As soon as he leaves the hospital, Qu Yi says confidently, he and his fiancee finally can get married.

His "Little Swallow" already has arrived here to plan their wedding, he says. During the day, she slips into his locked and barred ward, then vanishes into thin air afterward. At night, while he watches TV, Qu confides, she sends him secret messages over the airwaves that only he can decipher.

To Qu, it's love. To his doctors, it's a delusion, born of a mind rent by severe schizophrenia. Neither Qu's fiancee nor his upcoming wedding really exists.

Qu is one of more than 1,300 schizophrenics at China's oldest psychiatric facility, here in the heart of Guangzhou. They are part of the growing number of people now recognized as mentally ill in a country that once dismissed them as victims of bad karma or as political misfits whose problems stemmed from improper Communist ideology.

Millions of Chinese every year have afflictions ranging from minor depression to major psychosis diagnosed. Psychiatric drugs such as Prozac are widely used, replacing "treatments" that once consisted of studying Mao's quotations.

But far more of the sick don't receive the care they need. China, with one-fifth of the world's population, also suffers from one of the highest suicide rates on Earth. Ignorance, high medical costs and the heavy stigma attached to mental disease discourage people from seeking help.

Those who do are confronted with a tottering public health system that is ill-equipped to serve their needs - and that experts predict will be even less able to meet the swelling demand for psychiatric services in the future. Virtually no one in the countryside gets free care anymore, and free health care for urban workers is declining rapidly as state-owned enterprises go under.

"It's going to get worse before it gets better," warned Michael Phillips, a Canadian psychiatrist in Beijing who has studied mental- health care in China for the past 15 years.

The magnitude of the looming crisis in mental health is difficult to pin down. Officially, just 16 million people suffer from psychiatric disorders out of a population of 1.2 billion. But Chinese and Western experts scoff at the government figure, saying the real number is easily twice or even three times that.

While scholars debate the exact figures, no one doubts that only a fraction of the sick receive proper treatment in a land with just 110,000 psychiatric hospital beds and an even more serious dearth of physicians and psychologists trained to handle mental illness - a paltry corps of about 13,000.

By contrast, the U.S. boasts twice as many hospital beds and nearly 200,000 psychiatrists and psychologists who serve a population about a quarter the size of China's.

"To have 11,000 to 14,000 psychiatrists, depending on how you count it, (for 1.2 billion people), you're kidding yourself," Phillips said.

Many victims follow the path of Qu, whose family balked at the idea of mental disease and waited 3 1/2 years before bringing him in for treatment.

Qu, 28, is now on medication and lives with the other patients in his ward, men such as Professor Zeng, a mild-mannered academic who is convinced that his wife is trying to poison him.

The men mill about in their thin white pajamas, watching TV, singing karaoke, playing pingpong and fanning themselves to beat the southern summer heat. Women occupy their own wards. Facilities are basic and stark. Sharp objects are stowed out of reach.

The 3 1/2-year delay in seeking treatment probably will mean a longer recovery time for Qu, said his doctor, Jiang Zeyu.

"The key is to detect and treat it early," Jiang said. "If society better understood these symptoms, people would go to the hospital earlier. But society's understanding of (mental illness) is extremely shallow."

The ignorance harks back to ancient tradition and more recent misguided policies by China's Communist rulers.

Notions of bad karma, divine wrath or possession by evil spirits still color views of psychiatric disorders, especially among the 800 million residents in China's vast countryside.

"They think that you did something bad, or that your ancestors did something wrong," said Chen Hsueh-Shih, who at 83 is the doyen of psychiatrists in China. "It's like Europe in the Middle Ages."

During the 1950s and '60s, fanatical communism took over from superstition. Particularly during the 1966-76 Cultural Revolution, mental illness was considered the outcome of clinging to the wrong ideology. Officials dismissed psychology as a bourgeois Western science.

At the Guangzhou Psychiatric Hospital, patients were taken off their regular medication and put on a course of Mao Tse-tung's quotations and traditional Chinese herbs. Other facilities in the country were shut down.

Psychiatry didn't re-emerge until about 20 years ago, when China opened up again to the outside world, but it remains hobbled by the interruption. Few medical students opt to specialize in psychiatry, which is still looked on as the ugly stepchild of modern medicine. Mental-health professionals earn among the lowest salaries of China's physicians, about $125 a month.

Psychiatry's marginalization means that general doctors often are ignorant of mental disorders and don't know how to diagnose or treat them, while specialists sometimes are hard to find.

The stigma associated with mental illness is still so strong that even those who have recovered fully often face the prospect of losing their jobs, housing and spouses. Psychiatric problems are still seen as a source of shame to one's entire family.

Efforts to promote awareness and understanding of mental disease have an ally in international pharmaceutical companies, which see China as a huge well of untapped profit, particularly for anti- depressants, the fastest-growing segment of the psychiatric drug market.

Sales of Prozac have jumped 50 percent every year since the drug's introduction to China in 1995, according to representatives from manufacturer Eli Lilly. Prozac now accounts for 40 percent of the anti-depressant market in China.

Ironically, the same economic reforms that have enriched drug companies have taken their toll on the state health-care system and made psychiatric care less accessible for many Chinese.

Mental hospitals, forced to compete in the open market, have had to resort to serving customers who can afford to pay high fees while cutting back on treatment for the poor, the increasing ranks of China's uninsured and the slightly ill.

More facilities are closing unprofitable wards. Many psychiatric hospitals in poorer provinces such as Hunan, Sichuan and Jiangxi are only 50 percent to 80 percent full and don't have enough money to pay their staffs.

Last November, the Chinese government publicly committed itself to combating mental illness, acknowledging the problem and embarking on studies and awareness programs in conjunction with the World Health Organization.

It was an important step forward, experts say, for a regime that first drafted guidelines for protecting mental patients more than 15 years ago but has never approved them.
　　
　　(From HealthWorld Online)