Development of a Comprehensive Psychiatric Care System (SMI-V) with Family and Community Involvement, at Mae Wadi Hospital, Roi Et Province

Abstract

Purposes: This study aimed to investigate problems and needs, develop, implement, evaluate, improve, and disseminate a family- and community-based care system for patients with severe mental illness with complex needs (SMI-V).

Study design:  A research and development design was employed

Materials and Methods :. Participants included 40 healthcare providers (physicians, nurses, pharmacists, and village health volunteers), 30 service users (patients with mental illness and their families), and 5 experts. The study was conducted between October 2024 and July 2025. Data were collected using standardized instruments: global functioning assessment, psychiatric symptom scale, quality of life questionnaire, knowledge test, and feasibility and appropriateness evaluation form. Data were analyzed using frequency, percentage, mean, standard deviation, and paired t-test.

Main findings : 1) Problems in SMI-V care were classified into four domains: service users and families, service providers, healthcare system, and medical equipment and supplies. 2) The developed SMI-V care system consisted of five components: (1) establishment of a multidisciplinary working group for continuous care, (2) creation of a Line application group for community communication and coordination, (3) case management, (4) monitoring and evaluation of high-risk aggressive behavior, and (5) psychosocial interventions (Matrix program) and community-based treatment and rehabilitation (CBTx). 3) After implementation, caregivers’ knowledge significantly increased (p<.001), with mean scores higher by 4.00 points (95% CI: 3.09–4.09). Patients showed significantly improved psychiatric symptoms, global functioning, and quality of life (p<.001 for all), with mean increases of 28.43, 15.46, and 33.43 points, respectively (95%CI: 22.82–34.03; 12.55–18.37; 29.20–37.65). Feasibility and appropriateness were rated at a high level (Mean=4.39, SD.=0.12).

Conclusion and recommendations: The developed family- and community-based SMI-V care system represents an innovative approach that fosters collaboration among patients, caregivers, and service providers, leading to positive outcomes at individual, family, and system levels. However, limitations related to generalizability and long-term sustainability highlight the need for further studies to validate and expand the model for broader application.