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A Mental Challenge

By Yin Pumin (Beijing Review)

08:45, October 08, 2011

Xu Wu, a former firefighter with the Wuhan Iron and Steel (Group) Corp. (WISCO), a state-owned steelmaker in central China's Hubei Province, finally returned to his family in early June.

The 43-year-old claimed he had been incorrectly diagnosed with paranoid personality disorder and kept in a psychiatric rehabilitation facility for more than four years. He insisted he had been sent to the facility because his employer wanted to punish him for his longstanding petitioning over a wage dispute.

On three occasions Xu was diagnosed with mental illness. Xu's parents said they were forced to sign an agreement to send their son to mandatory treatment, and entrusted lawyers and psychiatrists to evaluate Xu's condition in 2009, but were refused access to their son during that time.

On May 12, Xu was re-diagnosed by several prominent psychiatrists who said although he suffered from paranoia that did require treatment, he did not need involuntary hospitalization.

In recent years, repeated media reports about sane people misidentified as mentally ill have raised awareness and concern of the issue across China.

"In some cases, the police or the employer forced people to be mentally assessed, and then sent them to mental institutions," said Wang Xixin, a law professor at Peking University. "If this power is abused in some circumstances, any of us might be forced to undergo a psychiatric assessment."

In the past, disorganized procedures and low standards for mental hospital admission meant that virtually any company, neighborhood committee or individual could send somebody they suspected of being mentally ill to a hospital.

"I was shocked by the irrationality of current regulations and deeply worried about the drawbacks and loopholes that could be exploited to violate any citizen's basic rights," said Huang Xuetao, a lawyer at the Beijing Horizon Law Firm who has been working on the issue since 2006. "Hospitals are only responsible to those who pay the fees, and as long as they pay, patients might be stuck in there forever."

Believing few hospitalized patients represent a true danger to society, Huang favors a joint diagnosis of mental illness involving medical experts and judicial workers.

A long-awaited law

On June 10, the Legislative Affairs Office of the State Council published a draft for China's first Mental Health Law and started soliciting public comments. The proposed law came after 26 years of debate over how to frame mental health legislation.

"The complexity of mental illness and lack of diagnostic standards contribute to the challenges of legislation," said Yang Fude, President of Beijing Huilongguan Hospital, one of the best-equipped mental health institutions in China. Yang was involved in the drafting of the Mental Health Law.

Legislation on mental health has been a social focus for years. Thus the public debate on it covered many procedural details such as involuntary commitment and medical standards. According to Yang, the legislative goal, however, is always to protect the rights of mentally ill people and to standardize medical conduct.

There is already consensus among lawmakers that mental health lawmaking is both a legal and medical matter. From a medical point of view, the priority is to cure a mentally ill subject, no matter what it takes. From a legal point of view, the priority is to safeguard a patient's basic rights, to avoid violating individual rights, and to secure the safety of the surrounding people. These different objectives sometimes contradict, and leave the public and lawmakers with a hard choice.

"Rather than pushing forward the law in a hurry, legislators should do thorough research and have clear reasoning beforehand. The purpose of legislation is to better protect the rights of the patients," Yang said. "Legislation won't solve the current problems if the law is hard to apply."

The draft law sets rules on the diagnosis of mental illness and the involuntary treatment of mental health patients, stipulating except in legal circumstances, hospitals are prohibited from confining anyone with mental illness against their will.

The draft also states a patient or their guardians have the right to a second qualified opinion after a diagnosis. The second diagnosis must be carried out by two licensed psychiatrists. If the patient or their guardians still have doubts about the conclusion, they can apply for an assessment carried out by a forensic department qualified in identifying mental illness.

According to the draft, if a patient is diagnosed with no mental illness by a forensic department, no organization or individual is allowed to continue to confine the patient. In addition, if the hospital finds the patient's condition improves enough to cease involuntary treatment, it must immediately inform the patient and their guardians.

If a doctor considers a patient's discharge from hospital inappropriate, he or she should inform the patient or his guardians about the matter, record the notification details and provide technical advice if a patient or his guardians insist on a discharge.

The draft also stipulates mentally ill people who cannot pay or have difficulties paying for treatment will receive funding and help from the central and local governments.

It also states it is the responsibility of civil affairs authorities to send homeless people suspected of suffering mental disorders to mental health institutions.

The draft law establishes the rights of mental health patients, including the right to education, work, medical insurance, privacy and social assistance.

It also stipulates community health centers should provide facilities and venues to care for mentally ill people.

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