In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community-care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community-care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.