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Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World
apy stations, guardianship networks, walk-in clinics, psychological counseling facilities, and telephone hotlines. Research has demonstrated that the factory and family methods have reduced symptoms, dysfunction, and hospitalization, and are cost-effective. A parallel family program in Hubei Province has demonstrated in a clinical trial that if it were generalized to the nation as a whole, it would save as much money as is currently spent on all mental health services for the chronically mentally ill in China.
Yet these model local demonstration projects have never been generalized to China as a whole. And in the current era of economic reforms, it is uncertain whether these programs can survive. Failing state industries are reluctant to accept rehabilitated patients back to their work site; psychiatric hospitals, now faced with declining occupancy owing to prices that patients and work units can no longer afford, are less interested in rehabilitating patients; and funding is drying up for community services. Because the Shanghai and other programs have proven so successful that they are models for other developing societies, their decline as an unintended consequence of China's return to the market would represent a terrible loss.
A common denominator in the great variety of situations and systems of care for people afflicted with psychotic illnesses in the developing world is that the modest successes achieved in many countries are increasingly vulnerable to the local repercussions of economic globalization. In all societies, including developing countries, the stigma surrounding mental illness is likely to mean that people with severe mental disorders are the first and most seriously disadvantaged by shrinking government health expenditures. Thus it is imperative to initiate on an international scale proactive measures designed to forestall such developments.
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