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Shanghai Archives of Psychiatry, 2013, Vol.25, No.1 ·63· • Correspondence • China’s new mental health law Rehabilitation in the Mental Health Law of the People´s Republic of China José. M. BERTOLOTE Mental health laws and acts usually have a long international reviews of mental health laws conducted history behind them when they are eventually adopted. under the aegis of the World Health Organization[4,5] In most jurisdictions the time spent between initial rehabilitation was not identified as a main topic for discussions and drafts and the formal adoption of comparison across different jurisdictions. At most, a few mental health legislation is not less than 10 years. Lesser progressive documents examined as part of the reviews regulatory instruments, such as ministerial decrees, had some provisions on social integration of persons orders of service and the like have a more immediate with mental disorders.[5] effect, although they tend to draw less attention and However, in the Chinese Law, rehabilitation is one debate. In many cases the content of the law simply of its three major content sections, the other two confirms and codifies the practice of mental health being promotion and prevention, and diagnosis and services as it existed over the extended period of treatment (the remaining sections are more procedural drafting the law.[1] Things have not been different with in nature). Article 54 through Article 59 in the law the Mental Health Law of the People´s Republic of specifically addresses the provision of community-based China,[2] recently adopted after more than 15 drafts and rehabilitation to people with mental disorders and the 20 years of debate. Although it will not come into force provision of support to families of persons with mental until May 2013, its influence could already be perceived disorders. The high degree of detail in these articles in practice throughout China over the last decades is uncommon in major national laws. For instance, in because its successive drafts (or section of them) were Article 54 the type of rehabilitative training required is de facto implemented by mental health authorities in specified: ‘training in life skills, social skills and other diverse Chinese provinces. skills to persons with mental disorders who need There are several innovative facets of China’s rehabilitation.’ new mental health law that deserve closer scrutiny, In line with the WHO´s position that ongoing particularly the importance given to promotion and treatment is an integral part of psychosocial reha- prevention, to psychological support as part of emerg- bilitation,[6] Article 55 stipulates that as part of the ency response plans, and to rehabilitation. In this letter rehabilitation of mental disorders ‘medical facilities shall I would like to specifically draw attention to the section provide maintenance treatment with basic psychiatric on rehabilitation, an area that is absent or, at best, medications to persons with severe mental disorders.’ minimally addressed in the mental health laws and acts Psychosocial researchers and health managers might of most high-income countries. appreciate another part of Article 55, which establishes Historically, mental health laws were primarily a health registry for people with severe mental disorders, concerned with consent (i.e., regulations about in- a fundamental tool for research and management that is voluntary admissions), and only gradually incorporated gradually being banned in high-income countries largely issues related to treatment of people with mental because of concerns about the potential infringement disorders. The implications of legal distinctions between on individual rights. The second paragraph of the article admission and treatment (i.e., admission as a security encapsulates in a few lines a whole agenda for the measure or admission as a prerequisite for treatment) appropriate integration of community mental health only became relevant after the Italian Psychiatric Reform care into general health care, a dream for many mental with the adoption of Italian Law 180.[3] In the two large health care activists. doi: 10.3969/j.issn.1002-0829.2013.01.013 Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia correspondence: [email protected] ·64· Shanghai Archives of Psychiatry, 2013, Vol.25, No.1 Finally, Article 58 rightly addresses the ultimate References goal of a sound mental health rehabilitation program, 1. Bertolote JM. Mental health legislation: a review of some namely, ‘suitable work for persons with mental international experiences. Revista de Saúde Pública 1995; 29(2): disorders based on their actual capabilities.’ The article 152-156. also highlights major issues that need to be addressed 2. Chen HH, Phillips MR, Cheng H, Chen QQ, Chen XD, Fralick D, et when organizing work for persons with mental disorders al. Mental Health Law of the People’s Republic of China (English including ‘equal pay and equal treatment’, job training, translation with annotations). Shanghai Arch Psychiatry 2012; improvement of the work environment, and rewarding 24(6): 305-321. doi: 10.3969/j.issn.1002-0829.2012.06.001 work accomplishments. 3. Italian Law no. 180. International Digest of Health Legislation 1978; 30(1): 75-79. This emphasis on rehabilitation is in line with the 4. Curran WJ, Harding T. The Law and Mental Health: Harmonizing importance China has placed on the so-called ‘second- Objectives. Geneva: WHO, 1978. generation human rights,’ that is, social, economic and 5. Poitras S, Bertolote JM. Mental Health Legislation: International cultural rights.[7] It is not known how much the expert Trends. In: Henn F, Sartorius N, Helmchen H, Lauter H (eds). committees and legislators who drafted China’s mental Contemporary Psychiatry, Vol. 1. Berlin: Springer, 2001: 269-285. health law benefited from the long history of mental 6. WHO. Psychosocial Rehabilitation: A Consensus Statement. health legislation in other countries. However, at the Geneva: WHO, 1996. very least, in the area of legislation about the rehabili- 7. Brody E. Biomedical Technology and Human Rights. Paris: tation for people with mental disorders, other countries UNESCO, 1993. have a lot to benefit from a careful reading of the new Mental Health Law of the People´s Republic of China. Professor Bertolote graduated from the School of Medicine and Biological Sciences, Botucatu, Brazil in 1971 and obtained his specialization in Psychiatry in São Paulo, Brazil, in 1974. He also obtained a M.Sc. and Ph.D. in Social and Transcultural Psychiatry from McGill University in 1978 and a Ph.D. in Clinical Sciences in Porto Alegre, Brazil in 1991. He is currently Professor at the Australian Institute for Suicide Research and Prevention at Griffith University and Voluntary Professor at Botucatu Medical School in UNESP, Brazil. He is also Special Advisor on Alcohol and Other Drugs to the Brazilian Ministry of Justice, a member of the Technical Chamber on Drug Policy for the São Paulo State Secretary of Justice, and a member of the Technical Chamber on Social Action for the Brazilian Federal Medical Board. His research interests include suicide prevention, psychoactive substance use and related disorders, epidemiology of mental disorders, and public health.