Objective To understand the current condition and existing problems of management of rural patients with severe mental disease, so as to provide suggestions and countermeasures for the health administrative departments for making policies. Methods We took a self-designed questionnaire to make a investigation among the 120 randomly selected guardians of rural patients with severe mental disease. Results Among the 120 guardians, most of them were the parents of the patients, and most of the guardians were farmers who had a low degree of education, bad family economic condition and poor guard capacity with the age ranging from 36 to 60. The medication compliance of the patients who could get medicines for free was better than that of the patients who should buy medicines by themselves. The difference between them showed the statistical significance(P＜0.05). The stability of illness of the patients who could get medicines for free was better than that of the patients who should buy medicines by themselves. The difference between them showed the statistical significance(P＜0.05). The medication compliance of the patients who took medicines according to their guardians' arrangement was better than that of the patients who took medicines on his own. The difference between them showed the statistical significance(P＜0.05). The rate of file archiving was 99.16%, the participation rate of free health examination was 73.33% and the rate of follow-up visit was 81.66%. Conclusion We suggest that the treatment and salvation of patients should be strengthened and the policy of dispensing free medicine should be fully implemented. Meanwhile, the mental health education of patients and their guardians should be improved.