IPA Bulletin 

Where Are They Now?

WHO WILL TAKE CARE OF CHINA’S MENTALLY ILL ELDERLY IN THE NEXT CENTURY?

XIN YU
IPA Research Scholar, 1996

[Editor’s note: This article is another in our series, “Where Are They Now?” by for-mer IPA Research Award winners and IPA Research Scholars, who will share with us what they are doing and describe some of the ways in which IPA recognition has influenced their careers. From 1989 to 1999 the IPA Research Awards were sponsored and supported by Bayer AG. The IPA Research Scholar Program was sponsored and supported by Pfizer Central Research, Pfizer Inc] 

The vice-minister of the Ministry of Health, People’s Republic of China, has announced that there will be 10% elderly (60 and older) in China next year, when China can be officially labeled an “elderly type nation.” Ten percent of the population means 120 million people, which is larger than the population of most nations in this world. The average life expectancy is 72 for women and 69 for men, a figure that surprised an American professor when I put it in a paper, as he thought half the Chinese might die of famine before age 50! In some big cities such as Beijing and Shanghai and in coastal areas, life expectancy is quite close to that of developed countries. Furthermore, the “one child policy” has been in place in China for 20 years, coinciding with the increasing dominance of nuclear families in urban areas. Therefore, it is not surprising at all when you see an old couple carrying a bag of food and climbing up to their home unassisted in the forest of steel and cement, relying on one another for support.
 

IT WAS A TURNING POINT IN MY LIFE.

The latest statistical figures indicate that there were 1 million beds (summing up all beds in various institutions) available for the elderly so far. Although statistics is not always an exact science in China, I have reason to believe this figure. Ninety-nine percent of the elderly are living in communities; their families take care of some, while others do not receive such help. Some may attribute this to the “one child policy”; some blame the deterioration of traditional virtues under the impact of “Western-corrupted civilization,” as well. China is confronting tremendous reform, which she never experienced before in her 5000-year history. The power of this reform impacts everything: political and economic systems, family structure, and the value/belief system of every Chinese. You could take it as a miracle that China has lifted her life expectancy from 36 years to 70 years in five decades.

Gap between supply and demand

By Western standards, China remains poor in provision of health care, with 2.6 beds per 1,000 persons, and spending only US$5 per person, per year, on health care. However, if you note that home beds are uti-lized as medical beds and families are trained as nurses, this miracle turns out to be an artificially built pyramid. Right now, the “unpaid laborers” who used to build such a pyramid have to survive in the ocean of reform. Medical service systems, which are centralized in big cities, need to be relocated and extended to communities. Health care resources need to be rearranged. This process, referred to as “health care going to community,” is not too difficult for general medicine. However, psychiatric services, especially geriatric psychiatric services, face a great and rapidly increasing demand.

China has 15,000 psychiatrists, one-quarter of the number in the USA, although the population is six times bigger. Among these 15,000 psy-chiatrists, geriatric psychiatrists number no more than 100. Almost all psychiatric hospitals are isolated, both geographically and academical-ly, from comprehensive general hospitals. Basically, there are no psy-chiatric departments in comprehensive general hospitals, which proba-bly is a product of the “Sino-Russian honeymoon” of the 1950s. Most psychiatric hospitals have yet to establish geriatric wards. The huge gap between supply and demand doesn’t petrify most Chinese psychiatrists, who are resisting the seduction of pharmaceuti-cal companies (in the last five years, half the psychiatric residents in my institute switched to work for drug companies as salesmen) and fighting neglect and social prejudice. I don’t mean to depict a gloomy picture. What I really want to say is, you always can do something to change the place around you.

When I was awarded the IPA/Pfizer Research Scholarship in 1996, I took a sabbatical in my career path. Although I had been working in a geri-atric ward in Beijing for almost four years, I had a stronger interest in psychopharmacology, partly because pharmaceutical companies were more generous than governmental foundations if you happened to do some research related to their products. The four months I spent in Normanby House, St. George’s Hospital, Melbourne, became a turning point in my life. I know how a geriatric team works and what great achievements this work can bring. I brought back thousands of new ideas, mixed with the bright sunlight and the smell of the fresh green grass of Australia.

