Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr 7;10(4):e0121425.
doi: 10.1371/journal.pone.0121425. eCollection 2015.

Unlocking patients with mental disorders who were in restraints at home: a national follow-up study of China's new public mental health initiatives

Lili Guan  1 , Jin Liu  1 , Xia Min Wu  1 , Dafang Chen  2 , Xun Wang  1 , Ning Ma  1 , Yan Wang  2 , Byron Good  3 , Hong Ma  1 , Xin Yu  1 , Mary-Jo Good  3
Affiliations

Unlocking patients with mental disorders who were in restraints at home: a national follow-up study of China's new public mental health initiatives

Lili Guan et al. PLoS One. .

Abstract

Background: In 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.

Methods: 266 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.

Results: 96% 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.

Conclusion: Practice-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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study profile.
a36 patients who were not included in the Stage Two study aged from 18 to 61 (mean 40.1 [SD 12.1]). 31 (86%) were male and 28 (78%) were from rural area. 20 (56%) were unreachable due to moving and other reasons.
See this image and copyright information in PMC

References

    1. Yang G, Wang Y, Zeng Y, Gao GF, Liang X, Zhou M, et al. (2013) Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381(9882): 1987–2015. 10.1016/S0140-6736(13)61097-1 - DOI - PMC - PubMed
    1. Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, et al. (2012) PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 9(12): e1001359 10.1371/journal.pmed.1001359 - DOI - PMC - PubMed
    1. Patel V, Thornicroft G (2009) Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series. PLoS Med 6(10): e1000160 10.1371/journal.pmed.1000160 - DOI - PMC - PubMed
    1. Phillips MR, Zhang J, Shi Q, Song Z, Ding Z, Pang S, et al. (2009) Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 373(9680): 2041–2053. 10.1016/S0140-6736(09)60660-7 - DOI - PubMed
    1. Liu J, Ma H, He YL, Xie B, Xu YF, Tang HY, et al. (2011) Mental health system in China: history, recent service reform and future challenges. World Psychiatry 10(3): 210–216. - PMC - PubMed

Publication types