Some good news about the chaining of mentally ill patients in China, from the 686 Program

by Michael Woodhead
In recent years there have been several media articles about mentally ill people in China being chained up - usually by families - because there are no mental health services. 

The impression given by the articles is that this is a widespread practice and is going unchallenged. "This is an example of how mental disorders are dealt with in rural China" said The Independent. It is enlightening, therefore, to read that such practices are rare and have been targeted for elimination for more than a decade. In a sobering paper published in PLOS One this week, Dr Lili Guan and colleagues at the Peking University Institute of Mental Health talk abut the so-called 686 program that has been running since 2005 to provide basic mental health services and ensure human rights are upheld for people with severe mental disorders.

In their article they describe how they recruited village health workers across China to seek out and identify mentally ill people who had been chained up by families. Their program found 271 such people - some of whom had been in chains for 28 years, but most had been chained for shorter periods and intermittently as circumstances arose, rather than continuously. Cases of chaining were rare - accounting for only 0.2% of mental health patients reviewed in the program.

Most of the chained people had schizophrenia and none of them were receiving care from mental health institutions, usually because there were no such community services in their area, or the families could not afford it. The patients were restrained mostly because they were violent and abusive, causing harm to people and property.

The program of 'unlocking' was focused on providing free antipsychotic medications. Patients were first admitted to psychiatric units and assessed, and then families were provided with free medications and a treatment plan. The 'unlocked' patients were then returned home to live in the community.
The good news from the program is that regular treatment rates went from 1% to 75% and most patients complied with treatment and showed great improvements. Their functioning improved and the family burden also lightened significantly. Relapse into ''locking' occurred with only 21 patients (8%), with families citing lack of adherence to medication and return to violence or harmful behaviour and lack of caretaker/financial resources to access help.

"The finding that more than 92% of those unlocked and entered into continuous treatment by the 686 Program remained free of restraints by 2012 demonstrates the feasibility of improving the human rights of persons with severe mental illness by increasing access to mental health care in the community, even with limited societal resources," the researchers said.

"Nevertheless, the failure to prevent relocking for 21 individuals suggests that considerable room for improvement of our mental health care practice still exists."

The researchers also noted that their program covered less than 1% of the population of mentally ill people in China, and said it would require more resources to allow it to cover the whole country.

"There is obviously much to be done in China to scale up the 686 Program for the whole nation and to improve quality of care. This will require substantially increased investment in mental health services. However, the success of the program in maintaining the severely ill individuals in treatment over three to seven years, and the benefits of the intervention for those who have lived for years with untreated psychosis and for their families, attests to the feasibility and social value of the “686” model."

Authors note: Restraint for people with mental illness is not uncommon practice in  western countries, particularly for elderly people in nursing homes. Medical groups in countries such as Australia have expressed concern that patients who are agitated and have challenging behaviour are sometimes restrained due to lack of staff and for convenience, rather than for their own wellbeing.

Denial of medical treatment to government critics is "callous and calculating" - Amnesty

The Chinese government is using denial of medical treatment as a way of punishing critics, says Amnesty International, following the death of Cao Shunli in Beijing.
Ms Cao was a legal rights activist who was imprisoned for five months after trying to go to Geneva to attend a human rights training course. She died of organ failure on Friday at a hospital in Beijing, shortly after being released from five months in detention.Her family say authorities rejected repeated request for Cao Shunli to receive medical treatment for serious health problems. She had tuberculosis in both her lungs, cirrhosis of the liver and uterine fibroids.
Cao Shunli faced charges of “picking quarrels and making trouble” after organizing a sit-in protest along with other campaigners outside China’s Ministry of Foreign Affairs.
Amnesty said the Chinese government should allow all detainees to access medical care, and the case of denying it to Cao Shuni was reprehensible.
"Cao Shunli's death exposes just how callous and calculating the Chinese authorities are prepared to be to silence critics. The authorities today have blood on their hands." said Anu Kultalahti, China Researcher at Amnesty International.
"Cao Shunli was a courageous woman who paid the ultimate price for the fight for human rights in China.  She should have never been detained in the first place; but to then deny her the medical treatment she desperately needed is a most barbaric act.”
Her death has prompted criticism from the UK and US governments, but has not been reported in Chinese media. The Chinese government has made no comment on her case and blog and social media posts about Cao Shunli have been censored in China.

Eight medical stories from China you should read

by Michael Woodhead

1. Beijing will start to enforce new anti-smoking laws with 200 yuan on-the-spot fines (up from 10 yuan) for people who smoke in public indoor shared areas, and institutional fines of 30,000 yuan (up from 5000 yuan). Cameras will be used to compensate for the lack of enforcement officers, especially after hours, the city government says.

2. The Chinese government has been accused of withholding medical care from dissidents. An article by Sophie Richardson in the WSJ says civil rights campaigner Cao Shunli is now in intensive care because she was denied access to medical care while detained for her efforts to promote a civil society.

