This week, Sixth Tone is looking at the realities and challenges of mental health care in China. Part one, on the rise of poorly qualified mental health counselors, can be found here.

As of late last year, 6.6 million Chinese were living with serious mental disorders, including schizophrenia, paranoid psychosis, and bipolar disorder. That’s roughly equivalent to half the total number of takeaway delivery drivers nationwide.

But if delivery drivers are a ubiquitous sight on streets up and down the country, the millions of Chinese living with mental disorders are all but invisible, in large part because of stigmas and discriminatory practices that exclude them from the workplace.

Employment is a thorny problem for people with mental disorders everywhere in the world. Even so, in my professional experience, the employment rate of people with serious mental disorders in China is much lower than in places like the United States and Europe. This tendency toward exclusion is a significant roadblock to resuming their lives after their diagnoses, one that makes it harder for them to find gainful employment and reintegrate into society.

Take 27-year-old Cai, for example. (To protect the identities of my research participants, I am identifying them only by their surnames.) Following his diagnosis with schizophrenia eight years ago, he spent time in a hospital. After being discharged, he tried working as a waiter, but struggled to find jobs due to employer discrimination. “During the interview for the first job, I told them straight up about my condition and they didn’t want me,” he recalled. “On my way out, the manager took me aside and suggested I shouldn’t tell anyone else about my condition.”

At the second interview — for a job at a different restaurant — he decided not to mention his condition and was hired. When his manager found out about his disorder, however, the man began pressuring Cai to leave.

A 2005 study found that 42% of mental health patients in China have been subjected to unfair treatment in the workplace More than 85% of survey respondents, including family members and mental health professionals, believed patients had suffered confidence hits as a result of discrimination, and over 75% believed the stigma around mental disorders seriously affected the lives of patients’ families.

One of my interviewees, Li, said his return to work was made almost unbearable by his coworkers’ treatment of him. “Originally, I thought it was just an illness, and that after taking some time out to relax I would be better,” he said. “But after returning to the factory full time, I was so depressed that I felt like I couldn’t breathe. Every day on the work bus to and from the factory, my colleagues would be sitting together chatting and joking — the only empty seat was next to me.”

There have been attempts to remedy this situation. A 2007 policy offered preferential tax treatment to employers who hire people with mental disorders. The Mental Health Law passed in 2012 not only provided employers with tax incentives, but also offered support in areas such as production, operations, technology, capital, materials, and land.

These measures have had little practical effect. When I asked the head of a state-affiliated institution why, he argued that the benefits to employers aren’t enough to offset the opposition from other workers. “Employing someone with a mental disorder doesn’t have much effect on our taxes, nor does it particularly influence the actual amount we pay the employee,” he explained. “Plus, if we hire someone who is recovering from mental health problems, we need to consider the feelings of other employees as well as matters such as whether they’re willing to work with him or her.” Heads of other companies I spoke with expressed concern that the intensity and pressure of work could have a negative impact on people with mental disorders.

The current welfare benefits system also disincentivizes patients from returning to the workplace. In recent years, China has introduced welfare policies for people with serious mental disorders, including free medication, unemployment subsidies for those with particularly severe conditions, and transportation subsidies, which patients can claim by showing their disability card. That card is revoked once the patient finds employment, however, causing them to lose access to their benefits. Given the challenges of integrating into a workplace, some patients weigh the pros and cons and make the rational decision to stay on disability.

“If I don’t work, I can get more than 2,000 yuan ($281) a month in benefits,” one of my interviewees, Zhang, told me. “If I work, I could only get some minimum wage job in Shanghai and work myself into the ground. So, not working actually works out better.”

Surprisingly, many patients’ families also pressure them to stay out of the workforce. Families are a key source of support for patients in China, and most Chinese with serious mental disorders live with a family member. While the economic burden this places on patients’ families can be heavy, their relatives sometimes view the risks of returning to work as greater than any potential benefits.

For patients who didn’t have a job when their mental illnesses first presented, their family members are already accustomed to the lack of income. For others, as long as the reduction to their quality of life is bearable, there is little pressure on patients to find work. Many families worry that problems in the workplace could lead to a relapse, especially for those with chronic diseases that have a high recurrence rate, such as schizophrenia. In this view, it’s better to not work — and avoid the stress of the workplace — than to find a job.

In short, the challenges people with mental illnesses face in the workplace go far beyond discriminatory hiring practices. Addressing them will require convincing more than just companies that people with mental disorders can be full and capable members of society.

In the meantime, new employment support systems can help bridge the gap. For example, the government should design targeted vocational training courses with people with mental disorders in mind. It should also pay more attention to the need for occupational psychology and health management training. Ultimately, only when patients and their families see employment as a viable path to a better life — and are confident that they will not be cast aside at the first sign of trouble — will they be willing to lower their guard and reintegrate into society.

Translator: David Ball; editors: Cai Yiwen and Kilian O’Donnell; portrait artist: Wang Zhenhao.

(Header image: Shijue/VCG)