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By Elizabeth M. Lynch, July 24, 2013

Over at the new blog – China Law Translate – Jeremy Daum has translated two recent mainland articles about individuals with mental illness and the impact of China’ new Mental Health Law (articles are here and here). 

On October 26, 2012, after working on a draft law for close to 27 years, China finally passed its first Mental Health Law; that law took effect on May 1, 2013.  Unfortunately, much of the focus of the foreign press about the new law has largely been on the changes to involuntary commitment and whether those changes will reduce the threat that political dissidents  will be wrongfully and involuntarily committed.  What’s been less of a focus has been the law’s impact on its actual target audience: those with diminished mental capacity. 

And that’s why Daum’s two translations – both recently published articles from the Chinese pres s – are interesting.  Both focus on the plight of the mentally ill.  Both examine the all too prevalent practice of caging severely mentally ill individuals. 

The pictures that accompany the articles – photos of individuals chained and in cages, some of whom are stark naked – are shocking to say the least.  And it would be easy to conclude that this reflects the callousness of a culture toward the mentally ill.  But nothing could be further from the truth – if anything, the caging of these individuals is a result of the dire situation of mental health care in China, especially in the rural areas. 

In “Cage People,” the Chinese reporter estimates that in Hebei Province alone 100,000 severely mentally ill individuals (usually considered people with schizophrenia, bi-polar disorder, etc.) are kept in cages as their only form of treatment.  Although the reporter gives no citation for this number (thus use this number with caution), the use of restraints and cages has been well documented in other sources.  In a 2011 World Psychiatry article entitled Mental Health System in China: History, Recent Service Reform and Future Challenges which examined China’s first experimental national mental health program – known as 686 Program and adopted in 2004 – the authors note the need for the program to include support for unlocking and freeing mentally ill individuals and finding treatment for them.

Lack of Mental Health Professionals

More than anything, this caging is a last resort in a system that has provided little financial support and few specialists in mental health.  China estimates that over 100 million people suffer from some form of mental illness; 16 million of those suffer from severe mental illness.  According to Mental Health System in China, China only has 16,103 licensed psychiatrists and 24,793 licensed psychiatric nurses;  in other words, 1.24 licensed psychiatrists for every 100,000 people and 1.91 licensed psychiatric nurses for every 100,000 people.  China is far below the  global average, where there are 4.15 psychiatrists and 12.97 psychiatric nurses per 100,000 people.  Id.  As a result, it’s not surprising that 91.8% of all the mentally ill in China never seek help.  For those with severe mental illness, 27.6% never receive any type of help and 12.0% of the severely mentally ill only visited non-mental health professionals.  Id.  

Social workers, who are key in a community-based mental health care system, are few in China.  However, China is rapidly expanding its program, with the goal of training 3 million social workers by 2020.  See Renne C. Lee, UH Aids China in the Developing Social Work Profession, Houston Chronicle (Mar. 4, 2013).

Disparities between Urban and Rural Life in China – extends to mental health care

Disparity Between Rural and Urban Areas

But what makes that shortage even worse is that since the economic reforms, there has been a brain drain from the rural clinics to more profitable hospitals in the urban areas.  See Yanzhong Huang, The Sick Man of Asia, Foreign Affairs (November/December 2011).  Even though the Chinese government has recognized the need to institute a community-based care model for mental illness, where patients are not all hospitalized but instead are treated while remaining in the community, the Chinese government still expends much of its resources on psychiatric hospitals.  See Mental Health System in China.  This inherently means that money will flow to the urban areas. 

Lack of Adequate Insurance and Funding to Rural Health Care Services

Finally, even with the reforms of health care funding, especially in the rural areas, mental health care is still too expensive for many Chinese.  According to WHO, only 2.35% of China’s total health budget is spent on mental health (in the U.S. 5.6% of the national health care spending is on mental health – see Washington Post article);  as of 2011, less than 15% of China’s population had insurance which covered mental health (although 45% of US mental health patients cite cost as a major burden).  See Mental Health System in China. 

Due to these factors, many severely mentally ill in the rural areas have only their families to take care of them.  With little to no treatment, these families sit by while their relatives’ illness only gets worse.  As a last resort, these families resort to restraints, not because they want to but because they have no choice. 

Does the Mental Health Law Change the Current Situation?

Chapter IV of the Mental Health Law– “Rehabilitation from Mental Disorders” – creates a community based model of care which should limit

All for One, One for All – Community Based Mental Health Services

hospitalization to only necessary situations.  This type of model allows those with diminished capacity to be integrated into society and is in line with China’s commitments under the Convention on the Rights of Persons with Disabilities (which China has ratified and the U.S. still has not).  Rural and village governments are required to assist those families obtain the services they need.  This assistance includes financial assistance. 

Unfortunately, the law leaves the funding of what could be a useful framework to the local areas.  For already impoverished villages, they just don’t have the resources to carry out their responsibilities.  As Daum’s translation of “The Need to Promote the Mental Health Law” demonstrates, even when families apply for their legal mandated “Minimum Subsistence Allowances,” the local fund is often inadequate and does not enable them to seek the medical help their relative needs; there will still be out of pocket costs that are too high for many villagers.   

As Huang Xuetao, a lawyer at the Equal Justice Initiative, noted in the article, the hopeful prospects of the Mental Health Law are diminished by three things: (1) the lack of education to the people about the protections of the new law; (2) the lack of funding for mental health care and (3) the government’s  lack of attention to the matter. 

Until those factors change, especially the last two, China’s Mental Health Law will not achieve its objectives.  However, these frank articles in the Chinese press – soon after the Mental Health Law took effect – might be a positive sign that change is on the way. 

