Evaluation Of Service Model For Patients With Severe Mental Disorders

BackgroundSevere mental disorders are characterized by high morbidity,low cure and high recurrence,which cause serious harm to patients themselves,their families,and society.How to effectively manage and treat patients with severe mental disorders has become a major public health problem and a prominent social problem in China.From the national "686"project,the exploration of the socialization and standardized management model of patients with mental illness,to the advocacy of the service model of "critical care in hospitals and rehabilitation management in the community",and then to the detailed specification of the links of patient discovery,treatment,follow-up and rehabilitation,the service model for patients with severe mental disorders in China has been initially developed and adopted nationwide.However,how well the model is being implemented across the country?What are the problems in the links of the models?Global evaluation studies are still lacking.ObjectiveIn this study,based on the analysis of relevant national norms and guidelines,we summarize the service model for patients with severe mental disorders in China,evaluate the current situation and problems of the model promotion in three areas in China,and make suggestions for targeted improvement.MethodsIn this study,the purpose sampling method was used to select Yunfu,Linyi,and Chengdu for investigation.Data were obtained mainly through interviews,questionnaires,and the medicare system.Semi structured interviews with stakeholders in each link of the service model were conducted,with a final interview of 21 institutions,105 stakeholders.The interview transcripts were converted to text materials,which were coded and categorized in Excel 2019,and a thematic framework method was used for in-depth analysis;A structured questionnaire was designed to survey the families of 100 patients and data was collected from the medical insurance system at the research site,Excel 2019 and SPSS 24.0 were used to collate and analyze the data obtained by both modalities.Results(1)The service model for patients with severe mental disorders mainly includes identification and confirmation,treatment,follow-up management,and mental rehabilitation of patients.(2)For the identification and confirmation,the discovery and diagnosis of patients were carried out well.However,there are some problems in the registration and filing work,such as insufficient information sharing among medical institutions,insufficient introduction of mental disease prevention and control personnel by sychiatrists to patients,cumbersome data sorting and so on.(3)For the treatment,there are some problems in medical resource guarantee,such as insufficient number of medical personnel and relatively low technical level;In terms of the ways of seeking medical services,the average length of hospital stay is longer than needed;In terms of treatment methods,there are many problems,such as poor compliance with oral drugs,insufficient sustainability of capital guarantee,limited cognition and treatment concepts,and few departments involvement in the application of long-term injections.On treatment efficacy,4.2%of the patients in the study had a culprit schadenfreude behaviour,33.3%had a recurrence,of which 37.5%had repeated recurrence,and 69.8%had improved,but only 13.4%of the patients were engaged in work;Regarding cost coverage,the median percentage of medicare reimbursement and individual out of pocket coverage for inpatients was 68.7%,19.7%respectively;The corresponding proportion for outpatients was 64.2%,21.0%respectively.(4)For follow-up management,40.0%patients never received follow-up nearly half a year,and more than half patients received follow-up less than 1 time on average quarterly,which did not meet the corresponding requirements.(5)For mental rehabilitation,there are some problems in hospital rehabilitation,such as"limited concept and cognition" and "there are rehabilitation departments but few rehabilitation services".Community rehabilitation has neither professional rehabilitation institutions nor professional rehabilitation teams.ConclusionsThe service model for patients with severe mental disorders in our country has been greatly developed,but there are still problems in some specific implementation links.For the identification and confirmation,the hospital and community had insufficient cooperation on registration and filing;For the treatment,insufficient human resources and long average length of hospital stay are the main problems;For follow-up management,the follow-up work was carried out less and did not meet the corresponding specification requirements;For mental rehabilitation,hospital rehabilitation and community rehabilitation were less frequently conducted.Based on the above conclusions,the suggestions are as follows:(1)Strengthen the contact and cooperation between the hospital and the community,and jointly do a good job in patients registration and filing;(2)Raise wages to promote more people to engage in mental health work;Society,families and hospitals should make efforts to reduce unnecessary hospitalization of patients;(3)Pay more attention and strengthen supervision,and strictly implement the follow-up management of patients with severe mental disorders;(4)Establish rehabilitation institutions and expert teams,and gradually implement mental rehabilitation.