A cross-sectional analysis of the community-based management and treatment status of patients with severe mental disorders in Eastern China

Abstract

Background

Although the effectiveness of community-based services for severe mental disorders (SMDs) has been established globally, evaluations within specific contexts—especially in low- and middle-income countries, and particularly regarding national programs—remain relatively scarce. This study analyzes the current status of the National Information System for Psychosis during its implementation in Anhui Province, China, aiming to assess its impact and identify persistent challenges, to provide a reference for formulating targeted policies.

Methods

Data on SMDs were obtained from the National Information System for Psychosis. The registration, Management, and treatment status of patients with SMD in Anhui Province from 2015 to 2023 were analyzed and compared with national data.

Results

From 2015 to 2023, Anhui Province’s SMD management and treatment indicators showed significant improvement (P < 0.0001). Compared to 2015, 2023 rates increased substantially: registration (+ 41.69%), management (+ 13.22%), regular management (+ 109.29%), medication-taking (+ 116.02%), regular medication-taking (+ 231.23%), and patient stability (+ 148.35%). These rates were positively correlated (P < 0.0001). However, significant inter-regional imbalances persisted (P < 0.0001). In 2023, Anhui had 318,521 registered SMD patients, predominantly aged 18–59 (74.36%), with education below middle school (85.63%), and residing rurally (78.77%). Among six SMDs, patients with mental retardation and mental disorders had the longest mean Duration of Untreated Psychosis (DUP)(4.93 years), lowest medication-taking rate (82.75%), and lowest regular medication-taking rate (66.26%).

Conclusions

The National Information System for Psychosis has produced a significant positive impact on service coverage and treatment outcomes in Anhui. However, significant disparities exist between different regions. This study has identified specific high-risk populations within the cohort of patients with mental disorders. These findings provide actionable evidence for policymakers: prioritizing resource allocation to reduce regional disparities, developing targeted interventions for rural populations and those with low educational attainment, and implementing specialized support strategies for patients suffering from schizophrenia and mental retardation with mental disorders are essential for achieving equitable and high-quality community mental health services in China.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-025-07421-y.

Introduction

In 2007, the Lancet Global Mental Health Group called for a shift in mental health services from an “institution-based” model to a “community-based” model, establishing it as a core function of national health systems [1]. In 2008, the World Health Organization, through its Mental Health Gap Action Programme (mhGAP), explicitly called on Member States to integrate “community mental health services” into national health planning and establish a continuum of care encompassing “screening, referral, and follow-up“ [2]. In 2004, the Chinese government launched the National Continuing Management and Intervention Program for Psychoses, also known as Central Government Support for the Local Management and Treatment of Severe Mental Disorders Project or “686 Project” [3, 4]. This project classified schizophrenia, paranoid disorders, schizoaffective disorders, bipolar disorders, mental disorders caused by epilepsy, and mental retardation with mental disorders as ‘severe’ conditions. This marked the beginning of mental health services in China from psychiatric hospitals to the community. Severe mental disorder (SMD) is defined in three dimensions: clinical diagnosis, duration of the disorder, and the effect on social, family, and workforce participation [5]. SMD is commonly used to describe people experiencing psychotic disorders that compromise their personal and social lives in the long term and require both health and social care [6]. In 2009, the Management of services for patients with SMDs was included in the national basic public health service project. In 2011, with the establishment of the National Information System for Psychosis, China’s hospital community integrated healthcare system framework was preliminarily established [4, 7].

The framework of China’s hospital-community integrated healthcare system for mental health is as follows: Psychiatric specialty hospitals are primarily responsible for the in-hospital treatment of SMD patients and the diagnosis and treatment of newly identified patients, as well as providing professional training for community health service personnel. The typical hospital stay for patients with mental disorders in psychiatric specialty hospitals ranges from 1 to 3 months, and can exceed 3 months in cases of SMDs when the condition is critical. After discharge, patients are connected with community services.

