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Poverty, Fear and Other Factors Cause Relatives to Lock Away the Mentally Ill: --; the single province of Hebei has 100,000 mentally ill persons locked away
Give Them Back Their Dignity
It is difficult to describe the dark and disordered world of the seriously mentally ill to a normal person who inhabits the world of light. It is a type of illness that conjures bizarre and colorful stories. And it shows its cruel side to even more ordinary people.
It can unexpectedly turn a person into someone frightening and unknown, so that they kill their father, mother or strangers without any 'reason' at all. The reporters interviews revealed helpless families that can only shut the mentally ill into cages they have made; or beg police to have them put them in jail; or abandon them in a psychiatric hospital and never visit.
This is a huge population, the Chinese Center for Disease Prevention and Control's Center for Mental Health's statistics from early 2009 show that there are more than 16 million patients with severe mental illness in China, that is to say that there is one person with a serious mental illness in less than every 100 Chinese citizens.
The caretakers for this population, however, are "tiny", China has only 20,500 registered psychiatrists and 30,000 psychiatric nurses, a doctor-patient ratio around 1:840, far below the global average. They face a massive amount of professional and emotional pressure.
The healthcare infrastructure on which care relies is also clearly 'thin'. Even in Beijing, a leader in medical capacity, there is a several month or even a half-year wait for beds in the Huilongguan hospital psychiatric facility.
Beginning today, this paper is launching a special feature "Unchaining the Severely Mentally Ill", in six parts, that will show you how the current situation of their being locked up at home or abandoned in mental hospitals, and will also explore the psychiatric hospitals, community treatment, the challenges faced by psychiatric physicians and finally an authoritative discussion to lay out a path to overcoming these obstacles. Only more care and love can spill sunshine into the dark mental world of these patients, and return them to a dignified life.
■ Key Focus Points
The news media occasionally reports an incident of a mentally ill person locked in a cage or shackled in irons, but this reporter has discovered that number of this kind of 'caged person' is actually enormous, and that Hebei Province alone has about 100,000 such persons. China has about 16 million people with severe mental illnesses, of which 10% have the potential for violent tendencies, and a large proportion of these become a "caged people."
On May first, the new Mental Hygiene Law took effect and restrictions on liberty became prohibited by law. But the reporters investigations revealed that because of factors such as economic limitations, insufficient family care, and villages and communities' fearful perceptions of mentally ill persons, an iron cage becomes the final 'home' for a large number of mentally ill persons.
Mental health experts have pointed out that without the support of families, communities and society, "caged people's" fate will be difficult to change. □ Beijing News reporter Liu Ding, report from Hebei
"You absolutely must not let him out! " Local villagers were visibly nervous and on guard when they saw reporters appear in front of Liu Yuegui's house on July 5, 2013, in the Sheceng village of Nansunzhuang township, Fengnan district of Tangshan City, Hebei province.
The glass windows were plugged up with newspapers and rags, so that not even sunlight could seep through the cracks. And in a cage in this room is fifty-two year-old Liu Yuegui. The cage is constructed of steel rebar as thick as a thumb and is a meter and a half tall; he cannot stand up, so only sits or lies there.
Liu Yuegui is a schizophrenic. He has already lived in this cage for ten years.
In March of 2009, he was given care by the Hebei Provincial #6 People's Hospital's 'Project Unlock'. After two months of treatments, Liu Yuegui, who had already recovered some social ability, was sent home. But he was once again shut in the cage.
Based on the 2006 epidemiological study on severe mental illness in Hebei province , there are about 100,000 mentally ill persons locked up in cages or shackles , like Liu Yuegui, in Hebei.
Data released by the China CDC center for mental health in early 2009 showed that in there are more than 100 million people in China with some form of mental illness, of which more than 16 million patients have a severe mental illness, the number of these that can receive hospitalization is less than 10%, and 10% feel the potential accident cause injury and disturbances.
Many of the severely mentally ill who have violent tendencies, have been chained by their families or caged.
Currently it is primarily Liu Yuejin, the family's third son, who looks after feeding the caged Liu Yuegui. He gives him some food and water every day.
On July 5, when talking about his caged little brother, there is one sentence that the family's eldest son, Liu Yuefu, repeats again and again, "What can we do? "
Previously, Liu Yuegui's father took principle care of his food and water, but this year the father is 85 years-old and lacks the strength to care for him.
The villagers in Shenjiang are all opposed to releasing Liu Yuegui, and feel that a free Liu Yuegui is a major threat to their safety.
