Rehabilitation in the mental health law of the peoplés republic of china.

Abstract

Mental health laws and acts usually have a long history behind them when they are eventually adopted. In most jurisdictions the time spent between initial discussions and drafts and the formal adoption of mental health legislation is not less than 10 years. Lesser regulatory instruments, such as ministerial decrees, orders of service and the like have a more immediate effect, although they tend to draw less attention and debate. In many cases the content of the law simply confirms and codifies the practice of mental health services as it existed over the extended period of drafting the law. (1) Things have not been different with the Mental Health Law of the Peoples Republic of China, (2) recently adopted after more than 15 drafts and 20 years of debate. Although it will not come into force until May 2013, its influence could already be perceived in practice throughout China over the last decades because its successive drafts (or section of them) were de facto implemented by mental health authorities in diverse Chinese provinces. There are several innovative facets of China's new mental health law that deserve closer scrutiny, particularly the importance given to promotion and prevention, to psychological support as part of emerg- ency response plans, and to rehabilitation. In this letter I would like to specifically draw attention to the section on rehabilitation, an area that is absent or, at best, minimally addressed in the mental health laws and acts of most high-income countries. Historically, mental health laws were primarily concerned with consent (i.e., regulations about in- voluntary admissions), and only gradually incorporated issues related to treatment of people with mental disorders. The implications of legal distinctions between admission and treatment (i.e., admission as a security measure or admission as a prerequisite for treatment) only became relevant after the Italian Psychiatric Reform with the adoption of Italian Law 180. (3) In the two large international reviews of mental health laws conducted under the aegis of the World Health Organization (4,5) rehabilitation was not identified as a main topic for comparison across different jurisdictions. At most, a few progressive documents examined as part of the reviews had some provisions on social integration of persons with mental disorders. (5) However, in the Chinese Law, rehabilitation is one