In accordance with the requirements of the “National Basic Public Health Service Program—Management Services for Patients with SMD“ [8], community health centers are equipped with psychiatric outpatient clinics and community day rehabilitation service stations. Psychiatric outpatient clinics are staffed with mental health doctors. Community mental health doctors are required to follow up with all Managed patients with SMDs at least once every quarter, with no more than a 3-month interval between follow-up visits. For patients who have mobility issues or refuse to seek medical treatment, mental health doctors conduct quarterly home visits, which include disease assessment, medication guidance, rehabilitation training, and provide psychological support and caregiving guidance to family members. Patients with SMDs can receive basic antipsychotic medications, such as risperidone and clozapine, free of charge. Community day rehabilitation service stations offer professional rehabilitation services to patients, including supportive psychotherapy, social functioning training, and symptom self-monitoring. These measures aim to help patients improve treatment adherence, enhance social adaptability, and gradually reintegrate into society. Some regions have implemented Peer support services, which have yielded favorable outcomes [9]. The hospital-community integrated healthcare system framework better meets patients’ needs by integrating medical resources and services.

According to the literature, 4,921,505 and 6,430,587 people with SMDs were registered in the National Information System for Psychosis in China in 2015 [10] and 2020 [11], respectively, accounting for an increase of 30.66% compared to 2015. The increase in SMD has greatly burdened the healthcare system in China. Therefore, understanding the management of SMDs is essential to inform future policies and practices in China.

Located in the heart of eastern China, Anhui Province is a major driver for the economic development of East China, which has been stable in recent years. The development of Anhui province is a microcosm of China’s development. he National Health Commission of the People’s Republic of China issued the “Notice on Strengthening and Improving Mental Health Specialty Medical Services” in 2020, proposing to increase the number of psychiatrists to 3.3 per 100,000 population by 2022 [12]. According to data released by the Health Commission of Anhui Province on July 18, 2023, Anhui Province has achieved 3.2 psychiatrists per 100,000 population [13], which is close to the national target. This indicates that Anhui Province’s mental health status can serve as a good case study for examining China’s mental health conditions. However, no studies on the current situation of SMDs in Anhui have been reported so far.

Therefore, this study utilizes data from the National Information System for Psychosis to evaluate the implementation and outcomes of community-based management for SMDs across Anhui Province, China. Beyond confirming the general benefits of community services, this analysis specifically aims to: [1] Quantify the magnitude and trajectory of improvements a national program; [2] Assess the equity of service delivery by examining regional variations; and [3] Identify specific patient subgroups facing the barriers to effective care. The findings are intended to provide context-specific evidence critical for refining national mental health policies and optimizing resource allocation to address persistent disparities within the SMD population in China.

Data sources

The data utilized in this study were sourced from the National Information System for Psychosis, ensuring the accuracy and reliability of the presented data. Specifically, information regarding the number of cases, general conditions, medications, and Management status of SMD patients in Anhui province was obtained from the National Information System for Psychosis from January 2020 to December 2023.

According to the Declaration of Helsinki, the study was conducted with the approval of the Ethics Committee of Bengbu Medical University (Approval number: 2022 − 235). Because this retrospective study analyzed routine surveillance data and only the anonymized data were used, the Ethics Committee of Bengbu Medical University waived the need for informed consent.

The population figures for the permanent residents were based on data from the Chinese Center for Disease Control and Prevention as of December 31, 2023. Additionally, national data on SMD patients, including information from Anhui Province for the years 2015 to 2020, were collected from previously published literature [10, 11, 14–17].

Participants

The inclusion criteria were as follows: patients diagnosed by psychiatrists according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and included in the National Management of Severe Mental Disorders. The exclusion criteria were as follows: patients who refused to enroll in management, or who were lost or confirmed dead after three consecutive years of follow-up.

Patients were diagnosed by psychiatrists and reported after diagnosis. Patient information collection and data entry were carried out by staff of the primary medical and health institutions. The system sets verification rules to ensure correct data and reduce input errors. National, provincial, city, and county levels have data quality controllers, responsible for the daily quality control of system data.

Measurement indicators

The measured indicators used for the purpose of the study were:1) registration rate (%) = number of registered patients alive as of December 31/total permanent residents in the jurisdiction × 100%; 2) management rate (%) = number of patients with ≥ 1 documented follow-up within the year/total registered patients × 100%; 3) regular management rate (%) = number of patients receiving quarterly follow-ups/total registered patients × 100%; 4) medication-taking rate (%) = number of patients with ≥ 1 recorded antipsychotic medication use/total registered patients × 100%; 5) regular medication-taking rate (%) = number of patients maintaining prescribed antipsychotic regimen/total registered patients × 100%; 6) patients’ stable rate (%) = number of patients demonstrating stable condition across all follow-ups/total home-visit patients × 100%; 7) duration of untreated psychosis (DUP) = time from initial onset to first use of psychiatric medication; 8) disease course = current statistical date minus date of initial onset, subsequently converted to ‘years’.

