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The Need for Psychosomatic Medicine and Psychotherapy

There is a great need for further development of the health care in the field of psychosomatic medicine and psychotherapy in China. According to different large scale reports, up to 241 million Chinese people are currently living with a mental disorder. The prevalence rate for mental disorders in China lies between 7.0% and 17.5% (see Table 21.1). Only few get proper medical treatment for their mental illness. About 222 million (92%) of these patients with mental illnesses have never been treated (Phillips 2009).

Table 21.1 Mental disorders
Full size table

With a distribution key of 1.5 psychiatrists per 100,000 habitants and a strong urban-rural gap, one of the reasons for this high number of patients who have never received medical help for their mental illness could be the lack of qualified medical personnel especially in the rural regions of the country (Cyranoski 2010). If patients with mental disorders are not treated, there is a high risk for chronification of the mental disorder. Chronification is highly cost intensive for the whole society, as these patients can become unable to work and remain in the health-care system for a long period of time.

There are also high comorbidities between mental disorders, such as depressive disorder or anxiety disorder and physical diseases, such as cancer, coronary heart diseases, stroke, and diabetes. The interaction between physical and mental disorders is mostly overlooked in the Chinese health-care system. However, qualified psychosomatic care makes it possible to efficiently improve central outcomes such as mortality, quality of life, and degree of impairment of somatic diseases. Thus, psychosomatic medicine raises “somatic medicine” not only to a higher level through qualified “psychosomatics” with psycho-oncology, psychocardiology, and psychosocial support in the context of complex/complicated disease processes (transplantation, intensive care) but has also become an important pillar of modern high-end medicine and is indispensable in order to remain “competitive.”

Mental Health-Care Developments in China

It is imperative to improve the training of non-psychiatrist, nurses, psychiatrists, and psychologists. One decisive step in the right direction was the Mental Health Law, which became effective on May 1, 2013 (Phillips et al. 2013). It specifically demands the establishment of a psychiatric and psychosomatic consultation and liaison service in the general hospital. In 2015, the General Office of China’s State Council published the 2015–2020 National Mental Health Work Plan which focuses on the recognition and treatment of “severe mental illnesses” such as schizophrenia, bipolar disorder, and mental retardation. However, psychosomatic medicine and the interactions between common physical diseases and common mental disorders, such as depression, are not mentioned in the 2015–2020 National Mental Health Work Plan, while it refers to psychotherapy only on the side (Xiong and Phillips 2016).

What Kinds of Trainings Have Been Implemented So Far?

Psychotherapy

In the past few decades, the need for qualified personnel has been answered with the help of international cooperations in the field of clinical education and research. The German-Chinese Academy of Psychotherapy has been established over 20 years ago. It organizes regular training programs in psychodynamic psychotherapy, cognitive behavioral therapy, and systemic and family therapy. By now it can look back at several thousands of participants, who successfully completed the training in China. Over the past years, education programs from Norway, the USA, and France have been added.

But nevertheless psychotherapy in China is still in the process of formal regulation. The new mental health law promotes the role of psychiatry in assessment of mental disorders and subsequently engaging psychiatrists and clinical psychologists in their treatment. Mental health institutions are requested to regularly improve mental health services and research. Yet unclear and not specified by the law, though, is the type of treatment and especially the formal training that is considered necessary for psychotherapy in China (Phillips et al. 2013).

Psychosomatic Medicine

The Sino-German cooperation in the field of psychosomatic medicine was initiated in 2002: the ASIA-LINK program was funded by the European Union and trained medical doctors in psychosomatic medicine (Fritzsche et al. 2012). Over the past years, the Balint group method, offered within the framework of psychosomatic basic care, has spread across China (Wei et al. 2016). Training courses on the topic of “breaking bad news” have been offered by foreign experts in psycho-oncology, and courses in psychocardiology have been implemented since 2016 (Wuensch et al. 2012; Pang et al. 2015).

