A HAPPY GROUND: Mental patients exercise outdoors at the Gaoxin District People's Hospital in Weifang City, east China's Shandong Province, on October 7, 2012 (SUN SHUBAO)

According to Wang Shaoli, Vice President of the Beijing Huilongguan Hospital, a leading psychiatric hospital, of the mentally ill patients with severe conditions, 10-20 percent are prone to attacking others or harming themselves if not treated properly.

"Of the 16 million severe cases around the country, more than 70 percent were never institutionalized for proper treatment," Wang said.

Beijing is believed to have some of the best resources for the mentally ill in China, but even there the problem is severe.

According to the Beijing Municipal Health Bureau, the capital alone has 71,000 people registered as suffering from mental illness, among whom 63,000 are patients with severe conditions. However, there are only 26 specific institutions for mental health with 9,888 beds and 1,105 professional psychiatrists.

"Beds are always full here. Sometimes patients find it hard to make bookings for treatment at the hospital," said Jiang Hongfang, an official at Beijing Anding Hospital, one of the most famous mental care facilities in the country.

While there are many patients with mental diseases waiting to be treated, the problem is exacerbated by patients unwilling to leave once treatment has been completed.

"There are some 800 patients suffering from a mental illness in the hospital, of which more than 100 have been here for more than five years, with the longest 20 years," Jiang said. However, most mentally ill patients only need about three months to resolve their symptoms.

According to China's Mental Health Law, which became effective on May 1, hospitals cannot force patients with a mental illness to leave without their consent or that of a relative.

"After spending time here, some lack confidence and are scared to face their normal lives even though they have been cured. So they choose to stay here, causing a waste of medical resources," Jiang said.

Community treatment

In the wake of the fatal assaults in July, the Beijing Municipal Health Bureau is working with other government agencies on a community-based rehabilitation scheme that covers long-term medication and nursing care for patients who are not institutionalized.

"Compared to in-patient treatment at hospitals, most of the mentally ill spend more time in the community and at home. So it is important to build a community-based treatment system to monitor patients who are not institutionalized," said Guo with the Beijing Municipal Mental Health Maintenance Institute.

Tang Hongyu, Deputy Director of the Institute of Mental Health affiliated to Peking University, believes that community-based treatment for the mentally ill is a general trend.

"Not all of the country's 16 million patients with severe mental illnesses need in-patient treatment. It's enough for some to be treated and managed within communities," Tang said. When patients are discharged, community healthcare centers are supposed to get in touch, set up a health profile and pay regular visits to monitor their condition.

However, recent attacks committed by the mentally ill indicate that there is still room for improvement.

Wang Tao, Director of the Department of Community Treatment of the Dongcheng District Mental Health Maintenance Institute of Beijing, said that problems often happen during regular visits.

"Families of the mentally ill are sensitive. They are often reluctant to give their information, and even worse, refuse to accept the visits," Wang said.

Zhang Na, a doctor at Huilongguan Community Healthcare Center in Beijing's Changping District, has encountered similar issues.

"We have drawn up profiles for more than 300 people in our community, with about 50, including their family members, refusing our regular visits," Zhang said.

Zhang said such reluctance comes from the stigma attached to mental illness. Patients don't want others to know about their condition, she added.

Yang Lei, a doctor at Peking University Sixth Hospital, a mental health facility in Beijing, said that among the patients who returned to his hospital due to relapse, hardly any were visited by community health workers.

"These patients may have avoided such services, but on the other hand, sometimes community health workers do not have enough energy for the job," he said. "There are communities where a health worker has to track hundreds of mental health patients."

However, today's community-based services are still limited in delivering knowledge about medication use. "Without professional trainings, it's impossible for the patients to really re-engage in the society," Wang said.

According to him, the employment rate for recovered mentally ill patients is only 15 percent. "A large group of these idle around all day long. This situation increases the possibility of incident," he said.

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