Statistical analysis

Excel 2019 software was used to organize and summarize the data. ArcMap10.2 software was used to draw grade maps. SPSS25.0 software was used for data analysis, calculating the proportion of registered SMD cases, and descriptive analysis of regional and patient demographic characteristics. To evaluate statistical differences among different groups, a Wilcoxon rank sum test was applied for variables with two categories, and a Kruskal-Wallis rank sum test was used for variables with three or more categories. Chi-squared (χ²) test was used to compare proportions. Pearson correlation analysis was conducted to discern relationships between variables, with a significance level (α) set at 0.05. The analytical unit of DUP, disease course, medication-taking rate, and regular medication-taking rate differences in the analysis were at the year level. A two-sided test was performed, with a significance level of α = 0.05.

Results

Utilization of national information system for psychosis in Anhui

In 2023, 16 cities and 50 districts/counties across the country used the National Information System for Psychosis, achieving full coverage of all cities and counties in the information system.

General demographic characteristics of registered patients

A total of 318,521 patients with psychosis were registered in the information system on December 31, 2023. Among registered patients, the Male-to-female ratio was 0.95:1; working-age patients (18–59 years old) accounted for 74.36%; 85.63% of the patients attained junior high school or below; 78.77% of patients lived in rural areas and 21.23% of patients lived in urban areas; 88.75% of the patients had no family history of SMDs; the proportion of unmarried, Married, divorced, and widowed was 32.43, 58.59, 4.81, and 2.7%; 67.62% of patients were peasants, with only 1.69% being employed; 59.11% of patients used community rehabilitation services; 73.71% of patients used family physician signing services; 63.13% of patients used care and assistance group services; and 73.5% of the patients had schizophrenia (Table 1).

Table 1.

The demographic data of SMD patients in anhui, 2023

Variables	Number of Cases (persons)	Composition ratio(%)
In total	318,521	100.00
Patients under follow-up services	317,148	99.57
Patients under regular follow-up services	315,584	99.08
Gender
Male	155,039	48.67
Female	163,482	51.33
Age(years)
< 18	3643	1.14
18–44	111,613	35.04
45–59	125,227	39.32
≥ 60	78,038	24.50
≥ 65	55,613	17.46
Educational level
Illiterate	107,158	33.64
Primary school	82,192	25.80
Junior high school	83,412	26.19
Senior high school or technical secondary school	21,418	6.72
College	6152	1.93
University	4282	1.34
Postgraduate	780	0.24
Unknown	13,127	4.12
Ethnicity
Han	317,707	99.74
Minority	814	0.26
Residence
Urban	67,624	21.23
Rural	250,897	78.77
Family history of severe mental disorders
Yes	17,448	5.48
No	282,673	88.75
Unknown	18,400	5.78
Marriage
Not married	103,290	32.43
Married	186,634	58.59
Widowed	8587	2.70
Divorced	15,333	4.81
Unknown	4677	1.47
Occupation
Employed	5382	1.69
Farmer	215,379	67.62
Laid off or unemployed	38,323	12.03
Students	4617	1.45
Retired	5028	1.58
Professional skill worker	2065	0.65
Other	29,737	9.34
Unknown	17,990	5.65
Diagnosis
Schizophrenia	234,127	73.50
Paranoid disorders	1326	0.42
Schizoaffective disorders	4015	1.26
Bipolar disorder	23,878	7.50
Mental disorders caused by epilepsy	20,688	6.50
Mental retardation with mental disorders	34,487	10.83
Participation in community rehabilitation services
Yes	188,289	59.11
No	130,232	40.89
Family physician signing services
Yes	234,749	73.71
No	83,772	26.36
Care and assistance group services
Yes	201,078	63.13
No	117,443	36.87

The number of registered patients is equal the number of registered patients who were alive by December 31, 2023 minus the number of registered patients who died during January 1, 2019 and December 31, 2019

Monthly risky behavior and follow-up status of SMD patients

In 2023, on average, 2.90% of SMD patients committed acts of endangering the safety of others, 9.74% of patients were at risk of endangering the safety of others, 0.52% of patients committed suicidal or self-injury, and 1.30% of patients were at risk of suicidal or self-injury. For home-based patients, follow-up methods included home visits, telephone calls, and video consultations. The monthly follow-up rate ranged from 34 to 46%, ensuring that each patient was followed up at least once annually (Table S1).

