In recent years Taiwan has been growing increasingly aware of what countries that preceded it on the economic development continuum have long known – that the pressures of life in modern society inevitably take a serious psychological toll on some members of the population.
Compounding the problem, it can be difficult to assist those with severe mental disorders. As their cognitive functions deteriorate and they become more divorced from reality, they may not even realize they have a problem. And even if they recognize the need for psychological help, they may avoid seeking it out of paranoia or fear of being stigmatized. Others wind up in prison after committing crimes.
As part of a government plan to broaden Taiwan’s social safety net, the Ministry of Health and Welfare (MOHW) is now placing increased emphasis on mental health issues, especially for sufferers of psychosis and schizophrenia as well as attempted suicides. From May this year, responsibility for mental health programs – which previously had been combined with other medical specialties – was given over to a dedicated independent department.
“When there are people in society who need help and cannot help themselves, it’s the obligation of government to come to their aid,” says Dr. Shen Lih-jong, the Director-General of the ministry’s new Department of Mental Health. “When Taiwan was mainly an agricultural economy, there wasn’t much psychological pressure. Now that pressure begins when you’re a student and continues when you enter the working world.”
At the same time, the modernization process has eroded the system of family support that was traditionally central to Taiwanese culture.
Compared to the U.S. and Europe, Taiwan was a relative latecomer to the notion that government should take the lead in looking after the mentally distressed. Yet that lag meant that Taiwan did not have to start from square one in devising its strategy. “It’s given us models to refer to in setting our policies,” says Dr. Shen. After studying the relative virtues of the systems in numerous advanced countries, MOHW has embarked on a plan to establish 71 community mental health centers around the island within the next four years and 100 in 10 years. So far, 20 are in operation.
The centers operate on a case-management system. “While hospitals are passive, waiting for patients to come to them, we need to engage in active outreach to help people who won’t seek help on their own,” explains Dr. Shen. The case managers assist the patients in connecting with available resources – medication for those who need it, lodging for the homeless, psychological counseling, assistance in finding a job for those able to work, financial aid for the destitute, and other social welfare services.
Anti-psychotic drugs can be very effective in controlling mental disorders, Dr. Shen says, but the traditional oral medications must be ingested daily, and many patients forget or purposely neglect to follow that regimen. Now available, but more expensive, are slow-release injectable medications that remain effective for several months at a time. The Director-General expressed hope that budget will be provided to enable to injection program to be considerably expanded.
When fully staffed, the network of community mental health centers will employ around 3,000 professionals, including case managers, social workers, nurses, rehabilitation therapists, and psychologists. Provided that sufficient budget is appropriated, Dr. Shen is confident that the hiring goals can be met. Although Taiwan had few psychologists and psychiatrists a generation ago, he notes, many have been trained over the past decades.
The goal of the program is to help as many mental patients as possible to recover – or at least stabilize their condition and be able to live satisfactorily within the community and be accepted by their neighbors. The advent of telemedicine will enable case managers to extend their reach. “Face-to-face visits are always preferable,” says Dr. Shen. “Over the internet you can’t tell whether a person has a bad body odor, you can’t see their living environment, and it’s harder to make a personal connection. But if you can reach people in the mountains or other remote areas that you wouldn’t see otherwise, or those who insist on more privacy, it’s a blessing.”
Dr. Tsai Chang-jer, president of the Taiwanese Society of Psychiatry, sees the need for additional steps to increase public awareness of mental illness, including adoption of a mandatory course on the subject for all upper-grade primary school and high school students to help reduce the stigma attached to the disease and gradually make mental patients more accepted by the community. “The widespread phenomenon toward the mentally ill of ‘not-in-my-backyard’ must be overcome through greater public understanding,” he says.
Longer term, Dr. Shen hopes the government will not merely provide assistance to the mentally ill but devote more resources to promoting a healthy lifestyle for all citizens, especially for young people, to help them develop positive lifelong interests. “We need to encourage everyone to engage in healthy activities like sports and other forms of exercise, music, mountain climbing, bicycling, and dancing,” he suggests. “That’s the way to build up more resilience to stress.”
Message from Johnson & Johnson.