Background
Methods
The study location and policy brief
Region | Per capita GDP (US dollars) | Mental health resources per 100,000 population | ||
---|---|---|---|---|
Psychiatrists | Nurses | Beds | ||
Liuyang Municipality | 10,979.6 [21] | 1.77* | 2.72* | 34.03* |
Hunan Province | 7043.9 [22] | 2.15** | 5.32** | 44.99** |
China | 8090.3 [23] | 1.99 [24] | 4.16 [24] | 24.68 [24] |
Evaluation frameworks
Evaluation Section | Examining areas | Brief description |
---|---|---|
Checklist for Mental Health Policy
| ||
Process Issues | Mandate & approval | • The level of mandating to develop & approving policy; |
Evidence base | • Situation & needs assessment; • Other country experience; • Research; | |
Consultation | • Consultation with stakeholders; | |
Content Issues | Vision, principles & objectives | • Realistic & clear statement; • Promoting key values; • Internal consistency; |
Action areas & key groups | • Suggested action areas in clear statement & in a committed way; • Consideration for key groups; • Consistent with other related policies; | |
Checklist for Mental Health Plan
| ||
Process Issues | Mandate & approval | • The level of mandating to develop & approving policy; |
Evidence base | • Situation & needs assessment; • Other country experience; • Experience from other related policy/documents; | |
Consultation | • Consultation with stakeholders; | |
Operational Issues | Strategy | • Strategy for priority action areas; |
Time frames, indicator & targets | • Availability, feasibility and suitability; | |
Activities | • Clear defined; • Responsibility, time, outputs, obstacles & funding; | |
Content Issues | Action areas | • Suggested action areas; • Integrated into other related plans. |
Evaluation section | Examining areas | Brief description |
---|---|---|
Implementation issues | Policy activities | • Leadership and coordination mechanism for mental health; • Mental health service network construction; • PWP surveillance, management & interventions; • Interventions for other key population; • Dissemination & popularization of mental health knowledge; • Financing. |
Evaluation indicators | • Mental health literacy rate among the general population (by 2010 & 2017); • Prevalence of mental disorders among children & adolescents (by 2010); • Training rate of mental health professionals (by 2010); • Detection rate of psychiatric illnesses (by 2015); • Treatment rate for schizophrenia (by 2010 & 2015); • Rate of PWP’s crimes & violent/disruptive behaviors (by 2010 & 2015); • Rate of PWP under guardianship (by 2010 & 2015); • Rate of PWP’s significant improvement (by 2015); • Coverage rate of mental health prevention, treatment& rehabilitation work (by 2010). |
Data collection
Interviewees | n | Role | Mean interview time |
---|---|---|---|
Senior leaders of Liuyang MHC&PH | 3 | Policy formulators & implementers | 45 min* |
Department directors of Liuyang MHC&PH | 2 | Policy formulators & implementers | 40 min |
MHOfrom a town hospital** | 1 | Policy implementers | 25 min |
PWP *** | 1 | Policy recipients | 20 min |
Family members of patients | 2 | Policy recipients | 20 min |
Data analysis
Results
Formulation process issues
Mandate, level of approval and official dissemination
“In 2007, our hospital submitted the policy (draft) to the Municipal Health Bureau for approval…Liuyang (Municipal Health Bureau) has approved 24 positions for public health staff…” (A, Policy formulator and implementer).
“This policy has been approved by the Municipal Health Bureau, and Liuyang (government) has included it in the general health plan.” (Interviewer: But I cannot find the two documents (referring to Liuyang Policy and Liuyang Plan) on the government website, so only the staffing positions of public health or the whole policy got approved?)“There may be no formal documents. However, after our hospital submitted the policy, the Municipal Health Bureau officially responded that they agreed for us to conduct work according to the policy. Because this policy also involves town hospitals for issues like appointing MHOs, agreement from Municipal Health Bureau is needed.”(B, Policy formulator and implementer).
