Security monitoring inside Tianjin’s ankang hospital. Source: Tianjin Municipal Public Security Bureau Ankang Hospital
China’s new Mental Health Law, passed by the National People’s Congress Standing Committee in October and effective May 1, 2013, has been welcomed by many as a major step forward in the protection of the rights of individuals with mental illness. Of particular note are provisions requiring that patients facing involuntary commitment in psychiatric hospitals be given the opportunity for independent review of their cases and that mechanisms for appealing involuntary commitment be established.
Some remain concerned, however, about the potential for continued use of abusive psychiatric commitment against petitioners, dissidents, and others deemed to threaten China’s social or political order. This is because the new law exempts ankang hospitals from many of its provisions.
Ankang hospitals, which fall under the jurisdiction of the Ministry of Public Security, are police-run facilities intended to provide compulsory medical treatment to persons diagnosed with mental illness who have committed serious crimes but are exempted from criminal responsibility under the law. As of 2010, there were 22 ankang hospitals located in 18 Chinese provinces, and the Ministry of Public Security had lobbied for the construction of additional hospitals to meet rising needs. During their long history in China, ankang hospitals are known to have been used to treat “political maniacs” and others holding dissident views—a practice modeled on one used widely by the Soviet Union.
As a result of a new section dedicated to compulsory medical treatment that was added to the Criminal Procedure Law (CPL) in March (translated below), new restrictions will be formally imposed on police discretion to carry out involuntary psychiatric commitment. Under these provisions, which will take effect on January 1, 2013, police recommendations regarding commitment will have to go through two levels of external scrutiny: undergoing review by the procuratorate before reaching the court, which will have sole authority to make decisions on involuntary psychiatric commitment for those who have committed serious offenses but are exempt from criminal responsibility under the law.
Until now, regulation of involuntary commitment in ankang hospitals has been governed primarily by rules enacted by local government in locations where these facilities are established. As internal institutional regulations, the procedures are not clearly subject to review by procuratorates or the court. Local regulations also vary considerably in terms of their level of detail and the degree to which they protect individual rights.
Consider, for example, two sets of commitment measures from Tianjin Municipality and Xi’an, Shaanxi Province (translated below). The Tianjin regulations, enacted in 1991 and amended in 2010, are typical of rules enacted in other cities throughout China during the 1990s and lack the mechanisms of the Xi’an measures, enacted in 2011, aimed at curbing arbitrary psychiatric commitment. For example, the Xi’an measures explicitly exempt certain categories of individuals from involuntary commitment, give persons facing commitment clear rights to challenge the decisions made against them, and require ankang hospitals to carry out periodic evaluations.
Clearly, the relatively progressive Xi’an measures anticipate the more rights-protective provisions of the new CPL, which aims to limit arbitrary police authority and establish a more uniform process for involuntary psychiatric commitments carried out within the criminal justice setting. The success of these goals awaits actual enforcement. Drafts of implementation rules being considered by the Supreme People’s Court and recently passed by the Supreme People’s Procuratorate suggest a seriousness about establishing mechanisms to prevent abusive and arbitrary commitment of individuals who are healthy or who do not pose any danger to society. The Ministry of Public Security has yet to publicize its own relevant regulations, but once the revised CPL and the new public security regulations take effect, local ankang regulations will almost certainly undergo substantial updates.
Criminal Procedure Law Excerpt: click to expand
[Criminal Procedure Law Excerpt]
Chapter 4: Procedures for Compulsory Medical Treatment of Mentally Ill Persons Excluded from Criminal Liability in Accordance with the Law
Article 284: Where a mentally ill person commits violent acts that endanger public security or seriously endanger the personal safety of citizens and has been determined through statutory procedures to be excluded from criminal liability in accordance with the law, if he or she has the potential to continue endangering society, he or she may be subject to compulsory medical treatment.
Article 285: According to this chapter, decisions to subject a mentally ill person to compulsory medical treatment shall be made by people’s courts.