3. A link has been found between damp housing in Shanghai and rates of asthma in children. Researchers from the University of Shanghai for Science and Technology say asthma symptoms could be reduced by 25% by simply keeping a child's window open at night.

4. A vaccine against enterovirus 71 developed by Sinovac Biotech has proved effective against EV71-associated hand, foot, and mouth disease or herpangina in infants and young children, according to a study in 5000 children done by the Jiangsu Provincial Center for Disease Control and Prevention, published in the New England Journal of Medicine.

5. Eating shark fin is not only cruel and bad for the environment, it is also a health hazard because of high mercury levels in the product, researchers from Zhejiang have shown. After testing samples of shark fin they found that up to 33% contained toxic levels of mercury.

6. Antibiotics are widely overused by parents in rural China, with more than 60% dosing their children with antibiotics bought over the counter, Shanghai researchers have found. Most parents were ignorant about how antibiotics worked and had little idea hat they do not help viral infections.

7. Migrant workers have little access to healthcare and many of them put off seeing a doctor for illness, a survey in Shanghai has found. Two thirds of migrant workers said they had never had a medical check up and nearly 40% said they had ignored symptoms because they couldn't get to see a doctor.

8. Health workers in Guangdong have completed a successful pilot trial of a cervical cancer screening program using the ThinPrep cytological system. The program offered Pap test cancer screening to more than 40,000 women, and found that improvements are needed in basic education regarding cervical cancer screening for young and poorly educated women.

Hubei group protest forced psychiatric treatment of people without mental illness

People who complain against the government are being forced into mental institutions and given forced treatment with antipsychotics and electroconvulsive therapy, a human rights group in Hubei has told Radio Free Asia.. Liu Feiyue, a spokesman for the Civil Rights and Livelihood Watch says the psychiatric hospital system is being abused and there have been 40-50 cases of forced treatment of healthy people during 2013, in contravention of China's new Mental Health Law, which came into effect in 2013 but is not being implemented on the ground.

Psychiatric hospital used to detain outspoken professor, dissidents say

A law lecturer at Jiliang Universty Hangzhous was sent to a psychiatric institution after speaking about 1989

Authorities in the eastern Chinese province of Zhejiang have had an outspoken professor who talked to his students about the 1989 Tiananmen Square massacre forcibly committed to a psychiatric facility, rights groups and fellow activists said on Tuesday.
Professor Wang Peijian, who teaches at China Jiliang University in Hangzhou, initially resisted being forced into a psychiatric hospital by authorities for expressing “politically sensitive” opinions in class over the past few weeks, the China Human Rights Defenders (CHRD) said in an e-mailed statement.
Wang was informed by a school administrator on Dec. 7 that his classes would be suspended beginning the next day.
"Wang believed that this was because he had spoken to students about his views on, among other topics, the [ruling] Chinese Communist Party’s monopoly on power, the 1989 massacre around Tiananmen Square, and suppression of human rights lawyers," CHRD said.
Hangzhou-based writer Zan Aizong, who is a close friend of Wang's, said Wang had managed to evade psychiatric committal for a while by locking himself inside a room.
"Wang Peijian called me a number of times ... and he told me the school had contacted his brother to try to get him to go along with the school in having him taken to a mental hospital," Zan said.
Wang Peijian had also said that his comments to students that the ruling Communist Party should relinquish power had probably been reported by his students to the authorities, he added.
"The school thought he must be having a mental breakdown, or that his mood must be unstable, and that they should suspend his classes and have him taken to a psychiatric unit," Zan said.
The school's security personnel later succeeded in taking Wang to the No. 7 Hangzhou Psychiatric Hospital, according to sources close to the family.
Wang's brother, Wang Zhuangjian, said he was unable to manage the situation without help, and confirmed that he had collaborated with school security officials.
"Everything went pretty smoothly, with a minimum of physical resistance," he said. "We have already taken the measures most likely to protect my brother."
According to a post on the popular Sina Weibo microblogging service by Beijing-based legal scholar Teng Biao, Wang had been a founding member of the banned opposition China Democracy Party (CDP).
Trained in law, Wang had been refused a license to practice as a lawyer after he graduated and finished his law firm apprenticeship, Teng said.
"He had divorced a few months ago ... and was under huge psychological pressure," Teng's post said.
Chinese psychiatric patients are routinely subjected to abuse of their rights in a system that makes scant distinction between different kinds of mental illness, according to a recent report by CHRD.
While reports have become more widespread in recent years of the incarceration of rights activists and petitioners in psychiatric institutions for political reasons, genuine mental health patients are also highly vulnerable to abuses under the current system, the group said.
The report, titled "The Darkest Corners," detail the grim conditions and human rights abuses faced by people who are committed to psychiatric care against their will, even if they do not pose a demonstrable threat of harm to themselves or to others.
Source: Radio Free Asia