Key Characteristics of the Innovation
In 2004, with the disappearance of SARS and reconstruction of China's public health system, Project 686 obtained the financial support from central government, as a unique non-infectious disease program. The program aims to provide comprehensive service for patients with severe mental disorders (SMD), to improve the accessibility and equity of the service by integrated management and treatment within hospital and community settings.
The program began with a pilot, which gradually worked towards production of an information system, an assessment system, etc. Relevant policies were also revised in order to guarantee the progress of work for this programme. New pilot programmes were established in accordance with the development of the project. In 2015, Phase II of Project 686 was launched, and 40 cities participated in the 3-year pilot program of comprehensive mental health service.
The development of a region-based and national level-based training system is a key element in the development of the 686 program. In 2005, there were 557 mental health institutions in China, and only 13,122 practicing psychiatrists (China Health Statistical Yearbook). In order to scale up mental health services into the community, the Community-based Prevention and Control Team of Mental Illnesses was established.
Peking University Mental Health Institutions, Shanghai Mental Health Center, The Second Xiangya Hospital of Central South University, Mental Health Center of West China Hospital, Huaxi University undertook the training of their surrounding 7-8 provinces and cities, and established a team of national-level lecturers with 108 senior professors and lecturers. They provided training for psychiatrists, nurses, administrators, GPs, community health workers, policemen and patients’ families. This large scale training program was conducted for 11 years. The training materials were produced in China, most of which were originally produced by Project 686.
Psychiatrists and Physicians
Psychiatrists were provided with two “basic” training sessions, which included basic techniques and basic knowledge of SMD, such as the standardized treatment for schizophrenia and bipolar disorder, assessment, and interview skills. The main aim was to improve the standard treatment provided by psychiatrists and to provide guidance.
In addition, training was provided to community physicians, which included popularizing management, law and ethics regarding community prevention and control.
Personnel from 686 Project Offices
Training sessions were provided to personnel from each Project 686 office. This training included information on prevention, treatment and management training of community mental diseases. The key points covered were: project management, case management, data quality control, standardized treatment, information system, rehabilitation, leadership, health education, emergency intervention, basic research capabilities, etc.
Personnel responsible for mental health prevention and control
GPs, nurses, community workers, public health workers, community management workers and community police were provided with local training sessions which were organized and implemented by the provincial and municipal project office.
Training was also targeted at patients’ families and this was organized by local institutions.
In 2005, the Ministry of Health of China developed a program-based registration information system in order to collect patients’ information. In 2011, the National Information System for Psychosis was launched; patient data including in-hospital and community follow-up information were put into the system.
The information was found to be useful for community health workers as it provided reminders for follow up. The information was also integral for policy makers in order to provide statistical data for analysis, including calculation of e.g. medication, poverty etc.