If psychology departments want long-term development, the key is to look at revenue
Text/Xin Ying, Ling Xin, Cao Yujie
Editor/ Wang Xiao
Picture/Pixabay
After the adjustment of epidemic prevention and control policies, the lives of some epidemic prevention service personnel will gradually return to daily life. However, a community psychological service provider in Beijing observed that those epidemic prevention service personnel who often go in and out of the community often face questions and complaints from residents. They need psychological counseling and intervention as early as possible to prevent them from developing mental illness.
People are increasingly accepting that "unhappiness" may be a disease. Data from the 2021 Health Statistics Yearbook show that the number of psychiatric outpatient and emergency visits has increased by approximately 8.49 million compared with 2019.
Restaurant owners whose shops have closed down, middle-aged people from large factories who pretend to work after layoffs, couples who are divorcing after being quarantined at home, high school students who are tired of studying after school resumes, etc. are all common patients of psychologists in major hospitals. "The increase is mainly caused by mild mental illnesses such as anxiety and depression, or psychological illnesses." Jiang Changqing, deputy director of the Clinical Psychology Center of Beijing Anding Hospital Affiliated to Capital Medical University (hereinafter referred to as "Anding Hospital"), told Caijing reporters.
From September 2021 to August 2022, Shanghai psychological hotline 962525 received a total of nearly 50,000 calls. In Beijing, if you want to enroll in a psychotherapy clinic at a well-known hospital, the waiting period is 3 to 6 months, or longer.
Nine ministries and commissions, including the National Health Commission, the Ministry of Education, and the Ministry of Finance, jointly issued a document in 2021 requiring all psychiatric hospitals in pilot cities to set up psychological outpatient clinics. 40% of general hospitals at level 2 and above have opened psychiatric or psychological outpatient clinics, which is double the number in 2020. At the same time, more than 80% of villages and communities need to open psychological consultation rooms or social studios.
There are now 5,936 mental health medical service institutions across the country, an increase of 205% compared with 2010. Guangdong, Jiangsu and other places have successively opened medical insurance "reimbursement" for psychological outpatient clinics.
A nationwide network for treating "unhappiness" is gradually taking shape.
Getting people to receive psychological treatment is a problem
During the epidemic in Shanghai from March to May 2022, the number of telephone consultations was two to three times the daily volume. This is the statistical data obtained by Caijing reporters from the Shanghai psychological hotline 962525 in September.
In order to provide 24-hour hotline service, Shanghai has mobilized 349 professional psychological volunteers, 58 teacher volunteers, and 6 university psychology students, working in three shifts every day.
A study in the medical journal "The Lancet" also showed that after the onset of the new coronavirus pandemic, the deterioration of global mental health and the growing number of cases were closely related to restricted activities.
For mild anxiety and depression, professional psychological hotlines can solve some of the problems. Cai Jun, deputy director of the Shanghai Mental Health Branch for Disease Control and Prevention, said that by calling the hotline, , in addition to emotional problems such as anxiety, panic, and worry about infection caused by lockdown and quarantine, in addition to the fluctuations in the condition of patients with original mental illnesses, there are also practical problems such as work, income, and studies. Among children's emotional problems, distress caused by online classes during the epidemic accounts for a high proportion.
Although "unhappy" people accept that they may be sick, they still resist going to a "mental hospital", which can be uncomfortable and even shameful for some. They don't want to face the doctor.
picture/Beijing Anding Hospital registration window Photo/Xin Ying
"Online I can only see your expression and know that you are crying, but I cannot fully see your body language. On site, if you cry, I can pat your shoulder. The emotional connection of the psychological clinic is very close." Wang Zhen, deputy director of the Shanghai Mental Health Center (hereinafter referred to as "Shanghai Jingwei"), told the Caijing reporter that the hospital's online psychological clinic is only open to patients who have completed their first offline consultation.
After choosing online consultation or hotline consultation, most new mild patients will go to a familiar general hospital.
Article data published in "Nervous Disease and Mental Health" shows that among depression patients in Beijing, 42.58% choose general hospitals for their first visit, mainly because of the convenience of treatment; 32.10% choose psychiatric hospitals for their first visit.
Psychiatry has an inherent "bad reputation" and it has indeed gone through a difficult time. Until the 1990s, the closed area of the psychiatric hospital, which mainly treated critically ill patients, still had iron doors, iron windows, iron chains, and a shot of sedatives from time to time.
The first time the Chinese public really put down their guard against psychotherapy was after the 2008 Wenchuan earthquake. Jiang Changqing recalled that many psychology professionals voluntarily went to disaster scenes to provide assistance, which gave the public an understanding of mental illness. Since then, the country has deployed psychologists in handling various disasters and public health incidents.
