London School of Hygiene & Tropical Medicine

The three new papers mark the launch of the China-India Mental Health Alliance, a long-term project co-led by Professor Vikram Patel at the London School of Hygiene & Tropical Medicine in partnership with colleagues from Shanghai Jiao Tong University, China. The Alliance brings together experts from China and India to look at the current status of mental health and mental health services in both countries.

The authors shed light on the significant mental health treatment gap in China and India, which have a combined population of over 2.5 billion - 38% of the world's population. A third of the global burden of disease for mental, neurological and substance use disorders occurs in these two countries alone, which is more than in all high-income countries combined. However, the majority of people with mental disorders in China and India do not receive treatment. 

The research suggests that by 2025, 39.6 million years of healthy life will be lost to mental illness in China, and 38.1 million years in India. Less than 1% of the national healthcare budget in either country is allocated to mental health care, and both have very few trained mental health professionals, poor access to mental health services (especially in rural areas) and high levels of stigma which may prevent people from accessing services.

In China, less than 6% of people with common mental health disorders (mood or anxiety disorders), substance use disorders, dementia and epilepsy seek treatment; 40% of people with psychotic disorders have never sought treatment from mental health professionals. In India, only about 1 in 10 people with mental health disorders are thought to receive evidence-based treatments.

Professor Vikram Patel, global mental health expert at the London School of Hygiene & Tropical Medicine and the Public Health Foundation of India, said: "While India has progressive policies regarding mental health care, the actual implementation of comprehensive community oriented services is patchy and the treatment gaps, especially in rural areas, are very large."

To address these, the researchers suggest that community engagement and increased support for community health workers are key to providing more accessible, affordable, and acceptable mental health care.

Additionally, they highlight the importance of collaboration with traditional and alternative medicine specialists, such as yoga and Traditional Chinese Medicine practitioners, whose clients often include many individuals with mental health problems. Alternative forms of therapy can provide promising treatments for mental illness, although the authors note that clinical trials are needed to provide firm evidence for their efficacy and safety. Traditional medicine practitioners could be trained to recognise and refer patients, or to advise people against stopping their medication, working together with mental health professionals as a promising way to bridge the mental health treatment gap.

Professor Patel said: "Innovators have shown how these gaps might be reduced, for example through task-sharing with front-line workers and engagement of the community.  These are the models of care which deserve public financing for scaling up. Additionally, we must explore how alternative medicine practitioners can work in collaboration with medical doctors to improve the lives of people living with mental health problems."

These three papers are the first of several publications to be released over the coming year by the China-India Mental Health Alliance, which is jointly coordinated by the Shanghai Mental Health Center at the Shanghai Jiao Tong University in China and the Public Health Foundation of India. The activities of the China-India Mental Health Alliance have been supported by a grant from the China Medical Board and by technical assistance from the World Health Organisation, Emory University, the London School of Hygiene & Tropical Medicine, and Harvard University.

Hear more about the research in a Lancet Podcast, 'Mental health in China and India,' in which The Lancet Psychiatry Editor Niall Boyce talks to authors Vikram Patel and Michael Phillips about the mental health care needs of two countries undergoing massive social and economic change.

Publications

• Fiona J Charlson, Amanda J Baxter, Hui G Cheng, Rahul Shidhaye, Harvey A Whiteford. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. The Lancet. DOI: 10.1016/S0140-6736(16)30590-6
• Vikram Patel, Shuiyuan Xiao, Hanhui Chen, Fahmy Hanna, A T Jotheeswaran, Dan Luo, Rachana Parikh, Eesha Sharma, Shamaila Usmani, Yu Yu, Benjamin G Druss, Shekhar Saxena. The magnitude and health system responses to the adult mental health treatment gap in India and China. The Lancet. DOI: 10.1016/S0140-6736(16)00160-4
• Jagadisha Thirthalli, Liang Zhou, Kishore Kumar, Jie Gao, Henna Vaid, Huiming Liu, Alex Hankey, Guojun Wang, Bangalore N Gangadhar, Jing-Bao Nie, Mark Nichter. Traditional, complementary and alternative medicine (TCAM) approaches to mental health care and psychological wellbeing. DOI: 10.1016/S2215-0366(16)30025-6

Related course

• MSc Public Health
• MSc Global Mental Health