BEIJING // The axe murders this week of six people - including two young children - have sparked questions over whether China does enough to treat its mentally ill.
Four adults and two girls were on their way to a nursery school when they were attacked by a 30-year-old farmer on Wednesday in the city of Gongyi in Henan Province.
News reports claimed the killer had a history of mental illness.
The tragedy is the latest in a series of incidents in which children in China have fallen victim to random attacks.
In March 2010, a community doctor, Zheng Minsheng, 42, stabbed eight children to death and injured five others in Fujian province. He was executed weeks after the killings.
A month later, there were three separate incidents in one week in which children were stabbed or hit with hammers by men who broke into their school or nursery.
Then in May 2010, nine people, including seven children, were stabbed to death in Hanzhong city in Shaanxi province.
The attacks on children by men suspected of being mentally ill has highlighted the lack of treatment in China for people with these conditions.
"There's a lack of comprehensive mental health services in China, even in the cities. Services in the rural areas are more inadequate," said Daniel Fu Keung Wong, a professor at City University in Hong Kong and the author of Clinical Case Management for People with Mental Illness.
While there are quality facilities in China, Mr Wong said treatment is often too expensive.
"Mental health services for in-patients have to be paid for by family members," he added. "You're talking about a few thousand dollars for a patient to be admitted and stay in a psychiatric hospital."
"Because of that, they may not be able to send their relatives to the hospital to receive adequate and prompt care."
Mr Wong said the lack of community mental health care means patients are often looked after by family members who lack the required knowledge and skills to manage their conditions.
According to a 2009 report in the medical journal The Lancet, written by Chinese and American doctors, fewer than 10 per cent of the estimated 173 million people in China with mental health disorders have ever sought treatment.
Among the psychiatric hospitals in Beijing is the Peking University Sixth Hospital, a facility in the north of the city where patients represent a spectrum of ages and social classes. Its facilities are modern, if slightly gloomy.
There are also many private clinics run by psychiatrists and psychologists.
Zhao Xigang, a psychologist who has a clinic in central Beijing, said the network of treatment centres in China was "very big".
But he admitted it was often difficult to identify individuals who might be at risk of causing harm to others.
"It's very hard for his family members or society to know this beforehand," said Mr Zhao.
Awareness of mental health issues is growing in China, according to Mr Zhao, helped by greater coverage in the media.
The pressures brought about by rapid social change have been cited as potential contributory factors to the spate of attacks over the past 18 months.
Last year, China's premier, Wen Jiabao, talked of "deep-seated causes", including "social conflicts".
Mr Wong cautioned that there were reasons other than mental illness that may cause people to commit attacks.
He said many mentally ill people were not necessarily more likely to carry out atrocities than anyone else.
"You can have a person who is not mentally well attacking others out of rage and other different reasons," he said.