Characteristics and Outcome Predictors of Conditionally Discharged Mental Patients in Hong Kong

Article excerpt

Abstract

Objectives: To explore the characteristics and short-term outcomes of mentally ill patients conditionally discharged in Hong Kong and identify factors associated with the risks of readmission 1 year after the first conditional discharge.

Participants and Methods: A retrospective case notes review was undertaken. Subjects included all adult patients first conditionally discharged before 31 August 2005 and currently under the care of the psychiatric service of the New Territories East Cluster of Hong Kong. Socio-demographic data, clinical variables and outcomes during the first year after conditional discharge were retrieved. A comparison between patients with or without readmission was made using univariate and logistic regression analyses in order to identify risk factors associated with readmission.

Results: A total of 140 subjects were included. The subjects were characterised by diagnoses of psychotic disorders, poor compliance with treatment, and a history of committing psychotically based serious dangerous acts in the recent past. In the first year after conditional discharge, 10% displayed violent behaviour, about 5% had forensic contacts, and I% attempted suicide or deliberate self-harm. One-fourth of subjects were readmitted. Factors associated with readmission were prior psychiatric admissions, younger age on index date, persistent substance misuse, and being brought up in the care of the social welfare department.

Conclusions: Most subjects did not display violent behaviour 1 year after conditional discharge. The identification of avoidable risk factors for readmission such as persistent substance misuse sheds light on possible ways to enhance community aftercare. The results provide useful information for clinical practice, service provision, and future research.

Key words: Forecasting; Mentally ill persons; Patient readmission

Introduction

Patients with severe mental disorders often present with psychiatric illness-related dangerous behaviour, chronic non-compliance and high utilisation of inpatient psychiatric services. (1) The management of this group of patients is difficult. While they may become stable in hospital with the use of medication, they may discontinue these and quickly decompensate after discharge. Despite the wide variability in implementation and practice, (2-5) all services aim to enhance community psychiatric care in patients who have poor insight and high-risk behaviour. The term Compulsory Community Treatment (CCT) was coined to refer to policies covering a wide range of interventions including community treatment orders, involuntary outpatient commitment, extended leave, conditional discharge (CD), conditional release, and supervised discharge. (6) Use of CCT has, in fact, been expanding in western countries despite controversy over the legal, social, and ethical issues involved. (7,8)

Most studies have found that patients under CCT are male and those aged under 65 years. (2,9-11) They are commonly single, (12) and more likely to be living away from their families or to have changed their addresses shortly before being committed. (2) They are generally of low educational level, unemployed, and relying on social security. (13-15) Although schizophrenia is the most common diagnosis among patients under CCT, this group of patients also exhibit high diagnostic complexity. (10-12)

In Hong Kong, CD was first formalised and implemented in 1988. It can be applied to certified patients hospitalised in mental hospital who are stable enough to be discharged but are liable to have further risky behaviour upon relapse and prone to not comply with treatment. As with other forms of CCT, the legislation requires the patients to comply with certain conditions such as an obligation to be followed up in specified psychiatric clinics, take recommended medications, and allow access or monitoring by social workers and community psychiatric nurses. …