Students cope when dark clouds gather
Course aims to identify signs of mental illness
Jin Jin, a psychiatrist, posed this question to a group of adult students during a course on mental health in Shanghai: When talking to people suspected of having severe depression, should we ask them whether they can accept the idea of suicide or not?
Depression comes with a suicide rate of more than 15 percent — the highest among all common mental health disorders. Also, about 60 percent of those who commit suicide have the disorder, Jin said.
In answer to the question, most students said “no”, but Jin said they should have replied “yes”.
“Such a question won’t induce people to commit suicide if they don’t plan to do so. But for those who already have the idea, we should encourage them to voice their feelings and help prevent such tragedies from happening,” said Jin, a psychiatrist with the Shanghai Mental Health Center.
Basically, people with suicidal tendencies do not commit the act suddenly. Instead, they exhibit signs and symptoms from an early stage. The key is whether there are people around who can spot such signs and take measures in advance, Jin said.
She was speaking during the Mental Health First Aid course, which originated in Australia and aims to help identify those who have signs of mental illness and assist people with suicidal tendencies.
Nearly 30 people took part in the course late last month. The participants included human resources managers, medical workers and individuals with mental disorders, or who have family members with such conditions.
He Yanling, chief psychiatrist at the Shanghai Mental Health Center, said, “There is a ‘golden time period’ to treat physical diseases, which will help increase the survival rate ... It is the same regarding mental health.”
Such treatment is important as the incidence of such disorders is higher than most people imagine, He said.
The Shanghai center collaborated with the Mental Health Association of Hong Kong to introduce the course to the Chinese mainland for the first time.
Services available
Epidemiological surveys on the mainland show that about one in six people experience a mental disorder at least once. In 2017, the morbidity rates for depression and anxiety were nearly 4 percent and 5 percent, respectively, the surveys found.
“Many people do not realize they have mental disorders, or hesitate in seeking medical assistance for various reasons, including the stigma traditionally attached to mental illness,” He said.
Wang Rui, senior director of the China branch of the CEO Roundtable on Cancer, a United States NGO, said it is considering promoting the course, which has been taken by 1.7 million people in 23 countries and regions, to other areas of China.
The NGO is committed to helping employers provide a healthy work environment for staff members.
Mental health medical services are available in nearly all cities nationwide, and many of them, including Beijing, Shanghai, Dalian in Liaoning province, and Zhongshan in Guangdong province, have provided residents with 24-hour psychological counseling hotlines.
But experts said hotlines are seldom used, as most Chinese are not used to confiding in strangers.
Instructors on the course stressed that it was not designed to train beginners as professional psychiatrists, but was aimed at equipping them with the skills to help those with mental problems.
“Through the two-day course, they will be able to generally identify such people. Before providing them with professional assistance, they can get to understand the mental state of the person concerned through nonjudgmental listening, and help to prevent the condition from deteriorating,” He said.
Instructors encouraged the students to ask those who they help, in a straightforward way, if they had thought of committing suicide. They must also ask those they help if they have ever abused alcohol or drugs — two factors that increase the suicide risk.
Jin said, “If people are taking alcohol or drugs, we should persuade them to stop. We should not leave them alone, and should remove any knives and ropes from their surroundings.”
The key to getting honest answers from those with depression, who are usually reluctant to talk, is to listen and communicate nonjudgmentally — to respect their ideas rather than negate their feelings.
Jin said responses such as “How could you think that way?” or “You will destroy your life” will put a stop to any form of communication. Only open-ended questions, such as “What makes you think like that?”, may encourage those with depression to continue talking.
One of those taking the course, a human resources manager at a foreign company, said the content was extremely helpful, as just days before he took the course, an employee at the company sent a text message to a colleague stating that she wanted to die. The manager was responsible for dealing with the issue.
Another participant, Xu Liang, senior manager with the environment, health, safety and facility department at pharmaceutical company Bristol-Myers Squibb China, said such courses are essential, as mental health is still a relatively new concept compared with physical health.
“Many of our employees are familiar with coping with cuts, scalds and even with using portable devices to treat sudden cardiac arrest through defibrillation, but most people don’t fully understand mental conditions,” he said.
‘Cold in the brain’
Instructors also asked the students that if they had to experience any kind of disease, either physically or mentally, how would they cope?
Nearly 90 percent of the students chose physical illness.
A middle-aged nurse in an orthopedic department said she would rather have severe multiple fractures than a mental illness, as she would know where to get medical treatment and would be confident of recovering from broken bones, but had no idea how she would cope with a mental condition.
Jin said such results showed that people lack knowledge of mental disorders and may misunderstand them — for example, that they are incurable.
But experts said that for most mental illnesses, if patients receive standardized treatment as early as possible and take medication under doctors’ advice, they can gradually recover and continue with their daily lives and work.
“Depression is like a cold in the brain,” Jin said.
“People will recover from a cold, but nobody can guarantee that they will never catch a cold again. It is the same with ‘the cold in the brain’, and severe depression can be lethal, just like severe flu or pneumonia.”
Experts said a series of issues can trigger anxiety or depression. These include romantic disappointment when people are in their 20s, a career crisis in their 30s and health problems in their 40s, as well as financial tension, prolonged physical illness and loss of family members. But the decisive factors can be hormone changes, brain disorders and genetic reasons.
Zhang Yanhua, a psychiatrist at Jiading District Mental Health Center in Shanghai, said, “It explains why almost everyone is confronted with frustrations and failures, but most can recover emotionally and rebuild their confidence in the future.”
A key factor in diagnosing depression and anxiety is that the symptoms are severe, last for two weeks or more and affect daily life and interpersonal relationships, Zhang said.
The main symptoms of depression include “feeling down” and losing enthusiasm for key interests. Those for anxiety include excessive concern over something that is about to happen, or feeling panicked on a particular occasion, she said.
“Therefore, standardized medical treatment for a mental disorder occurring for the first time is crucial,” Zhang said.
However, doctors said a low number of those with mental disorders seek medical treatment, as some feel ashamed to have such conditions and doubt the effectiveness of assistance.
Only 10 percent of patients with depression seek treatment, He said.
Jin said, “I once received a teenage patient with depression who was finally sent for medical advice after attempting suicide multiple times.”
The acceptance of professional medical treatment among people in big cities is far greater than those from small, remote areas, Jin added.