Evidence base and consultation
Content issues
Vision, principles and objectives
Action areas and operationality
Evaluation indicators | Liuyang requirements | National requirements | Liuyang Baseline (2007) | Liuyang Progress (Mar. 2015) | |
---|---|---|---|---|---|
Set before 2007 | Set after 2007 (latest by 2015) | ||||
Mental health literacy rate among the general population | 50% (by 2010) | 30% (by 2005) [3] | < 30%* | 58.3% among rural adults by 2011 [42] | |
80% (by 2017) | 50% (by 2010) [3] | 80% (by 2017) [6] | |||
Prevalence of mental disorders among children & adolescents | lower to 12% (by 2010) | lower to 12% (by 2010) [3] | lower to 12% (by 2010) [3] | Unknown | Unknown |
Training rate of mental health professionals | 80% (by 2010) | 50% (by 2005) [3] | 80% (by 2010) [3] | 21.8% [43] | 100% **, *** |
80% (by 2010) [3] | |||||
Detection rate of psychiatric illnesses | over 0.8% (by 2015) | – | 0.4% for psychosis (by 2015) [43] | 0.4% for psychosis** | 0.38% for psychosis *** |
Treatment rate for schizophrenia | 60% (by 2010) | 30% (by 2005) | 80% (by 2015) [6] | < 30% for psychosis* | 73.18% for psychosis *** |
over 60% (by 2015) | 60% (by 2010) [3] | > 80% (by 2020) [4] | |||
Rate of PWP’s crimes & violent/disruptive behaviors | < 0.2% (by 2010) | – | – | Several incidents, without specific number** | 1 incident by PWP in last year *** |
almost eradication (by 2015) | |||||
Rate of PWP under guardianship | 90% (by 2010) | – | – | Unknown | 98.93% for PWP *** |
> 95% (by 2015) | |||||
Rate of PWP’s significant improvement | > 70% (by 2015) | – | 60% for registered PWP in stable condition (by 2012) [44] | Unknown | 75.82% for registered PWP in stable condition *** |
Coverage rate of mental health prevention, treatment& rehabilitation work | 75% (by 2010) | covering a population of 400 million by 2005 & 800 million by 2010 [3] | covering a population of 400 million by 2005 & 800 million by 2010 [3] | Unknown | Unknown |
Implementers | Policy activities | Implementation status |
---|---|---|
Municipal government | • The leadership team for mental health; | + |
• Working mechanism of multi-department coordination; | + | |
• Financing for mental health; | + | |
• Medical aid and relief to PWP; | + | |
Liuyang MHC/PH | • Mental health education; | + |
• Mental health professionals’ training; | + | |
• The information system of PWP; | + | |
• Regular guidance for treatment scheme and risk assessment of PWP; | + | |
• Evaluation on Liuyang mental health work; | + | |
• Medical treatment and rehabilitation; | + | |
• Liuyang mental health information website; | 0 | |
Town hospitals | • Mental health education; | + |
• PWP screening, reporting, visit and management; | + | |
Village/community health centers/village committees | • Reporting potential PWP; | + |
• PWP management; | + | |
General hospitals, maternal &children hospitals | • Mental health education; | 0 |
• Early screening & psychological consultation; | 0 | |
Education department (primary & middle schools) | • Inclusion of mental health education into curriculum; | 0 |
• Early screening & psychological consultations; | 0 | |
• Mental health training for school teachers and doctors; | 0 | |
Women’s & Elders’ Federations | • Mental health education; | 0 |
• Early screening. | 0 |
Implementation issues
Implementation progress and quality
“We have a team similar to the leadership team for mental health; however, its purpose is to manage (patients’) violent or socially disruptive behaviors. The team is led by the Political and Legal Affairs Commission, and other departments like Health, Civil Affairs, Public Security, Justice and Federation of Disabled Persons will attend. One to two meetings will be organized annually. As a main implementing organization in health sector, our hospital will also attend the team meetings.” (A, Policy formulator and implementer).
