The presentation shall discuss on mandatory mental health treatments in the community, stakeholders' perspectives on conditional discharge, and review of the effectiveness of a compulsory intervention, namely "Community Treatment Order" (CTO), which had been implemented in some Western countries.
Conditional discharge (CD) is a legal provision regulated by Section 42B of the Mental Health Ordinance (Cap. 136) and its primary objective is to safeguard the health and safety of patients and others by mandating individuals with mental disorders, who meet certain criteria, to follow a course of treatments after discharge. There are several limitations on the local CD mechanism which restrict the scope of patients to benefit from CD. The Mental Health Review Report under the Health Bureau in 2017 recommended a more effective use of CD and to explore the applicability of CTO in Hong Kong. A working group was formed in the Hospital Authority to review the existing CD mechanism, and it was tasked by the Advisory Committee on Mental Health.
Focus groups were organised to collect perspectives of relevant stakeholders including patients, care-givers, psychiatrists, nurses and allied health professionals and representatives from Non-Government Organisations. The results highlighted the consensus from stakeholders regarding the benefits of CD on patients' recovery, and suggested a regular review mechanism of the CD status.
CTO is a mandatory intervention that keeps patients actively engaged in the mental health services outside the hospital settings. The effectiveness of CTO was reviewed through systematic review and meta-analysis on clinical outcomes when patients were in the community, including psychiatric service usage, number of emergency visits and violence. The results included 16 studies and demonstrated statistically significant effects in pre-post design studies, in terms of promoting service contacts, and reducing both emergency visits and violence; while the effects were insignificant in control studies.
