China Power | Society | East Asia

The Misuse of China’s Mental Hospitals

Feng Xiaoyan’s case shows how practices of involuntary hospitalization and adult guardianship can combine to lock away unfortunate victims – sometimes for life.

By Chi Yin and Jerome A.Cohen for
The Misuse of China’s Mental Hospitals
Credit: Illustration by Catherine Putz

It has long been known that China’s psychiatric facilities are routinely manipulated by government officials in order to silence political dissidents. Yet a growing number of cases are coming to light in which mental hospitals are also being misused by influential citizens for more personal reasons. Because people diagnosed with mental illness often end up in a civil confinement facility for years, if not for the rest of their lives, the system of involuntary hospitalization for mental illness has become a catch-all for all kinds of unwanted people.

The case of Feng Xiaoyan, who was diagnosed with schizophrenia in April 2020 and is currently confined in a Shandong province hospital, has been reported as an all-too-familiar case of political repression. On closer examination, however, it is not clear that Feng’s political activities alone were offensive enough to provoke the government to hospitalize her. Her activities may have been eccentric enough to make her husband concerned about the impact of her behavior on his career. It was her husband who took her to the hospital in the first place and her husband who now refuses to enable her discharge. Whatever the root cause of her situation, Feng is now stuck in a legal limbo from which escape is extremely difficult.

As Radio France Internationale, Human Rights in China, and The Globe and Mail have all reported, Feng’s confinement began shortly after she was picked up by Beijing police for distributing pro-democracy leaflets near Wangfujing in April. Her leaflets promoted, among other things, “democratic reform and reelection.” Yet, according to a recorded conversation with the Dongcheng District police, which has jurisdiction over the Wangfujing area, the offense that got Feng picked up was not political dissent, but rather the simple distribution of pamphlets; she would have been detained equally for distributing advertisements. This assertion is supported by the fact that the Beijing police did not charge her or institutionalize her. They allowed Feng’s husband to pick her up and transport her back to their native city of Linyi in Shandong.

Rather than taking Feng to their home, however, her husband took her to the Linyi No. 4 People’s Hospital. His decision to hospitalize her may have been encouraged by his former supervisor in the local government. In any event, Feng underwent involuntary admission and was diagnosed with schizophrenia. Her daughter, who has been the primary source of information for all reports on this case, including our own, maintains that Feng is entirely sane. She says that, if her mother has any mental illness at all, it is the result of being improperly institutionalized and medicated.

This is not Feng’s first stay in a mental hospital. The Globe and Mail has corroborated through the Linyi Foreign Affairs Office that Feng was previously diagnosed with paranoid schizophrenia at a hospital in Tianjin in June 2019. Their daughter maintains that this initial involuntary admission was the husband’s way of preventing Feng from suing him for a domestic assault. Soon thereafter he had a change of heart and retrieved her from the hospital. However, The Globe and Mail also reports that Feng was again sent to the mental hospital in Linyi in both October 2019 and January 2020.

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This time Feng’s husband has not relented. Their daughter believes that her father, a former Communist Party official who has recently gone into the real estate business, sees her activism as a threat to his career. He has received messages from his former supervisors in the local government about their dissatisfaction with Feng’s behavior. Given a real estate market in which good relations with government officials are essential, he might easily be motivated to silence a wife who espouses dissident views. In this sense, prior reports are not incorrect in saying that Feng’s confinement is the result of her political views. To be clear, though, it was her husband and not a government agency that decided to confine her, and preventing her further pamphleteering is only one of his possible motivations for keeping her confined. By their daughter’s report, we should recall, Feng’s original confinement was entirely in order to prevent her from suing her husband, and he has also threatened his daughter with mental confinement if she continues to advocate for her mother’s discharge.

Feng’s episodes of involuntary admission were probably illegal under China’s Mental Health Law, which only took effect in 2013. This law states explicitly that “voluntariness” is the principle of psychiatric admission; the sole exception that allows for – or even mandates – involuntary admission is when a patient has endangered or is about to endanger herself or others. To the best of our knowledge, Feng has never shown any indication of endangering anyone. Nevertheless, unfortunately, involuntary confinement of people, despite no evidence of threatened danger, keeps occurring. Reported cases of illegal involuntary confinement include a homosexual spouse who came out of the closet, an older college student who did not get along with his younger classmates, a nagging parent, and a cynical and rebellious adult child. According to a 2019 study by a group of Chinese psychiatrists, which sampled 3,864 involuntary admission (IA) cases in Shanghai, “Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.”

