Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey

Lei Xia; Feng Jiang; Jeffrey Rakofsky; Yulong Zhang; Yudong Shi; Kai Zhang; Tingfang Liu; Yuanli Liu; Huanzhong Liu; Yi-Lang Tang

doi:10.3389/fpsyt.2021.573333

Resources and Workforce in Top-Tier Psychiatric Hospitals in China: A Nationwide Survey

Front Psychiatry. 2021 Feb 24:12:573333. doi: 10.3389/fpsyt.2021.573333. eCollection 2021.

Authors

Lei Xia^{1

2}, Feng Jiang^{3

4}, Jeffrey Rakofsky⁵, Yulong Zhang^{1

2}, Yudong Shi^{1

2}, Kai Zhang^{1

2}, Tingfang Liu⁶, Yuanli Liu⁷, Huanzhong Liu^{1

2}, Yi-Lang Tang^{5

8}

Affiliations

¹ Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.
² Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China.
³ Healthcare Management and Evaluation Research Center, Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China.
⁴ Research Center for Public Health, Tsinghua University, Beijing, China.
⁵ Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.
⁶ Institute for Hospital Management of Tsinghua University, Beijing, China.
⁷ Public Health School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁸ Atlanta Veterans Affairs Medical Center, Decatur, GA, United States.

Abstract

Objectives: Mental healthcare has gained momentum and significant attention in China over the past three decades. However, many challenges still exist. This survey aimed to investigate mental health resources and the psychiatric workforce in representative top-tier psychiatric hospitals in China. Methods: A total of 41 top-tier psychiatric hospitals from 29 provinces participated, providing data about numbers and types of psychiatric beds, numbers of mental health professionals, outpatient services and hospitalization information covering the past 3 years, as well as teaching and training program affiliation. Results: Significant variations were found among participating hospitals and across different regions. Most of these hospitals were large, with a median number of psychiatric beds of 660 (range, 169-2,141). Child and geriatric beds accounted for 3.3 and 12.6% of all beds, respectively, and many hospitals had no specialized child or geriatric units. The overall ratios of psychiatrists, psychiatric nurses, and psychologists per bed were 0.16, 0.34, and 0.03, respectively. More than 40% of the hospitals had no clinical social workers. Based on the government's staffing guidelines, less than one third (31.7%) of the hospitals reached the lower limit of the psychiatric staff per bed ratio, and 43.9% of them reached the lower limit of the nurse per bed ratio. Conclusion: Although some progress has been made, mental health resources and the psychiatric workforce in China are still relatively insufficient with uneven geographical distribution and an acute shortage of psychiatric beds for children and elderly patients. In the meantime, the staffing composition needs to be optimized and more psychologists and social workers are needed. While addressing these shortages of mental health resources and the workforce is important, diversifying the psychiatric workforce, promoting community mental health care, and decentralizing mental health services may be equally important.

Keywords: China; mental health; psychiatric hospitals; resources; workforce.