Liu Yuefu says that in 1983, Liu Yuegui worked in a flour factory and that after a conflict with a coworker which resulted in him getting injured, he began to be a little off. Talking to himself, then spending the entire day running around outside and at night having a sickle or club at his side, always saying that he wanted to kill someone.
Liu Yuefu said that that year his little brother saw a doctor and took medication but that his symptoms showed no clear improvement. When he divorced later, Liu Yuegui's condition became more severe. Neighbors often saw him standing on the roof shouting.
On July 5, Shenjing Director Guo Lianhua recalls, Liu Yuegui sometimes slither through the cotton fields on his stomach, popping out suddenly to grab people's ankles. At that time, the village women were afraid to work alone in the cotton fields.
Around the turn of the millenium, in the village to the south of Shenjing, a woman who also had mental health problems was found dead one evening and the villagers all suspected she was killed by Liu Yuegui. There were no witness and no one could say how an encounter and struggle between these two mentally ill persons might have occurred, so ultimately the matter was not deeply looked into.
Before the rumor of Liu Yuegui murdering someone in the other village had faded, he killed someone in his own village.
On July 8, 2002, an over 60-year-old villager of Shenjing village was cut down by Liu Yuegui with a sickle.
Liu Yuefu recalls that deceased was named Liu Shaowu, and had previously exchanged words with Liu Yuegui, and that when the two bumped into each other on the street, they started to fight. Liu Yuegui gave chase with a sickle and Liu Shaowu, who couldn't get away quickly enough, was cut down and then had his head pounded with a brick as well.
This event shook the village of Shengjing. The mentally ill Liu Yuegui was not put in prison and the villagers were extremely afraid.
Liu Yuegui's home is very close to the village primary school. Liu Yuefu says, the family was afraid he would cause more trouble, so just found someone to weld an iron cage and rounded up Liu Yuegui.
Poverty and Padlocks
A schizophrenic like Liu Yuegui, Wang Zhanyong was one locked by his family in a cage in [Hebei's] Shijiazhuang, Xinle city's Matoupu township, Chenjiazhuang village.
"It isn't that I don't feel for him, it's that I can't afford to feel for him!" says Wang Zhanyong's mother, Guo Suxin on June 25. In 2003, Wang Zhanyong's father died of cancer, and afterwords the person who had agreed to marry him backed out. After that, Wang Zhanyong began acting "wacky".
The father had already spent the family nest-egg on treatment so they borrowed a few thousand yuan to take Wang Zhanyong to the nearby hospital for treatment. The treatment didn't take and the family had no more money to offer.
Most troublesome was that Wang Zhanyong would go to the school gates and chase after students, hitting them. "If he hit someone, the family could only pay them with out lives, we really had no way to live." " says Guo Suxin. Later, the family just shut Wang Zhanyong in cage, leaving only a hole for giving him food.
For schizophrenia sufferer Liu Huijie, the balcony has become his 'alcatraz', at his family home in Shijiazhuang city, Hangtang County, Zhili village.
On June 28, Liu Huijie's father, Liu Linbao, that all of his family's money was spent to let his son see doctors. When Liu Huijie's illness is upon him, he will run far off, and come back home having lost his clothes and bicycle. And he sings every day, and shouts about wanting to cut people with knives.
The fathers says that he was afraid his son would cause an incident, and that he couldn't look after him as he got older, so had him tethere him to the the terrace slab with iron chains. But Liu Huijie drags his iron chains inside and out, smashing furniture. Later the floorboard was augmented with three pieces.
On July 3, Li Keqing, Director of the #6 People's Hospital of Hebei province explained that hospitalization of mental patients costs approximately ten or twenty thousand yuan. Currently mental health disorders have already been included in the basic public health service, but even with insurance and cooperative medical reimbursement, families must still cover at least a few thousand dollars, and some poorer families can not afford , or are unwilling to spend this.
Wang zhanyong and Liu Huijie thing have both been the subject of media attention, after which they received care from the Hebei Provincial Armed Police Corps Hospital. Following treatment, the families said that they have continued to take medication, and have both left the "prison cage" behind, are have jobs outside the home.
When he was picked up by the #6 People's Hospital of Hebei province for treatment, Liu Yuegui had already spent 7 years in the cage.
The Hebei Provincial Mental Health Center and the #6 People's Hospital of Hebei province began "Project Unlock" in May 2008, and essentially took care of 1 or 2 "caged people" each month.
On 31, 2009, the hospital received a call from the Nansun Township police station and went to Shenjing Village to "rescue" Liu Yuegui.
