Source: Chengdu Commercial Daily Hongxing News
Published on: November 22, 2024, in Sichuan
A year after leaving the mental health center, Mr. Shen is still trying to help his former patient friend, Li, discharge from the facility.
In 2023, Mr. Shen was hospitalized for about six months at the Shanghai Baoshan District Mental Health Center (referred to as “Baoshan Mental Health” hereafter). He noted that Li, despite being a patient, served as a ward leader, assisting nurses with management and distribution tasks. “She seemed quite normal.”
During their time together, Mr. Shen learned that Li had been hospitalized at Baoshan Mental Health for eight years and wished to be discharged. However, with her father deceased and her mother missing, discharge requires consent from the neighborhood committee. Li asked Mr. Shen to help coordinate her discharge after she was released.
In January 2024, the Shanghai Baoshan District Health Committee responded to Mr. Shen’s inquiry, stating, “Li’s condition is currently stable. If her psychiatric symptoms are well-controlled in the future, Baoshan Mental Health will communicate with the neighborhood committee to discuss discharge.” However, as of now, Li has still not been discharged.
Details of the Situation
1. Diagnosed with Schizophrenia: Eight Years in Treatment
Every week, Baoshan Mental Health allows family visits for one hour. On November 19, during a visitation period, a Hongxing News reporter met with Li as a family friend.
The wards are located on different floors of Baoshan Mental Health, with a designated room for family visits equipped with multiple tables and chairs. Family members announce the patient’s name upon entering, prompting staff to call for them.
When staff informed Li about the visit, they loudly shouted, “Xiao Li, Xiao Li!” and then asked the reporter, “Are you from the neighborhood committee?”
Li, 35, with short hair and dressed in a hospital gown, sat with several other patients at a table. She told the reporter that “the medical staff has been very nice to me.” Usually, only neighborhood committee staff visit her, primarily delivering gifts without discussing discharge matters. She indeed asked her friend Mr. Shen for help and currently hopes to be discharged. Li recalls being diagnosed with schizophrenia and is still taking daily medication, stating, “This illness requires lifelong medication.”
The meeting lasted about ten minutes, and Li expressed that hospital conversations were not very convenient due to people walking in and out.
Mr. Shen shared that during his six-month stay, he observed Li as the ward leader, assisting with management and helping distribute food and tidy up. He noticed that her behavior and speech were stable during their interactions.
Li shared that her parents divorced during her childhood, and she lost contact with her mother, living with her father. After her father’s death at age 27, she became distressed, making random emergency calls, which led to her being sent to Baoshan Mental Health for treatment, where she has remained for nearly eight years. Although she has other relatives in Shanghai, she has lost contact with them.
2. Neighborhood Committee Applying for Disability Subsidy
Concerns Over Post-Discharge Care
In September 2023, Mr. Shen was discharged. His discharge record stated he was diagnosed with alcohol-induced mental and behavioral disorders, with notable improvements by discharge. He reported he did not attempt to apply for discharge independently.
After his discharge, Mr. Shen began assisting Li in her discharge process. By the end of 2023, he contacted relevant authorities, stating that “Li now wishes for the neighborhood committee to take her home.” A response from the Baoshan District Health Committee in January 2024 indicated that Li’s guardian is the neighborhood committee, necessitating their consent for her discharge; her condition was deemed stable.
On November 20, a staff member from Baoshan Mental Health confirmed that due to the complexities of schizophrenia, patient discharge requires a guardian’s consent; patients cannot independently request discharge.
Subsequently, the reporter inquired with the Baocai New Village Neighborhood Committee, where a deputy secretary named Jin explained they had contacted Li’s other relatives, but they had refused to care for her. Previously, her relatives covered her living expenses, but there have been gaps this year, prompting the neighborhood committee to apply for a disability subsidy to assist her financially. They are still awaiting results from the disability assessment.
Jin also noted changes in neighborhood committee staff and admitted he was unsure whether Li had undergone a civil capacity assessment or the process of appointing the neighborhood committee as her guardian. He recalled that staff had visited Li last month and learned her condition was unstable. Although Li has housing in the community, he expressed concern about who would care for her once discharged.
To understand Li’s current situation, the neighborhood committee staff visited Baoshan Mental Health again on the afternoon of the 20th. The next day, Jin informed the reporter that they had not seen her attending physician but learned that Li requires long-term medication.
3. Can Patients with Mental Illness Apply for Discharge Independently?
Analysis from Doctors and Lawyers
“Not having family supervision or care does not justify remaining in the hospital,” analyzed Jiang Cuiting, a doctor from Guangdong Second People’s Hospital’s psychiatric department. She stated that many grassroots mental health resources can offer support.
As a worker in a provincial-level mental health institution, Jiang has years of experience collaborating with mental health social organizations and evaluating community rehabilitation for chronic mental illness. She explained that schizophrenia is considered a severe mental disorder, requiring registration and filing according to health commission protocols. For registered patients, there are detailed regulations regarding treatment and rehabilitation beyond just health departments and medical institutions.
“District-level mental health centers can still seek other mental health resources,” Jiang added. She mentioned that some community hospitals have doctors specifically responsible for mental health prevention and treatment, making access to medical care easier. Some communities also provide transitional facilities, sometimes serving as welfare centers or social work stations, helping patients rehabilitate and develop life and vocational skills while assisting in monitoring their conditions. “In recent years, there has been significant progress in mental health prevention and services in our country. Community mental health services can provide patients with affordable access to medications, evaluate their conditions, and assess side effects.”
Jiang noted that the goals of mental health prevention and treatment in China have changed over time. “Keeping patients confined in mental hospitals is an outdated method. Now, we hope to leverage more robust mental health resources, especially at the grassroots level, to help these patients reintegrate into society. The goal of medical treatment is social reintegration and functional recovery. They need normal lives and social interactions, and some even wish to rebuild families without losing their rights to live.”
Regarding discharge standards for schizophrenia, Jiang explained that mental health institutions continually assess the stability of a patient’s symptoms, considering the duration of stability, the patient’s insight into their illness, and their medication management capabilities. “Can schizophrenia be cured? We talk about clinical recovery, where, with standard treatment, clinical symptoms can reach a stable state. The risk of relapse is not solely related to the illness; it also connects with the age of onset, medication adherence, family support, and social support. Relapses are possible, but with proper treatment, there are more resources to prevent episodes. Continuous assessment and management are essential.”
Can Li independently apply for discharge? Jiang analyzed that according to mental health laws, involuntarily hospitalized patients need a guardian’s consent for discharge. However, if a patient shows improvement during hospitalization, demonstrating insight into their condition, they can apply for a judicial psychiatric assessment regarding their civil capacities and request a change in their status to voluntary hospitalization. Patients with full civil capacity can apply for discharge voluntarily with the physician’s approval.
Lawyer Xu Mengni from Shanghai Shenhu Law Firm stated that “civil capacity assessment is a special procedure in judicial processes. Mental disorders do not directly equate to limited or no civil capacity.” She believes that an assessment of Li’s civil capacity can be requested. If deemed capable, she would not need a guardian and could apply for discharge independently.