Development of a community-based care model for high-risk psychiatric patients (KAEDAM Model)of a community-based integrated mental health care model for psychiatric patients
DOI:
https://doi.org/10.64838/jmht.2026.287294Keywords:
action research, care model, community-based care, psychiatric patients, violenceAbstract
Objective: To develop and evaluate a community-based care model for patients with serious mental illness with high risk to violence (SMI-V).
Methods: This mixed methods action research was conducted in Kaedam District, Maha Sarakham Province. Participants consisted of 20 health personnel, 82 community network partners, eight SMI-V patients, and eight caregivers. The study was divided in three phases: Phase 1, a situational assessment and problem analysis; Phase 2, development of a care model using the PAOR (Plan–Act–Observe–Reflect) cycle; and Phase 3, evaluation and reflection on the implementation outcomes, including community network partners’ knowledge and participation, caregiver burden, and psychiatric symptoms.
Results: The study area demonstrated an increasing trend in SMI-V cases, along with challenges related to continuity of care, follow-up and information referral systems, negative attitudes and social stigma, and insufficient knowledge and competencies among healthcare personnel and family caregivers. These challenges contributed to psychiatric relapses and violence in the community. Accordingly, the KAEDAM Model was developed, comprising six key components: network capacity building, improved access to services, empowerment of patients and caregivers, depression prevention, community-based rehabilitation, and policy-level monitoring and evaluation. After implementation, community network partners showed increased knowledge and participation scores, while family caregivers experienced significant reductions in caregiver burden, depression, and stress. Among SMI-V patients, significant reductions in psychotic symptoms, stress, depression, and suicide risk were observed, with all patients classified as low risk (green) within one year.
Conclusion: The KAEDAM model showed potential to enhance knowledge and participation among community network partners, while reducing caregiver burden and psychiatric symptoms among patients. Further studies using a comparison group and long-term follow-up are recommended to confirm the model’s effectiveness and sustainability.
Downloads
References
Department of Mental Health. Guidelines for continuous monitoring and care of psychiatric patients with alcohol/drugs/narcotics (Trial version) [Internet]. Bangkok: Prosperous Plus Company Limited; 2020 [cited 2026 May 26]. Available from: https://www.dmh-elibrary.org/items/show/1303 (in Thai)
Anti-Drug Operation Centre, Ministry of Public Health. National drug treatment and rehabilitation information system (Bor Sor Tor) [Internet]. Nonthaburi: Ministry of Public Health; 2023 [cited 2026 Aug 15]. Available from: https://antidrug.moph.go.th/ (registration required) (in Thai)
Department of Mental Health. Number of psychiatric outpatients of service units under the Department of Mental Health, fiscal year 2022 [Internet]. Nonthaburi: Mental Health Data Center, Department of Mental Health; 2022 [cited 2026 Aug 15]. Available from: https://datacenter.dmh.go.th/DTC/ReportSERVICE_PID.aspx (in Thai)
Duangsawang N. Situation analysis: state of mental health of people in Maha Sarakham province which is the impact of the outbreak of coronavirus 2019. Journal of Social Science and Cultural. 2024;8(8):212-24. (in Thai)
Jirawikrankul S. Development of a surveillance and care system for serious mental illness with high risk to violence patients in communities with community network participation, Buriram province. Journal of Mental Health of Thailand. 2024;32(3):224-35. (in Thai)
Lekphet P, Lekphet K, Nawamawat J. The development of surveillance and care model for psychiatric diseases based on community participation, Kaolieo District, Nakhonsawan Province. Journal of Public Health and Health Sciences Research. 2024;6(1):164-77. (in Thai)
Chutanawaropakon K. Development of a community-based care model for chronic psychiatric patients in Phu Ruea District, Loei Province, Thailand. Journal of Loei Provincial Public Health Office. 2025;3(1):101-17. (in Thai)
Pimsaengsil D. Development of a community network-based care model for chronic psychiatric patients: the "4 build, 2 use" innovation Nasiew Sub-district, Mueang Chaiyaphum district. Chaiyaphum Medical Journal. 2025;45(2):e16769. (in Thai)
Parnjun C. Development of mental health and substance abuse patient care model in community, Khun Han district, Sisaket province. Sisaket Journal of Research and Health Development. 2026;5(1):60-75. (in Thai)
Chujohor P. Development of a participatory drug addiction psychiatric patient service system of the Non Thai District network. Journal of Environmental Health and Community Health. 2025;10(1):634-40. (in Thai)
Pengkred C. The effect of applying a family psycho-education program on medication adherence behaviors among schizophrenia patients in a community, Somdejprapiyamaharachrommaneeyaket hospital, Kanchanaburi province. Journal of Nursing and Public Health Research. 2021;1(3):1-16. (in Thai)
World Health Organization. Guidance on community mental health services: promoting person-centred and rights-based approaches. Geneva: World Health Organization; 2021.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64-78. DOI: https://doi.org/10.1377/hlthaff.20.6.64
Kemmis S, McTaggart R. Participatory action research: communicative action and the public sphere. In: Denzin NK, Lincoln YS, editors. The SAGE Handbook of Qualitative Research. 3rd ed. Thousand Oaks: Sage Publications; 2005. p. 559-603.