Characteristics of MHOs n = 32 | |||
Age, Mean (Std) | 38.5 (8.7) | ||
Male, n(%) | 20 (62.5) | ||
Major of higher education, n(%) | |||
Clinical medicine | 16 (50) | ||
Nursing | 8 (25) | ||
Public Health | 4 (12.5) | ||
Pharmacy | 4 (12.5) | ||
Professional qualification, n(%) | |||
Physician (Assistant) License | 14 (43.8) | ||
Nurse License | 8 (25) | ||
Public Health Practitioner (Assistant) License | 3 (9.4) | ||
Pharmacist License | 4 (12.5) | ||
Without medical license | 3 (9.4) | ||
Part-time, n(%) | 32 (100) | ||
Being Mental Health Officer for over 3 years*, n(%) | 9 (28.1) | ||
Times of in-service training per person-year, Mean (Std) | 0.8 (0.5) | ||
Mental health work of towns n = 32 | |||
Detection rate of PWP (%), Mean (Std) | 0.38 (0.6) | ||
Treatment rate of PWP (%), Mean (Std) | 73.18 (25.1) | ||
Rate of PWP in stable condition (%), Mean (Std) | 75.82 (34.7) | ||
Rate of PWP under guardianship (%), Mean (Std) | 98.47 (3.3) | ||
Number of PWP’s crime & violent/disruptive behaviors, last year | 1 | ||
Visit to PWP, n(%) | |||
Frequency: Semi-monthly | 1 (3.1) | Methods: Face-to-face only | 5 (15.62) |
Once every 2 months | 6 (18.8) | Telephone only | 1 (3.1) |
Quarterly | 24 (75) | Mixed | 26 (81.3) |
Half-yearly | 1 (3.1) | Full coverage of patients | 27 (84.4) |
Number of mental-health-related training for village doctors in last year*, n(%) | |||
0 | 2 (6.3) | ||
1 | 12 (37.5) | ||
2–4 | 12 (37.5) | ||
> 4 | 5 (15.7) | ||
Top barriers for work implementation, frequencies | |||
Lacking/insufficient cooperation from patients and/or families (including refusal to physical exams, medication & visits from MHOs, communication with patients and/or families) | 29 | ||
Bad adherence (to medication) of patients | 5 | ||
Heavy workload and pressure as being a part-time MHOs | 4 |
Barriers for implementation
“… the staff of (Liuyang MHC) are mostly part-time, consisting of leaders, members of the Medical Administration Department and clinicians in our hospital. According to (public mental health) work requirements for this period, our hospital will organize meetings and allocate human resources and funding as needed… Mental health professionals are in extreme short supply. There are not enough mental health professionals for clinical services, let alone for management… There are no (additional) psychiatrists or psychologists for other hospitals to provide psychological consultations” (A, Policy formulator and implementer).
“(There are) only two full-time staff, including myself (for Liuyang MHC). We are responsible for supervision and guidance for local (communities/towns) mental health work.”(C, Policy formulator and implementer).
“… next-year government budget (for our hospital, including Liuyang MHC) is based on how much work we have done in this year. If economic growth is good and the government has a larger surplus, we will get a higher budget approved. (Interviewer: Any budget specific for public mental health?) No …” (D, Policy formulator and implementer).
“… (MHOs report that) there are financial problems (in their work). Funding for public health is a package; the allocation for public mental health is less.”(C, Policy formulator and implementer).
“… some patients frequently change their telephone numbers … , reluctant to be contacted by MHOs.” (E, Policy implementer).
“… my mom and brother are not willing to take medicine or receive MHO’s management. They think the medication or management is useless (to their disease, referring to schizophrenia) … perhaps, using better medicine will improve the situation (referring to un-cooperation to medication and PWP management and intervention).”(F, Policy recipient).