Are western community psychiatric models suitable for China? An examination of cultural and socio-economic foundations of western community psychiatry models using assertive community treatment as an example

Abstract

Western community psychiatry models, such as Assertive Community Treatment (ACT) and Case Management, are well-studied and considered to be effective and cost-effective; in particular, ACT is perceived as a gold standard for community treatment of severe and persistently mentally ill patients. With China's recent rapid economic reform and attendant cultural and healthcare system changes, it is timely to examine the suitability of these western developed models of community psychiatric for China. In this paper selected cultural and socio-economic foundations of community psychiatry will be explored to ascertain their ‘fit’ in the Chinese setting. These are: availability of public funding for psychiatric care; role of the family in patient care; availability of functioning mental health laws and community and resource readiness. It is concluded that there are wide ranging differences between China and the western jurisdictions that currently operate extensive community psychiatry models. Wide adoption of these models in China may not be feasible from financial, legislative and social perspectives at present, but selected local trials of culturally informed adaptation of these models, including ACT or its key elements, may be useful and beneficial. The development process may be very informative for China's future services planning and provision and the continued global evolution of community psychiatry as a field.

Keywords:

• China
• community psychiatry
• ACT model
• cultural psychiatry