Doctor Tang Denghua opened the letter handed to him by a girl in her early 20s sitting before him - one of his dozens of patients he sees in a day at the Institute of Mental Health at Peking University.

He frowned after reading it. Distressing words filled the page. Tang, a psychiatrist specializing in the mental health of adolescents, knew too well the awkward and sticky situation he now faced.

The girl's note read: "Leaving the world forever is my biggest wish at present." After he'd finished reading it for the second time, his young patient spoke to him directly. She said: "The only way you can help me is to help me find a way of ending my life."

She told Tang she had been hiding her suicidal thoughts from her parents. Around the family home she pretended to be happy.

She gave an equally distressing explanation for her contradictional behavior.

She said she wanted to make sure her parents were relaxed and not watching over her too much. She believed this would create a window of opportunity to kill herself, to die.

Such desperate sadness is not unique. To Tang, the girl displayed the behavior and language of a typically depressed young person - one of many cases he encounters each day. Among the eight outpatients visiting him that morning, six were diagnosed as suffering from severe depression.

For these people, happiness for just plain contentment is alien emotions, and whatever they try to do to lift them from their despair, the pain and illness goes on.

Based on research carried out by Tang, nearly 10 percent of children and adolescents in China are inflicted with depression.

"Depression is the mental illness most strongly associated with suicide," Tang explains, "and 70 percent of this group develop the tendency to commit suicide."

Sufferers determined to kill themselves can be stopped if accompanied 24 hours a day, says Tang.

But the best method to combat the illness that leads to such drastic actions by the sufferer is public awareness that depression is an illness like any other.

Tackling the taboo

"Many people who develop depression do not recognize this as a mental illness," says Michael Phillips, executive director of the Beijing Suicide Research and Prevention Center. "They do not seek treatment or they feel too ashamed to seek treatment for a psychological problem. The failure to seek treatment leads to a large number of unnecessary suicides."

Compared with other mental diseases such a schizophrenia, depression is relatively easier to treat. So confident in successful treatment, psychiatrists now describe this once taboo illness "a mental cold."

"Current treatments for depression are quite effective," says Phillips, a Canadian physician who has been living in China for 20 years.

But other mental illnesses among children and adolescents are worrying.

Because of their concerns, Tang, Phillips and their colleagues are using the mental health of China's youth as the main theme on World Mental Health Day 2004.

The annual health awareness campaign organized by various mental health organizations around the world was started by the World Federation for Mental Health in 1992.

According to the data from Ministry of Public Health, at least 30 million children and adolescents aged 17 and below suffer some kind of emotional and behavior disorder.

They are mainly manifested in poor interpersonal relationships, mental stability and learning motivation.

The Institute of Mental Health at Peking University recently surveyed and analyzed college drop-outs from 16 colleges in Beijing during the past decade.

The researchers discovered that before 1982, the primary cause for students to forgo college education was infectious diseases such as Hepatitis B.

But after 1982, mental illness has been the major reason for long-term and permanent classroom absence.

The research also showed the percentage of mental disorder among children in Beijing has been rising steadily in recent years.

Tang blames the worsening mental health on a number of factors.

A major cause is parents' excessive care and lack of discipline for their children.

Tang said many parents have shielded their children from everyday, normal setbacks that help a young person develop into adults.

He said that many parents have also failed to help their children acquire the abilities necessary to enact self-discipline.

Internet addiction among students, which has attracted already much of the social attention, is also blamed.

"Parents should try to train their children to find the ability of self-control as early as possible," adds Tang.

Tang says society has not understood fully what causes depression or even more severe mental problems.

Most believe outside social pressure was responsible for the high number of suicide cases.

It has been reported time and again in the media that someone who committed suicide did do simply because of an unsuccessful relationship with a lover or pressure to achieve unattainable academic achievement.

"In my opinion, they are just one of the causes, but the social pressure that leads to suicide has been exaggerated," Tang says.

There are many factors, including pressure from social relationships but more likely, from a biological imbalance of chemicals in the brain.

"The biological cause is generally neglected, especially among cases involving the young," says Tang.

During the adolescent period, the endocrine system in the body goes through a great change. Sometimes, they might generate too much matter inhibiting the brain.

People suffering depression caused by biological changes in the brain can alleviate their symptoms by going to doctors and taking related prescription drugs, Tang says.

But there are not sufficient medical and consulting services to which students can turn for help in China, according to Phillips.

Neither is he satisfied with the situation of mental health consultation services available in colleges.

"The students are afraid of going to seek help from the mental-health staff in the school because it is highly possible that they would be forced to drop out of their studies if they are identified with certain mental disorders," says Phillips.

Role of volunteers

Psychiatry lessons are absolutely necessary for the students and they can help correct their attitudes towards their psychological crises, he says.

"Of course, school policies that are prejudiced against students with mental health problems must be changed," he added.

Phillips also argues there are frequent situations in which a "rapid response team" is needed to help manage a large-scale disaster or a major psychological trauma.

For example, suicides in schools can produce imitative suicides if not managed correctly.

Explosions, fires or other emergencies where multiple people die or are severely injured produce severe psychological trauma that unless dealt with promptly, can result in lifelong disability "This is better known as Post-traumatic Stress Disorder," Phillips explains.

Now Phillips and his colleagues are focusing their efforts on the training of "life goal-keeper" in the community.

They have already selected the first batch of volunteers from Beijing Normal University. They will undertake training in acquiring the necessary psychological crises management skills.

Phillips says the volunteers are not mental health professionals to deliver the mental therapies. They are an essential link in the chain of effective care. Volunteers are required to know how to talk in a correct and caring manner to people about their mental health.

(China Daily October 9, 2004)