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On October 26, 2012, after three readings by the National People’s Congress, China’s top legislature, the law finally passed. It states that mental health examinations and treatment must be conducted on a voluntary basis, unless a person is considered a danger to himself or others. Only psychiatrists will have the authority to commit people to hospitals for treatment, and treatment may be compulsory only for patients diagnosed with a severe mental illnesses. Significantly, the law gives people who feel they have been unnecessarily admitted into mental health facilities the right to appeal.
The law was first drafted in 1985 and the draft had been repeatedly revised before it was released online on June 10 to seek public feedback.
“It is a big legal step forward to protect the human rights of patients and I hope it can be put into practice soon,” blogged Huang Xuetao, a lawyer in Shenzhen, south China’s Guangdong Province, after the draft was released. Since 2006, Huang has devoted herself to defending the rights of people victimized through compulsory inpatient treatment for wrongfully diagnosed mental illnesses.
The law gap
Thirty-year-old Zou Yijun was forcibly committed by her brother and mother to the Baiyun Institute of Psychology in Guangzhou, Guangdong, in October 2006.
Though Zou claimed that she was healthy and was wrongly hospitalized, she was under 24-hour supervision in the mental hospital. Her cellphone was confiscated and she was injected with drugs against her will almost every day. Zou managed to contact Huang who agreed to take her case pro bono.
It was the first time for Huang to deal with such a case. She went to the hospital asking to meet Zou, but was denied. Huang then turned to the media for help and finally, with much legal wrangling and media exposure, Zou was released after three months.
In the background of the legal proceedings, Huang witnessed the deplorable conditions of China’s mental healthcare system and subsequently dedicated herself to providing legal aid to people like Zou.
According to the statistics from the Ministry of Health, about 100 million people in China need mental healthcare and among them, 16 million people are suffering from serious mental problems. Mental illness accounts for 20 percent of all diseases in the country and has become a serious threat to public health. The ratio is expected to rise to 25 percent by 2020.
Huang found out that Zou is definitely not the only person to have been treated with unnecessary compulsory therapies for nonexistent mental illness. In 1995, Chen Miaosheng, a former employee of a Beijing unit of Sinopec, China’s largest state-owned oil refiner, was sent to a mental hospital by his employer, who said Chen was unstable. Chen remained institutionalized for 13 years until his death at the age of 65 in 2008. Chen’s wife sued, but the court found Sinopec not guilty.
What Huang couldn’t understand in the beginning was that how come a law on mental health should go so long unratified?
Ma Li, a member of the Mental Health Law research team, said years ago that the lawmaking process had been prolonged not because regulations were difficult to constitute, but because the government couldn’t guarantee enough money to enforce them.
“Most general hospitals do not have clinics specializing in mental illnesses and many medical workers, other than psychiatrists and psychologists, lack awareness and fail to effectively identify symptoms of mental disorders,” Ma said. “Besides, China only has about 20,000 registered psychiatrists, or 15 psychiatrists for every 1 million sufferers. The number of mental health institutions and doctors lags far behind actual need. All of this needs heavy government investment.”
In 2008, Huang, together with other experts in this field, started researching more than 100 cases of forced psychiatric treatment as well as 30 laws and regulations on this subject. In October 2010, they released a report based on the study, revealing the urgency of making changes to the current mental healthcare system.
Based on the research, Huang said that the reason for the law not being formed was not just a simple matter of money. “It estimated that all these problems can be solved with an investment of 3 billion yuan ($480 million),”Huang said. “It is not a heavy burden on the government. There are many other factors to halt the passing of the law.”
Huang listed the other reasons including social discrimination on people with mental problems and the lack of well-trained psychiatrists.
“Mental problems haven’t received as much attention as physical problems. Inevitably some people working in this field are not so qualified. This cannot be changed within a short period,” Huang said.
Many people claiming to have been forcibly treated for nonexistent mental illnesses are institutionalized by family members. Li Renbing, a lawyer at the Sino Promise Law Firm in Beijing, revealed that in many cases, they do this over financial disputes.
Chen Guoming, a former gold store owner, was forced into a mental hospital in 2011 by his wife and locked up for 56 days. When he was released, he found his wife had transferred nearly 800,000 yuan ($128,109) from his bank account and taken all of the jewelry in his store. “The same happened to many other victims and the mental hospitals tend to believe the family members. We can’t deny making profits is another reason for the hospitals to admit them,” Li said.
Li said that there are no limits placed on the number of patients that mental hospitals can receive, so they can easily profit from falsely diagnosing healthy people with mental illnesses and receiving them for compulsory treatment.
“The loopholes in current system made compulsory mental health treatment ripe for abuse,”Huang said. “Under that system, there is no standard verification for sending a person to a mental hospital for forceful treatment provided he or she is accused of having a serious mental illness. Those who forcibly sent their family members to mental hospitals just take advantage of this.”
A step forward
The new law grants mental health patients rights to education, work, medical insurance, privacy and social assistance. It states that tests must be carried out only at the discretion of the patient or their guardian, and people who have recovered from illness can be discharged from hospitals at their discretion.
Under the law, every mental illness diagnosis should be made by a qualified psychiatrist. Patients and their relatives can seek a second opinion from another professional, and if they still disagree with the diagnosis, they can turn to another qualified medical institution for verification.
To cope with such a situation, the law requires general hospitals to train medical workers to perform basic psychiatric evaluations, and sets up mental illness clinics under the guidance of government health departments.
“Patients who go to general hospitals may have both physical and mental illnesses. If hospitals provide a better psychiatric service, they will be treated properly and promptly and valuable medical resources will not be wasted with inappropriate therapy,” said Wang Shaoli, Vice President of Beijing Huilongguan Hospital, a leading psychiatric hospital in the country, in an interview with Xinhua News Agency.
The law includes a provision asking the government to provide a special allowance for medical workers at mental health institutions, as their work is of high risk and their incomes are relatively low. This has been widely welcomed by psychiatrists. They have also called for more investment in education.
“With this law, there will be clear nationwide procedures to appeal involuntary institutionalization,” said Liu Xiehe, one of the drafters of the Mental Health Law who is also a doctor at West China Hospital affiliated to Sichuan University. “But it fails to address the power of the police in the mental health industry, and it doesn’t state clearly what to do if the guardians have different ideas in sending the patients for tests.”
According to Huang, a few other regulations in the law may also trigger controversies.“It says psychological consultants don’t have the right to make diagnoses, only certificated psychiatrists have such a right. It is very confusing as it is hard to distinguish between consulting and diagnosing,” Huang said.
Huang admits that it is impossible for the law alone to eliminate malpractice regarding hospitalization. “Besides the law, we need well-designed medical protocols and strict implementation of laws and protocols,” she said.