Authors: MA Hong, LIU Jin, YU Xin, National Center for Mental Health, China-CDC (Peking University Institute of Mental Health) et al
After SARS, the Chinese government rebuilt the public health system. In 2004, China- Centre for Disease Control (CDC) and Peking University visited community mental health services in Melbourne, and decided to use the Victorian Model for reference. In September 2004, after competing with over fifty proposals, the Mental Health Service Model Reform Program was the only non-communicable disease program included in the national public health program.
In December 2004, the Mental Health Reform Program was formally supported by the Ministry of Finance, and named the “686 Program” because of its funding of 6.86 million RMB. The National Centre for Mental Health and China-CDC took charge of the program and established a national working group as well as a foreign consultant group with experts mainly from the University of Melbourne.
In 2005, 60 demonstration sites were established in 30 provinces in China: one urban and one rural site in each province, covering a population of 43 million. 602 training courses were held and nearly 30 thousand people were trained, including psychiatrists, community physicians, case managers, community workers, public security staff and family members of the patients. A national computerised case database was established.
In 2006, this program received increased funding of 10 million RMB, enabling improved monitoring and intervention for psychoses, as well as the establishment of a local comprehensive prevention and treatment team in each demonstration area. Staff including 15% psychiatrists and psychiatric nurses from over 12,000 facilities, were trained. Nurses were recruited from psychiatric hospitals or departments, community and village health centres, and neighbourhood or village committees. By December 2006, more than 65,000 patients were registered, nearly 22,000 patients with violent tendencies received regular follow-up, over 9,000 poor patients with violent tendencies received free medication, over 2,600 people exhibiting violent behaviours received free crisis management, and more than 1,000 poor patients with violent behaviours accessed free hospitalisation. For patients who received follow-up, the level of violent incidents decreased.
In 2007, the budget was increased to 15 million RMB, for continued service provision across the 60 sites. Case management training for the demonstration areas was provided jointly by The University of Melbourne and the Chinese University of Hong Kong (CUHK). The budget for 2008 is 27.35 million RMB, enabling more patients to receive free medication and hospitalisation, and the establishment of a new demonstration area in Xinjiang Province.
It is projected that new demonstration areas will gradually be set up across China. Future directions may also include the National Mental Health Reform Program Office delegating its management role such that each province oversees its own demonstration area, thereby reducing the rapidly increasing workload as the program expands. More officials should be encouraged to provide local resources to enable mental health to become core business and to adapt the reform model to their local context. As the Program develops, staff training and project management will become more challenging, and local experts will need to take responsibility for supervision and monitoring. The MOH has already established standard evaluation forms and all provinces will use these forms to report their progress.
As a result of this program, more local officials pay attention to mental health issues, and psychiatric hospitals now consider integrated prevention and comprehensive treatment. A community-based network has been established, led by the psychiatric hospitals, and supported by general hospitals and the Centre for Disease Control. Further, the program has benefited patients, particularly those of low-socioeconomic status and has promoted social harmony.
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