Registration, community-based Management, and treatment of SMD patients by city in Anhui as of december 31, 2023

Patients’ stable, registration, management, regular management, medication-taking, and regular medication-taking rates of patients in each city of Anhui Province are shown in Table S2 and Fig. 1.

Fig. 1.

Grade map of SMD patient registration rates by city in Anhui Province

Comparison of registration, community-based Management, and treatment of SMD patients across three regions in Anhui Province in 2023

As shown in Table S3, the management and treatment rates of SMD patients differed significantly among the regions of Anhui Province. The registration rate and patients’ stable rate in Southern Anhui were significantly higher than those in Northern and Central Anhui (P < 0.0001). Meanwhile, the management, regular management, medication-taking, and regular medication-taking rates were significantly higher in Northern than in Central and Southern Anhui (P < 0.0001).

Correlation analysis of indicators of registration, community-based Management, and treatment of SMD patients in Anhui Province from 2015 to 2023

It was found that patients’ stable, registration, management, regular management, medication-taking, and regular medication-taking rates were positively correlated with each other (P < 0.0001) (Table S4).

DUP, disease course, medication-taking rate, and regular medication-taking rate of six SMDs during 2020–2023

A comparison of the DUP of SMD patients in Anhui Province from 2020 to 2023 is shown in Table S5. The average DUP of SMD patients in Anhui Province was 2.66 years. The proportion of DUP ≤ 2 years was the largest (82.16%), the mean value of DUP of mental retardation with mental disorders was the longest (4.93 years), and mental retardation with mental disorders accounted for the largest proportion of SMD patients with DUP > 10 years.

A comparison of the disease course of SMD patients in Anhui Province from 2020 to 2023 is shown in Table S6. The average disease course of SMD patients in Anhui Province was 9.25 years. The proportion of disease course > 10 years was the largest (34.59%), the mean value of disease course of mental retardation with mental disorders was the second-longest (11.48 years), and mental retardation with mental disorders accounted for the second-largest proportion of SMD patients with a disease course > 10 years.

A comparison of medication-taking and regular medication-taking rates for different diseases in Anhui Province from 2020 to 2023 is shown in Table S7. The medication-taking rate of 82.75% and the regular medication-taking rate of 66.27% are the lowest for mental retardation with mental disorders.

Comparison of registration, community-based Management, and treatment of SMD patients between Anhui Province and China from 2015 to 2023

Registration, management, regular management, medication-taking, regular medication-taking, and patients’ stable rates of Anhui Province from 2015 to 2023 are shown in Table S8. Comparison of management, regular management, medication-taking, regular medication-taking, and patients’ stable rates between Anhui Province and China from 2015 to 2023 showed no difference (P > 0.05). This result supports the notion that Anhui Province’s development level in this field is close to the national overall situation. Moreover, community-based Management and treatment indicators of SMD patients in Anhui Province improved year by year from 2015 to 2023 (Tables S8 and S9 and Fig. 2). Registration, management, regular management, medication-taking, regular medication-taking, and patients’ stable rates of SMD patients in Anhui Province increased by 41.69, 13.22, 109.29, 116.02, and 231.23, and 148.35% respectively in 2023 compared with 2015.

Fig. 2.

Trend of registration, community-based management and treatment for SMD patients in Anhui Province. Note: Registration rate (%) = the number of registered patients/the total number of permanent residents in the jurisdiction × 100%; Registered patients refer to patients who were alive by December 31 in a year; Management rate (%) = the number of patients under follow-up services/the number of registered patients × 100%; Patients under follow-up services referred to patients with at least one complete follow-up on record in a year; Regular management rate (%) = the number of patients under regular follow-up services/the number of registered patients × 100%; Patients under regular follow-up services referred to patients who were followed up at least once every three months in a year; Medication-taking rate (%) = the number of patients taking antipsychotics/the number of registered patients × 100%; Patients taking antipsychotics referred to patients who had at least one follow-up record of taking antipsychotics in a year; Regular medication-taking rate (%) = the number of patients taking antipsychotics regularly/the number of registered patients × 100%; patients taking antipsychotics regularly referred to patients taking medication according to the doctor’s prescription in a year; Patients’ stable rate (%) = the number of patients with stable condition of disease/the number of patients at home under follow-up services × 100%; Patients with stable condition of disease referred to patients who were in a stable condition in each follow-up record in a year

