58. Psychological health care service model and legal policy support in grassroots community governance

Background As mental health issues increasingly become an important factor affecting public health and social harmony, China is gradually promoting the sinking of mental health services to grassroots communities. However, there are still fragmented, non-standard, and insufficient sustainability issues in the supply mode of mental health care services in grassroots communities, and the relevant legal and policy support system is not yet sound, which restricts service coverage and intervention effectiveness. Therefore, this study systematically sorts out the existing mental health care service models in grassroots communities, analyzes their legal and policy support status and bottlenecks, in order to provide theoretical and practical basis for building a standardized and sustainable community mental health service system. Methods The study selected 24 urban and rural communities from six provinces in eastern, central, and western China as survey subjects, covering three types of institutions: community health service centers, street social workstations, and community mental health service points. Conduct a systematic review and content analysis of community mental health related policy documents issued by the national and local governments since 2015. A questionnaire survey was conducted on 320 community mental health service providers, including general practitioners, social workers, and psychological counselors, to investigate service models, resource allocation, policy awareness, and implementation barriers. Finally, 36 policy makers, institutional managers, and service users were selected for semi-structured interviews to understand the service operation mechanism and policy implementation effectiveness. The study used SPSS 26.0 for descriptive and comparative analysis of questionnaire data, and Nvivo 12.0 for topic coding and qualitative analysis of interview texts. Results The study identified four main service models, with the "medical social collaboration" integrated service model accounting for 35.4% of the sample communities. The community health service center collaborated with community organizations to conduct psychological assessments and referrals. The "social worker led" supportive service model accounts for 29.2%, relying on community social work stations to carry out mental health education and group counseling. The "family neighborhood" mutual aid model accounts for 20.8%, based on community volunteers and neighborhood networks for psychological companionship and crisis warning. The "digital platform+" remote service model accounts for 14.6%, providing psychological assessment and counseling through online platforms. Policy analysis shows that the national level has issued the "Mental Health Law of the People's Republic of China" and relevant guidance on mental health services, but only 41.7% of communities in local supporting policies have clear service implementation guidelines and funding guarantee measures. The survey results show that 67.3% of service providers believe that the lack of specialized legal basis is the main obstacle to service development, and 71.5% reflect that the training time is less than 20 hours per year, and the standardization of services needs to be improved. Discussion The current grassroots community mental health care has formed a prototype of a diversified service model, but due to insufficient legal and policy support, lack of cross departmental collaboration mechanisms, and unsustainable resource guarantees, the overall service is still in a fragmented stage. The study provides a model reference and policy recommendations for improving the grassroots psychological service system, and further comparative research and long-term impact assessment of different regional models should be carried out in the future.