Reporting on China’s Mental Health Surveillance

Countries like the United States have already developed mental health surveillance, extensively covering diagnosis of mental disorders, symptoms, risk factors, and mental health services (1). These data guide Medicare and Medicaid coverage decisions and direct attention to new areas, such as adolescent suicide. In 2012, China’s first National Mental Health Law explicitly stipulated that a mental health surveillance network should be established (article 24) and that mental health work plans should be based on surveillance results (article 60).

The National System of Basic Information Collection and Analysis for Psychoses, launched in 2011, is the only mental-health-themed surveillance system in China. Six severe mental illnesses—schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder, psychotic disorder due to epilepsy, and mental retardation—are reported. Information on diagnosis, medication, risk of violence, and history of crime and violent or disruptive behavior is also collected. However, the surveillance system has at least three major problems.

First, the system is a part of the National Continuing Management and Intervention Program for Psychoses (also named 686 Program), which was originally a response to the government’s concern about social harmony and stability (2). This explains why the surveillance focuses only on patients with severe mental illnesses and their violent or socially disruptive behaviors. This surveillance information is shared with public security departments.

Second, although data dissemination is a core principle of surveillance, accessing data from the system is extremely difficult in China. Unlike monthly reporting of communicable-disease surveillance, no report on the national psychosis surveillance has been released by so far, except for a few papers published by local surveillance staff based on data from their regions (3). Authorization for data access must first be applied for from local health administrations and then reported to the National Health and Family Planning Commission for approval. The government has been reluctant to approve data use by researchers and clinicians working outside the surveillance system.

Third, despite quality control procedures included in the surveillance design, data quality is a major concern. There is no evaluation report on the whole system. The sole published evaluation study was conducted only in one city and shows that the completeness and validity of the data are problematic, with only half of the cases accurately reported (4). This record is poor even compared with surveillance of other types of illnesses in China (5). One reason may be competition for resources between surveillance for psychoses and other diseases, as funding is allocated to locales in a package covering eight other health topics. Also, there is a lack of professionals dedicated to public health surveillance in China (5, 6). Performance in rural areas is particularly poor, with less training for rural staff and difficulties in reaching widely dispersed rural residents of regions with poor transportation systems (4). The government set the goal for the national detection rate at 0.35% in 2014 (7), which is far below the estimated psychotic disorder prevalence of 1% in the general population (8).

The World Health Organization promotes accurate surveillance to support evidence-based decision making and improvements in capacity and quality of clinical practices (9). The Chinese mental health surveillance program needs to transform its narrow focus on severe mental illnesses and violent or socially disruptive behaviors into full coverage of mental health-related events. Moreover, the government must make the data accessible for clinical practices, research, and evidence-based decision making at all government levels. Finally, meaningful evaluation criteria must be established and published, and funding and training of staff must be provided.