Dr. Yan Baoping recalls that the villagers seemed very enthusiastic about Liu Yuegui being taken away. The cage was rusted solid so that it couldn't open, and the villagers searched for electric saws to help saw it open.
After the iron cage was opened, Liu Yuegue did not at first come out, and he was still rambling on about wanting to kill people. After being released from the cage, he seemed very excited. Liu Yuegui who had not stood up straight for 7 years, tottered forward with the support of the doctors, as if he had just learned to walk.
Yan Baoping recalls that, after two months of treatment, Liu Yuegui restored most social capacity, and didn't have any obvious violent tendencies.
On June 2, 2009, Liu Yuegui's in-hospital treatment ended. The director of the Hebei #6 Hospital publicity information center, Zhao Xianghui and others, brought him back home. The result left them extremely surprised.
Although the family was informed in advance, when Liu Yuegui got home, they found the front door locked tight, and when contacted by telephone, the family members said to leave and don't come back.
At this time, , the villagers of Shenjing Village, under the leadership of the Shenjing village cadres, came out to the to prevent Liu Yuegui from returning to the village.
The villagers took a stand in front of the ambulance, saying that if they wouldn't take away Liu Yuegui , then "just run us over as you go" More and more villagers gathered, some people pointed and cursed and Liu Yuegui also became excited: "You are bad people, I'll kill you all. "
Zhao Xianghui and the others brought Liu Yuegui onto the ambulance, and brought him to the Nansun Township police station. Very quickly, the station head and police left saying they had police business, leaving behind an attendant.
Eventually, Zhao Xianghui and the other made their getaway, and Liu Yuegui was left there with that attendant. "We drove hundreds of kilometers to transfer the patient, the hospital provides free care, and then a situation like this, where thefamily members refuse to accept him, it leaves a terrible feeling in our hearts. " said Zhao Xianghui on June 27.
" There is nothing the family can do. The villager are all watching us, and won't let us take him. We aren't able to resist them. We can only hide away. " said Liu Yuefu on July 5 of this year; the villagers shun Liu Yuegui "If he can be thrown out, then just throw out and it'll prevent another incident."
That year, after Liu Yuegui remained in the police station for several days, he was still sent back to the village. As soon as he got home, the family put him directly back into the iron cage, under the watch of the entire village.
On July 3, Li Keqing, the director of the #6 People's Hospital of Hebei Province, said that the guidance of rehabilitation organizations and the support of the family are a critical part of whether the mentally ill person can sufficiently be rehabilitated upon reenty into the community, and return to their home. But the shortage of community psychiatric rehabilitation organizations is problem shared across the nation. Currently, Hebei does not have a single community rehabilitation organization.
Families support of the mentally ill that are returning after having received treatment in the hospital also seems quite weak.
The Convenience of "Locking Them Up"
When asking after Tian Shuwei, villagers in Xishiduan, Baoding City would tell us that "that whack-o" is locked in the house right behind the electrical transformer.
"That whack-o", is the the villagers common way of referring to Tian Shuwei. Just like Liu Yuegui, he was once helped by Project Unlock, only to be locked up anew.
On June 28, 2013, in an overgrown corner, Tian Shuwei lies naked in a short squat house. This was left to him by his parents.
Villagers describe that regardless of the season, Tian Shuwei stays locked in there naked. His ankles are tied with pinky-thick metal chains, about two meters longs, and the other end stretches to the room's floor. Tian Shuwei's bodily functions are all performed within this two meter range.
Tianshu Wei is 30 years-old, he lost his parents when in his teens, and became ill when 20. His three older brothers take turns caring for him.
The eldest, Tianshu Ling, says that the three brothers also disagree about locking up their little brother. Some time ago, the second brother became a bit distraught and wanted to open the chains. However, Tian Shuling and the youngest brother, Tian Shukuang disagreed saying "And what if he hurts someone? "
Tian Shuling says that Tian Shu has never actually hurt anyone but that when his illness comes on he can scream and shout, smash things or chase people, and that the neighbors are all frightened. Moreover, Tian Shuwei refuses to wear clothes, "a big fellow, bare naked, with lots of women outside, people have a lot to say about that. "
Tian Shuling says that the village committee had the family think up a solution. He says that locking him up was the best method they could think of.
Tian Shuwei's is a case that left the #6 Hebei Provincial Hospital with feelings of regret.
On September 28, 2010, Tian Shuwei, who had already been locked up for over two years, was given care by 'Project Unlock'. Upon receiving more than two months of treatment, he was released from the hospital.
