Development of a Community-Based Mental Health Care Model through the District Quality of Life Development Committee in Ban Thaen District, Chaiyaphum Province

Abstract

This study employed an action research design aimed at developing a community-based care model for psychiatric patients through the District Health Board (DHB) mechanism in Ban Thaen District, Chaiyaphum Province, Thailand. The research process was conducted in four phases: (1) situation and problem analysis, (2) development and implementation of the community-based psychiatric care model, (3) reflection on the implementation process, and (4) evaluation of the outcomes. The study period spanned from November 2024 to November 2025. Participants included 210 psychiatric patients and their caregivers, purposive sampling based on inclusion criteria. In addition, key stakeholders involved in the research included 21 members of the District Health Board and 60 related personnel, resulting in a total of 291 participants. Research instruments included focus group discussion, in-depth interview, a satisfaction questionnaire, and an assessment form for severe mental illness with violent behavior (SMI-V). Data was analyzed using pair t-test, descriptive statistics and content analysis.

The findings revealed that the developed model was a “foster family system” emphasizing the integration of kinship-based roles within the community network. In this model, village health volunteers assumed the role of “mothers,” community leaders served as “fathers,” and health personnel acted as “relatives,” collaboratively supporting the care of psychiatric patients in the community. The effectiveness of the model demonstrated a significant reduction in violent incidents among high-risk psychiatric patients (SMI-V) by 80%, decreasing from 43 incidents to 5 incidents. Before and after the operation was statistically significantly different at the 0.05 level. In addition, 67.56 %  of patients classified in the red category transitioned to the yellow category, indicating a safer level of risk. All patients (100%) were able to access continuous medication. The rate of missed appointments among patients was significantly reduced from the baseline (p < 0.05). The overall satisfaction of stakeholders with the model was at a high level (Mean=3.52, SD=0.40).

Policy implications suggest that this model should be prioritized as a key agenda item for community mental health care at the district level. Future research is recommended to assess cost-effectiveness from a health economics perspective and conduct long-term follow-up studies to ensure the sustainability of community-based psychiatric care systems.