Pressure to adhere to treatment in Hong Kong mental health care - A pilot study

Abstract

Background: Pressures to adhere to treatment (‘leverage’) refers to an informal practice whereby practitioners attempt to influence patients’ treatment adherence. Little is known about the use of leverage in community psychiatric services in Hong Kong.

Objectives: To examine the prevalence of leverage in mental health care in Hong Kong and evaluate its association with patients’ sociodemographic and clinical characteristics.

Methods: A pilot study was conducted from December 2014 to February 2015. Consecutive adult patients attending a local psychiatric centre for personalised care programme, with recovery-oriented multidisciplinary case management service for patients with severe mental illness (SMI), were recruited. Using structured interviews, the four commonest forms of leverage, in areas of finance, housing, criminal justice and child custody, were evaluated. In addition, their sociodemographic and clinical characteristics were collected. Participants were also interviewed with Perceived Coercion Scale, Insight and Treatment Attitudes Questionnaire, Brief Psychiatric Rating Scale, Global Assessment of Functioning, Conjoint CAGE and Montreal Cognitive Assessment.

Findings: A total of 59 participants were recruited. Their mean age was 48.5 years, and two-thirds of them were men. On average, they have had SMI for 19.6 years. About 80% of participants were diagnosed as having schizophrenia. The remaining participants had either a depressive or bipolar affective disorder. Nearly half of the participants (N = 28) reported experiencing leverage. Financial leverage was the most commonly reported form of informal coercion (33.9%), followed by housing leverage (15.3%). Participants who were younger when they first came into contact with psychiatric services were more likely to report experiencing leverage (p < 0.05).

Conclusions: Leverage is as commonly used in Hong Kong as in other developed countries. However, the pattern of leverage employed in different mental healthcare systems varies. Understanding leverage applied onto psychiatric service users will facilitate a closer consideration of their justifications and gives insightful perspectives to the mental healthcare planning and policy making in Hong Kong.