Government-procured community-based psychiatric rehabilitation delivered by social organizations: a three-year institutional ledger study in an urban–rural District of Shanghai
Abstract
BackgroundCommunity-based psychiatric rehabilitation (CBPR) is central to mental health deinstitutionalisation, yet evidence on government-procured services delivered by social organizations remains scarce, particularly in urban–rural mixed settings. This descriptive study evaluated the service system, resource allocation, and service content coverage of government-purchased CBPR in Shanghai’s Minhang District using 3 years of institutional ledgers (2023–2025), identifying structural deficiencies to inform policy optimisation.MethodsWe analyzed ledgers from 13 township-level Sunshine Heart Gardens (government-established community rehabilitation stations for people with serious mental disorders), district civil affairs, disabled persons’ federations, mental health centers, and two social organizations (216 institutional record entries covering funding, staffing, facilities, and 15 standardized services). The same annual questionnaire was completed annually and linked by institution; annual changes are reported descriptively, without formal longitudinal analysis. Descriptive statistics, spatial distribution, and exploratory Spearman correlations were used, without missing-data imputation.ResultsIn 2025, the district-reported rate of receiving community rehabilitation services among registered home-based patients with serious mental disorders was 99.99%, with standardized management and medication adherence rates exceeding 98%. In contrast, township-level service content coverage-the breadth of the 15 service items each institution reported providing-ranged from 20.0% to 100.0% (median 60.0%; n = 13). Vocational rehabilitation, employment support, and legal aid were each reported by 4 of 13 institutions (30.8%); peer support groups by 6 of 13 (46.2%). Median full-time staff was two (n = 13); no psychological counselors, occupational therapists, or rehabilitation practitioners were reported among the 11 institutions with these data. Funding was almost exclusively fiscal, with substantial annual variation in procurement expenditure. Recorded follow-up visits declined by 69.9% between 2023 and 2025, reflecting fewer recorded visits rather than necessarily less service delivery. Township-level correlations between resource indicators and service content coverage were low (ρ = 0.14–0.26; n = 10–12) and imprecise (95% confidence intervals included zero).ConclusionHigh administrative coverage coexists with substantial gaps in the breadth of reported service content and in advanced integration services. One-year procurement contracts and process-oriented evaluations are plausible institutional mechanisms warranting further testing; longer procurement frameworks, outcome-based assessments, and differentiated resource allocation merit evaluation rather than interventions whose effects have been established.
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BibTeX
@article{chen2026governmentprocured,
title = {{Government-procured community-based psychiatric rehabilitation delivered by social organizations: a three-year institutional ledger study in an urban–rural District of Shanghai}},
author = {Yankai Chen and Xiaolan Wang and Yanli Liu and Yi Zhu and MiaoMiao Zhao and Hao Yao and Yu Zhou and Zixuan Tang and Guo Xuan and Lijun Wang and Jun Cai and Weibo Zhang},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1995183},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1995183},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Government-procured community-based psychiatric rehabilitation delivered by social organizations: a three-year institutional ledger study in an urban–rural District of Shanghai
AU - Yankai Chen
AU - Xiaolan Wang
AU - Yanli Liu
AU - Yi Zhu
AU - MiaoMiao Zhao
AU - Hao Yao
AU - Yu Zhou
AU - Zixuan Tang
AU - Guo Xuan
AU - Lijun Wang
AU - Jun Cai
AU - Weibo Zhang
PY - 2026
DA - 2026/11/12
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1995183
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1995183
AB - BackgroundCommunity-based psychiatric rehabilitation (CBPR) is central to mental health deinstitutionalisation, yet evidence on government-procured services delivered by social organizations remains scarce, particularly in urban–rural mixed settings. This descriptive study evaluated the service system, resource allocation, and service content coverage of government-purchased CBPR in Shanghai’s Minhang District using 3 years of institutional ledgers (2023–2025), identifying structural deficiencies to inform policy optimisation.MethodsWe analyzed ledgers from 13 township-level Sunshine Heart Gardens (government-established community rehabilitation stations for people with serious mental disorders), district civil affairs, disabled persons’ federations, mental health centers, and two social organizations (216 institutional record entries covering funding, staffing, facilities, and 15 standardized services). The same annual questionnaire was completed annually and linked by institution; annual changes are reported descriptively, without formal longitudinal analysis. Descriptive statistics, spatial distribution, and exploratory Spearman correlations were used, without missing-data imputation.ResultsIn 2025, the district-reported rate of receiving community rehabilitation services among registered home-based patients with serious mental disorders was 99.99%, with standardized management and medication adherence rates exceeding 98%. In contrast, township-level service content coverage-the breadth of the 15 service items each institution reported providing-ranged from 20.0% to 100.0% (median 60.0%; n = 13). Vocational rehabilitation, employment support, and legal aid were each reported by 4 of 13 institutions (30.8%); peer support groups by 6 of 13 (46.2%). Median full-time staff was two (n = 13); no psychological counselors, occupational therapists, or rehabilitation practitioners were reported among the 11 institutions with these data. Funding was almost exclusively fiscal, with substantial annual variation in procurement expenditure. Recorded follow-up visits declined by 69.9% between 2023 and 2025, reflecting fewer recorded visits rather than necessarily less service delivery. Township-level correlations between resource indicators and service content coverage were low (ρ = 0.14–0.26; n = 10–12) and imprecise (95% confidence intervals included zero).ConclusionHigh administrative coverage coexists with substantial gaps in the breadth of reported service content and in advanced integration services. One-year procurement contracts and process-oriented evaluations are plausible institutional mechanisms warranting further testing; longer procurement frameworks, outcome-based assessments, and differentiated resource allocation merit evaluation rather than interventions whose effects have been established.
SN - 2296-2565
ER -