Kaewmuang T, Chaiywiratnanukul P, Naaon P, Kanchanapinyowong S, Wongsawat P. Manual of guidelines for screening psychiatric patients at high risk of violence (SMI-V) [Internet]. Nonthaburi: Sector for Mental Health Service Administration, Department of Mental Health; 2021 [cited 2026 Aug 15]. Available from: https://dmh-elibrary.org/items/show/1391 (in Thai)
Cohen JM, Uphoff NT. Rural development participation: concepts and measures for project design, implementation and evaluation. Rural Development Monograph No. 2. Ithaca (NY): Rural Development Committee, Center for International Studies, Cornell University; 1977.
Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychol Rep. 1962;10(3):799-812. DOI: https://doi.org/10.2466/pr0.1962.10.3.799
Suwanmaitree S, Limsiew U, Sianglam C, editors. Guidelines for the care of psychiatric emergency patients (acute care) for public health service units (levels A, S, M1 and M2), trial edition. 2nd ed. [Internet]. Nonthaburi: Department of Mental Health, Ministry of Public Health; 2020 [cited 2026 Aug 15]. Available from: https://mhso.dmh.go.th/assets/pdf/guidebook/general/38.pdf (in Thai)
Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry. 1986;143(1):35-9. DOI: https://doi.org/10.1176/ajp.143.1.35
Kongsuk T, Arunpongpaisal S, Janthong S, Prukkanone B, Sukhawaha S, Leejongpermpoon J. Criterion-related validity of the 9 Questions Depression Rating Scale revised for Thai Central Dialect. Journal of the Psychiatrist Association of Thailand. 2018;63(4):321-34. (in Thai)
Silpakit O. Srithanya stress scale. Journal of Mental Health of Thailand. 2008;16(3):177-85. (in Thai)
Department of Mental Health. Manual of screening assessment tools for persons with suicidal behaviour problems (2Q plus, 9Q, 8Q) [Internet]. Nonthaburi: Mental Health Promotion and Development Division, Department of Mental Health; 2024 [cited 2026 Aug 15]. Available from: https://dmhpd.dmh.go.th/ (in Thai)
Zarit SH, Reever KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist. 1980;20(6):649-55. DOI: https://doi.org/10.1093/geront/20.6.649
Pinyopornpanish K, Pinyopornpanish M, Wongpakaran N, Wongpakaran T, Soontornpun A, Kuntawong P. Investigating psychometric properties of the Thai version of the Zarit Burden Interview using Rasch model and confirmatory factor analysis. BMC Res Notes. 2020;13(1):120. DOI: https://doi.org/10.1186/s13104-020-04967-w
Trebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. BMJ. 2010;341:c4078. DOI: https://doi.org/10.1136/bmj.c4078
Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Cochrane Database Syst Rev. 2017;1(1):CD007906. DOI: https://doi.org/10.1002/14651858.CD007906.pub3
Correll CU, Galling B, Pawar A, Krivko A, Bonetto C, Ruggeri M, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018;75(6):555-65. DOI: https://doi.org/10.1001/jamapsychiatry.2018.0623
Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, et al. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2015;206(4):268-74. DOI: https://doi.org/10.1192/bjp.bp.114.147561
van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, et al. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev. 2021;8(8):CD009149. DOI: https://doi.org/10.1002/14651858.CD009149.pub3
Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: a conceptual model to address disparities in care. Annu Rev Clin Psychol. 2018;14:185-208. DOI: https://doi.org/10.1146/annurev-clinpsy-050817-084825
Jordans MJD, Luitel NP, Lund C, Kohrt BA. Evaluation of proactive community case detection to increase help seeking for mental health care: a pragmatic randomized controlled trial. Psychiatr Serv. 2020;71(8):810-5. DOI: https://doi.org/10.1176/appi.ps.201900377
