A picture of the No.3 Hospital in Tengxian county, in the Guangxi Zhuang Autonomous Region, from which the 42 mentally ill patients escaped on July 5. They were all tracked down and returned to the facility. Photo: CFP

Tengxian county, in the Guangxi Zhuang Autonomous Region, was a typical sleepy county until July 5, when a large group of patients escaped from a facility for the mentally disabled. Since then, it has become the focus of debates regarding mental health throughout China.

Huang Zichao, a previously well-behaved patient in the mental ward of the local No.3 Hospital, shocked staff when he and his roommates robbed a doctor and then fled along with other patients. Altogether, 42 patients escaped the facility that night.

Web users commenting on the issue remarked upon the similarities to the famous 1976 American film, One Flew Over the Cuckoo's Nest, but it was a far more serious incident in the government's eyes. Over 400 people were dispatched that evening to track down the men who escaped. They were all successfully recovered.

When asked about why he fled, Huang simply said, "It is too hot and cramped here. I miss my home."

His words outlined a simple truth: Facilities for the mentally disabled in China, particularly in rural areas, are often basic at best. "This hospital has been overloaded for years, leading to poor conditions that fall far short of the appropriate level for mental facilities," Liu Xianjie, the chief of the local heath bureau, was cited by the Beijing Youth Daily as saying.

"Guangxi is not the only place that has overloaded mental facilities. The whole nation has resource constraints in terms of mental illness," Zhang Zanning, a law professor at Southeast University, who focuses on issues associated with the mentally ill, told the Global Times Sunday.

One flew over the hospital

There are as many as seven patients in Huang's dorm room, where they share one exhaust fan. During the hot, wet Guangxi summers, many patients suffer from insomnia.

Huang has a son and a daughter in Shanqing village, about 60 kilometers from the hospital. However, he hasn't seen them since he was diagnosed with schizophrenia and sent to the hospital.

After years of treatment, Huang's symptoms have become less severe. However, his family declined a request from the hospital to accommodate him, saying they can not accept the risk of another outbreak.

That night, Huang decided to make his way home by himself.

When Zeng came to lock the gate of the mental ward, Huang, as well as his six roommates suddenly held him from behind. They took his keys, his cell phone and some of his cash. Then they opened the gates and fled, with 35 other patients following them out.

 "There were too many mentally ill patients compared with the small number of doctors and nurses, so it was impossible to stop them from fleeing," local government official Huang Weiyuan told the Global Times Monday, adding that the capacity of the mental ward of the hospital should be limited to around 100 patients, but the actual number has reached more than 300, making it hard to regulate.

The escape drew nationwide attention, attracting a flock of journalists.

"After this incident, the government decided to transfer some of the patients to other local mental wards of hospitals to relieve the burden. The hospital also plans to improve its facilities, including hiring more staff and installing air conditioners, to make the patients more comfortable," Huang Weiyuan noted.

Overloaded facilities

Although the local government decided to transfer some of the patients to other hospitals, some observers remain unconvinced it will have any broad impact.

"I don't think it is going to help. Nearly all the local mental facilities are overloaded. A hospital in Cenxi county is even worse, with 70 to 80 patients living in a shared bungalow," Xue Lei, a journalist from the Beijing Youth Daily who went to Tengxian county to conduct interviews, told the Global Times Sunday.

The Guangxi Zhuang Autonomous Region is not alone. Even much wealthier cities such as Beijing and Nanjing have huge shortfalls in terms of resources for the mentally ill.

"There are over 100 million people who suffer from mental disorders in China, with 16 million having severe symptoms. However, there are only some 16,000 psychiatrists in China, meaning there are no more than two psychiatrists for every 100,000 mentally ill people, which is much lower than the international average," said Zhang.

Beijing is believed to have some of the best resources for the mentally ill in China, but even there the problem is severe.

"Beds are always full here. Sometimes patients find it hard to make bookings for treatment in hospitals," Jiang Hongfang, an official at the Beijing Anding Hospital, one of the most famous mental care facilities in China, told the Global Times Monday.

Fear of discrimination

While there are many patients with mental diseases waiting to be treated, the problem is exacerbated by patients unwilling to leave once treatment has been completed.

"There are some 800 patients with mental illness in the hospital, of which more than 100 have been here for more than five years, with the longest 20 years," Jiang said on Monday.

However, most of the mentally ill patients only need about three months to resolve their symptoms.

"After spending some time here, some of them lack confidence and are scared to face their normal lives even though they have been cured. So they choose to stay here, causing a waste of medical resources," Jiang noted.

Without the consent of patients or their relatives, hospitals cannot force them to leave.

Similar cases have also been found in Nanjing, Jiangsu Province.

According to a 2011 report in the Nanjing News, the proportion of patients in a local mental facility who had been there for at least five years was 80 percent, leading to some 200 patients not being able to receive treatment in a suitable time frame. Fear of discrimination is reportedly one of the reasons why they refused to leave.

"Mentally ill people have no real differences from those with physical problems. They are often conditions that can be cured, especially in cases where there has only been one breakout incident," Zhang told the Global Times, adding that patients with mental illness should learn to protect their rights using the National Mental Health Law, which was published on October 26, 2012.