Mental Health Services in Rural China: A Qualitative Study of Primary Health Care Providers

Table 2

Typical statements made by PHC providers by key themes.

	The situation of mental health service in PHC	Main difficulties to provide mental health care	Willingness to provide mental health care	Required abilities of the primary mental health providers	Attitude toward mental disorders	How to improve mental health care in rural area
Liujiang County with the hospital-community integrated service model	As the administrator of severe mental illnesses, I play a role of bridge and tie between hospital and mental ill patients, such as telling the patients to take physical examination, and to take a follow-up visit at any time.	I am afraid of the mental disorders experience relapses. The patients could not well understand our work, sometimes they curse and shout us.	As long as I have certain knowledge to help the patients, I would like to do.	On one hand, knowledge and skill of mental health, on the other hand, the abilities of diagnosis and treatment, the skills of communication, and so forth.	I treat mental patients as normal persons. I think we should mobilize people who around them to care about them.	The most important thing is that rural mental health care, as well as our village doctors, should be recognized by the society and supported by the government.
	I take the family visits of mental illnesses 2-3 times every month, as well as health education, and record the patient’s progress. Any condition changes I will contact the superiors. It is important to recognize the symptoms and to nip it in the bud.	It takes 50 minutes by motorcycle to the farest [sic] village. I asked the family members to come to establish medical records. They did not. How to reimburse the visiting fare is also a problem.	It is my responsibility to do it. When I saw some of mental illnesses could go back to farm work after taking pills, I have a sense of achievement.	Ability of communicate should be skillful. Firstly you should friendly talk about daily life, such as breakfast, farm work, crop of sugarcane, and so forth. Never asking illness immediately. Make the patient relax and happy. Then you can ask him what medicine he takes, how often and so on.	As a village doctor, I hope the mental disorders get proper treatment, recovery, live and work independently. I am happy if I am helpful in this.	I hope government pay more attention to improve our ability by increasing income, developing training and raising satisfaction, and so forth. Village doctors’ abilities are very important in mental health work.
	I am responsible to interview the mental disorders and observe their behaviors, to supervise whether they take medicine on time, and to report at any time.	The job had no subsidies in the past two years. However, we had to do the work without subsidies. No insurance, nothing.	I like to do this work not only for mental illnesses but also for people in our village.	At least PHC providers should know basic mental knowledge, and have the ability of communication. Don’t stigmatize.	Actually I think we do not care enough about mental disorder people and their family members.	The treatment of mental illness costs a lot while patients living in rural have no more money. Financial support is essential.
Liucheng County with the psychiatric hospital-centric model	To telling the truth, I am rarely active to do the work, because I have many other things to do, such as managing the diabetes and hypertensions.	The family members don’t cooperate with our door-to-door visits, and I am lack of professional skills. As a result, I don’t know how to help them.	I don’t want to do it. Nobody will work without pay. All this work was for nothing. No value.	We need to get more basic knowledge, and take trainings of mental health. We are lack of basic knowledge.	I do not discriminate the mental illnesses. They have no differences with us when they take medicine.	If the government increases subsidies, it will be quite a motivation for village doctors to do mental health care in an active way.
	Formerly, the management of the mental illnesses was almost nothing. Last year I attended a meeting that I was asked to look for the mental illnesses and fill up the health forms. But we have had no management approach yet.	The follow-up visit is required each month, but the subsidies of the extra work are so little. I have to cope with an ever-expanding workload without money.	I do love this job even it is very dangerous. It is very difficult for PHC providers to do well without governmental supports.	One point is professional ethics, the other point is mental strength and nice personality. What is more, the good communication with patients’ family members is also needed, as well as updated personal knowledge and skills.	Frankly speaking, I am afraid of mental disorders’ attack. Especially the manic patients. Even though it is dangerous, it is still my duty to contact with them.	Government should pay more money on the treatment of mental disorders. Free medicine for outpatients and reinbursement [sic] of hospital bills for severe mental illnesses should be provided.
	I do what the superiors ask me to do. Such as writing the materials and giving guidance to the family members of mental illnesses.	I don’t know much about mental health knowledge. I think I need to learn, to train, and then to manage the patients.	I have to do mental health care as a PHC provider whether there is good condition or not.	PHC providers should go on well with the villagers. That is to say, we should not only communicate with them, but also know the clinical knowledge.	I do not like to contact with mental disorders. They are abnormal and maybe dangerous.	Well, we do have policy to improve mental health in rural by central government. But very little has been achieved in the implementation at grass-roots level. This aspect should be strengthened.