Discussion

The present study analyzes, for the first time, information on registered SMDs in Anhui Province, in eastern China, and compares the results with the data in the National Information System for Psychosis 2015–2020, hoping to provide a basis for the formulation of mental health policies and development of mental health services by relevant authorities.

Management and treatment status of patients with SMD in Anhui Province

The World Health Organization (WHO)’s Comprehensive Mental Health Action Plan 2013–2020 (MHAP), adopted by the World Health Assembly in May 2013, sets out four goals to be achieved by 2020, including “to strengthen effective leadership and governance for mental health; to provide comprehensive, integrated, and responsive mental health and social care services in community-based settings; to implement strategies for promotion and prevention of mental health; and to strengthen information systems, evidence, and research for mental health” [2]. Accordingly, the Chinese government has also issued policy documents such as “China’s National Mental Health Working Plan (2015–2020)” and “Guidelines for the Management and Treatment of Severe Mental Disorders (2018)” [18, 19]. These documents define the role of primary healthcare institutions in the management and treatment of patients with SMDs. Community staff clarify their responsibilities, tasks, and work processes, and regularly followed up patients registered in the National Information System for Psychosis. The follow-up forms include outpatient visits, home visits, telephone calls, and videos. The follow-up content includes risk assessment, psychiatric symptom assessment, medication use, adverse drug reactions, social function, rehabilitation measures, physical condition, life events, etc. Meanwhile, community rehabilitation services, family physician signing services, and care and assistance group services are used to complement each other for the management and recovery of SMD patients after discharge. Anhui Province has achieved the above four goals in SMD management. The quality of SMD system management in Anhui Province has been improving year by year. Correlation analysis showed that the stability rate of disease, reported prevalence rate, management rate, standardized management rate, drug-taking rate, and regular drug-taking rate were all positively correlated, indicating that the higher the management rate, the higher the drug-taking rate and disease stability rate. However, an imbalance in management among the cities of Anhui Province was prominent, with significant differences in SMD management and treatment indicators across regions.

Age distribution of SMD patients in Anhui Province

Our study showed that the Majority of SMD patients are young and middle-aged adults aged 18–59 years (74.36%), consistent with recent reports in China [10, 11, 14–17]. SMD can seriously affect the patient’s ability to work, and the high proportion of young adults with SMD can significantly impact the entire social labor force, which deserves government attention. Healthcare services should detect and treat SMDs promptly and optimize care that suits people at this crucial stage of life.

Educational background and residency of SMD patients

Most SMD patients had a lower educational attainment, below middle school (85.63%). The majority of the population lived in rural areas (78.77%). Most SMD patients were farmers and unemployed people (79.65%). Although China’s rural living standards and medical services have been greatly improved, the majority of farmers and unemployed people have low educational attainment. People with lower educational levels have an insufficient understanding of maintaining mental health, which delays the treatment of diseases, resulting in an increased chance of converting to SMD. Taken together, these findings suggest that governments at all levels and mental health professional institutions should pay significant attention to patients with low educational levels and rural and urban unemployed, and government departments at all levels should integrate resources and provide multi-channel rescue and treatment policies.

Violence and suicidal behavior in SMD patients

Patients diagnosed with psychotic disorders (for example, schizophrenia and bipolar disorder) have elevated risks of engaging in violent or suicidal behavior. One of the most important goals in the Management of patients with SMD in China is to prevent and reduce violent behavior that causes harm to patients or others. Our data revealed that in 2023 alone, on average, 2.90% of SMD patients committed acts of endangering the safety of others, 9.74% of patients were at risk of endangering the safety of others, 0.52% of patients committed suicidal or self-injury, and 1.30% of patients were at risk of suicidal or self-injury. Notably, different studies have reported different rates of violent or suicidal behavior among people with mental illness, perhaps owing to different criteria of violent or suicidal behavior. A systematic review of different severity levels of violence among people with schizophrenia in China reported an incidence of 23.83 − 0.62 [20]. A 38-year total population study in Sweden found that 13.9% of men and 4.7% of women with schizophrenia and related disorders had a major adverse outcome (violent offense, died prematurely of any cause) within 5 years of their initial diagnosis [21].

