| [Objective]To understand the establishment content and operational state on community management model of prevention and cure among severe mental illness in the rural area of Liujiang County, evaluate the technical training of mental illness prevention and cure among primary health workers; assess the feasibility and sustainability of the community management model and the effect of mental illness prevention and rehabilitation, so as to further improve the model then popularize and apply, provide the scientific basis for the relevant government department to formulate more targeted rehabilitation programs on mental illness prevention and cure.[Methods]1. Collected the establishment content and health services implementation situation on community management model of prevention and cure among severe mental illness in the rural area of Liujiang County, Liujiang County Health Department, Prevention and Management Office of mental illness, township hospitals implementing the management model of mental illness prevention and cure as the object of study.2.8 towns of Liujiang County primary care health workers as the training object, the 8 towns all implemented the community prevention and rehabilitation management among severe mental illness. The primary care health workers were trained on mental illness prevention knowledge and technology by concentrate training. We evaluated the training effect in two ways:(1) Before and after the training, the training effect was evaluated by mastering knowledge and skills’ score changes as the indicator. (2) Investigated the trainees’evaluation to training process.3. Liucheng County was chosen as the assessment control county, it was the same as Liujiang County in the level of social economic development and other aspects of rural health service capacity. Investigated the expenditure amount of mental health work each year in the two counties to evaluate the government department degree of support on mental illness prevention and rehabilitation work; the two counties were investigated the detection rate of mental illness patients and the coverage rate of prevention and rehabilitation measure before and after running the model, to evaluate the work quality of mental illness prevention and rehabilitation.4.1838 severe mental illness patients were brought into the management system of the community mental illness prevention and cure, and 200 cases of schizophrenia as a study group were randomly selected to implement community prevention and rehabilitation management, while another 200 cases of schizophrenia were selected randomly as a control group from other towns severe mental illness patients files of Liujiang without implementing. The two groups were evaluated the cure and rehabilitation effect before running of the management model, the end of the first year and the end of the second year respectively, compare the differences of the effect to schizophrenia, and then started the economic evaluation on community management model of mental illness prevention and cure.[Results]1. Liujiang County has established mental illness health service system in Guangxi minority nationality rural area, the system was government-led, health system as the main, multi-sectoral cooperation, social participation, home-based rehabilitation; and established community prevention and rehabilitation network among severe mental illness in rural area, the network relied on psychiatric hospital, the township hospital as a platform, village doctor as a case manager. Community prevention and rehabilitation work of mental illness has gained the support by the county government and its departments at all levels; the mental illness idea of community prevention, treatment and rehabilitation has got the approbation from health agency staff and family members of patients.2. (1) After the training,208 workers of township hospitals test scores (72.3±9.6 points) were higher than before the training (30.6±10.1 points), the differences were statistically significant (t=43.160, P<0.01); 158 village doctors test scores (61.8±11.5 points) were also higher than before the training (20.8±14.9 points), the differences were statistically significant (t=27.381, P<0.01). (2) Whether the works of township hospitals or village doctor, the four aspects satisfaction of the training teachers, teaching programs, training materials and the overall effect were more than 90%.3. Currently, all counties under the jurisdiction of Liuzhou had no mental illness special funds of community prevention and rehabilitation, the community prevention and cure work of mental illness in Liujiang was funded by the national mental health special funds, Longquanshan psychiatric hospital self-financing and the research funding of mental health; the detection rate of mental illness and the coverage rate of prevention and rehabilitation measure in Liujiang County were all higher than Liucheng County (P<0.01), the differences were statistically significant.4. The effect of community prevention and rehabilitation for schizophrenia in rural area:(1) Compared with the model before running, the rate of patients drug regular treatment in the study group has gradually increased, and higher than the same period of the control group (P<0.01), the differences were statistically significant. (2) Compared with the model before running, the improvement rate of the study group has gradually increased, and higher than the same period of the control group (P<0.01), the differences were statistically significant; compared with the model before running, the deterioration rate of the study group has gradually declined, and lower than the same period of the control group (P<0.01), the differences were statistically significant. (3) Compared with the model before running, the social participation rate of the study group has gradually increased, and higher than the same period of the control group (P<0.01), the differences were statistically significant. (4) Compared with the model before running, the rate of social impact in the study group has gradually declined, and lower than the same period of the control group (P<0.01), the differences were statistically significant. (5) The recurrence rate of the study were 9.5% and 21.3% respectively after 1 year and 2 years of the model, lower than the control group (20.5% and 46.7%) (P<0.05), the differences were statistically significant. (6) After running of the model, the direct medical costs, indirect medical costs, indirect costs and total costs of the study group were lower than the same period of the control group (P<0.05), the differences were statistically significant.[Conclusions]1. Community prevention and cure mechanism of severe mental illness has effective operated in Liujiang County, the mechanism was government-led, health system as the main, multi-sectoral cooperation, social participation and home-based rehabilitation. Liujiang County popularized and applied appropriate prevention of mental illness relapse and rehabilitation nursing technique in rural area; the mental illness idea of community prevention, treatment and rehabilitation has got the approbation from local government and related departments, health agency staff and family members of patients.2. A community mental health service team which consisted of the workers of township hospitals and village doctors, had basic knowledge of mental health and skills of prevention and rehabilitation has initially established in the rural area of Guangxi.3. The community prevention and rehabilitation measures among severe mental illness in Liujiang were advantageous in increasing patients’drug treatment compliance, improving patients’treatment effect, restoring their social function, reducing patient’ trouble-making rate, preventing and delaying case recurrence, reducing patients family financial burden; The community management model of the prevention and cure among severe mental illness in rural area reflected the characteristic of government-led, well organized, clear responsibilities, service continuity, met local realities conditions, had a strong feasibility and operability.4. The management model of community prevention and cure among severe mental illness in the rural area of Liujiang County has initially solved the problem of patient treatment and management, but there were still some shortage, such as, lack of mental health knowledge, insufficient investment, inadequate laws and regulations, lack of human resources, inadequate medical security, and so on; So recommend to universal mental health knowledge, increase investment, formulate mental health laws and regulations, strength the qualified personnel of mental health, improve the social security system and promote basic public health services to equalize gradually, so that the prevention and cure management model can run continuously and effectively, and then better to popularize the management model to other local rural area or even to the nationwide. |
