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IPA Bulletin

Joint Meeting of IPA, Institute of Mental Health, Beijing Medical University, a Success on Many Levels

James Lindesay

As we prepare to leave the American Century, and enter what may well be the Chinese Millennium, Beijing was a highly appropriate venue for IPA's April 1999 Joint Meeting. The capital of the most populous nation on Earth, nothing (except perhaps Shanghai) can prepare you for the sheer size of this city. It is huge; according to my guidebook, its acreage is equivalent to that of Belgium. The scale and speed of change is equally enormous, as vast commercial developments transform both the skyline and the character of the city.

The challenges facing health services in this region of the world are just as great. The context and purpose of this meeting was clear from the outset, as speaker after speaker throughout the meeting spelled out the demographic changes that China, along with other countries in Southeast Asia, is facing. The aging of these populations over the next few decades will be explosive, and the sheer numbers of elderly people will have profound implications for health and social care policies and priorities.

Our hosts underlined the importance of this meeting in raising public awareness of the public health implications of these changes, and in promoting academic research into the mental health problems associated with aging. The meeting offered a rich and varied diet of Eastern and Western thought on these issues, and in this brief report I cannot do full justice to the range of fact and opinion expressed. What follows are just some of the ideas and impressions that I took away from this fascinating and excellently organized event.

Treatment and prevention

In his opening address, Barry Reisberg reminded us of a few of the great Chinese inventions, such as paper, printing, meritocracy, and examinations, which still preoccupy us as academic clinicians. There is also a long and distinct tradition of geriatric medicine in China, as Wang Xinde and Xiao Peigen demonstrated in their lectures on the subject. As long ago as the T'ang Dynasty, “diet treatment” was advocated to ward off the diseases of old age. The Chinese materia medica contains many botanical compounds that have traditionally been used to correct the Yin-Yang and Qi imbalances associated with aging. Whatever one thinks of this particular explanatory model, it is likely that the Chinese pharmacoepia has considerable potential. We in the West are familiar with the notion that plants have their uses; studies have shown that Ginkgo biloba (the Chinese temple garden tree) has an effect in Alzheimer's disease, and other plant-derived drugs such as galanthamine are also currently under investigation. The Chinese experience with herbal remedies may have much to offer in the treatment and prevention of dementia, and I predict that this is something that will be of increasing interest to the pharmaceutical companies in the years to come.

Preventive strategies may also be important in depression, as Anthony Mann explained in his summary of the research that he and his colleagues have carried out in London. They have shown that disability/handicap and social isolation are important risk factors, which suggests that the preventive solutions need to be primarily social and environmental. There are messages here for societies such as China, where traditional urban communities are currently being cleared and replaced with new developments, and where population control measures such as the Single Child Policy are having a major impact on family structures.

Systems of care

Several speakers addressed the important issue of what systems of care need to be developed to meet the mental health needs of the growing elderly populations of Southeast Asia. Ed Chiu expounded on the “Arie model” of old age psychiatry, which has been extremely influential in stimulating service development in many parts of the world. This model is already operating in Hong Kong, where psychogeriatric services and patterns of institutional care are already relatively well developed along Western lines. In less economically advanced parts of the region however, it is by no means clear that there will be the resources available to support Western-style services in time to meet the demographic demand, particularly in the vast rural hinterlands beyond the urban centers. It may be that different models will be needed, emphasizing social care and the support of families who will have to do most of the caring. However, this approach may also be difficult in societies where traditional family support systems are being eroded by economic growth, rapid urbanization, and strict population control. Perhaps the new technologies will help, with developments such as telephone counseling and telemedicine (telepsychogeriatrics?); presentations on these suggest they may be of value, but there is still much to learn about their use and acceptability.

On the social side of the meeting, there was much to see and do. Those with a day to spare had the opportunity to undertake the assault course known as the Great Wall of China. I understand that this tour also included a visit to a traditional Chinese medical center, complete with traditional check-up!

Much of the Forbidden City was under wraps while we were there, being restored in anticipation of the fiftieth anniversary of the Revolution; however, what was visible was very impressive. On another side of Tiananmen Square (also undergoing repairs) was the Great Hall of the People, a vast, dour, but undeniably imposing building where we assembled for the opening banquet. We arrived in a convoy of 10 coaches, and I think this is the first time an IPA meeting has had the honor of a police escort (very useful in the Beijing rush hour traffic!) Unfortunately, I had to leave for home before the closing Peking duck dinner, but there were plenty of other opportunities to sample the splendid local food, which is quite distinct from the Cantonese variety that most of us are more accustomed to in the West. A final question: does anyone know the poultry population of China?

With Appreciation to Our Beijing Colleagues IPA congratulates Shen Yucun, Chair of IPA’s April 1999 Joint Meeting with the Institute of Mental Health, Beijing Medical University, and her colleagues and staff, who spearheaded our highly successful regional meeting in Beijing. The three-day event, IPA’s first in China, was attended by 485 professionals from 26 countries. Three hundred thirty-nine attendees were from China. Dignitaries in attendance included Dr. Wang Longde, Minister of Health, P.R.C., Prof. Wang Debing, President of Beijing Medical University, and Prof. Peng Ruicong, editor-in-chief of the Journal of Chinese Mental Health. The meeting, characterized by a multidisciplinary approach and new developmental trends in psychogeriatric research and treatment, as well as the warmth and friendship of our gracious hosts, led to a successful and fruitful academic exchange on a high level. It attracted wide-ranging media attention in China, including coverage by 16 news agencies. As a result of this meeting, Prof. Shen said, “I am confident that … research and clinical practice in mental health of the elderly will be further improved in this region, especially in China.”

James Lindesay heads the Department of Psychiatry, University of Leicester, Leicester General Hospital, Gwendolan Road, Leicester LE5 4PW, England (Tel: +116 258 8161, Fax: +116 273 1115, E-mail: jebl1@le.ac.uk). He is a member of IPA’s Board of Directors and Editor of the IPA Bulletin’s Culinary Corner.

Reprinted from IPA Bulletin, Volume 16, Number 3