Effect of Community Treatment Orders on Mental Health Service Usage, Emergency Visits, and Violence: a Systematic Review and Meta-Analysis.

INTRODUCTION: Community treatment orders (CTOs) enable patients to actively engage in mental health services while being supervised in the community outside the hospital setting. However, the efficacy of CTOs remains controversial in terms of mental health services usage or service contacts, emergency visits, and violence. METHODS: The databases PsychINFO, Embase, and Medline were searched on 11 March 2022 by 2 independent reviewers through the Covidence website (www.covidence.org). Randomised or non-randomised case-control studies and pre-post studies were included if they examine the effect of CTOs on service contacts, emergency visits, and violence in individuals with mental illnesses by comparing with control groups or pre-CTO conditions. Conflicts were resolved by consultation of the third independent reviewer. RESULTS: Sixteen studies provided sufficient data in the target outcome measures and were included in analysis. Variability in the risk of bias was high among studies. Meta-analyses were conducted separately for case-control studies and pre-post studies. For service contacts, a total of 11 studies with 66,192 patients reported changes in the number of service contacts under CTOs. In 6 case-control studies, a small non-significant increase in service contacts was observed in those under CTOs (Hedge's g = 0.241, z = 1.535, p = 0.13). In 5 pre-post studies, a large and significant increase in service contacts was noted after CTOs (Hedge's g = 0.830, z = 5.056, p < 0.001). For emergency visits, a total of 6 studies with 930 patients reported changes in the number of emergency visits under CTOs. In 2 case-control studies, a small non-significant increase in emergency visits was noted in those under CTOs (Hedge's g = -0.196, z = -1.567, p = 0.117). In 4 pre-post studies, a small significant decrease in emergency visits was noted after CTOs (Hedge's g = 0.553, z = 3.101, p = 0.002). For violence, a total of 2 pre-post studies reported a moderate significant reduction in violence after CTOs (Hedge's g = 0.482, z = 5.173, p < 0.001). CONCLUSION: Case-control studies showed inconclusive evidence, but pre-post studies showed significant effects of CTOs in promoting service contacts and reducing emergency visits and violence. Future studies on cost-effectiveness analysis and qualitative analysis for specific populations with various cultures and backgrounds are warranted.

Lived experience of caregivers of persons with dementia in Hong Kong: a qualitative study.

OBJECTIVES: To report the lived experience of caregivers of persons with dementia in Hong Kong, and to explore their service needs. METHODS: This was a qualitative study of caregivers of persons with dementia. Four focus group interviews, each group comprising 6 to 7 informal caregivers, were conducted. A total of 27 participants were recruited. With the participants' consent, interviews were audiotaped and transcribed verbatim. Colaizzi's methods for phenomenological analysis were used. RESULTS: Caregiving in dementia in Hong Kong is as demanding and challenging as reported in other developed communities. 'Confusion regarding diagnosis', 'Emotional impact', 'Difficulty in coping with the care recipient behaviours', 'Provision of care recipient's daily care needs is demanding', and 'Conflicts among social roles' were themes pervasive across every focus group. In addition, the needs of carers changed as the disease of their care recipients progressed. CONCLUSIONS: As the local population continues to age, family caregivers are faced with increasing demands. Understanding their experience is pivotal in the design of effective carer support services. Our findings highlight the sources of strain and unmet needs of Hong Kong Chinese caregivers, which may serve as a guide for future service development.