If a public security organ discovers that a mentally ill person meets the conditions for compulsory medical treatment, it shall make a suggestion for compulsory medical treatment in writing and submit it to the people’s procuratorate. Where the people’s procuratorate finds, either at the [suggestion] of the public security organ or during the process of pre-prosecution review, that a mentally ill person meets the conditions for compulsory medical treatment, it shall submit an application for compulsory medical treatment to the people’s court. Where the people’s court finds during the hearing of a case that a defendant meets the conditions for compulsory medical treatment, it may issue a decision to impose compulsory medical treatment.
Where a mentally ill person has committed an act of violence, the public security organ may impose temporary, protective restrictive measures [upon that person] before the people’s court [issues] a decision on compulsory medical treatment.
Article 286: After the people’s court accepts an application for compulsory medical treatment, it shall form a collegiate bench to review [the application].
Where a people’s court reviews a case involving compulsory medical treatment, it shall notify the legal representative for the subject of the application or the defendant to appear in court. If the subject of the application or the defendant has not engaged legal counsel, the people’s court shall notify a legal aid agency to assign a lawyer to provide legal assistance.
Article 287: Where, in the course of its review, the people’s court [finds that] the subject of the application or the defendant meets the conditions for compulsory medical treatment, it shall issue a decision for compulsory medical treatment within one month.
Where the person subject to a decision for compulsory medical treatment, the victim, or their [respective] legal representatives or immediate relatives do not accept the decision for compulsory medical treatment, they may apply to the people’s court at the next higher level for reconsideration.
Article 288: Facilities for compulsory medical treatment shall periodically carry out diagnostic evaluations of persons receiving compulsory medical treatment. Where there is no longer any risk to personal safety and it is no longer necessary to continue compulsory medical treatment, a facility shall promptly recommend revocation and report to the people’s court that made the decision on compulsory medical treatment for approval.
Persons receiving compulsory medical treatment and their immediate relatives have the right to apply for revocation of [said] treatment.
Article 289: People’s procuratorates shall oversee decisions on and enforcement of compulsory medical treatment.
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Tianjin Measures  No. 47: click to expand
Tianjin Measures for Commitment, Treatment, and Management of Mentally Ill Persons Who Endanger Social Order
[Tianjin] People’s Government Order (1991) No. 47
(Approved by the [Tianjin] People’s Government on December 8, 1991, and amended in accordance with the Decision on Amending Certain Municipal Government Regulations passed at the 59th Standing Committee meeting of the [Tianjin] People’s Government on November 8, 2010.)
Article 1: In order to strengthen protective custody, management, and treatment of mentally ill persons who endanger social order; to protect social order; to safeguard the lives, property, and safety of the people; and protect the lawful rights and interests of mentally ill persons; these measures are hereby enacted in accordance with the relevant national regulations and in combination with the actual circumstances in this municipality.
Article 2: Any mentally ill person who carries out one of the following acts, whether he or she is from this city or an outsider who has come to this city, shall be compulsorily committed for treatment by the municipal public security bureau’s ankang hospital:
- Murder, arson, rape, setting explosions, or other acts;
- Serious disruption of official work order at party, government, or military organs [or] of the production or work order of enterprises;
- Serious disruption of public order or endangering of public safety;
- Other [acts] that affect social stability and cause serious consequences;
- Having once committed one of the aforementioned acts, again showing an obvious onset of symptoms after release [from compulsory treatment] following remission of symptoms.
Article 3: The ankang hospital of the municipal public security bureau is the institution of the municipality dedicated to compulsory commitment for treatment of mentally ill persons who endanger social order. It has the dual functions of public order management and treatment under protective custody.
The ankang hospital provides admitted mentally ill persons with compulsory treatment under protective custody according to the principles of: management in accordance with the law, scientific treatment, integrated governance, and service on behalf of social order and the patient.
