Chinese Medicine as First-Line Treatment for Subthreshold Mental Disorders in Primary Care: Opportunities and Challenges

Subthreshold mental disorders (SMDs), characterized by clusters of psychiatric symptoms that do not meet the criteria for a formal diagnosis yet are sufficiently severe to impair daily functioning. SMDs exhibit a high prevalence and an elevated risk of progression to diagnosed disorders and impose a substantial socioeconomic burden. Despite their significant impact, SMDs often go overlooked and untreated due to a global shortage of mental health professionals and stigmatization associated with conventional psychological and psychiatric treatments. This perspective advocates the integration of Chinese medicine (CM) as a first-line treatment for SMDs in primary care settings. Emerging evidence has shown that CM treatments, including acupuncture, herbal medicine, and other modalities, can be effective in managing various mental disorders. Systematic reviews have shown that herbal medicine not only has fewer side effects compared to psychotropic medications but also reduces adverse effects when used as adjunctive therapy. The potential benefits of using CM include mitigating the shortage of mental health professionals by supplementing primary care, preventing the exacerbation of SMDs, alleviating workforce shortages, and offering a less stigmatized, cost-effective option that could improve help-seeking behaviors. However, challenges such as lack of recognition, insufficient collaboration between CM and mental health specialists, and differing theoretical frameworks hinder its integration into primary care in the mental health care field. Addressing these challenges will require public education, robust research evidence, policy changes, and the development of collaborative frameworks. This study highlights the need for greater recognition and integration of CM as a viable first-line treatment for the management of SMDs within primary care settings.