Date Published: July 5, 2017
Publisher: Public Library of Science
Author(s): Qiuxia Wu, Xiaoyang Luo, Shubao Chen, Chang Qi, Jiang Long, Yifan Xiong, Yanhui Liao, Tieqiao Liu, Xiang Yang Zhang.
Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals’ conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis.
In 2014–2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured.
Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse.
The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals’ mental health knowledge in mainland China in order to provide better support for mental health service users.
Mental health has always been a challenging public health issue. Mental and substance disorders accounted for 6.6% of global disability-adjusted life years and 18.9% of global years lived with disability, making them among the leading causes of the non-communicable disease burden in 2015 [1,2]. In 2013, the total expenditure of mental disorders accounted for over 15% of the total health expenditure in mainland China and for 1.1% of gross domestic product . With the rapid development of the economy and of society, common mental disorders (e.g. anxiety disorder and depression) and psychological behavioral disorders are increasing, leading to severe challenges in mental health work in mainland China. Mental health service resources are insufficient and unevenly distributed. According to the 2015–2020 National Mental Health Work Plan of China there were 1650 specialized mental health institutions, 228,000 psychiatric beds with an average of 1.71 for 100,000 population (4.36 for 100,000 population globally) and over 20,000 psychiatrists nationally; most of these resources were distributed at the provincial or municipal levels, and a community-based rehabilitation system for mental disorders has not yet been established . The public’s awareness of anxiety, depression, and other common mental disorders, as well as about psychological behavioral problems, is poor. Because of the obvious social biases and stigma towards mental illnesses, most mental health service users would rather conceal their illness, with few seeking support from mental professionals .
This is the first study to examine the MHL of non-mental health professionals in mainland China by using vignettes. The survey showed that the rate of identification for the depression vignette was relatively higher than those for the schizophrenia and the GAD vignettes. When the participants were asked about the helpfulness of various people, medications, and interventions, although they tended to give the highest ratings to medical interventions (psychiatrists, clinical psychologists, antipsychotics, antidepressants, anxiolytics, psychotherapy), they also rated lifestyle interventions (help from close family, psychical activity, getting out more) highly.
We found that the identification rate for schizophrenia, depression, and GAD among non-mental health professionals in the six general hospitals in Hunan Province was low and that their beliefs about treatment were inadequate to reduce the disease burden caused by mental illness. The findings stress the need to improve non-mental health professionals’ MHL so that they are able to identify mental disorders, take appropriate actions when needed, and provide well-founded support and advice to patients in need.