Article 4: Where it is necessary to place a mentally ill person covered under Article 2 of these measures under compulsory commitment for treatment, the branch (county) public security bureau shall report the case and, following arrangement of a mental illness forensic medical evaluation by the ankang hospital, conduct admission formalities pursuant to the issue of a “Notice of Hospitalization for Commitment and Treatment of a Mentally Ill Person Who Endangers Social Order” by the ankang hospital. Under special, emergency situations where it is necessary to immediately carry out compulsory commitment for treatment, a mental illness forensic medical evaluation shall be carried out promptly after commitment and intake formalities conducted after the fact.
Article 5: With respect to the medical expenses of hospitalized mentally ill persons subjected to compulsory commitment for treatment: for those with work units, [the expenses] shall be handled in accordance with labor insurance and public health service regulations; for those employees who are under labor contract, [the expenses] shall be handled in accordance with relevant national regulations; for those without fixed employment or income, a guardian shall assume responsibility; where there is no guardian, the civil affairs department shall assume responsibility.
Article 6: A mentally ill person who has been subjected to compulsory commitment for treatment may be discharged after obtaining approval from the ankang hospital if he or she has been cured through treatment, his or her symptoms have stabilized, and he or she is basically no longer able to endanger social order or has other serious illnesses.
Article 7: Where a mentally ill person receives approval to be discharged, his or her guardian or work unit shall conduct discharge formalities in accordance with the notification of the ankang hospital. Where discharge is refused without legitimate reason, the branch (county) public security bureau that originally reported hospitalization for the compulsory commitment for treatment shall order a guardian to retrieve [the person refusing discharge]. Where there is no guardian and no fixed employment or income, the civil affairs department shall take custody and arrange for placement.
Article 8: When a mentally ill person dies during the period of compulsory commitment for treatment, an evaluation of [the cause of] death shall be performed and notice given to the guardian or work unit to go to the ankang hospital to handle post-mortem affairs. Where there is refusal without legitimate reason or there is no guardian and no work unit, the body of the deceased shall be handled by the ankang hospital in accordance with relevant national and local regulations.
Article 9: During the period of compulsory commitment for treatment, the guardian or relatives of a mentally ill person shall actively cooperate with treatment. Guardians or relatives who go to the hospital to create serious disruptions or disturb order shall be dealt with by the public security organ in accordance with the law and in light of the seriousness of the circumstances.
Article 10: The public-order units of each branch (county) public security bureau and the security units of enterprises shall, under the direction of the ankang hospital, implement prevention-responsibility systems aimed at mentally ill persons who endanger social order and implement measures for custody, control, and management of mentally ill persons who endanger social order.
Article 11: A mentally ill person’s guardian, work unit, and local residents’ committee or village committee shall strengthen protective custody over the mentally ill person, protect his or her personal and property rights and other lawful rights and interests, and prevent the mentally ill person from causing trouble and endangering social order.
Article 12: These measures take effect from the day of announcement. At that time, the “Several Temporary Provisions for Custody and Management of Aggressive Maniacs [sic],” approved for implementation by the Tianjin People’s Committee on August 9, 1965, shall cease to be effective.
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Xi'an Order No.93: click to expand
Xi’an People’s Government Order
The “Xi’an Measures on Commitment for Treatment of Persons with Mental Disorders Who Seriously Endanger Social Safety” were passed at the 153rd meeting of the 14th [Xi’an] People’s Government Standing Committee on July 11, 2011. They are hereby published and will become effective on August 30, 2011.
Mayor Chen Baogen
July 22, 2011
Xi’an Measures on Commitment for Treatment of Persons with Mental Disorders Who Seriously Endanger Social Safety
Article 1: In order to strengthen [the system of] commitment for treatment and the management of persons with mental disorders who seriously endanger social safety, to safeguard social public order and public safety, and protect citizen’s personal rights and public and private property, these measures are enacted in accordance with the provisions of the Criminal Law of the People’s Republic of China (PRC), the People’s Police Law of the PRC, and other laws and regulations and in combination with the actual circumstances in this city.
