Exporting culturally responsive mental health care

Forget coal, one of Australia’s most significant exports to China has been a model of health care that’s being used in more than 250 cities.

As China continues its rise as a dominant force on the international stage, the nation is also working towards reforming a healthcare system that must cater for 1.3 billion people.

In 2009, the World Health Organisation noted that mental illness had overtaken heart disease and cancer as the biggest burden on China’s healthcare system.

It is estimated that roughly 173 million Chinese suffer from a mental health disorder – 158 million of those have never received professional help.

As a co-director of Asia Australia Mental Health (AAMH), Prof Chee Ng, Director of International Unit, Department of Psychiatry at St Vincent’s, has been able to play a prominent role in implementing a mental health reform agenda that covers one fifth of the world’s population, in the process fostering one of Australia’s most influential relationships with China.

Prof Chee Ng
Prof Chee Ng

Launched in 2003, AAMH is a consortium of St Vincent’s and the University of Melbourne’s Department of Psychiatry and Asialink.   AAMH has worked in China since 2003, with a long term focus on building genuine and strong partnerships with China’s mental health leaders.

In November last year, AAMH was named a finalist in the inaugural Australia-China Achievement Awards. The winners and finalists were announced by former Prime Minister Tony Abbott during Chinese President Xi Jinping’s recent visit to Australia.

AAMH has undertaken a number of significant projects, looking at a wide range of mental health challenges affecting China, including the implementation of a patient-centred model of mental health care.

‘The key to this project was to develop a model that would be suitable for China. We took the best practices and key principles from Australia and adapted them to create a specific Chinese model of community mental health care,’ Prof Ng says.

‘We started with 30 sites, two in each province, and we helped to develop the curriculum and deliver national training material. After the first phase of the project it became evident that there were a number of clear positive outcomes, so it was decided to expand the project nationally.’

Over the last 10 years, the number of sites has gradually increased, now covering over 200 cities and reaching a population of nearly one billion.

‘That is about 80% of the Chinese population – we think it is the largest mental health reform globally.’

As well as having direct involvement in the implementation of mental health reform, AAMH has hosted delegations of Chinese mental health leaders, exposing them to some of the best clinical practice on display at St Vincent’s.

‘We also host individual clinicians through our postgraduate placement program, which provides clinical placement for professionals, allowing them to spend time with our own clinicians, shadowing them in order to get hands-on experience that they can apply back home.’

Mental Health in China

During the Cultural Revolution, political shifts led to strong civil control over diagnosis and treatment – a change that overshadowed patients’ real needs.

‘Treatment of mental health was largely focused on medical models of care, such as drug intervention and custodial care, with very little community care with its emphasis on promoting rehabilitation, recovery and integration back into society.’

The SARS epidemic was a turning point for China. The nation could no longer manage such issues using the hospital system alone. It highlighted the need for a comprehensive health system with a robust community component in the management of public health, including mental health.

China began the process of considering how best to provide early intervention, recovery and support for people suffering from mental health issues.

‘What China did at that time was look across the world to find a suitable model that would work in a Chinese context.  They went to various parts of the world, including the US, UK and others, before deciding upon the Victorian Model of Care.’

The Victorian model of care

The Victorian model of care focuses on coordinating care around a patient and providing continuity of care for patients in all phases of their illness.

It is a recovery-oriented model that promotes independence and looks at the needs of both consumers and carers.

Prof Ng says the Victorian model was well suited to application in China due to the importance of family in Chinese culture.

‘Good mental health care in China needs to take into account the family system and the support structure around a patient, which the Victorian model does very well.

‘St Vincent’s is regarded as a centre of excellence in community mental health delivery. That, coupled with our pre-existing relationships with peak bodies and understanding of cultural needs, made us perfect to deliver this reform.

‘St Vincent’s is known for delivering culturally sensitive health care and applying that in our training and partnership has made a significant difference.’

Early last year, AAMH joined with the Peking University Institute of Mental Health to establish a new joint China –

Australia mental health centre in Beijing. The Melbourne – Peking Centre for Psychiatric Research and Training will bring together experts from both institutions to study all aspects of mental health.

Prof Ng has always viewed AAMH’s relationship with China as a reciprocal one and is excited about the opportunities that abound through this cooperation.

‘The new centre will allow us to exchange best practice research models and collaborate on more innovative ways of helping people.

Mental health is a global issue and we have a lot to learn from each other.

‘Clinicians in Australia have the potential to access best practice models and increase our knowledge of culturally responsive care, which we can apply back home.  We also gain access to large study cohorts, which we could never get in a small country like Australia.’

The success of the collaboration with China has encouraged AAMH to expand. It is now working with clinical leaders in Myanmar to support their mental health reforms.

‘The work we’ve done in China has opened the door for us to have more of an export focus and expertise,’ says Prof Ng. ‘Appreciating cultural differences, having relationships, building trust, having a good track record, those things count. It has taken over 10 years to develop that, and it can’t be underestimated.’

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