State provision for the mentally ill is a relatively recent phenomenon in China. Prior to the early twentieth century, mentally ill individuals were typically kept within the home, and State agents did not intervene unless the individual was violent or criminal. It was not until 1908 that the first public asylum was erected in China for the exclusive care of the insane. From that point on, subsequent governing regimes experimented with a variety of approaches to treating mental illness and managing those who were affected by the disorder. This chapter will place Chinese psychiatric welfare in its historical context, and will argue that certain issues facing psychiatric welfare in China today can be traced back to longer historical processes. In particular, it will discuss three factors that continue to exert an influence on the current state of psychiatric welfare: first, the longstanding priority placed on domestic, rather than State, care of the mentally ill; second, uneven geographical access to psychiatric care, with urban areas being prioritized over rural ones; and, third, popular attitudes and beliefs about the nature and proper treatment of mental illness. By examining the contemporary state of Chinese psychiatric welfare in its historical context, this chapter will show how Western forms of welfare do not always function as expected when transplanted into a Chinese setting.