Background: The disease burden associated with chronic psychiatric illnesses is high and is projected to grow rapidly. A community-based management system for persons with mental illness was established in Shanghai in 2012 based on the Shanghai Mental Health Regulations that were developed to conform with China's new mental health law.
Aim: Evaluate the guardianship services provided by family members to persons with mental illnesses living in the Changning District of Shanghai.
Methods: The legal guardians of 4034 of the 4283 community-dwelling persons with psychiatric disorders living in Changning District who are registered in the Shanghai Information Management System of Mental Health were interviewed by local community health doctors and local neighborhood committee officials. The adequacy of guardianship was assessed based on standardized criteria (including the guardian's regular attendance at mental health training sessions, and their level of assistance in the treatment, daily life, and rehabilitation of the patient) and the main reasons for inadequate guardianship were recorded.
Results: The majority of guardians (3331, 83.6%) adequately fulfilled their guardianship duties. Advanced age and ill-health of the guardian was the main contributing factor in 87% of the 703 cases in which the guardianship was classified as inadequate. Other factors associated with inadequate guardianship included the patient's unstable clinical condition or failure to adhere to medication, and when the guardian did not live in the same household as the patient. The patient's diagnosis, the guardian's level of education, and the relationship between the guardian and patient were also associated with the adequacy of guardianship.
Conclusions: The guardianship-based community services for mentally ill individuals in urban China works reasonably well. But the rapid aging of China's population may gradually decrease the ability of China's families to continue to assume this heavy burden. Alternative models of providing high-quality, community-based services for persons with mental disorders need to be developed as part of the roll-out of China's new mental health law.
背景: 慢性精神病性障碍所致的疾病负担很高，预计还将快速增长。根据上海市精神卫生条例（为与中国新的精神卫生法相一致，该条例之后又经过了修订），2012年上海建立了基于社区的精神疾病患者管理系统。.
目标: 评估居住在上海市长宁区的精神障碍患者家属提供的监护服务。.
方法: 在上海精神卫生信息管理系统中登记的长宁区社区精神障碍患者共4283例，通过社区卫生服务中心家庭医生和居委会工作人员对患者法定监护人进行调查，实际调查4034人。监护的落实情况是根据规范标准进行评估的，这些标准包括监护人定期参加精神卫生培训课程，以及他们在患者的治疗、日常生活和康复方面的协助情况，也记录了监护不力的主要原因。.
结果: 大多数监护人（3331名，83.6%）充分履行了监护职责。在划分为监护不力的703名监护人中，87%的主要因素为监护人年事已高、自身体弱多病。与监护不力相关的其他因素包括患者病情不稳定、未能坚持服药以及患者独居。患者的诊断、监护人的教育水平以及监护人和患者之间的关系也是监护落实的影响因素。.
结论: 中国城市中，对精神障碍患者实行的以监护人为基础的社区服务工作相当有效。但是，中国人口快速老龄化可能会逐渐降低中国家庭继续承担这个沉重负担的能力。中国实施新的精神卫生法后，需要制定另一种模式，为精神障碍患者提供高品质的、以社区为基础的服务。.
中文全文: 本文全文中文版从2015年4月8日起在http://dx.doi.org/10.11919/j.issn.1002-0829.214094可供免费阅览下载.
Keywords: China; community care; guardianship; mental health law; psychiatric patients.