Violence and suicidal behavior are among the key focus areas of the follow-up study. A coherent, structured treatment plan that includes both pharmacotherapy and community rehabilitation services is of utmost importance in preventing both suicidal behavior and acts of violence [22]. However, this study shows that as of 2023, the community rehabilitation service rate for SMD patients in Anhui Province was 59.11%. The low community rehabilitation service rate among SMD patients may be attributed to the following factors: Although China has established a hospital-community integrated healthcare system framework, national mental health resource surveys [23, 24] reveal shortages of psychiatrists, psychological counselors, and psychotherapists, coupled with uneven development of service quality across regions. These deficiencies may prevent some areas from meeting established community mental health service standards. Consequently, government authorities should implement macro-level adjustments to optimize workforce allocation within the mental health service system, while facilitating a paradigm shift from symptom-focused management to rehabilitation-oriented care. This transition represents a critical pathway for enhancing community mental health service quality and reducing incidents of violence and suicidal behavior.

DUP status in SMD patients

DUP is defined as the time from the onset of psychotic symptoms until the first treatment. Previous studies [25] reported that long DUP statistically significantly correlated with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission, and poor social functioning and global outcome (correlations 0.13–0.18). The current study found no significant difference in the four consecutive years of DUP from 2020 to 2023 (P > 0.05), indicating that DUP in Anhui Province remained largely unchanged in recent years. This was inconsistent with the results showing annual improvements in various management indicators.

Our study found that the average DUP of SMD patients in Anhui Province was 2.66 years. Generally, DUP under 2 years accounted for the largest proportion of total registered individuals (average 82.16%). Although DUP over 10 years was relatively small, only 7.01%, compared with the total number of registered individuals in Anhui Province, the total number of patients with a DUP > 10 years was large. A previous meta-analysis [26] reported that the DUP of patients with first-episode psychosis in Asia was 48.8 weeks. The present study indicated that patients with SMD had a higher DUP than those with general mental disorders. In 2005, Bertolote and McGorry on behalf of the WHO and the International Early Psychosis Association recommended reducing mean DUP to less than 3 months in individuals with first-episode psychosis [27]; however, the recommendations have not been implemented successfully with the current strategies.

What factors contribute to the longer DUP? A meta-analysis incorporating 30 studies with 16,473 participants revealed that in low- and middle-income countries, the primary social factors significantly associated with DUP among psychiatric patients are the stigma surrounding mental illness and lower social class [28]. Our study also demonstrated that SMD patients were predominantly from low educational backgrounds, rural areas, and unemployed. Therefore, governments need to enhance mental health services for lower socioeconomic groups and increase financial allocations for these populations.

According to the World Psychiatric Association guidelines, anti-stigma campaigns must be tailored to local contexts [23]. For instance, lower social classes often have poorer awareness of mental disorders, and in such cases, education alone may not sufficiently improve the situation. Carefully designed interventions are necessary—such as showcasing successfully treated and recovered patients to the general public—to challenge the persistent stereotype that “mental illness leads to disability.” This approach is one of the most effective ways to reduce stigma.

Schizophrenia requires comprehensive prevention and control

Herein, schizophrenia had the highest proportion among registered SMD patients (73.50%), consistent with the nationally reported data in recent years [10, 11, 14–17]. While schizophrenia is commonly perceived as a highly disabling condition [29], research demonstrates that with active treatment, many patients can achieve favorable outcomes [30]. This high prevalence and significant disability rate may reflect inadequacies in the existing service system for schizophrenia. Consequently, relevant departments should enhance community-based mental health services for schizophrenia patients, including: community case management, family involvement, health education and stress management, supported employment services, and self-help activities.

The present study found that the mean DUP for schizophrenia was 1.98 years, consistent with the 2 years previously reported [31]. A longer DUP is associated with a poorer outcome in schizophrenia. A previous meta-analysis showed that a shorter DUP was associated with less severe negative symptoms at short and long-term follow-up, especially when DUP was shorter than 9 months [32]. Since there was no effective treatment for negative symptoms, reducing DUP to less than 9 months might be the best ameliorative approach.