Jordans MJD, Kohrt BA, Luitel NP, Komproe IH, Lund C. Accuracy of proactive case finding for mental disorders by community informants in Nepal. Br J Psychiatry. 2015;207(6):501-6. DOI: https://doi.org/10.1192/bjp.bp.113.141077
Homjandee J, Dangdomyouth P. The effect of social support emphasizing community participation program on burden of community schizophrenic patients' caregivers. Journal of The Police Nurses. 2019;11(2):433-43. (in Thai)
Dana K. Development of the roles for psychiatric patients care among family caregivers and partnership networks in the community. Journal of Health Science of Thailand. 2021;30(3):406-14. (in Thai)
Thaopha R, Srisathan E. Development of a care system with network participation for individuals with substance use disorders in Nong-bua Lamphu province. Journal of Mental Health of Thailand. 2025;33(1):12-23. (in Thai)
Taloh S, Waichomphu N. Developing a care model for high-risk schizophrenia patients to prevent severe violence occurrences, Pattani hospital. Journal of Health Science and Pedagogy. 2024;4(2):58-70. (in Thai)
Prakiranaya P, Swangthaisong C, Boonmee D, Chanthanuy K, Chaisorn O. Guidelines for the care of drug addicts with mental illness and high risk of violence with community participation, Yang Si Surat District, Maha Sarakham Province. Journal of Environmental Health and Community Health. 2024;9(6):218-28. (in Thai)
Yamueang SS, Bunpok S, Changmuang S, Chairatana W. Development of a comprehensive psychiatric care system (SMI-V) with family and community involvement, Maewadi Hospital, Roi Et Province. Journal of Research and Health Innovative Development. 2025;6(3):58-73. (in Thai)
Serirattana T. Development of an integrated approach to reduce the aggressive behavior of drug users with psychiatric symptoms in Roi Et Province. Singburi Hospital Journal. 2024;32(3):B127-40. (in Thai)
Kishimoto T, Hagi K, Kurokawa S, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: a systematic review and comparative meta-analysis of randomised, cohort, and pre-post studies. Lancet Psychiatry. 2021;8(5):387-404. DOI: https://doi.org/10.1016/S2215-0366(21)00039-0
Fazel S, Zetterqvist J, Larsson H, Langstrom N, Lichtenstein P. Antipsychotics, mood stabilisers, and risk of violent crime. Lancet. 2014;384(9949):1206-14. DOI: https://doi.org/10.1016/S0140-6736(14)60379-2
Sornpaisarn B, Rehm J, Tamdee D, Wisutthananon A, Thummathai K, Tongtua K, et al. Evaluating the efficacy of a community participatory intervention to prevent suicide in Thailand: a randomised controlled trial protocol. BMJ Open. 2023;13(7):e066201. DOI: https://doi.org/10.1136/bmjopen-2022-066201
Kongsuk T, Supanya S, Kenbubpha K, Phimtra S, Sukhawaha S, Leejongpermpoon J. Services for depression and suicide in Thailand. WHO South East Asia J Public Health. 2017;6(1):34-8. DOI: https://doi.org/10.4103/2224-3151.206162
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012;10(10):CD006525. DOI: https://doi.org/10.1002/14651858.CD006525.pub2
Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol. 2005;34(1):215-20. DOI: https://doi.org/10.1093/ije/dyh299
McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol. 2014;67(3):267-77. DOI: https://doi.org/10.1016/j.jclinepi.2013.08.015
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Journal of Mental Health of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
- Authorization to photocopy items for internal or personal use of specific clients, is granted. The consent does not extend to other kinds of copying, such as for general distribution, for advertising, or for resale.
- Unless otherwise states, the views and opinion expressed in Journal of Mental Health of Thailand are those of authors of the papers, and do not represent those of the editorial board or the Department of Mental Health.
