The community-based models that did evolve focused on providing basic mental health services for the severely mentally ill rather than on rehabilitation per se, but the use of the politically correct “rehabilitation” rubric ensured a level of support that would not otherwise have been available. Some smallscale community-based models were quite successful, particularly the comprehensive service network developed in the Zhengyang district of Shenyang (a large industrial city in check details northern China).51 Two large-scale community-based models – the “Shanghai model”52,53 and the “Yantai model”54 – were also successful. The Yantai model provided basic mental Inhibitors,research,lifescience,medical health services

to the 6.3 million rural residents of the Yantai district of Shandong Inhibitors,research,lifescience,medical province via a multi-tiered delivery system. This included an advisory group in the central urban psychiatric hospital, community psychiatrists

in small county-level psychiatric hospitals who trained nonpsychiatric physicians to provide outpatient psychiatric services in township-level general hospitals, and village paramedics (“village doctors”) who supervised patients in the community. The Shanghai model provided an integrated support network for persons with chronic mental illnesses (primarily schizophrenia) among Shanghai’s 13 million residents that combined: (i) community follow-up Inhibitors,research,lifescience,medical of psychiatric outpatients at primary-level general hospitals; (ii) the innovative “guardianship networks” operated by nonprofessional Inhibitors,research,lifescience,medical volunteers (usually retired workers, patients’ neighbors, and community officials) who supervised the care of patients in the community; and (iii) work therapy stations (ie, sheltered workshops) that provided an occupation to patients who had a limited capacity to work. The All China Disabled Persons’ Federation promoted the generalization of a slightly revised version of the Shanghai model to 64 sites around the country as part of their Eighth Five-Year National Development Plan (1991 -1995) and to 200 urban and rural communities as part of their Ninth Five-Year National Development

Plan (1996-2000). However, sustaining Inhibitors,research,lifescience,medical and generalizing these during excellent models of care delivery in the 1990s has proven difficult, largely because the economic reforms have changed the socioeconomic factors that made the models possible in the first place. Community volunteers are much harder to find because more retired persons are now involved in income-generating activities, so guardianship networks are difficult to develop and maintain. Many factories are laying off workers and trying to improve their efficiency, and so they no longer have piece-work to give to the sheltered workshops; without revenue producing work, many workshops have had to close because they arc no longer economically viable. Moreover, many local governments are trying to reduce their expenditures, and are thus reluctant to support any expansion of health and welfare services.