New Taiwanese Legislation Targets Asylums to Help Mentally Ill Inmates : Health: Aim is to improve care and punish families and institutions that fail to give patients proper treatment.

Hundreds of people in Buddhist robes file silently into a simple dining room. At the first whistle, they pray. At the second, they pick up bowls and chopsticks. At the third, they start eating.

Like a reverent army, they remain completely silent.

They are not monks and nuns. They are inmates at the Lung Fa Tang, a Buddhist asylum in the southern Taiwan city of Kaohsiung, which is at the center of an unprecedented debate over the island’s policies towards the mentally ill.

Lung Fa Tang made headlines in November as one of a number of private institutions that will be affected by Taiwan’s first legislation dealing with mental health, which parliament had just passed.

The bill mandates a better government network to help the mentally ill and spells out punishment for families and asylums that do not provide patients with proper care.

Mental illness carries a heavy burden of shame in traditional Chinese society. Relatives of people with mental disorders are loath to admit that there is a patient in the family, and psychiatric treatment is never mentioned, publicly or privately.

For many, Lung Fa Tang represents an end to their suffering. The temple takes patients for life in exchange for a contribution ranging from about $7,500 to $22,000.

More than 600 mental patients live in the unlicensed asylum, which was founded 20 years ago by Hieh Kai-feng as a grass-roots way of dealing with a problem that was rarely acknowledged publicly.

When Lung Fa Tang was established, Kaohsiung’s only mental asylum accommodated a mere 45 patients.

Hieh claims to be a Buddhist monk and insists on the honorific title of Master, although his temple has never been accredited by Taiwan’s semiofficial Chinese Buddhist Society.

In an interview at Lung Fa Tang, Hieh, a robust 60, whose Buddhist robes cloak a businesslike demeanor, said the temple was operating perfectly without the assistance of trained psychiatrists.

“We haven’t had any psychiatrists for the past 20 years,” he said. “Why do we need them now?”

The temple’s treatment methods stress prayer and simple, repetitive tasks, such as raising chickens, collecting eggs and making clothing.

The temple keeps no medical records and restrains violent cases in separate rooms.

“We are not doctors and we don’t need any records. We just want to take care of these poor people,” Hieh said.

Rumors of inhumane treatment and the obviously hefty income from several businesses run by the asylum have aroused curiosity about its financial status.

The asylum, a Spartan seven-story concrete building closely resembling the gray factories that surround it, is said to be one of Taiwan’s chief producers of eggs.

“It’s like other businesses. Sometimes we also have financial problems, but we can always manage it,” said Hsin Yen, a Buddhist nun who acts as temple spokesperson.

Inside Lung Fa Tang, a new golden statue of Hieh sits next to a statue of Buddha. Patients pray to both several times a day.

“When inmates see master’s statue, they calm down,” a volunteer worker said.

There are hints, however, that for some inmates life may not be so serene. Critics say Taiwan’s lax attitude toward mental health has allowed Hieh to set up a workhouse run with free labor.

“They beat me if I don’t listen to them and lock me in the toilet,” whispered an inmate, who fell silent when a nun approached.

Psychiatrists take a positive view of “folk healing”--calming patients through work--but urge psychiatric treatment be used as well.

Wen Jung-kwang, an associate professor of psychiatry at Kaohsiung Medical College, spent a year doing research at Lung Fa Tang but was eventually asked to leave.

“It’s a small world set up by its master without any government control,” said Wen.

“Patients are calm there because they are suppressed and blocked from the outside world,” Wen said. “Just like criminals in jail all behave well.”

Taiwan has at least 60,000 mental patients, but only 13,000 places at 112 registered mental hospitals and asylums.

About one-third of the island’s mental facilities are privately run, and more government subsidies will go to private institutions now that the new mental health bill has passed, a health department official said.

“The aim of the bill is to build a better medical network for mental patients, not to close asylums,” said legislator Hong Chi-chung, one of its sponsors.

Nevertheless, Hieh has threatened to close his asylum rather than accept outside supervision, although Lung Fa Tang officials said recently that they are now considering government assistance but no agreement has been reached.

Frightened families of Lung Fa Tang inmates have staged protests outside parliament, afraid that their mentally ill relatives will be returned to them.

“It can become a legal institution and receive the government’s help, but they have to publicize their finances and cooperate with psychiatrists,” said Cho Chun-yin, head of the social affairs department of the Kaohsiung county government.

The fate of Lung Fa Tang is unclear, but officials said the government is ready to take over its patients if the asylum closes.

“This is a tragedy and farce in a developed country,” said Kaohsiung Medical College’s Wen. “It either has to close or adopt psychiatric methods.”