Liu Minxia

    mllmx@msn.com

    GUO ZHIHONG’S worried eyes watched his adult daughter, Guo Jiajia, eat a 5-yuan (US$0.77) fish and rice meal Thursday.

    “We found her to be abnormal when she was around 4 years old,” said Guo, who said he is in his early 50s but looks older with grey hair and a wrinkled face. “At the beginning we thought she was just a disobedient child. But it was not that simple.”

    Guo Jiajia began showing signs of mental illness at 4, but it wasn’t until 2002, at age 16, that she saw a psychiatrist in Shenzhen.

    A left-behind child, Guo Jiajia lived with her grandmother in Meizhou City in Guangdong while her parents worked in Shenzhen.

    “She attacked her grandmother, her younger brother, her mother and me, but never anyone outside the family,” said Guo Zhihong. “Because we realized that she might have mental problems, we kept her in our sight.”

    When his daughter’s violent episodes finally forced Guo Zhihong to solicit professional help, Guo Jiajia was diagnosed with schizophrenia.

    Guo Jiajia’s story is not unique in Shenzhen, which has the highest rate of adult mental illness out of any city in China, according to a survey performed by Kangning Hospital. Twenty-one percent of Shenzhen residents above 18 suffer from mental disorders, a rate 0.19 percent higher than the national average, the survey showed.

    The survey estimated that there are at least 150,000 people in Shenzhen that are high-risk psychiatric patients, but only about 16,000 have registered with the city’s mental health management system since it was launched in 2008.

    Why Shenzhen?

    Why do so many suffer from mental illness in Shenzhen? One explanation is that migrant workers bring mentally ill family members to Shenzhen to avoid the stigma they feel in their hometowns.

    Xiao Jiankang, a native of Sichuan Province, said he brought his 23-year-old schizophrenic daughter to Shenzhen for treatment after she broke her grandmother’s wrist.

    But even outside of a conservative Sichuan the stigma around mental illness is strong.

    “Fortunately she is recovering,” said Xiao. “But she is so ashamed and afraid of people learning about her problem that she refuses to leave the home. I worry living that way will make the problem serious again.”

    More than 80 percent of Shenzhen residents are unwilling to work in the same company or even eat at the same restaurant as someone who is mentally ill, the Kangning Hospital survey found.

    “Psychiatric patients and their families are less willing to face their problems than patients suffering other kinds of health problems as the bias against the mentally ill is common in our society,” said Liu Tiebang, president of Kangning Hospital. “Many of our patients choose to use their own money to pay for medical bills instead of medical insurance in order to avoid their employers finding out.”

    Zou Guangyu, chief of the Shenzhen Association of Psychological Counseling, said he has met a lot of people who refuse to see a psychiatrist even when they know they are ill.

    “Shenzhen residents are more open to psychological counseling now than 10 years ago, but it is still the norm that people suffering from mental problems are reluctant to see a doctor until their life or work is seriously affected,” said Zou. “In many cases, years pass before they get professional help, by then the problem has become more difficult to deal with.”

    Understaffed, overburdened

    Part of the problem of getting treatment for the mentally ill is a lack of professionals willing to work with them. No one has applied to be a social worker to work with the mentally ill since Luohu District’s Chronic Disease Prevention and Control Hospital began advertising positions in March.

    The problem is compounded by a lack of government support, according to Liu. “The national standard is that there should be 1.71 psychiatric beds for every 10,000 residents, but in Shenzhen, the number is 0.43. About one-fourth the national standard,” he said.

    “There is a huge gap between Shenzhen and other major Chinese cities. The number of psychiatric beds in Shenzhen is only one-tenth that in Guangzhou and the number of psychiatric doctors in Shenzhen is about one-fourth of that in Guangzhou, but the number of patients we’re taking care is about the same.”

    Shenzhen is building a second psychiatric hospital called Jianning Hospital, which is expected to be completed in 2018 and supply 800 psychiatric beds, but Liu said that is still not enough.

    For now, Kangning Hospital remains the only hospital dedicated to helping psychiatric patients in the city. And it is struggling.

    Zhou Bin brought his wife to Kangning Hospital for treatment for postpartum depression three years ago and saw conditions firsthand.

    “I saw how crowded the inpatient rooms of Kangning Hospital were,” he said. “My wife was tied to her bed while others who seemed to have longer-term and more serious problems wandered around in the same room… Other patients approached my wife and mocked her for being restrained.”

    Zhou decided his wife would fare better at home.

    At a community level, Shenzhen employs about 600 social workers in its mental health management system. They collect information on the ground and act as psychiatric patient supervisors. The 600 are tasked with looking after the 16,000 patients who have registered with the system along with possible psychiatric patients. That means each oversees almost 30 patients.

    “Things like reminding them to take their medication on time and helping them readjust to social life sounds easy, but it’s a difficult job due to misconceptions,” said Liao Wenxia, a social worker in Nanshan District.

    But the system is broken, according to Zou. Zou described the system as outdated and dysfunctional, saying psychological counselors should be hired for the job instead of social workers who are rarely adequately trained.

    Deadly consequences

    In 2015, seven mentally ill people killed or injured others in Shenzhen. In late May this year, a 38-year-old man with mental illness stabbed seven passers-by in Bao’an District.

    These attacks have led to repeated calls for Kangning Hospital to be relocated from the urban Cuizhu Road area in Luohu District.

    But relocating the city’s only mental hospital to a remote location — and thereby making it more difficult for patients to get treatment — isn’t going to help the situation, according to Wang Zhibin, director of the mental health department of Luohu District’s chronic disease prevention and control hospital.

    “The fact is, as long as people suffering from mental illness take medication as required, the rate of them being violent is even lower than normal people,” said Wang.

    In the end, Shenzhen’s nature as a city of migrants and the deep stigma attached to mental health have combined to create a problem that law enforcement officers are beginning to speak openly about.

    “It’s not rare for us to come across a mentally ill person who commits a crime and then refuses to identify themselves,” said Huang Xiaoyang, a police officer in Longgang District’s Bantian area.

    “Just days ago, a young man with mental illness attacked several kids before we got him under control. It took us days to find who he was through a picture identification system. He actually moved to Shenzhen only a few weeks ago,” Huang said.

    Watching his daughter eat, Guo Zhihong said that he wished he had gotten her help sooner, instead of trying to hide the problem. “I’ve begun losing hope that she will recover,” he said. “But I need to find a way for her to survive after we pass away.”