Mental health care in China: review on the delivery and policy issues in 1949­2009 and the outlook for the next decade.

Using qualitative and quantitative methodologies, delivery models and policies on mental health care in China during the period of 1949­2009 were reviewed and characteristics of different stages of the mental health-care development were also analysed in this period. Recent studies demonstrate that mental health-care services in China are being transformed from large mental hospital-based pattern to community-based pattern in the past six decades. Combining the international experiences with current strategies and situations of Chinese health care, we provided the outlook for mental health-care services in the next decade in China. In addition, we proposed relevant policy recommendations that mainly focus on the equity and availability of mental health-care services with the purpose of promoting community-based health services.

Collectivism, individualism, and pragmatism in China: implications for perceptions of mental health.

This study aimed to better understand how minor mental health problems (MMPs) are perceived by well-educated urban dwellers in China who are influenced by Western values. Urban China is a rapidly changing society in which traditional Chinese culture and Western thought coexist. As a result, the established processes of interdependent self-appraisal have been challenged and a sense of a bicultural self has developed among a growing proportion of the population. The fieldwork for this study included interviews and observations. The results are derived mainly from interviews with professional practitioners, students, and lay people from three urban sites. One of the main findings was that respondents who referred to traditional and collectivistic Chinese values tended not to label MMPs as psychiatric disorders or illnesses but as challenges in daily life and relationships strain. While the Western medical model of MMPs considers them a form of illness, they were not viewed in this way in traditional collectivistic China in the past, even among educated urban dwellers. However, the urban and educated Chinese who have developed a stronger sense of a bicultural self are now more likely to perceive and deal with MMPs from a Western viewpoint.

Time for paradigmatic substitution in psychology. What are the alternatives?

This article focuses on the "machine paradigm" in psychology and its consequences for (mis)understanding of human beings. It discusses causes of the mainstream epistemology in Western societies, referring to philosophical traditions, the prestige of some natural sciences and mathematical statistics. It emphasizes how the higher psychological functions develop dialectically from a biological basis and how the brain due to its plasticity changes with mental and physical activity. This makes a causal machine paradigm unfit to describe and explain human psychology and human development. Some concepts for an alternative paradigm are suggested.

De-institutionalisation and trans-institutionalisation - changing trends of inpatient care in Norwegian mental health institutions 1950-2007.

BACKGROUND: Over the last decades mental health services in most industrialised countries have been characterised by de-institutionalisation and different kinds of redistribution of patients. This article will examine the historical trends in Norway over the period 1950-2007, identify the patterns of change in service settings and discuss why the mental health services have been dramatically transformed in less than sixty years. METHODS: The presentation of the trends in the Norwegian mental health services and the outline of the major changes in the patterns of inpatient care over the period 1950-2007 is founded on five indicators: The average inpatient population, the number of discharges during a year, the average length of stay, the number of beds or places, and the occupancy rate (average inpatient population/beds). Data are reported by institutional setting. Multiple sources of data are used. In some cases it has been necessary to interpolate data due to missing data. RESULTS: New categories of institutions were established and closed during the 57 years period. De-hospitalisation started in Norway in the early 1970s, de-institutionalisation in general 15 years later. Six distinct periods are identified: The asylum period (-1955), institutionalisation and trans-institutionalisation (1955-65), stabilisation and onset of de-hospitalisation (1965-75), de-hospitalisation (1975-87), from nursing homes to community-based services (1988-98), and the national mental health program (1999-2007). There has been a significant reduction in the number of beds and in the average in-patient population. The average length of stay in institutions has been continuously reduced since 1955. The number of patients actually treated in psychiatric institutions has increased significantly. Accessibility, quality of care and treatment for most patients has improved during the period. The mental health system in Norway has recently been evaluated as better than the systems in USA, England and Canada. CONCLUSIONS: De-institutionalisation means fewer beds but not fewer patients treated, neither in institutions in general nor in psychiatric hospitals. The periods represent different kinds of de-, trans-, and even re-institutionalisation. Expansion of the welfare state, increased professional focus on active treatment and increased focus on patients' preferences are the factors that best explain de-institutionalisation in Norway.