Dr. Yi Baoping explains that Tian Weishu recovered fairly well at the time and could his family with chores. He took three months of medicine from the hospital, but afterwards the family never and hospital had no contact regarding pick up of free medicines. One year later, Tian Weishu's illness returned. After several disputes with neighbors, his big brothers once again locked him away.
Yan Baoping feels that Tian Shuwei's relapse is due to insufficient care by the family. He says that the dozapine which Tian takes daily, only cost 5 yuan for a 100 pill bottle, or about 34 yuan a month. Further, these drugs can be picked up for free in Xushui county, and that the #6 provincial hospital can also be contacted to provide them for free. But the brothers weren't willing to take care of it.
On June 28, Tian Shuling said that when they gave their brother medicine, he wouldn't take it, and after a while they gave up.
Yan Baoping explained that in June and July of 2012, the hospital visited 100 patients that had received their care. One third had recovered very well and could join in work and labor, another third were able to suppress violent tendencies and live on their own, but the final third had relapsed and were locked up once again. A few had already died while others had gone missing.
Doctors also discovered a pattern, whereby those patients that were looked after by their parents, by and large kept up fairly well, but those without parents did not recover as well.
Public Interest is a "Drop in the Bucket,"
Those who like Tian Shuwei and Liu Yuegui who received aid from 'Project Unlock' are in the minority of, "lucky" patients.
In 2006, the Hebei Provincial Mental Health Center and Hebei Province #6 People's Hospital conducted a epidemiological study of people with severe mental illness across the entire province, and found that Hebei had about 100,000 mentally ill persons locked in cages or shackles.
According to Zhao Yonghui's explanation, since 2008, the Hebei #6 provincial hospital has received information regarding more than 3000 'locked away people' that need care and has screened over 280, but in some cases they cannot contact families and in some cases the families do not consent to the treatment; and there are those where the hospital itself lacks the capacity to offer care.
An example is the 26-year-old woman who contracted a severe mental illness in Shijiazhuang's Yuanshi County, whose mother was also mentally ill and whose father was over 70 years old. But this woman was a lower body double amputee with no ability to care for herself, so it was difficult for the hospital to take on.
Zhao Xianghui says, the hospital has already spent over one million yuan on "Project Unlock".
The Armed Police Corps Hospital of Hebei province has also rescued a number of mental patients since 2003. Chen Yunfang, a physician with that hospital's Mental health Center said that the hospital, the hospital has also spent nearly 200,000 yuan. He said that Corp hospital should bear some social responsibility, but that it is only a drop in the bucket.
The Armed Police Corps Hospital of Hebei has had an "Unlock Action" for the last 2 years. Chen Yunfang said that the hospital lacks medical staff, that the Center has no male nurses, and that many female nurses are unable to control severely mentally patients during the onset of their illness.
This year，the Hebei #6 provincial hospital's "Project Unlock" has also been suspended.
In part, it is because the new building is currently under construction and there are insufficient rooms. The other part, says Director Li Keqing, is that with the implementation of the Mental Health Law, in-patient care now follows a voluntariness principle, and the hospital must consider whether actively 'rescuing' mentally ill people might cause them to encounter legal problems. According to the Mental Health Act, it is unlawful for family members to lock away the mentally ill, but the law also provides that the principal persons who should deliver patients to the hospital are guardians, public security organs and civil administration authorities.
Li Keqing said that as a public hospital they must bear a certain amount of social responsibility but when the launched "Project Unlock", they never though about carrying it out on such a scale. In his view, such a public interest action, the ideal approach for this kind of public interest action would be for philanthropists, entrepreneurs, and the hospitals to work together.
Dr. Yan Baoping of the Hebei #6 hospital went with his colleagues to check up on Tian Shuwei in June 2012. The Tian family hoped they would take him away again for free treatment, but Yan Baoping feels that even if he was taken back for more treatment, it the family didn't look after him well, he would relapse again and that the all the hospital's efforts would be for naught.
So Tian Shuwei continued to be locked up.
The caged Liu Yuegui ,has also not undergone any further treatment since 2009.
Lan Xiaocheng, the director of the Nansunzhuang village civil affairs office explained that Liu Yuegui currently receives a minimum living standard of 2900 rmb each year. He said that there are also a few other mental patients in the village, but that the civil administration can't do more than send greeting cards at holidays and occasionally send over some household goods.
Liu Yuegui's minimal living standard was sent by the civil administration in 2008 and this made many villagers unhappy. "So even murderers get the minimal living allowance. "
His older brother, Liu Yuefu says "Liu Yuegue won't come out again, we're just counting the days go by. "
Special Feature Coordinator / Beijing News reporters Kong Pu and Li Tianyu