When strangers visit, Shang Zhijun is on his best behavior. The 22-year-old Hebei peasant only seems a little pushy--talking too loudly, asking for cigarettes too often. "He doesn't admit he's mentally ill," says his adoptive mother, Zhao Shulan. "If my husband and I refuse to give him money, he flies into a rage. That's why we had to put him in a cage."
A four-meter-square metal cage sits outside the farmhouse, now filled with ears of corn. In August, when Shang had one of his violent fits, the couple and some neighbors wrestled him to the ground, then locked him up. After a month behind bars, he was released when relatives brought him to Beijing for treatment for schizophrenia. But his parents couldn't afford to institutionalize Shang; soon he was back home. "He got some pills and so he's behaving better," says his mother. But she knows the respite won't last; his pills run out in less than two weeks.
Schizophrenia. Depression. Anxiety disorder. Little more than a decade ago, most families like Shang's had never heard of such illnesses. But today, China's demand for psychiatric services is soaring. Huilongguan Hospital, China's largest psychiatric facility, reports that its outpatient count has doubled in the past two years. The Chinese Society of Psychiatry has set up a mental-health Web site that gets 20,000 hits daily. And suicide--the leading cause of death for Chinese between the ages of 15 and 34--has reached an alarming pace, double the U.S. rate per capita. Says Michael Phillips, a psychiatrist at Huilongguan Hospital, "Two million Chinese try to kill themselves annually, yet almost none of those who survive get psychological treatment at the time."
Part of the problem no doubt lies in the fast-paced changes afoot in Chinese society. Experts say that mounting social pressures--from job stress, fragmented family lives and the rollback of state safety nets--help explain the growing need for psychological counseling. But the other side of the problem is the poor treatment that awaits many who show the first signs of needing help. China's 750 or so state-run mental-health institutions can't keep pace with the rising demand for their services--and are often too costly for the staggering number of patients who lack insurance. Many Chinese have no choice but to turn to cheaper alternatives, like Web sites, school counselors or--at best--one of the country's roughly 1,200 private hospitals. "Some are small or poorly qualified--but they're better than nothing at all," says Dr. Zou Yizhuang, vice superintendent at Huilongguan Hospital.
One such grass-roots clinic is the Chaoyang district sanitarium. Although affiliated with the All-China Disabled Person's Association, "we're essentially a private psychiatric facility," says administrator Yang Yun. "Families come to us when they can't afford anywhere else." Yang's patients pay as little as $84 a month for inpatient care--less than half what it would cost in a state-run institution.
What Yang's staff lacks in resources they try to make up in compassion. The wards are shabby, but full of chatter and jokes. Patients wear street clothes--not the striped pajamas that evoke movie-set loony bins. Foreign and Chinese volunteers teach patients gardening, as a form of therapy, as well as English. Yet Yang scrambles each month to make ends meet. Just last week Yang and her charges were forced to move across town by a developer who wanted to replace the clinic with a car showroom. The shift involved a chaotic logistics train involving 160 patients, 10 staff, 14 dogs, two cats, beds, medicine and equipment. In the new compound, Yang dreams of building something "to help give patients simple jobs, like selling vegetables or copying papers on a Xerox machine."
Clinics like Yang's are often the last stop for those with nowhere else to go. When Wang Lanrong was first brought to Yang's sanatorium, she had already spent three decades in psychiatric institutions. A schizophrenic, Wang also had serious gastrointestinal ailments. One day last month her heart stopped beating. As staff applied CPR, Yang and Wang's relatives hurriedly transferred the patient to a better-equipped, state-run hospital. "Two days later, I was shocked when her brother came back with Wang on a stretcher," says Yang. The brother couldn't afford the hospital fees. Frantic, Yang tried to find a hospice. While she was on the phone, Wang died on the chilly steps of the sanitarium.
The government and the public are beginning to wake up to China's mental-health crisis. "After the SARS epidemic, people became more interested in how to deal with stress," which is believed to be a factor in making people susceptible to the disease, says vice superintendent Zou. Foreign physicians and experts are also working to raise public awareness. Calling suicide "a huge public-health problem that hasn't gotten enough attention," Phillips, a Canadian psychiatrist, helped launch China's first national toll-free suicide prevention hot line in August. "Demand has been incredible," he says. At one point in September a thousand people called daily. But more education is clearly needed, considering that more than 90 percent of China's suicide victims had received no psychiatric treatment. This week Phillips and other specialists plan to hold a workshop in Beijing, to stress the need for a national suicide-prevention plan.
Although the late Mao Zedong maligned psychiatry as a bourgeois discipline, the current government will have to pour more money into the field if they want to rectify a growing imbalance: psychiatric ailments that account for one fifth of China's public- health burden now receive only 2 percent of the health budget. China has not yet promulgated a long-awaited national mental-health law, which would obligate the state to shoulder at least some of the cost of care. And today China has only about 14,000 qualified psychiatrists, "about the same number as France, with 60 million people--compared to China's 1.3 billion," says Zou. "There's a huge gap between supply and demand." Until the government addresses that imbalance, far too many Chinese are going to have trouble finding peace of mind.