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By Elizabeth M. Lynch, July 18, 2013

Diners at Manhattan’s new Hunan Manor

For the past few years, Sichuan restaurants have opened in New York City like no one’s business , with over six being clustered in just a few blocks of Manhattan’s midtown east.  But if you are like me – you are Sichuan’ed out.  In fact out of all of China’s various cuisines, Sichaun probably has the least versatility.  Eventually that spicy, tingly feeling and taste after every dish gets a bit repetitive.

That is why I was excited to learn that a new cuisine had moved into the Sichuan barrio – Hunan Manor.  Hunan Manor boasts of an equally spicy cuisine – that of Hunan province – but with a lot more freshness, flavor and diversity.  Hunan food relies less on the chili paste and peppercorns of Sichuan cuisine and instead incorporates greater use of garlic, fresh chili peppers and shallots.  Hunan food is usually a treat.

Unfortunately that was not the case at Hunan Manor.  Hunan Manor is the Manhattan sister restaurant of perhaps one of Flushing’s bests, Hunan House.  I had eaten twice before at Hunan House in Flushing and both times thought the food was amazing.  So I was looking forward to trying out Hunan Manor.

But perhaps because Hunan Manor does not serve an exclusively Chinese clientele, its food was bland and ultimately uneventful.  In fact, the menu itself demonstrates that Hunan Manor must serve two masters – the first two pages of the menu are filled with traditional American Chinese food, an option that is missing in Flushing’s Hunan House.

My dining companions and I ordered five different dishes and only one was particularly outstanding, the eggplant and string bean dish.  The

Sauteed Eggplant and String Bean

dish was extremely flavorful and fresh with the string beans appropriately crispy and the eggplant not too soft.  Also the garlic flavor was pronounced in a good way – while noticeable, it did not over power the vegetables .

Unfortunately from this dish it was pretty much downhill.  The Hunan fried noodles were far from spectacular.  The flavor was bland and ultimately it tasted too much like take out.  But not good take out; more like 1 AM hangover take out where nothing better is open.  The braised pork Mao style, which is perhaps one of my favorite dishes in the Flushing restaurant, lacked the flavor and the richness of Hunan House.  And the sizzling tofu with shrimp was nothing to write home about.  It was good but nothing great.

Although there was only one stand out dish out of four, my dining companions and I decided to continue to venture the further down the menu, with the hope that things would get better.  As a result, we ordered one of my favorite dishes – a dish that I don’t understand why more Chinese restaurants in America haven’t realized that this dish would be a big hit: zha mantou (pronounced ja man-toe).  Zha mantou is basically fried bread dipped in sweet condensed milk.  Just thinking about it makes my mouth water.  The zha mantou redeemed Hunan Manor a bit – the mantous came out hot which makes the dish even more divine.  It could have been fried a bit less but ultimately I ate three of these little guys.

Sizzling tofu and shrimp

Strangely, we were served no tea at Hunan Manor.  At first I thought this was an oversight, but many of the other tables lacked any teapots.  This itself should have been a sign.

My ultimate take away – skip Hunan Manor and instead make the venture to Hunan House in Flushing.  The food is more authentic, fresh and flavorful there.  It does justice to the amazing cuisine which is Hunan food.

Rating:

Hunan Manor

339 Lexington Ave (at 39th Street)
New York, NY 10016
(212) 682-2883
http://www.hunanmanornewyork.com/

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By Elizabeth M. Lynch, July 14, 2013

Happy birthday China Law & Policy!  Monday marks the 4th anniversary of this blog’s founding and we want to take this moment to thank all our readers, commentators and supporters these past four years.  When we posted our first post on July 15, 2009, we didn’t know where this blog would take us.  Over the past 4 years, we have been able to analyze various areas of Chinese legal development and interview a number of experts in the field.

Year 4 started off with a bang.  Last July, we ran a three part series on the proposed legislation in the United States known as the Chinese Media Reciprocity Act that was picked up by a number of other websites.  The Chinese government’s increasing belligerence toward Western reporters became an issue that we would return to throughout the year, especially after New York Times reporter Chris Buckley’s journalist visa was not renewed and after China’s most prestigious news paper – Southern Weekend – protested government censorship of the paper’s New Year’s message.

In terms of traditional legal development, China Law & Policy interviewed Prof. Margaret K. Lewis on China’s amended Criminal Procedure Law which took effect in January of this year.  Soon after that interview, Gu Kailai – the wife of Bo Xilai – was tried and found guilty of the murder of British citizen Neil Heywood.  Glenn Tiffert, a PhD candidate in history at the University of California, Berkley, guest blogged in two posts analyzing the jurisdictional issues in the Gu Kailai trial and the role of the party-state in the Bo Xilai affair.  Those two posts are still being commented on.

We finished off our third year with China Law & Policy’s most popular blog post – at least by numbers – “Chen Guangcheng and the Commandeering of Our China Human Rights Policy.”

So what does the future hold for China Law & Policy?  This blog’s goal has always been to make one of the most important relationships in the world – the United State’s relationship with China – more accessible to the general public, to those who are not “China people.”  Central to understanding a modern China is understanding its developing legal system.

So we will continue to blog about legal developments in China and general policy issues.  We will look to increase the number of experts we interview and hopefully can convince more people to guest blog.  We will also continue with our periodic book reviews and “Just For Fun” section which often informs you of the best Chinese restaurants out there.

This means that China Law & Policy needs you!  Have a blog post idea, email us (elynch@chinalawandpolicy.com).  Want to write a blog post, email us (all posts are reviewed and edited).  We are especially looking for younger, less established “China people” so don’t think just because you don’t have a PhD you can’t blog.

All suggestions from the public to make this website better are always appreciated.  Like something we did and want to see more of it?  Don’t like something?  Just email: elynch@chinalawandpolicy.com

Happy birthday and thank you again to everyone who has helped to make this blog a success!