Mental retardation with mental disorders require strengthened management and treatment

Among the six registered SMDs, mental retardation with mental disorders had the second-highest number of patients, the longest mean DUP (4.93 years), and the largest proportion of SMD patients with a DUP > 10 years (16.29%). mental retardation with mental disorders had the lowest rate of medication-taking (82.75%) and regular medication-taking (66.26%) among the six SMDs. These data suggested that patients suffering from mental retardation with mental disorders have deficiencies in diagnosis, treatment, and management, warranting the improvement of the quality of community health services in Anhui Province.

Individuals with mental retardation with mental disorders were at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, anxiety disorders, psychotic illnesses, impulse control disorders, etc [33]. Because of symptoms and disabilities associated with these illnesses, these patients are often served in a mental health service system framework. However, patient treatment in these settings has typically not been sufficiently nimble, knowledgeable, or adept. Most mental health professionals received little training about the needs of this population [34], which might contribute to the long DUP, long disease course, low medication-taking rate, and low regular medication-taking rate in patients suffering from mental retardation with mental disorders. It is therefore necessary to ensure equitable access to treatment and care for people with mental retardation with mental disorders by making reasonable adjustments at the organizational level.

Limitations

Firstly, our results were derived from a cross-sectional analysis of available data, which limited our ability to establish causal associations. Secondly, the data extracted from the National Information System for Psychosis primarily represented percentages of the overall population rather than individual-level information. As a result, the variables used in our study were constrained and not exhaustive. Therefore, further cohort studies are warranted. Additionally, due to constraints within the National Information System for Psychosis, we only accessed data spanning from 2020 to 2023 in Anhui Province. Furthermore, for national data on SMD patients, we relied on references, limiting our comparison between Anhui and China to the years 2015 to 2020, as national data for 2021 to 2023 had not yet been published.

Conclusion

This study indicates that the utilization of the National Information System for Psychosis in Anhui Province, China, has significantly expanded healthcare access channels for patients with SMDs and improved their treatment outcomes. This provides robust evidentiary support for the primary goals of the Movement for Global Mental Health [35] and the WHO Mental Health Gap Action Program [2].

Critically, it moves beyond confirming the general value of community services by revealing inequities and pinpointing specific populations at heightened risk of poor outcomes – notably those in underserved regions, rural communities, individuals with low educational attainment, and particularly patients with comorbid mental retardation. Addressing these identified gaps through targeted resource allocation, development of specialized interventions for complex subgroups, and strategies to enhance the quality and equity of community services is essential for the National Information System for Psychosis to fulfill its potential in achieving recovery-oriented and equitable mental health care for all SMD patients in China. These research findings provide a foundation for improving mental health policies and service planning in China and potentially other countries as well.

Abbreviations

SMD

Severe mental disorders

DUP

Duration of Untreated Psychosis

mhGAP

Mental Health Gap Action Programme

ICD-10

International Statistical Classification of Diseases and Related Health Problems

WHO

The World Health Organization

MHAP

Comprehensive Mental Health Action Plan 2013-2020

Authors’ contributions

FD, NCX, and XYL have accessed and verified the data, and all authors were responsible for the decision to submit the manuscript. FD, NCX, and XYL are considered co-first authors. Dr. YL, and DLJ are considered co-corresponding authors. Concept and design: FD, NCX, XYL, YL and DLJ. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: FD, NCX, and XYL. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: FD, NCX, and XYL. Administrative, technical, or material support: CFZ, YM, JZ, CPZ, WLZ, and FFD. Supervision: YL and DLJ.

Funding

This project was supported by the Health Research Project of Anhui Province (AHWJ2022a029), Bengbu Medical College key Laboratory of Addiction Medicine 29 − 3, Anhui Provincial graduate Student Innovation and Entrepreneurship practice Project (2022cxcysj176). All funders didn’t interfere in study design, collection, analysis, interpretation, or writing of manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and Consent to Participate

According to the Declaration of Helsinki, the study was conducted with the approval of the Ethics Committee of Bengbu Medical University(Approval number: 2022-235). Because this retrospective study analyzed routine surveillance data and only the anonymized data were used, the Ethics Committee of Bengbu Medical University waived the need for informed consent. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests" in this section.