Mental illness is absent from the Classification and Catalogue of Occupational Diseases of China: Mental health protection of health care workers amidst the COVID-19 pandemic
The COVID-19 pandemic has claimed many lives around the world. While the aftermath of this devastating pandemic has yet to fully emerge, the Chinese government is already rushing to hold a ceremony to show its success in its fight against the pandemic.
At the grand COVID-19 hero-praising ceremony held on 8 September 2020 in Beijing,  the brave and dedicated side of the medical and nursing staff was on full display. However, there was no acknowledgement of the stress and mental trauma they had to endure. 
1. Chinese Medical workers suffer from depression, fear and stress disorder
On 29 July 2020, a young cardiac nurse from Wuhan Union Hospital, Ms Yanwan Zhang, committed suicide by jumping off the top of a building. This incident soon became the talk of town on Weibo. Despite the rumours flying around, the hospital administration has not yet conducted an official investigation nor has it explained the cause of Zhang’s suicide. 
Since the beginning of this year, some academics have started to pay attention to and study the percentage of health care workers suffering from depression, fear and post-traumatic stress disorder as a result of fighting the pandemic. Results reveal that a large number of doctors and nurses have become afflicted with mental and psychological difficulties[1].Although, the studies do not amount to psychological diagnoses of the mental illnesses faced by health care workers, they do serve as an indicator of the alarming prevalence of such illnesses amongst them. 
In fact, the Mental Health Center of Wuhan Psychological Hospital has also put on its website a special section that discusses the psychological and psychiatric problems health care workers might encounter amidst the outbreak of COVID-19. These problems include “fear or worry,” “overwork exhaustion,” “nervousness and anxiety,” “suppressed anger,” “acute stress reaction,” “acute stress disorder,” and “post-traumatic stress reaction.” 
Challenges such as the unprecedented nature of COVID-19, the ineffective allocation of manpower and equipment, and long working hours have all added to the pressures of health care workers, thereby making them more prone to psychological illnesses. Article 37(11) of the Law on Practicing Doctors of the People's Republic of China states that doctors’ practicing certificates can be revoked in the event that they fail to “follow the orders of the health administration departments during times of natural disasters, outbreaks of infectious diseases, sudden accidents with heavy casualties and other emergencies which pose a serious threat to people's life and health.” Therefore, it is difficult for front-line health care professionals to refuse posting arrangements even if they are already under significant mental stress. To deal with the difficulties faced by staff members, hospital administrations have only called for more counselling services and the creation of more supportive working arrangements to alleviate their stress. However, it is doubtful whether hospital administrations have provided adequate protective equipment and support for health care workers so that they are adequately protected in their fight against this pandemic.
2. COVID-19 and work-related injury
In the workplace, work injury claims and other civil actions are often the most common channels employees use to claim compensation, with the latter being comparatively more difficult and demanding. 
According to Article 14(1) of the Regulation on Work-Related Injury Insurance (2010 Revision), “employees shall be ascertained to have suffered from work-related injury if he is injured from an accident within the working hours and the working place due to his work.” On 23 January this year, the Ministry of Human Resources and Social Security (MOHRSS), the Ministry of Finance, and the National Health Commission jointly promulgated the “Notice on Issues Concerning the Guarantee of Medical Staff and Other Related Staff Infected with Novel Coronavirus (COVID-19) Pneumonia Due to Performance of Duties” (“the Notice”),  which states that “medical staff and other related staff who, during the prevention and control of the novel coronavirus (COVID-19) pneumonia, are infected with or die from the novel coronavirus (COVID-19) pneumonia due to performance of their duties shall be determined to have suffered a work-related injury and enjoy work-related injury insurance compensation in accordance with the law.” 
One may still remember the whistleblower, Dr Wenliang Li, who died after contracting the virus; this incident continues to attract heated discussion online. Many lamented his tragic death and criticized the government’s handling of the pandemic. Under immense pressure, both locally and globally, the Wuhan Human Resources and Social Security Bureau ruled Li’s death to be a workplace injury and awarded his family 821,000 Chinese Yuan in compensation.  However, there is no way of knowing how many other medical and nursing staff have actually been compensated for contracting the virus in their workplace. Even worse, there is still no established compensation mechanism in place to deal with incidents such as Ms Yanwan Zhang’s suicide, where health care workers develop mental illnesses in their workplace. 
