"Anyone who goes to a psychiatrist ought to have his head examined." That line comes to mind in connection with a local friend of mine who has suffered for the past several years from clinical depression. His many trips to the doctors always end with the same prescription; a handful of "happy pills" and the advice to "be more active." My friend's acquaintances, but oddly enough not his family, have looked around for available outpatient therapy, support groups, or any other type of psychological help. What they have found is that basically there is no help available. His situation reflects the extremely undeveloped state of mental health care in this nation. That fact was highlighted in the wake of the 921 earthquake when there was a clear lack of mental health professionals available to treat the victims.
Taiwan simply does not have enough mental health professionals. As of 1997, there were 794 psychiatrists and 200 clinical psychologists. The psychiatrists are doctors who have specialized in the treatment of mental problems. The numbers are not a typo; you would expect more clinical psychologists than psychiatrists, but the reverse is true. For some unknown reason, clinical psychologists must be civil servants and have passed the civil service exam. Government regulation of the mental health profession is desirable but the civil service requirement is nonsensical. It puts an automatic cap on the number of available clinicians.
When the general public thinks of mental health treatment they generally think first and foremost of severe mental health problems but the reality is that such problems have a wide range of severity and forms. Like physical health, mental health is not an "either/or" condition. It is rather a continuum. The public often makes a false division between people with mental health problems and "normal" people. This is false. Depression, alcoholism, drug problems, phobias can and do strike "normal and regular" people. Some experts feel that with the erosion of traditional society and the stresses of everyday life in an increasingly competitive environment people may be experiencing mental health problems at a higher rate.
Thus there is a need not only for a greater number of mental health professionals but also for a greater range of approaches to treatment. There is a whole range of psychological theories which in turn give rise to a whole host of approaches to treatments. There are the classical schools of Freud and Jung; behaviorist approaches; cognitive approaches; group therapy; psychoanalysis; art and dance therapy; a host of treatment modalities. Few of these ap-proaches, however, are available in Taiwan. If they are, they are available on such a limited basis as to be of little practical help.
The solution to mental health care for any nation is to have available a wide range of treatment specialists. It is also important to have a sufficient number of mental health professionals available throughout the island. It does limited good, for example, to have 100 trained clinicians specialized in the treatment of alcoholism and have them all in Taipei. Simply put, they need to be spread over the island. Likewise it does little good to have the entire mental health care system staffed by behaviorists. Behaviorism works for some problems, for some people but not for others. The solution also involves acceptance of the idea that mental health problems are common. They can and do strike "normal" people, their symptoms may be severe and obvious, but they may not be.
It is time to increase Taiwan's mental health resources.
Brian Kennedy is an attorney who writes and teaches on criminal justice and human rights issues.
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