Cross-Sectional Evaluation of the Adequacy of Guardianship by Family Members of Community-Residing Persons with Mental Disorders in Changning District, Shanghai

By Zhang, Qiongting; Chen, Hao et al. | General Psychiatry, February 2015 | Go to article overview

Cross-Sectional Evaluation of the Adequacy of Guardianship by Family Members of Community-Residing Persons with Mental Disorders in Changning District, Shanghai


Zhang, Qiongting, Chen, Hao, Ju, Kang, Niu, Xin, Song, Lanjun, Chui, Jia, General Psychiatry


1. Background

Mental disorders have high relapse rates and pose a substantial burden to families and society. [1,2] In 2010, mental and substance use disorders accounted for nearly a quarter of the overall loss of healthy life years measured by Years Living with Disability (YLDs). [3] Many psychiatric illnesses are chronic, so in addition to effective treatments for acute symptoms, the long-term care and monitoring of patients is essential to ensure their adherence to medications and to facilitate the rehabilitation process. In China, where family members are the primary care givers for the vast majority of psychiatric patients, the significance of adequate family support has been widely discussed. [4,5,6] Poor care and supervision of persons with serious mental disorders has been associated with higher levels of disability. [7,8,9]

With the rapid economic development in China and a corresponding decrease in mortality from infectious conditions, chronic illness--including mental disorders --have become increasingly important components of overall health. The first regional mental health law in China--the Shanghai Mental Health Regulations [10] --came into effect on April 7, 2002. Eleven years later, on May 1, 2013, China's first national mental health law [11] came into effect. The promulgation of these two laws are significant milestones in the protection of the rights of persons with mental disorders in China; they guarantee their right to treatment and rehabilitation. Both laws described the designation and roles of legal guardians of mentally ill persons who have limited civil capacity, and list the specific responsibilities of legal guardians when the ill person is not hospitalized. However, the new national law differs in some respects from the earlier regional regulations that were promulgated in Shanghai and some other parts of the country before the national law was passed. One of these differences is related to guardianship. The Shanghai Mental Health Regulations specified that the designation of guardianship should follow the General Principles of Civil Law of the People's Republic of China, [12] which designates the spouse as the first choice, followed by parents, adult children, any other close relatives, and other relatives or friends approved by the local neighborhood or village committee. In contrast, the China Mental Health Law specifies that anyone with full civil capacity from any one of the above categories is equally eligible to be a guardian.

Based on the 2002 Shanghai Mental Health Regulations, a community mental health service system was established that gave a significant role to the legal guardians of non-institutionalized persons with mental disorders. [13] As part of this initiative, the Shanghai Information Management System of Mental Health collects medical records of all patients diagnosed with severe mental disorders at the city-level psychiatric hospital or at one of the 19 district-level psychiatric hospitals. This registry is managed by the Shanghai Mental Health Center (the single city-level psychiatric center). Every patient living in Shanghai diagnosed at one of the psychiatric hospitals with a 'severe' mental disorder (including schizophrenia, bipolar disorder, delusional disorder, schizoaffective disorder, epilepsy-induced mental disorder, and mental retardation with associated mental disorder) is visited by a community doctor or a neighborhood committee administrator and asked for their informed consent to be registered in this system. Once registered, the patient will receive regular home visits from community doctors, free medications, and a monthly family allowance. During the initial visit, one legal guardian is identified for each patient based on the prioritization of relationships with the patient described above (i.e., spouse, parent, adult children, other close relative, friend). Upon agreement, the legal guardian and the neighborhood committee sign a formal Guardianship Agreement. …

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