BEIJING – We were watching a group of men and women kneading and preparing loaves of bread when my colleague Gu Bo suddenly asked, "There are six patients baking and one instructor, is that right?"
"Yes," replied Yang Yun, a petite Beijing native showing us around.
"So the one holding the knife is the instructor, right?" asked Bo.
"Yes," Yang answered again.
Bo's polite but firm persistence was understandable.
This was no ordinary kitchen. It was in the Beijing Chaoyang District Mental Health Service Center , a privately-run mental institution started up in 1999.
Yang, a veteran nurse, was the center’s director.
And the people baking were all patients diagnosed with serious mental illness.
"Most of our patients have gone through treatment at hospitals," said Yang. "But they still have mental problems, and their families can’t take care of them."
So they ended up at the center, which Yang said enables them to recuperate in a quiet and peaceful environment without any pressure. Families pay on average about $180 a month for the patient to live on the premises (not cheap given that the typical monthly income in Beijing is about $550).
Three doctors and some 40 caretakers look after the 190 patients. Virtually all are from Beijing and were brought to the center by relatives. "About 130 to 140 are men," said Yang. They range in age from 18 to 70.
The morning we visited, clusters of people sat in the garden, shaded by trees and grapevines, trying to beat the heat. A handful of patients watched television indoors. Some walked back and forth, quietly and purposefully, with a faraway look in their eyes.
But in the kitchen far off to the corner, there was a hubbub of activity.
Photo by Adrienne Mong/NBC News
The bakers wait for their challah loaves to cool.
The bakery was born five years ago when Natascha Prigge and Yvonne Gerig came to the center as volunteers.
"I think we as foreigners here in Beijing … have a pretty privileged life," said Prigge, who hails from Munster, Germany. She has been living in Beijing for nearly eight years and said that volunteering at the center is her way of helping her adopted country. "We can’t really change anything, but it’s a small thing I can do to give something back."
After starting an organic farm project at the center, she and Gerig, a Swiss native who studied psychology in college, came up with the idea of a bakery.
"We were thinking of something that we can teach to the patients, and we were looking for [an] occupation that they can do all year long," said Prigge, who studied business when she was in college. "And baking is something that is easy to learn, easy to handle, and when we started five years ago there were not so many bakeries around."
After raising a few thousand dollars, Prigge and Gerig bought equipment and refurbished a room in the center for the bakery to launch "Crazy Bake." ("Some people think the name is very direct," acknowledged Prigge, who canvassed opinions from native English speakers before deciding on the name. "But the patients are fine with it.")
Since then, every Friday, the group of six patients don their chef’s hats and aprons to work in their fully outfitted kitchen. Even during this slow season – most of their customers are expatriates who go away for the summer holidays – they churn out around 60 loaves of farmer’s bread and challah bread (each sell for about $3), in addition to bags of bagels.
"[The patients] do everything," said Prigge. "The only thing we do is distribution now." Each Friday, after the loaves are made, she or Gerig make the trip to downtown Beijing – occasionally with one or two of the patients – to deliver the bread to homes, schools, and embassies.
The bakery program was initially intended to give the patients something to do and to provide structure to their days. It’s also allowed them to re-engage with the wider world. A patient at the center since 2001, Jeff, who would only give his first name, loves making deliveries. "I like being outside, and I like seeing other people," he said.
"They have fun baking and gain confidence," said Yang. "They can also make some money out of it, some of which has been used to buy facilities for the center, and that makes them feel respected and valued. So it’s a great thing for them both mentally and physically."
Photo by Adrienne Mong/NBC News
Patients at the Beijing Chaoyang District Mental Health Service Center enjoy the quiet shade on a hot summer day.
'This needs our whole society’s attention'
Attitudes at the center seem a far cry from how the mentally ill are typically viewed in China.
"I personally don’t think we have much support from society, which discriminates against the mentally ill," said Yang. "Chinese society doesn’t know very much about mentally ill patients. They think of them as lunatics or weirdos."
Her remarks underscore perceptions that surfaced after a series of random school attacks last spring across the country, in which several men injured or killed several dozens of young students.
Although still very little is known about the perpetrators or their motives, commentators in the media were quick to note commonalities: some of the men were social misfits or nursing a host of grudges. Many Chinese sociologists and psychology experts spoke out about the need for a better social safety net to catch those unable to cope with modern-day challenges.
"Our society is changing and developing rapidly," said Yang. "We discover that many young people, although they are not sick, they do have a mental disorder. You never know when they may act extremely…. This needs our whole society’s attention."
But that attention appears to be sorely lacking.
"There aren’t a lot of psychological doctors and clinics like we have in the West," said Prigge. "I think it’s difficult to get the proper treatment."
Health experts here have estimated China has at least 100 million mentally ill people (out of 1.3 billion), but that fewer than half of the general public have any awareness of mental health.
Moreover, by the end of 2005, there were just under 600 mental institutes, some 16,000 registered psychologists, and only 133,000 psychiatric hospital beds in the entire country. Crunch the numbers, and it looks worse: One hospital bed for every 10,000 Chinese and one psychologist for every 100,000 Chinese.
(We could only rely on statistics from 2005. In response to our requests for more up-to-date information, the Chinese Center for Disease Control and Prevention refused, and the Chinese Ministry of Health stonewalled us.)
The World Health Organization confirmed that mental illness ranks as the second largest burden on Chinese health care, just lagging behind heart disease, but exceeding cancer. Factoring in neurological disorders such as epilepsy, Alzheimer’s, etc., neuropsychiatric diseases top the list.
Which makes the Beijing Chaoyang District Mental Health Service Center and the "Crazy Bake" program all the more remarkable. Since the program’s inception, the participating patients have shown marked progress, said Yang. The six bakers are now housed in assisted living a short distance away from the centre.
"I feel more freedom than here," said Jeff, one of the two bakers who speaks fluent English that he learned in university.
Jeff, who worked in engineering, marketing and even ran his own business before he was brought to the center by his family, exudes a friendly directness that hints at none of his troubled past, yet promises a hopeful future. "I feel happy, I feel [active]. I feel good," he said.