Another fellowship, the Hubert Humphrey Fellowship in Substance Abuse Program, at the Johns Hopkins University School of Public Health (USA) came my way in 1998. I am not a “drug guy,” especially compared to my classmates who used to work in opium fields in Burma or ghettos in Manila for substance abuse prevention. However, this fellowship offered me a wonderful chance to study epidemiology and statistics. More importantly, I learned to look at mental health issues from a much wider public health perspective. It also gave me an opportunity to compare the health care systems of two nations.

In 1999, a promotion

Another opportunity came last August, with a new promotion sys-tem at my institute, so that some vacant positions can be attained by competition. I wrote a proposal and presented it to all the staff of my institute. I was offered a new position (probably the lowest one in the entire Chinese hierarchy!), but the one I have been dreaming of, being the head of the geriatric ward. It came with 27 beds, one psychiatrist, one resident, three trainees (psychiatrists from outside Beijing), and 14 nurses to work with me.

The first floor, where the geriatric ward is located, was considered the “hell” of my institute. People were unwilling to visit it, let alone work there. The ward was dark, damp, noisy, and smelly. The office was so crowded the physician had to move several times in the morning if he wanted to finish a case report. Since I took up the new position, the ward has changed a lot. It is now bright, clean, and neat. We changed light bulbs, rearranged the lounge, bought trays for meals, and cleaned the bathrooms. Our dedicated and committed staff contributed to some of these expenses.
 

THE MOST IMPORTANT WORK I HAVE DONE IS TO MAKE GERIATRIC PSYCHIATRY A PROMISING AND ATTRACTIVE SUBSPECIALTY IN MY INSTITUTE...

I give lectures regularly to introduce what I have seen and read about geriatric psychiatry and invite experts in various fields to give talks. I meet families for family education, and encourage my doc-tors to write brochures for patients and families, offering basic infor-mation about mental disorders in the elderly. A form for a summary of hospitalization and a plan for rehabilitation also was designed.

New rules established for this ward include making visiting hours flexible; allowing patients with moderate improvement to eat out once or twice a week; and taking patients to visit parks and muse-ums regularly. Also, a brand new position was created: a geriatric nurse, who will act as an occupational/physical therapist, social worker, and counselor. (I hope this poor lady will not soon become exhausted!) The most important work I have done, which also makes me feel very proud, is to make geriatric psychiatry a promis-ing and attractive subspecialty in my institute and my ward an attractive place, in the space of two months.

I have an ambitious plan to make this the model ward of geriatric psychiatry in China. I have written two proposals to the Ministry of Health to seek political support from the government and four pro-posals to pharmaceutical companies for financial support. I know I need to walk step by step, but the situation is urgent. Our needs include: More financial support to expand (to 40 beds), reallocate space (add activity room, assessment room, physical and occupational therapy room, seminar room) and renovate (paint, carpet the floor, add handrail).
  Expertise of every kind in geriatric psychiatry, such as social worker, nurse, neuropsychologist, recreational therapist, etc.) Experts are welcome to visit my ward and give lectures (if you can work with us for a while, all the better) and staff members need to go abroad for short training (no more than four weeks), to see what is going on outside with their own eyes. In the future, trainees are welcome to visit my ward for internship.
  Collaborative study of any type that will be beneficial to the development of the ward.
  Suggestions; photos of your geriatric ward or departments (or descriptions of the physical environment); commonly used forms, sheets and scales; used books, handouts and slides; and encour-aging words.

Chinese are never despairing, even in the worst situations. We are not in the worst situation right now and we have millions of things to do, but we just keep doing and will never quit until we achieve our dream. 

 

Xin Yu, Consultant Psychiatrist, is affiliated with the Institute of Mental Health, Beijing Medical University, Huanyuanbeilu 51, 100083, Beijing (yuxin@public.fhnet.cn.net). RESEARCH AWARD AN IMPORTANT STIMULUS

Reprinted from IPA Bulletin, Volume 17, Number 2