On a warm, sunny afternoon in April, Mr. Yang burst from his home in this rural village near the Vietnamese border, carrying a kitchen cleaver. He encountered three youngsters headed home from school on the dirt path outside. He hacked two primary schoolers, badly wounding both, and slit a second grader’s throat, leaving him dying on the ground. Then he moved on. By the time police officers caught up and subdued him, he had slashed two more people to death.
The victims’ families have focused their rage on the police. Three days earlier, Mr. Yang had struck a neighbor in the head with an ax, but was not detained.
“They are completely responsible for this,” said Wu Huanglong, the second grader’s father. “They did not protect us.”
But Mr. Yang’s doctors see a bigger failing. Despite clear signs of schizophrenia, Mr. Yang had received medical care for just one month in the previous five years.
“If he had been given medication and treatment, his illness would not have developed,” said Chen Guoqiang, the psychiatric hospital’s chief doctor. “If he had been able to control his hallucinations, he would not have killed anyone.”
It has been nearly 35 years since the end of the Cultural Revolution, when mental illness was declared a bourgeois self-delusion and the sick were treated with readings from Chairman Mao. Psychiatric treatment has returned. But mental health remains a medical backwater, desperately short of financing, practitioners and esteem.
Too often, the official response to mental illness is to look the other way. The government authorities, already shaken by an attack the previous month in which eight schoolchildren were stabbed to death, threw a news blackout over the Xizhen incident lest it inspire copycats or incite further outrage.
At least three of six men whose attacks near schoolyards this year left 21 people dead had earlier appeared deranged or suicidal, according to news reports. But in the highest-level statement on the killings, Prime Minister Wen Jiabao said only that China needed to resolve “social tensions” underlying the attacks.
Yan Jun, director of the mental health division of the Ministry of Health, refused repeated requests for an interview. The ministry said in a written statement that the government was “continuously strengthening” both its resources and professionals to provide mental health care.
A Dearth of Care
It has far to go. Only 1 in 12 Chinese needing psychiatric care ever sees a professional, according to a study last year in The Lancet, a British medical journal. China has no national mental health law, little insurance coverage for psychiatric care, almost no care in rural communities, too few inpatient beds, too few professionals and a weak government mental health bureaucracy, Chinese experts in the field say.
The Health Ministry’s own mental health bureau, established four years ago, consists of three people. Dr. Yan, the director, is a public health specialist, not a psychiatrist.
Every few years, China’s news media declare that a national mental health law is speeding toward adoption. The first draft was written half a century ago. Asked how many revisions it has undergone, Dr. Ma Hong of the Peking University Institute of Mental Health said, “Countless.”
Most psychiatric hospitals are financially unviable, said Yu Xin, who directs the Peking University Institute of Mental Health. One, in Hubei Province, opened a box factory in the 1990s to stay afloat. The fee structure is so absurd, he said, that hospitals can charge patients more for computer-generated diagnoses based on filled-out forms than for sessions with actual psychiatrists.
The Lancet study estimated that roughly 173 million Chinese suffer from a mental disorder. Despite government efforts to expand insurance coverage, a senior Health Ministry official said last June that in recent years, only 45,000 people had been covered for free outpatient treatment and only 7,000 for free inpatient care because they were either dangerous to society or too impoverished to pay.
The dearth of care is most evident when it comes to individuals who commit violent crimes. For example, after Liu Yalin killed and dismembered an elderly couple cutting firewood in a Guangdong Province forest, he was judged to be schizophrenic and released to his brother. Unable to afford treatment, the brother flew Mr. Liu to the island province of Hainan, in the South China Sea, and abandoned him, a Chinese nongovernment organization, Shenzhen Hengping, said in a recent report.
Last year, Mr. Liu killed and dismembered an 8-year-old Hainan girl.
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