Under Article 109 of China’s General Provisions of Civil Law, some formerly involuntarily confined individuals have successfully sued their guardians and psychiatric hospitals in local courts for violation of their personal freedom and personality rights, claiming damages for the harm inflicted. It is a welcome improvement in China’s legal system that its citizens are turning to judicial channels to deal with this type of dispute and that judges are beginning to favorably respond. In 2015, Chinese courts changed the filing process for civil and administrative cases from an application system to a registration system. This means that, with few exceptions, courts must accept and register the filing of a lawsuit. This is a dramatic shift from the previous situation, when courts were authorized to exercise discretion, reviewing filings as mere applications and preventing cases from entering the judicial system by simply not accepting or even responding to the paperwork.

Notice, however, that all the above-mentioned cases were brought by plaintiffs who had already been discharged from confinement. Feng is different. She is still incarcerated in a psychiatric hospital and is thus considered to have diminished capacity in civil matters. She therefore has to rely on her guardian to act on her behalf in order to handle matters like hospital discharge and lawsuits. Yet, in her case, the first-tier guardian is her husband.

The Mental Health Law offers three pathways to discharge: first, discharge at any time upon the patient’s request during voluntary hospitalization; second, discharge at any time upon the guardian’s request for involuntarily hospitalized patients who showed a risk of endangering themselves at the time of admission; third, discharge upon the hospital’s permission for involuntarily hospitalized patients who showed a risk of endangering others at the time of admission. The law further provides that, if necessary, the guardian shall handle the discharge paperwork for the patient.

Although Feng should not have been hospitalized in the first place, now that she is hospitalized, her way out is limited to the last two scenarios, which both largely rely on her guardian — her husband.

Adult guardianship in China has long attracted calls for reform. A nominal reform was passed in 2016, when the General Provisions of Civil Law provided that a guardian shall act in the best interests of the ward and shall respect the ward’s wishes, including not to interfere with matters that the ward has the capacity to handle independently. However, these requirements are generally not implemented because of the absence of clear and detailed instructions and procedures. In practice, once a person is diagnosed with “mental impairment” as determined by either one or two licensed psychiatrists, she is then in fact treated as having diminished capacity to handle civil matters. No judicial decision is required. What is in the best interests of the ward and what matters the ward can handle independently are left up to the guardian’s judgment.

Therefore, most involuntarily hospitalized psychiatric patients remain in legal limbo for as long as their guardians decide to leave them there: they can neither discharge themselves nor initiate a lawsuit against abusive guardians.

The last resort is to turn to another qualified guardian. The law provides that a court may, upon the request of other qualified guardians, including individuals, government agencies, and organizations, disqualify the existing guardian and appoint a new one. However, filing such requests is not an obligation and it rarely happens. Especially when a psychiatric patient is involved, family members and organizations seem especially reluctant to take responsibility. The psychiatric hospital in Haidian District of Beijing reported that about four-fifths of the patients who should have been discharged were instead left in the hospital. In Beijing’s Anding Hospital, a “patient” has stayed on for 20 years after his recovery.

Nevertheless, like many other hospitalized psychiatric patients, Feng’s only possible recourse is to rely on another qualified guardian. Yet, as Feng’s second-tier guardian, her daughter cannot override the will of the first-tier guardian, Feng’s husband. In theory, the daughter could request the local court to disqualify her abusive father and appoint her as the guardian. In reality, as a college student in her early 20s, the daughter lacks the resources required to challenge her powerful father in a courtroom. Moreover, the capable mental-health lawyers that she has approached have refused to take the case for various reasons. In all respects, the daughter is fighting an uphill battle armed with nothing but love for her mother.

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It is now the eighth year since the passage of China’s Mental Health Law, the 19th year since China ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the 22nd year since China signed the International Covenant on Civil and Political Rights (ICCPR), which it has not yet ratified. China still has a long way to go to fulfill its obligations under the ICESCR, such as upholding its citizens’ rights to the enjoyment of the highest attainable standard of physical and mental health; nor has it eliminated citizens’ fear of arbitrary detention as described in the ICCPR.

As we have stated above, the criteria for involuntary psychiatric admission are met only if a patient has endangered or is about to endanger herself or others. Feng Xiaoyan’s case is one example of the way in which many Chinese psychiatric hospitals fail to uphold these criteria during admission; it also illustrates the Chinese legal system’s lack of an effective channel to challenge involuntary admissions. This allows powerful individuals, whether for political or personal motives, or both, to sentence unfortunate people like Feng to what may be a lifetime of arbitrary confinement.

Chi Yin, a former Intermediate Court judge in China, is a Research Scholar at NYU Law School’s US-Asia Law Institute.

Professor Jerome A. Cohen is Faculty Director Emeritus of NYU Law School’s US-Asia Law Institute and Adjunct Senior Fellow at the Council on Foreign Relations.