Authors (including presenting author) :
Lam EHY(1), Lai ESK(2), Lai ECL(3), Lau E(2), Tang YDY(1), Siu BWM(1)
Affiliation :
(1)Department of Forensic Psychiatry, Castle Peak Hospital
(2)Occupational Therapy Department, Castle Peak Hospital
(3)Department of Child and Adolescent Psychiatry, Castle Peak Hospital
Introduction :
Community treatment order (CTO) is an intervention to actively engage patients in the mental health service and provide supervision outside hospital setting. Patients who met specific criteria are required to follow treatment prescriptions under a legal provision. CTO was first introduced in the United States of America in the 1980s and subsequently implemented in other countries such as the United Kingdom, Canada, and European countries. Existing literatures evaluating the effectiveness of CTO focused on hospitalisation-related outcomes such as readmission rate and length of hospital stay, but the results were inconclusive. Owing to the conflicting evidence, CTO has not yet been introduced in Hong Kong. In response to the Mental Health Review Report published by the Review Committee on Mental Health under the Health Bureau in 2017, the applicability and practicability of introducing CTO in Hong Kong was examined by reviewing and updating the evidence on the effectiveness of CTO not only in hospitalisation-related outcomes, but also in other relevant outcomes while patients were still in the community, including psychiatric service usage, number of emergency visits and violence.
Objectives :
To update and expand evidence on the effectiveness of CTO by systematic review and meta-analysis
Methodology :
Three electronic databases including PsychINFO, Embase, and Medline were searched from inception to March 2022. Studies were included if they (1) were quantitative studies examining the effect of CTO; (2) included target outcome measures of psychiatric service usage, number of emergency visits and violence; and (3) provided sufficient data for effect size calculation. The search was conducted by two independent reviewers using the online programmme (Covidence). Eligible articles were selected based on the inclusion criteria and conflicts were resolved by consultation of the third independent reviewer. Meta-analysis was conducted to compare disparate outcome measures between studies using Comprehensive Meta-Analysis Software (CMA version 2).
Result & Outcome :
A total of 4,678 records were screened, of which 16 studies fulfilled the inclusion criteria and were included in the analysis. The results demonstrated statistically significant effects in pre-post design studies, in terms of promoting service contacts, and reducing emergency visits and violence; but the effects were insignificant in control studies. Given the inconsistent evidence supporting the use of CTO and ethical issues concerned, the implementation of CTO in Hong Kong remained controversial.