In 2015 the Sino-German Institute of Psychosomatics and Psychotherapy at the Beijing Union Hospital was founded. The aim is collaboration in training and research in the field of psychosomatic medicine. In 2016 the 4-year training program in advanced psychosomatic medicine and psychotherapy started at the Beijing Union Hospital. This project is funded by the German Academic Exchange Service (DAAD).

In the Sino-German research network in psychosomatic medicine and psychotherapy, Chinese and German scientists work together in clinical studies about somatic symptoms disorder, Balint group, psycho-oncology, psychocardiology, and transcultural issues. Results of the past projects have culminated in more than 25 publications in international peer-reviewed journals and 2 books, translated in to Chinese (Wei et al. 2016).

In 2017 the 3-year program “Sino-German Alumni Network in Psychosomatic Medicine and Psychotherapy” has started to bring together psychosomatic specialists from German universities and three Chinese partner universities (Peking Union Medical College Hospital, Tongji University Shanghai, West China University Chengdu). This project is funded by the German Ministry for Education and Research (BMBF).

In 2012, the West China Hospital of Sichuan University initiated a psychosomatic service plan called “the Sunshine Hospital” project. The aims of this project are to strengthen the medical staff’s ability to provide the psycho-social care and making the psychosomatic medical service available to all patients in the general hospital (Huang et al. 2019).

To increase recognition rates of psychological and psychiatric problems of patients, a new fast screening tool was developed by a Chinese project team after 2 years of research (Wang et al. 2017). They also modified the medical process and utilized the new technology to make the brief psychological assessment as “the sixth vital sign” of every inpatient in the hospital. They provided the psychosomatic medical trainings for the medical staff at all levels. A group called “the Sunshine Angels” was built up. The group members were from all the clinical departments in the hospital and trained to be able to give patients basic psychosomatic care in the wards. A collaborative psychosomatic medical care system, called The Sunshine Angels, was gradually set up by the medical staff in charge (the psychiatrists).

In 2016, China Sunshine Hospital alliance was established. It aims to provide the nationwide psychosomatic medical service in general hospitals in China. More than 30 general hospitals met the requirements and became members of this alliance.

Psychosomatic Medicine in Research

The state of research in the field of psychosomatic medicine should be demonstrated based on the example of somatoform disorders/functional syndromes: there are just as many patients with medically unexplained physical symptoms/somatoform disorders in China as in Western countries. Similar to Western countries, psychological and behavioral variables such as dysfunctional illness perception and illness behavior were associated with high somatic symptom severity and low quality of life (Schaefert et al. 2013; Zhang et al. 2014). Treatment satisfaction and the quality of the doctor-patient relationship in patients with MUS and high somatic symptom severity were the highest in TCM (Wu et al. 2015).

There is a currently finished validation study to explore the frequency of DSM-5 somatic symptom disorder (SSD) and the planned ICD-11 bodily distressed disorder (BDD) in a multicenter study in biomedicine, TCM, and psychosomatic medicine. For young doctors, there is a Sino-German doctorate program for being awarded with the academic title Dr. med.

The following four steps are necessary to develop psychosomatic medicine in the future in China:

  1. 1.

    Integration of training in psychosomatic medicine in the undergraduate student teaching.

  2. 2.

    Basic and advanced training in psychosomatic medicine and psychotherapy for physicians, psychologists, and nurses.

  3. 3.

    Assistance in setting up psychosomatic wards at the general hospital.

  4. 4.

    Supporting basic and clinical research in the field of somatic symptoms disorder (SSD), pain disorders, psychosomatic interaction between mental disorders and physical illness, especially in psycho-oncology, and psychocardiology and to study transcultural issues.

To summarize, the demand for psychosomatic medicine and psychotherapy in China is high. The continuity of training and research in psychosomatic medicine is only at the beginning. A graduate training program and a biopsychosocial health-care model is needed.