3. Mental impairment should be classified as an occupational disease
Incidents such as Zhang’s suicide bring out a key question: can health care workers who suffer from mental or psychological symptoms as a result of their fight against the pandemic claim occupational injury-related compensation? 
Sadly, the answer seems to be no if one looks at the latest revision of the Classification and Catalogue of Occupational Diseases of China.  The Regulation on Work-Related Injury Insurance and the Notice only address cases of infection or death due to COVID-19 resulting from being infected at the workplace. In other words, health care professionals suffering from mental or psychological illnesses due to their work barely receive any protection under the existing legal framework.
Admittedly, the causes of mental impairment may be more complex than other physical injuries. Nonetheless, the healthcare industry should pay more attention to the mental health of its employees. 
Mental health has always been a concern in the healthcare sector because healthcare professionals working long hours in the hospitals are at a higher risk of contracting diseases and are under greater pressure than workers in many other industries. Numerous Lancet studies have shown that, under the threat of COVID-19, health care workers have experienced fear, anxiety and even post-traumatic stress symptoms after their long hours of work.  Therefore, it is necessary to immediately classify mental illnesses as “work injury and occupational disease” in order to afford health care workers more comprehensive compensation. One should note that the classification of mental illnesses as occupational injuries/diseases allows for more than mere monetary compensation. 
According to Article 56(3)(4) of the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases (2018 Amendment), “employers shall transfer occupational disease patients who are no longer suitable for their original jobs from aforesaid jobs and settle them appropriately, and […] provide appropriate job allowances to employees conducting operations which expose them to occupational disease hazards.” With this flexibility in place, more protections can be provided that can allow health care workers to avoid mandatory posting arrangement when they are confronted with mental issues. 
Such legislation would not only protect the rights of health care workers, but would also confirm the legal responsibility of health care authorities as employers to safeguard the mental health and other interests of health care workers, thereby obligating health care authorities to take appropriate measures to prevent the mental impairment of health care workers and to ensure their mental and psychological well-being. 
Notwithstanding the absence of mental illnesses in the list of occupational diseases, it is not impossible to cover mental illnesses as occupational diseases by referencing the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases (2018 Amendment). Article 46 of said Law prescribes three factors to be considered in occupational disease diagnoses, namely: (i) “occupational history of a patient,” (ii) a history of exposures to occupational disease hazards and hazard factors in the work site, and (iii) clinical diagnoses, and so forth.” Applying these criteria, the high-risk and high-pressure environment in which health care workers are working, their prolonged contact with patients, and the inadequate support and equipment provided by hospitals should be considered as factors that underline the importance of classifying mental impairment as an occupational disease. However, because of the government's delay in including mental illnesses as an occupational disease, health care workers are still unable to obtain occupational disease compensation even though the conditions they face meet the criteria set out in Article 46. 
More importantly, the provision as articulated in Article 46 states that “where there is no evidence for denying a necessary connection between occupational disease hazard factors and a patient's clinical manifestations, the patient shall be diagnosed with an occupational disease.” Therefore, if the government includes mental illness as an occupational disease, circumstances will be more favourable for health care workers to have their labour rights protected by filing occupational disease claims for work-related mental or psychological impairment. 
This article aims to raise the issue of inadequate health care protections under existing legislation in the People’s Republic of China. Mental health is a problem faced by many workers in society today; the psychological and mental pressures borne by health care workers is even more apparent under this pandemic. The tragic death of the young nurse, Ms Zhang, is a searing reminder that the legislature must address the urgent mental or psychological needs of all health care workers. The author LAC hopes that the government can expediently address this problem and mitigate the legal loopholes. Indeed, health care workers need no accolades for doing their duty; what they truly need is the protection and care they deserve when mental or psychological harm comes their way. 
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