After the outbreak of the new crown epidemic, the medical teams that go to the affected areas to assist will be directly equipped with psychologists and a complete mental health intervention plan. For example, regular exchanges between medical staff are organized. "Many problems are common. When you know that it is not your problem, you can relieve stress and some symptoms will slowly disappear." Jiang Changqing said.
A message purportedly released by the mental health center once went viral: "If during isolation, you start chatting with flowers, plants and trees, it is normal and there is no need to call for consultation. It is only necessary to seek assistance if those flowers, plants and trees begin to answer your questions." Although the rumor was eventually refuted by the official as just an Internet joke, the mental health center is indeed working hard to get closer to patients.
Some hospitals will use a mild "psychology department" for their newly established psychiatric departments, which is easier for people to accept. On July 25, 2022, at the Wenshan Prefecture People's Hospital of Yunnan Province, a new psychological clinic was opened under the leadership of the original director of the psychiatric department.
Shanghai Mental Health Center and Shanghai Symphony Orchestra will also launch a joint coffee in 2022, with 10 different emotional symptoms to choose from in the packaging: anxiety disorder, workplace PUA, low self-esteem, mania, insomnia, emotionality, love brain, performative personality, sense of superiority, and fanatical enthusiasts. The QR code of the packaging bag corresponding to can be scanned to listen to the popular science and "healing system" symphony of professional psychologists.
What to do in the psychological clinic of the hospital
Hu Yongdong is very busy now.
As the director of the clinical psychology department of Beijing Chaoyang Hospital affiliated to Capital Medical University, he has been driving for 1 hour every Wednesday morning to visit Huairou Hospital in Beijing, where hospital hosts , since two years ago. Now he has to prepare for the opening of a psychological clinic in the east campus of Chaoyang Hospital in March 2023. In addition, the hospital headquarters has to travel and coordinate among the four places. The staff deployment under Hu Yongdong is indeed a bit tight.
Chaoyang Hospital, which is close to the most expensive office building complex in Beijing, will add a psychology department with a full-time doctor in the west campus near the West Fourth Ring Road in March 2022. "There were not many people registering at the beginning. In the past six months of development, every week has been full." Hu Yongdong said.
Picture/Registration window of Beijing Anding Hospital Photo/Xin Ying
This is also the hospital’s response to the National Health Commission’s request to increase the proportion of psychiatric (psychological) outpatient clinics in general hospitals. As of June 2022, there are 5,936 institutions providing psychological outpatient services across the country, an increase of 205% from 2010.
Hu Yongdong is busy because of lack of staff. Even the psychology department of Chaoyang Hospital, which has been open for many years, currently only has one therapist, and you have to register three months in advance. "The hospital still attaches great importance to the construction of the psychology department. In the past two years, it has been able to recruit one or two new people every year. Now it has eight psychiatric doctors and one psychotherapist."
Professor Zhou Xiaolin, former chairman of the Chinese Psychological Society, pointed out in his article that there are about 20,000 undergraduate graduates in psychology every year, and more than 400 doctoral graduates in psychology. However, the number of formally trained psychological counselors and psychotherapists is not large, and at critical moments it is necessary to mobilize the efforts of the whole country. For example, during the COVID-19 epidemic.
Hu Yongdong’s most ideal situation is to bring the psychological clinic of Huairou Hospital so that even if the experts withdraw, they can develop on their own. “We have always wanted to recruit a full-time doctor here, but the hospital is located in a remote location and good talents don’t want to go there. We haven’t found one yet.”
Beijing Puren Hospital established a rehabilitation psychology clinic in 2020 as a sub-specialty of the rehabilitation department to treat recovering patients. Today, two years later, working overtime has become a daily routine for Liu Nan, deputy chief physician of , and sometimes he cannot take a day off on weekends.
The psychological clinic also has a special role, treating "heart diseases" for patients who have repeatedly sought treatment in other departments without success. Liu Nan is most often exposed to patients who are recovering from orthopedic surgery. They complain of pain in their posterior joints, which affects their sleep. However, after a check-up at the hospital, all indicators were fine. Eventually, many patients with physical pain were found to have "psychogenic" pain, which could be relieved and cured through psychological treatment.
Puren Hospital integrates related resources of psychological rehabilitation, speech cognition, orthopedics, neurology . "We don't call it a treatment room, we call it a spiritual station, just to make the recovering patients more comfortable." Liu Nan said.
