Challenging Mental Health Stigma in Rural China: Interdisciplinary Insights

High prevalence of untreated mental illness (MI) in China is a pressing public health issue requiring systemic interventions. Amidst transformative economic growth, it is estimated that over 160 million Chinese people living with MI never received any treatments. In rural China, people with MI encounter even more pervasive stigma and discrimination than their urban counterparts because of tight-knit communities built on kinship and village networks. Ingrained traditional beliefs held by rural residents regarding the hereditary basis of MI result in high level of hostility and rejection towards people with severe MI, particularly those diagnosed with schizophrenia.

Although social work has been burgeoning as a profession in China, social work practitioners delivering mental health services are mostly concentrated in major cities. The lack of mental health resources puts the burden of patient caring on rural families, particularly when over 90% of people with schizophrenia live with their family members. This roundtable, led by researchers from an interdisciplinary team, will offer a dialogue on understanding stigma of MI from the experience of families as a core social unit. The discussion is informed by findings from a 21-year epidemiological-longitudinal study on the prevalence, course, and outcomes of mental illness, and a 3-year mixed-methods study on stigma in a rural county in southwestern China.

The first presenter practiced as a psychiatrist and has been conducting mental health research in China for 30 years as a public health and social work scholar. He will trace the developmental trajectory of mental health services in the changing socio-economic context of China, and summarize major findings of the 21-year study on treatment and outcomes of persons with MI including marriage, family caregiving, social functioning, poverty, and mortality.

The second presenter, a PhD candidate in social work, will explore internalized stigma in people with severe MI. She will present an integrative model to explain the relationships between internalized stigma and recovery-related factors (social support, social functioning, and symptom severity) in rural China. She will discuss how people with schizophrenia portrayed their experience of living with MI and responded to their stigmatized status as a community member.

The third presenter, a post-doctoral fellow in gerontology, conducted in-depth interviews with adult children with schizophrenia and their older-parent caregivers using the photo elicitation interviewing method. She will discuss how families in rural China experienced stigma, and the resulting psychological, emotional, and physical ramifications. She will offer recommendations on culturally-appropriate family-based interventions which could address affiliate stigma and caregiving burden.

The fourth presenter, a neuroscientist studying brain-based biomarkers that predict treatment adherence in patients and long-term behavioral changes in healthy participants, will discuss the application of neuroscience knowledge to design and evaluate educational strategies that could effectively change the stigmatizing attitudes held by healthcare providers towards patients with MI and their family members.

In concluding the roundtable session, the fifth presenter, a mental health services researcher, will synthesize the study findings and demonstrate how insights from different academic disciplines could contribute to mental health recovery in a family-centric cultural context.