Article 2: These measures are applicable to the commitment for treatment and management of persons with mental disorders who seriously endanger social safety within the administrative region of this city.
Article 3: Commitment for treatment of persons with mental disorders who seriously endanger social safety shall be incorporated into the city’s plan for mental health work. The funds necessary for undertaking commitment for treatment work are to be included in the budget.
Article 4: The public security organ is the competent authority with respect to commitment for treatment of persons with mental disorders who seriously endanger social safety and is responsible for arranging the implementation of these measures. Departments responsible for the administration of health, civil affairs, human resources and social insurance, finances, and other matters, along with mass organizations such as the China Disabled Persons’ Federation, shall, in accordance with their own functional responsibilities, assist with the proper commitment for treatment of persons with mental disorders who seriously endanger social safety.
The city ankang hospital is responsible for carrying out clinical treatment and management of those persons with mental disorders who seriously endanger social safety [and] that the public security organ has decided to commit for treatment.
Article 5: Where a person with a mental disorder meets both of the following conditions, the public security organ at or above the county level shall decide to commit that person for treatment:
- While unable to distinguish or unable to control his or her actions, commits an act that seriously endangers society and is suspected of a crime [but] is confirmed by an evaluation in accordance with statutory procedures not to bear criminal responsibility;
- Does not have a guardian or has a guardian who lacks the ability to look after [him or her], or, although having a guardian, is a person with severe mental disorders who could potentially continue to endanger society if commitment for treatment is not imposed.
Article 6: [Where a person with a mental disorder] meets any of the following conditions, the public security organ may not issue a decision to commit for treatment:
- Suffers from a serious contagious illness;
- Suffers from a serious, life-threatening physical illness;
- Is no longer able to endanger society;
- Is pregnant or nursing one’s own infant under the age of one;
- Meets other conditions for which laws, regulations, or rules provide that it is inappropriate to issue a decision to commit for treatment.
Article 7: Where a public security organ at or above the county level makes a decision to commit for treatment, it shall produce a written commitment decision and notify the guardian of the person being committed for treatment as well as the police station in that person’s place of household registration. Where it is impossible to determine the identity of the person being committed, notification shall be made in a timely manner after [the identity] is determined.
Article 8: Where the person being committed for treatment or his or her guardian does not accept the commitment decision made by the public security organ, application may be made for administrative reconsideration in accordance with the law or an administrative lawsuit may be filed.
Article 9: The public security organ that issues the decision to commit for treatment shall take the commitment decision and other relevant documents and escort the person being committed for treatment to the city ankang hospital to conduct admission formalities.
Article 10: After hospitalization, where a person committed for treatment meets any of the conditions listed in Article 6 of these measures, the city ankang hospital shall suspend treatment and notify the public security organ that issued the commitment decision to collect the person committed for treatment and deliver him or her to the care of his or her guardian or transfer him or her to another relevant medical facility for treatment. In urgent situations where it is impossible to give timely notification, the city ankang hospital may directly transfer the person to another medical facility and promptly notify the public security organ that made the decision to commit for treatment.
During the period in which commitment [at the ankang hospital] is suspended, the public security organ that issued the commitment decision is responsible for supervising the person that was committed for treatment. Once the conditions necessitating suspension of commitment cease to exist, the public security organ that issued the commitment decision shall immediately return the committed person to the city ankang hospital to continue to receive treatment.
Article 11: The city ankang hospital shall respect and protect the lawful rights and interests of persons committed for treatment and ensure their safety; discrimination against and humiliation and abuse of persons committed for treatment is prohibited.
Article 12: In carrying out commitment for treatment work, the city ankang hospital shall follow the technical specifications and operational procedures for medical treatment as established by the health administration authorities and conduct periodic assessments of the mental state of persons committed for treatment and prepare assessment records.
Article 13: Where the condition of a person committed for treatment shows obvious improvement and it is no longer necessary to continue treatment, the city ankang hospital shall produce a notice revoking commitment for treatment and deliver it to the public security organ that issued the commitment decision.
