Unlocking Patients with Mental Disorders Who Were in Restraints at Home: A National Follow-Up Study of China’s New Public Mental Health Initiatives

Abstract

BackgroundIn 2005, China implemented a demonstration program known as “686” to scale-up nation-wide basic mental health services designed to improve access to evidence-based care and to promote human rights for people with severe mental disorders. As part of the 686 Program, teams “unlocked” and provided continuous mental health care to people with severe mental disorders who were found in restraints and largely untreated in their family homes. We implemented a nation-wide two-stage follow-up study to measure the effectiveness and sustainability of the “unlocking and treatment” intervention and its impact on the well-being of patients’ families.Methods266 patients unlocked from 2005 in “686” demonstration sites across China were recruited in Stage One of the study in 2009. In 2012, 230 of the 266 cases were re-interviewed (the Stage Two study). Outcome measures included the patient medication adherence and social functioning, family burden ratings, and relocking rate. We utilized pre-post tests to analyze the changes over time following the unlocking efforts.Results96% of patients were diagnosed with schizophrenia. Prior to unlocking, their total time locked ranged from two weeks to 28 years, with 32% having been locked multiple times. The number of persons regularly taking medicines increased from one person at the time of unlocking to 74% in 2009 and 76% in 2012. Pre-post tests showed sustained improvement in patient social functioning and significant reductions in family burden. Over 92% of patients remained free of restraints in 2012.ConclusionPractice-based evidence from our study suggests an important model for protecting the human rights of people with mental disorders and keeping them free of restraints can be achieved by providing accessible, community based mental health services with continuity of care. China’s “686” Program can inform similar efforts in low-resource settings where community locking of patients is practiced.

A survey of the mental health workforce in Guangdong: implications for policy and workforce planning

“…19 In China, an evidence based study conducted from 2009 to 2012 showed that comprehensive community mental health care can improve social function and reduce the economic burden for people with severe mental illness and their families. 20 Appropriate models of mental health care invariably require both hospital and community components. 21 Similar to our findings, one study in China showed that most of the mental health workforce and resources are placed within psychiatric and general hospitals rather than in community health centres.…”

Factors related to pasung on people with mental illness

“…Violent behavior and properti destruction done by people with mental illness are the main factors on the act of pasung by family towards people with mental illness (2,11,12). The violent behavior mainly triggered by medication drop out (2,11,13). These commonly caused by financial issues and the unaccessible health provider from home of people with mental illness.…”

Household economic burden and outcomes of patients with schizophrenia after being unlocked and treated in rural China

“…Because financial difficulty was a major reason for putting patients under restraints (Guan et al, 2015;Laila et al, 2018), understanding household economic burden in this population is crucial for preventing future cases of restraining. Zhai et al studied the economic burden due to schizophrenia in patients treated at two leading psychiatric hospitals in China (Zhai et al, 2013).…”