Rehabilitation in the Mental Health Law of the Peoplés Republic of China

Abstract

Mental health laws and acts usually have a long history behind them when they are eventually adopted. In most jurisdictions the time spent between initial discussions and drafts and the formal adoption of mental health legislation is not less than 10 years. Lesser regulatory instruments, such as ministerial decrees, orders of service and the like have a more immediate effect, although they tend to draw less attention and debate. In many cases the content of the law simply confirms and codifies the practice of mental health services as it existed over the extended period of drafting the law.[1] Things have not been different with the Mental Health Law of the Peoplés Republic of China,[2] recently adopted after more than 15 drafts and 20 years of debate. Although it will not come into force until May 2013, its influence could already be perceived in practice throughout China over the last decades because its successive drafts (or section of them) were de facto implemented by mental health authorities in diverse Chinese provinces. There are several innovative facets of China's new mental health law that deserve closer scrutiny, particularly the importance given to promotion and prevention, to psychological support as part of emergency response plans, and to rehabilitation. In this letter I would like to specifically draw attention to the section on rehabilitation, an area that is absent or, at best, minimally addressed in the mental health laws and acts of most high-income countries. Historically, mental health laws were primarily concerned with consent (i.e., regulations about involuntary admissions), and only gradually incorporated issues related to treatment of people with mental disorders. The implications of legal distinctions between admission and treatment (i.e., admission as a security measure or admission as a prerequisite for treatment) only became relevant after the Italian Psychiatric Reform with the adoption of Italian Law 180.[3] In the two large international reviews of mental health laws conducted under the aegis of the World Health Organization[4],[5] rehabilitation was not identified as a main topic for comparison across different jurisdictions. At most, a few progressive documents examined as part of the reviews had some provisions on social integration of persons with mental disorders.[5] However, in the Chinese Law, rehabilitation is one of its three major content sections, the other two being promotion and prevention, and diagnosis and treatment (the remaining sections are more procedural in nature). Article 54 through Article 59 in the law specifically addresses the provision of community-based rehabilitation to people with mental disorders and the provision of support to families of persons with mental disorders. The high degree of detail in these articles is uncommon in major national laws. For instance, in Article 54 the type of rehabilitative training required is specified: ‘training in life skills, social skills and other skills to persons with mental disorders who need rehabilitation.’ In line with the WHÓs position that ongoing treatment is an integral part of psychosocial rehabilitation,[ 6] Article 55 stipulates that as part of the rehabilitation of mental disorders ‘medical facilities shall provide maintenance treatment with basic psychiatric medications to persons with severe mental disorders.’ Psychosocial researchers and health managers might appreciate another part of Article 55, which establishes a health registry for people with severe mental disorders, a fundamental tool for research and management that is gradually being banned in high-income countries largely because of concerns about the potential infringement on individual rights. The second paragraph of the article encapsulates in a few lines a whole agenda for the appropriate integration of community mental health care into general health care, a dream for many mental health care activists. Finally, Article 58 rightly addresses the ultimate goal of a sound mental health rehabilitation program, namely, ‘suitable work for persons with mental disorders based on their actual capabilities.’ The article also highlights major issues that need to be addressed when organizing work for persons with mental disorders including ‘equal pay and equal treatment’, job training, improvement of the work environment, and rewarding work accomplishments. This emphasis on rehabilitation is in line with the importance China has placed on the so-called ‘secondgeneration human rights,’ that is, social, economic and cultural rights.[7] It is not known how much the expert committees and legislators who drafted China's mental health law benefited from the long history of mental health legislation in other countries. However, at the very least, in the area of legislation about the rehabilitation for people with mental disorders, other countries have a lot to benefit from a careful reading of the new Mental Health Law of the Peoplés Republic of China.