| Objective:In studying of the three aspects of mental health service providing organizations (township health centre) in the sub-developed rural areas of Youxian district of Mianyang city, the township case manager, and the service receivers (severe psychiatric patients and permanent residents in the community), we especially examine their mental health input, service process and service effectiveness, and then we assess the current service capacity in this region. By doing this, we try to establish an initial framework for evaluating the community mental health service(CMHS) capacity and provide a reference of capacity evaluation system appropriate to CMHS)in the rural areas.Methods:In this article, our object of study focus on the Program of CMHS to patients with severe psychiatric disease from the sub-developed rural areas of Youxian district of Mianyang city. Using "Questionnaire on Mental and Psychological Health Knowledge" issued by the Ministry of Health as well as my self-formulated "Questionnaire on CMHS Capacity", we are able to get the idea of the current situation of the mental health service providing organizations(township health centre) in the sub-developed rural areas of Youxian district of Mianyang city, the case manager in these organizations, and the service receivers (severe psychiatric patients and their families), Besides, during this course, we’ve interviewed a number of target groups. By using quantitative analysis and qualitative analysis method to the above-mentioned materials, we can assess the status of mental health service capacity of this region.Results:1. Institutions:Among the 22 township health centers,21 of them have established two-level mental illness prevention network covering both the townships and the villages, in which the case managers (the post taken by a health care manager) in these towns and villages and village doctors will provide these services.2. Township case manager’s capacity:54.55% of these people graduated from secondary technical school before work,40.91% of them has an education background on Integrated Medicine. So far these people has participated in the mental health knowledge trainings 4.36 times per year.85.61% of these people are aware of the common sense on mental health.82.99% of these people have some knowledge on services of community mental health. But in the same time, their correct diagnosis rate was only 63.64%. Although they have accumulated considerable experience, they are often exhausted by a heavy workload with a doctor managing an average of 40.73 persons in a service radius of 7.65 km. Although they have confidence in CMHS work, their’enthusiasm is largely hurt by poor condition such as lack of adequate equipment.3. Investigation into the feedback from the people served:The follow up by the township case manager is dominated by telephone (49.8%) or the combination of on-site interview and telephone (35.2%). The follow-up frequency is mainly one time every 2-3 months or one time every 4-6 months (82.6%). During it, the township case manager pay more attention to the patients’conditions and how they take their drugs but less attention to education to their families and rehabilitation guidance.83.1% of patients are satisfied with this service. The population awareness rate about mental and psychological heath knowledge in the sub-developed rural areas of Youxian district of Mianyang city is only 46.24%.The Percentage of coverage on mental health education is only 13.6%.4.Through interviews we have known the factors which influence the mental health service capacity include: Township-Village working network and the Hospital-Community bidirectional referral patterns, equipment, manpower backup, reasonable performance evaluation system, re-education and good doctor-patient relationship and so on.Conclusion:1.Rural communities in the Youxian District have a relatively complete medical service system covering both townships and villages, which ensure the good momentum of development in community mental health services.2.In this district, a comparatively sound health insurance is set up.3.Through years of attempts, in the area of mental health services, the Hospital-Community bidirectional referral patterns and the Township-Village service network has been established around this district.4.In Youxian District, a team of case manager covering both townships and villages are formed, the members of which are given a special training about special knowledge and skill on mental health care and enabled to assume some special work such as enquiry on the mental illness patients, follow-up, medication guidance, education on mental health knowledge.5.According to the information feedback on patients management, effect of mental health services in rural communities of Youxian District is obvious.6.Mental health knowledge is partly known by people in different communities.7.Major problems found during the course of community survey and evaluation:mental health services facilities and tools are inadequate, no full-time staff, heavy workload, difficult work, township case manager’s lack of professional knowledge, family health education and intervention and residents health care are rare 8. Finally, we try to establish an initial framework for evaluating the community mental health service(CMHS) capacity... |
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