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In modern China, eye on mental health

Most psychotherapists and counselors are setting up shop as Chinese struggle with the demands of a rapidly changing society and the profession loses its stigma.

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Even so, Tian complains, the government's support for the profession has proved "far from enough. They did not realize society could be so sick."

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The past few years, however, have seen a sea change in authorities' attitude to mental health, says Dr. Phillips, head of the Beijing Suicide Research and Prevention Center. "There is a momentum ... which is positive for those working in mental health," he says. "There are still a lot of problems, but the trajectory looks pretty good."

In particular, he says, "the government is much more open" about suicide. "They are not sweeping it under the carpet; that's a big change." An official report last month showed that suicide attempts were the second-largest cause of injury in China in 2005, after traffic accidents. Government statistics, which some outside experts say still underestimate the problem, report around 250,000 suicides in China each year.

Few victims ever sought help, mainly because help was not available nearby. "The majority of regions lack mental-health prevention networks and the level of public knowledge about mental illness is not high," deputy Health Minister Wang Longde said in a speech last month marking International Mental Health Day.

A survey two years ago found that 60 percent of rural Chinese did not know what the word "depression" meant.

Phillips insists that the key problem in the countryside where suicide is most prevalent is not lack of counseling but the abundance of poisonous pesticides that farmers keep in their homes. That means that an unusually high rate of suicide attempts end in death. Fifty-eight percent of all fatal attempts used pesticides.

"Whether you live or die has little to do with how much you intended to die and a lot to do with which pesticide you took," says Phillips.

The Agriculture Ministry announced last month that it would cease production of the five most toxic pesticides. "That won't stop the behavior, but it will reduce the numbers who die," says Phillips.

Thirty percent of those who die by suicide and 60 percent of those who make nonfatal attempts – a large proportion by international standards – have no diagnosable mental illness. Suicidal tendencies are "usually prompted by intense interpersonal conflict, typically with the spouse," says Phillips, whose team carried out the largest study of suicide in China.

Still, authorities are setting up crisis hot-lines in a number of regions, while professional groups set new standards for psychological counselors to weed out those without proper training and to provide more skilled counselors.

That will take years, psychologists agree. In the meantime, as more Chinese understand that "between very serious psychiatric illness and simply being confused there are psychological problems that need help," as Mr. Che puts it, more may seek help.

"I am much busier now than I was a few years ago," says Tian, who later this month will become one of the first batch of counselors to receive a professional qualification from the China Psychology Society. "And in another few years I will be overbooked."