China sees resurgence of psychiatric care for ‘troublemakers’

When Zhang Junjie was 17 years old, he decided to protest in front of his university against the regulations imposed by the Chinese government. A few days later he was admitted to a psychiatric hospital and received treatment for schizophrenia.

Junjie is one of dozens of people identified by the BBC who were hospitalized after protesting or complaining to the authorities.

Many people we spoke to received antipsychotic medications, and in some cases electroconvulsive therapy (ECT), without their consent.

For decades there have been reports that hospitalization was used in China as a way to detain dissident citizens without involving the courts. However, the BBC has discovered that a problem the legislation was intended to solve has recently returned.

Junjie says hospital staff restrained him and beat him before forcing him to take medication.

His ordeal began in 2022, after protesting against China’s harsh blockade policies. He says his teachers saw him after just five minutes and contacted his father, who took him back to the family home. He says his father called the police and the next day, on his 18th birthday, two men took him to what they claimed was a Covid testing center but was actually a hospital.

“The doctors told me that I had a very serious mental illness… Then they tied me to a bed. The nurses and doctors repeatedly told me that because of my views on the party and the government, I must be mentally ill. It was terrifying,” he told the BBC World Service. He was there for 12 days.

Junjie believes his father felt compelled to hand him over to the authorities because he worked for the local government.

Just over a month after being discharged, Junjie was arrested again. Defying the ban on fireworks during Chinese New Year (a measure introduced to combat air pollution), he had recorded a video of himself lighting them. Someone uploaded it to the Internet and the police managed to link it to Junjie.

He was accused of “picking quarrels and creating trouble,” a charge frequently used to silence criticism of the Chinese government. Junjie says he was forced to be hospitalized again for more than two months.

After being discharged, Junjie was prescribed antipsychotic medication. We have seen the prescription: it was for Aripiprazole, used to treat schizophrenia and bipolar disorder.

“Taking the medication made me feel like my brain was a mess,” he says, adding that the police came to his house to check that he had taken it.

Fearing a third hospitalization, Junjie decided to leave China. He told his parents he was going back to university to pack his bags in his room, but in reality he fled to New Zealand.

He did not say goodbye to family or friends.

Junjie is one of 59 people the BBC has confirmed (either by speaking to them or their families, or by reviewing court documents) who have been hospitalized for mental health reasons after protesting or defying authorities.

The problem has been recognized by China’s government: the country’s Mental Health Law of 2013 was intended to stop this abuse, making it illegal to treat someone who is not mentally ill. It also explicitly states that psychiatric admission must be voluntary unless the patient poses a danger to self or others.

In fact, the number of people detained in mental health hospitals against their will has increased recently, a prominent Chinese lawyer told the BBC World Service. Huang Xuetao, who was involved in drafting the law, blames the weakening of civil society and a lack of checks and balances.

“I have come across many cases like this. The police want power and avoid responsibility,” he says. “Anyone who knows the shortcomings of this system can abuse it.”

An activist named Jie Lijian told us that he had been treated for mental illness without his consent in 2018.

Lijian says he was arrested for attending a protest demanding better wages at a factory. He says police questioned him for three days before taking him to a psychiatric hospital.

Like Junjie, Lijian says he was prescribed antipsychotic medication that affected his critical thinking.

After a week in the hospital, he says he refused any more medication. After fighting with staff and being told he was causing problems, Lijian was sent to ECT, a therapy that involves passing electrical currents through the patient’s brain.

“The pain was from head to toe. My whole body felt like it wasn’t mine. It was really painful. An electric shock went on. Then it went off. An electric shock came on. Then it went off. I passed out several times. “I felt like I was dying,” he says.

He says he was discharged after 52 days. He now has a part-time job in Los Angeles and is seeking asylum in the United States.

In 2019, a year after Lijian said he was hospitalized, the Chinese Medical Association updated its ECT guidelines, stating that it should only be administered with consent and under general anesthesia.

We wanted to know more about the involvement of doctors in these cases.

Talking to foreign media like the BBC without permission could get them into trouble, so our only option was to go undercover.

We booked telephone consultations with doctors working in four hospitals that, according to our evidence, are involved in forced hospitalizations.

We used a made-up story about a relative who had been hospitalized for posting anti-government comments online and asked five doctors if they had ever encountered cases of patients referred by the police.

Four confirmed yes.

“The psychiatry department has a type of admission called ‘troublemakers,'” one doctor told us.

Another doctor, from the hospital where Junjie was, seems to confirm his version that the police continued to monitor the patients once they were discharged.

“The police will monitor you at home to make sure you take your medications. If you don’t take them, you could break the law again,” they said.

We approached the hospital in question for comment but they did not respond.

We have been given access to the medical records of democracy activist Song Zaimin, hospitalized for the fifth time last year, making clear how closely political views appear to be tied to a psychiatric diagnosis.

“Today he was… speaking a lot, incoherently, and criticizing the Communist Party. Therefore, the police, doctors and the local residents’ committee sent him to our hospital for inpatient treatment. It was an involuntary hospitalization.” says.

We asked Professor Thomas G Schulze, president-elect of the World Psychiatric Association, to review these notes. He replied:

“As described here, no one should be involuntarily admitted and treated against their will. It reeks of political abuse.”

Between 2013 and 2017, more than 200 people reported they had been unfairly hospitalized by authorities, according to a group of citizen journalists in China who documented abuses of the Mental Health Law.

Their reporting ended in 2017, because the group’s founder was arrested and subsequently imprisoned.

For victims seeking justice, the legal system appears to be stacked against them.

A man we call Mr. Li, who was hospitalized in 2023 after protesting against the local police, attempted to take legal action against the authorities for his imprisonment.

Unlike Junjie, doctors told Mr. Li that he was not sick, but the police then hired an outside psychiatrist to evaluate him, who diagnosed him with bipolar disorder, and he was detained for 45 days.

Once released, he decided to question the diagnosis.

“If I don’t report it to the police it’s like I accept being mentally ill. This will have a big impact on my future and my freedom because the police can use it as a reason to lock me up at any time,” he says.

In China, the records of anyone diagnosed with a serious mental health disorder could be shared with police and even local residents’ committees.

But Mr. Li was unsuccessful: the courts rejected his appeal.

“We heard our leaders talk about the rule of law,” he told us. “We never dreamed that one day we could be locked up in a psychiatric hospital.”

The BBC has found 112 people listed on the official Chinese judicial decisions website who, between 2013 and 2024, attempted to take legal action against police, local governments or hospitals for such treatment.

Around 40% of these plaintiffs had been involved in complaints against the authorities. Only two won their cases.

And the site appears to be censored: five other cases we’ve investigated are missing from the database.

The point is that the police enjoy “considerable discretion” in dealing with “troublemakers”, according to Nicola MacBean of The Rights Practice, a London human rights organisation.

“Sending someone to a psychiatric hospital, avoiding procedures, is too easy and useful a tool for local authorities.”

Eyes are now on the fate of vlogger Li Yixue, who accused a police officer of sexual assault. Yixue was reportedly recently hospitalized for a second time after her social media posts talking about the experience went viral. He is now reportedly under surveillance in a hotel.

We presented the results of our research to the Chinese embassy in the United Kingdom. He said last year that the Chinese Communist Party “reaffirmed” that it must “improve mechanisms” around the law, which it says “explicitly prohibits illegal detention and other methods of illegally depriving or restricting the personal freedom of citizens.” “.

Additional reporting by Georgina Lam and Betty Knight