The proposed national mental health law in China: a landmark document for the protection of psychiatric patients' civil rights

The draft National Mental Health Law of China was released for public consultations on June 10, 2011[1]. Following wide-ranging public consultations, the draft was further amended by the Standing Committee of the National People's Congress on October 24, 2011[2],[3]. Although the penultimate draft has been finalized, there are continuous debates and concerns about its potential negative effects on mental health services in China. The article in this issue of the Shanghai Archives of Psychiatry by Professor Xie[4] argues that the proposed law over-emphasizes patient's self-sufficiency and, thus, neglects traditional Chinese culture, accepted practices of mental health care in the country, and the insufficient community resources for providing mental health services; he contends that these weaknesses in the law will lead to a number of undesirable consequences[4]. Professor Xie's concerns reflect the negative attitudes about the law of a considerable number of mental health professionals in China who assume that the strong emphasis on the protection of the rights of psychiatric patients will restrict clinician's treatment options. Our views about the draft National Mental Health Law, which we briefly summarize below, are different.

According to the United Nations Charter and relevant international treaties, the recognition of the human rights of psychiatric patients should be the fundamental basis for any mental health legislation[5]. China's proposed national law conforms to this basic international principle. It aims to promote mental health, improve the quality of mental health services, and protect the human rights of psychiatric patients during the process of hospital admission, treatment, and discharge[2].

There are an estimated 173 million Chinese citizens suffering from diagnosable psychiatric disorders[6]. But there are only about 20,000 psychiatrists in the county, most of whom work in specialized psychiatric hospitals in urban areas[7]. Given the inadequate number of psychiatrists, current hospital-based mental health services cannot meet the needs for all mentally ill individuals, so it is necessary to focus the limited institutional resources on patients at risk of violence to self or others. The most recent draft of the new law states that psychiatric hospitalization should be voluntary, but in cases where the patient is adjudged to be at risk of violence to self or others a guardian can initiate compulsory admission (Article 26) [2]. The draft law aims to provide appropriate protections of patients' human rights during the process of involuntary commitment. Professor Xie's article[4] states that this process goes against traditional Chinese cultural values that emphasize the responsibility of family members to coordinate the health care for ill family members. The latest draft of the law recognizes this important role of the family while protecting patients' civil rights; it stipulates that guardians (primarily family members) have the right to provide the consent for treatment if the patient lack insight (Article 35) [2].

Local mental health regulations have already been adopted and implemented for several years in six major Chinese cities: Beijing, Shanghai, Hangzhou, Wuhan, Ningbo and Wuxi. Professor Xie mentioned the apparent success of the Shanghai Municipality Regulations on Mental Health in dealing with involuntary hospitalization but, given the great diversity across the country in terms of population density, ethnicity, culture, geographic features, language and socioeconomic development, we are not sure that the Shanghai experiences can be applied to the whole country.

In recent years the importance of community mental health services in China has gradually been recognized. Both the central and local governments have begun to adopted policies that fund community mental health services, promote regular mental health training for community-based primary care providers, and reduce the financial burden on patients and their families. One important step was the initiation of a national community-based psychiatric service delivery model (the “686” project) in 2004 that integrated the resources of psychiatric hospitals and existing community health systems with the aim of training a core group of mental health professionals in community-based case management techniques[8]. By December 2010, the program covered 330 million people in 160 cities; a total of 270 506 patients with severe psychiatric disorders were registered and 181 990 of them considered at a high risk of violence received rehabilitation services and regular follow-ups[8],[9]. Another important step is the 2005 decision to cover most of the newer antipsychotic medications as part of the basic health insurance package. Given the rapid development of psychiatric outreach services and the rapid integration of a national network of community mental health services, it is expected that more and more individuals with mental health problems who are not willing to be hospitalized will be able to receive appropriate care in the community.

During the past decades both the international and local media have reported human rights violations in psychiatric hospitals in China, particularly in reference to involuntary admission[10]. Despite its limitations[3], the latest draft of China's National Mental Health Law is a great step forward in the protection of psychiatric patients' civil rights.