Objective: To investigate the prevalence, distribution characteristics, medication status, and management status of patients with severe mental disorders (SMD) in Fuzhou. The medication status and management status were compared between patients in urban and non-urban areas to provide scientific evidence for improving SMD prevention, control, and treatment in primary health care institutions. Methods: Data (case types, demographic data, distribution data, medication status, and management status, etc.) of 30,362 SMD patients in 12 districts, counties, and prefectures in the urban and non-urban areas of Fuzhou City were collected From March 2018 to September 2018. Three distributions were used to describe the epidemiological characteristics of SMD. Linear trend chi-square test was used to illustrate the relationship between the prevalence of SMD and monthly changes. χ2 test method was used to compare the severity in urban and non-urban areas (qualitative data of SMD patients). Results: A total of 30,362 registered SMD patients were identified in Fuzhou City (prevalence rate, 4.17‰), of which schizophrenia accounted for the highest number (26204, 86.31%), and paranoid psychosis had the least number (47, 0.15%). Moreover, most SMD patients were aged 18 (inclusive)-44 years old (45.38%). Most patients were farmers (30.23%), had a primary school and below education level (54.17%), were poor, with most below the poverty line standard (55.35%). The time-point prevalence of SMD was highest in Minqing County (5.29‰) and lowest in Mawei District (3.80‰). The prevalence rates of SMD were significantly different among various regions in Fuzhou (P<0.05). There was a linear trend between the month and SMD prevalence, with a statistically significant difference (P<0.05). A total of 22,989 (75.72%) of the patients were taking medications, and only 17,509 (57.67%) were taking medications regularly. Moreover, the rate of taking medications and regular-taking rates were higher in urban areas than in non-urban areas (P＜0.05). A total of 3065 patients were under management (10.09%). The management rate was higher in the urban areas than in the non-urban areas (P<0.05). Conclusion: Schizophrenia needs comprehensive prevention and control in Fuzhou. The management of severe mental disorders should focus on poor groups with low educational backgrounds. Drug usage and management are better in urban areas than in non-urban areas, and thus management should be enhanced in non-urban areas. The medication management and case management of patients with severe mental disorders in Fuzhou need further improvements.