It is not like opening a psychology department in a hospital and waiting for people to see the doctor. In the psychology department of a general hospital, there are only a few people in the outpatient clinic one afternoon every week. Patients do not trust enough in some psychological treatment plans that do not require injections, do not take medicine, and are slow to produce results. A secondary psychiatric hospital in Shanghai initially invested a lot of resources, such as a psychological sandbox, which cost thousands of yuan to purchase and occupied a consulting room, but patients could not see immediate results. This project slowly shrank, and later even the sand table was put into the warehouse.
Chen Jianhua, director of Shanghai Jingwei Medical Department, told Caijing reporters that the psychiatric and psychological outpatient clinics of general hospitals are more focused on early diagnosis and health services, especially for children with special needs such as family relationships, emotional problems, and learning difficulties.
When the First People's Hospital, a long-established tertiary hospital in Shanghai, approached Shanghai Jingwei to jointly build a psychology department, the latter selected a department director specializing in children and adolescents. She would then take the lead and teach junior doctors and psychotherapists who had just graduated from graduate school.
Beijing Chaoyang Hospital is already exploring the possibility of opening a psychological ward and the challenges it will encounter. For example, some patients with severe pneumonia combined with mental disorders may need to be transferred from a psychiatric hospital.
makes a distinctive brand, which is also a brand that a psychological clinic needs in the future competition.
Hospitals are also unwilling to engage in loss-making transactions
During the epidemic, the average subsidy for volunteer service workers in Shanghai 962525 was 7.5 yuan an hour on average. The volunteers' ability to persevere "really depends on their feelings." Cai Jun told Caijing reporters.
The Huoying Community Psychological Service Center in Changping District, where the above-mentioned Beijing community psychological service personnel are located, has successfully found a way to provide mental health services to some front-line epidemic prevention personnel from 2020. “At the beginning, we took the initiative to provide several social services The district's party branch committee and neighborhood committees provided services. Later, the district government realized the importance of this to front-line epidemic prevention personnel, and by 2022 it had become a proactive special purchase. We have received mental health assessment and intervention services for front-line epidemic prevention personnel in all 20 communities in Huoying Street."
Psychotherapy based on interviews takes up the most time. A single psychotherapy session usually lasts about an hour. A doctor can only see a few patients in a morning. Compared with a department where one doctor often sees dozens of patients, the service fee received by the psychology department is very low. According to Beijing’s unified charging standards, a single individual psychological treatment is 147 yuan.
"The income of psychiatric medical staff is at least one-third to one-half lower than that of medical staff in hospitals of the same level." Tan Junhua, director of the Medical Department of Nanjing Brain Hospital, once introduced to the media. The main reason is that the turnover rate of psychiatric beds is low, only one-half of that of general hospitals at the same level.
Psychology departments mainly accept patients with mild symptoms. Most hospitals do not have wards, which directly cuts off the "big part" of hospitalization income.
Hospitals are trying to raise prices. Shenzhen's practices divide pricing into different levels. Some hospitals divide psychological consultation into junior, middle, and high levels. The hourly pricing is 90 yuan for beginners, 110 yuan for intermediate, and 130 yuan for advanced. The deputy chief physician charges 140 yuan for 30 minutes, and the chief physician charges 160 yuan for 30 minutes.
A hospital in Shenzhen offers family therapy for 380 yuan per session, and group therapy for 550 yuan per session. Nanjing is taking even greater steps. Nanjing Brain Hospital offers single-person psychotherapy for 800 yuan for 50 minutes per session.
Beijing, Guangdong and other places are trying to include psychological treatment in medical insurance. For example, according to the Guangzhou Municipal Medical Insurance Bureau, the maximum charge for general outpatient "psychotherapy" in a tertiary hospital is 200 yuan. According to the 50% reimbursement rate for outpatient services in tertiary hospitals, patients need to pay about 100 yuan out of pocket.
Jiangsu Province has a total of 50 psychological diagnosis and treatment projects, 25 of which have been included in the payment scope of basic medical insurance, with annual medical insurance fund expenditures exceeding 550 million yuan, and another 25 items have not yet been included in the scope of medical insurance payment. Zhou Ying, director of the provincial medical insurance bureau, said that the provincial medical insurance bureau should carry out classified assessments, conduct key research and demonstrations on psychological treatment projects with heavy patient burdens, and promote their inclusion in the basic medical insurance payment scope.
"If the psychology department wants to develop in the long term, the key is how to make money." A psychiatrist at a secondary mental health center in the Yangtze River Delta bluntly said that compared with departments with more inpatients, psychological outpatient clinics have low profits. If they do too much, they may still lose money.
