed law—including improving access and treatment to all persons needing treatment or rehabilitation—is very ambitious. The clear objective of standardizing the evaluation and treatment process，especially if this is based on evidence-based practices，goes further than equivalent mental health legislation elsewhere.(In other countries some of these quality issues are dealt with by other policies.)The extent to which the new Act can realize its goal of preventing mental illnesses and the chronic deterioration associated with severe mental illness remains to be seen but the very fact that this goal is included in the legislation bespeaks an optimism about a better future and a willingness to commit governmental resources to work towards this future.

The inclusion of clauses aimed at clarifying the relative roles of the government，health care institutions，social welfare agencies，communities，work places，schools and families in the management of mentally ill individuals is a unique contribution with considerable face validity.It appears to be specifically attuned to China's social-cultural environment，but it is certainly an approach that could be adapted in other locations.For example，the important coordinating role assigned to primary care is a provision of the law that will be followed with intense interest by the many countries that have long agonised on how best to meaningfully integrate mental health services into networks of primary care.

China has now spent more than two decades developing its model of a national mental health law.That a version of the law is finally close to being operationalized is a clear indication of the community's recognition of the importance of addressing the needs of individuals with mental health problems.Chinese mental health professionals and other professionals involved in the process should feel proud that after such a long gestation period the comprehensive mental health law that is emerging takes so seriously service access，standards，and the needs and rights of both the community and the patient.Experience from other countries shows that there will be many bumps and turns on the road forward，but as the law gets ratified and promulgatedoverthecomingdecadeChina's unique approaches to these complex problems should generate innovative models that can be adapted for use in other countries.