Within seven days of receiving the notice, the public security organ that issued the commitment decision shall meet with the guardian of the person committed for treatment to conduct discharge formalities. Where there is no guardian or the guardian refuses to conduct the formalities, the public security organ that issued the commitment decision shall conduct the discharge formalities.
Article 14: Where a person committed for treatment dies while hospitalized, the city ankang hospital shall produce a death certificate and the public security organ that issued the commitment decision shall notify the person’s guardian to handle post-mortem affairs.
Where the guardian does not agree with the cause of death, he or she may appoint a body with the appropriate qualifications to carry out an evaluation of the death. If the guardian disagrees with the conclusion of the evaluation, he or she may apply for a re-evaluation in accordance with the law.
Where the guardian does not agree with the cause of death and does not appoint [anyone to conduct] an evaluation, the public security organ that issued the commitment decision shall arrange for an evaluation to be carried out, complete a death notice, and notify the guardian to retrieve the body.
Where the guardian refuses to retrieve the body within the stipulated period of time, the public security organ that issued the commitment decision shall, after taking photos [of the body], handle the matter in accordance with the law.
Article 15: Treatment expenses incurred by the city ankang hospital for patients committed for treatment in accordance with Article 5 of these measures, as well as mental illness treatment expenses incurred during [the patient’s] treatment period at other medical facilities when commitment for treatment is suspended in accordance with Article 10 of these measures, shall be handled according to the following provisions:
- For [patients who are] participants in the urban worker basic medical insurance and urban resident medical insurance schemes, [expenses] shall be handled according to the relevant regulations concerning the urban worker basic medical insurance and urban resident medical insurance schemes;
- For [patients who are] employees of work units that do not participate in the urban worker basic medical insurance scheme, expenses are to be assumed by their work unit;
- For [patients who are] participants in the new-style rural cooperative health insurance scheme, [expenses] shall be handled according to the relevant regulations concerning the new-style rural cooperative health insurance scheme.
Where none of the aforementioned [payment] channels are applicable to the medical treatment expenses of a person committed for treatment, or where one of the aforementioned [payment] channels applies but there is a portion that is not covered, responsibility for [such expenses] shall be assumed by the patient or his or her guardian. Where [these parties] are truly unable to cover [the expenses], the public security organ that issued the commitment decision or the relevant medical facility shall report to the finance authority at the same administrative level and resolve the matter in accordance with relevant policies.
Article 16: The public security organ shall recommend that inpatient treatment at an appropriate medical facility be sought by persons with mental disorders who, while unable to distinguish or control their own actions, violate public order management and, without hospitalization and treatment, will continue to endanger public safety or the personal safety of others or disturb public order, as well as those persons with mental disorders for whom, under Article 6 of these measures, a commitment decision cannot be made.
Article 17: After a person who has been committed for treatment is discharged, the police station and his or her local mental health agency or community health service institution shall establish cooperative relations with his or her family and jointly carry out proper follow-up treatment and rehabilitation work.
Article 18: Public security organs at all administrative levels shall, in conjunction with township or town people’s governments or sub-district offices, register persons with mental disorders who seriously endanger social safety within their jurisdictions and establish joint management mechanisms to prevent the occurrence of acts that seriously endanger social safety.
Article 19: Abuse of authority, dereliction of duty, or self-seeking misconduct by personnel of the public security organs or city ankang hospital shall be subject to administrative punishment by their work unit or a superior responsible authority; if [their conduct] constitutes a crime, criminal responsibility shall be pursued in accordance with the law.
Article 20: These measures take effect from August 30, 2011. At that time, the “Xi’an Measures on Compulsory Commitment for Treatment of Mentally Ill Persons Who Seriously Endanger Social Safety” (Gov’t Notice  No. 7) issued by the [Xi’an] People’s Government on January 9, 1997, will cease to be effective.
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第 93 号