By Claire Cardona
In an attempt to address the mental health of the country, China is drafting a national mental health law to protect the human rights of its citizens.
The current draft, made available for public viewing and comment on the Legislative Affairs of the State Council website June 10, would ban compulsory mental health screenings and would allow patients diagnosed with mental disorders to be discharged from the hospital at their discretion. Patients with serious diagnoses would require the consent of their doctor or guardian.
The proposed law represents a new direction for China, which some experts believe indicates increasing Western influence over Chinese practice of psychiatry. But the process of diagnosing and treating supposed mental disorders is still a contended issue.
“In the past several decades we have collected a lot of experiences in how to treat and diagnose the patients in a rational way and at the same time retain their human rights to the maximum extent,” said Dr. Zhuang Junpeng, a resident physician at Ruijin Hospital in Shanghai.
The draft law also lists the right to education, employment, medical insurance, privacy and basic human rights such as the freedom from discrimination, regardless of an individual’s mental health.
More than 100 million Chinese have been diagnosed with mental illness by doctors using the Chinese Criteria for Mental Disorders-III. Of that number, 16 million are considered severely ill, according to 2009 National Center for Mental Health statistics.
“The DSM also has very big influence in China,” said Shanghai-based psychiatrist Xu Yong, referring to the Diagnostic and Statistical Manual of Mental Disorders commonly used in countries like the U.S. and the U.K. “For a long time, treatment approaches for people with mental illness in China have predominantly used a hospital-based service model, and institutionalization and psychiatric and pharmacological treatment are mainly provided. The services delivered by clinical psychologists, social workers and occupational therapists are mostly unavailable.”
The law has been in the works and undergone more than 14 revisions since a group of psychiatrists began preparing it in 1985. If it is approved, the law will be the first of its kind in the country. Big cities like Shanghai and Beijing have local mental health regulations, but not so underdeveloped locations.
“Almost all people who face the screening reject it because they are ill and can’t control themselves so they reject everything,” said Li Sha, the deputy director of Shanghai Mental Health Center. “Sometimes we force them to do so but that’s because they’re really ill, but we have a very specific process.”
Li said the process involves doing checks and screenings multiple times before admitting a patient to the hospital. The individual’s diagnosis and mental state must be confirmed by the director, doctor and nurse, she said, to ensure they require treatment.
The diagnosis and treatment received in mental health hospitals is inevitably interconnected with the human rights issue, said Hu Zhitie, a human rights lawyer with Shanghai Mingqing Law Firm. Several people labeled as political dissenters have been hospitalized against their will as a form of containment, he said.
“The new law will be an improvement in the human rights of mental health patients,” Zhitie said. “They used to be forced by the government and hospitals to get screenings. This needs to change and the law is changing that.”
One of Zhitie’s clients was the victim of the forced screenings the new law aims to prevent. His client, whose identity is protected for anonymity, is currently negotiating compensation for an incident that led to his detainment in a local mental health clinic. The client was brought to the clinic when police broke up a quarrel between the man and an Internet café manager. Zhitie said his client was forced to stay in the clinic for a month against his will before being released.
Before economic reform, China was economically poor and the methods for dealing with those diagnosed with mental illnesses were oftentimes crude, Zhuang said. Because mental illness was considered taboo, families would confine their relatives who displayed any form of illness to the home so as not embarrass the family.
“Before we would treat this patient in a rude manner or hit them with a rod,” Zhuang said. “It’s not because we don’t care, it’s because we [were] poor and we [didn't] have the effective tools to treat him. It was the only way is to stop him from hurting others.”
Zhuang said this situation may still exist in the rural areas of China that lack proper facilities to treat mental illness, but the new law should help remedy this. The development of the law hints at the government’s awareness of the demand for mental health service.
“Chinese people experienced many fast and great changes of society, such as dissolution of social security, breakup of traditional family structure, the individual search for happiness, and therefore have to overtake much more psychological pressure than before,” Yong said. “The demand for mental health service is on the rise, as evidence by the increased utilization of both outpatient psychiatric and mental health counseling services and the tremendous popularity of hotlines and radio call-in programs.”
Xu attributed the change in China’s attitude toward mental illness to the influx of Western thought concerning counseling and psychotherapy for mental disorder patients, which did not previously exist in China.
“Many foreign counseling and psychotherapy experts visited China and developed and conducted workshops and short- or long-term training programs,” Xu said.
Zhuang said that in the past several decades, China has collected information on how to treat and diagnose patients in ways that retain their human rights—something they learned from the West.
“[The law] attracts so much attention because of intervention of Western culture,” Zhuang said. “More and more people know how the West deals with these issues and some Chinese people admit that for some aspects, Western society does a better job.
“We are walking a road the Western society already traveled.”