| Objective1 To understand the overall operation and management of community mental health service in Kunming city. To investigate the mental health service providing situation of four community health service centers in urban zone. To study the degree of mental disorders risk and awareness of mental health knowledge of community residents, finding out their objective need, meanwhile studying the utilization and expectation of residents for community mental health service.2 To analyze status and influencing factors of community mental health service in Kunming city, summarizing deficiencies and putting forward improvement suggestions, providing reference for better conducting and management of community mental health service.Methods1 Qualitative interview was used to find out the community mental health service management of Kunming health administrative department and service conducting of four community health service centers in urban zone.2 Quantitative study including 12-item General Health Questionnaire(GHQ-12) and self-made questionnaire was used to investigate the community residents, getting their basic information, degree of mental disorders risk, awareness of mental health knowledge, utilization and expectation for community mental health service and analyzing influencing factors. Statistical analysis methods including statistical description, chi-square test and multiple regression analysis were used.Results1 Management:Kunming health administrative department(1) Current community mental health service work in Kunming was mainly based on national laws policies and no local regulation was formulated, lack of guidelines and legal guarantee for local mental health work.(2) Current community mental health service work focused on the management of severe mental disorder patients and the supervision and evaluation were based on it. For other mental health service work such as health education, psychological consult and community rehabilitation, there was no clear guidelines and planning.(3) Resources investment for community mental health service was limited, which restricted the development.2 Service provider:four community health service centers in urban zone(1) There were few staff of mental health service and most of them did this as a part-time work. Shortage of human resources for community mental health service was serious.(2) Community mental health service main work were the management of severe mental disorder patients and mental health education. Some community centers carried out psychological consult and community rehabilitation.3 Service user:community residents(1) The major objects of this investigation were female, below 44 years old and 60-74 years old, married, local census registration, junior middle school education level, unemployed/retired/others, middle and low income families primarily. Majority of them considered themselves in good or general health. More than half of them were chronic disease patients. None of them had been diagnosed as mental disorder patients.(2) The screening positive rate of degree of mental disorder risk was 22.27% and main influencing factors were x4 census registration(OR=2.792,95%CI:1.853-4.206) and x8 self-assessment health status(OR=2.139,95%CI:1.643-2.787). The regression equation was yi=-3.051+1.027x4+0.761x8.(3) The high rate of awareness of general mental health knowledge was only 25.87%. Rate of mental disorder, treatment of mental disorder, mental health regulation and cause of mental disorder were 79.21%、39.73%、14.98% and 36.26% respectively, which had apparent gap and lack of understand for some knowledge poins. Single factor analysis showed that the respective difference of awareness between different gender, marital status, education level, occupation, family average monthly income, self-assessment of health status, chronic disease situation, receiving mental health services situation in community centre, mental health staff situation in community centre and psychological consult situation in community centre had statistical significance, P< 0.05. Multiple factor analysis showed that main influencing factors were x5 education level(OR=1.813,95%CI:1.539～2.136), x7 family average monthly income(OR=1.194,95%CI:1.006-1.417), x9 chronic disease situation(OR=1.727,95%CI:1.196～2.495), x10 receiving mental health services situation in community centre(OR=4.007,95%CI:1.136～14.134) and x12 psychological consult situation in community centre(OR=2.000,95%CI:1.381～2.896). The regression equation was y2=-3.828+0.595x5+0.177x7+0.547x9+1.388x10+0.693x12.(4) The utilization rate of community mental health service was only 1.61% and majority received mental health education. Main reasons of why not receiving any service were "no necessary" and "don’t know that community centre provides service". Most residents had the expectation that community centre can conduct kinds of mental health service and intensify propaganda.Conclusions1 Community mental health service of Kunming is attached importance, but not greatly enough.2 Community mental health service of Kunming is developed in certain extent, but not comprehensive enough.3 Mental health status and awareness of mental health knowledge of community residents are unsatisfactory.4 Utilization rate of community mental health service of residents is low.Suggestions1 Improving the supporting policies and regulations.2 Increasing the investment for community mental health service.3 Constructing and improving the system of community mental health service.4 Strengthening the supervision and management of community mental health service. |
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