The use of leverage to influence adherence to psychiatric treatment in Hong Kong

Abstract

Introduction and objectives.– Leverage refers to an informal practice whereby practitioners attempt to influence patients’ treatment adherence. We would like to report on the interim results of the first study in Hong Kong examining the prevalence and correlates of leverage in the local mental healthcare. Methods.– This is an ongoing study in which patients attending psychiatric services were recruited. The use of leverage in areas including finance, housing, child custody and criminal justice were assessed using structure interviews. Participants’ clinical data comprising age of onset, age of first contact with mental health services, number of hospitalisations, frequency of visits to outpatient clinics, suicide history and forensic record were retrieved from their electronic medical records. Findings.– To date, 114 participants were recruited from three psychiatric centres (59 from personalised care programmes, 28 from community psychiatric services, and 27 from substance abuse clinics). The mean age of the participants was 46.8 years, and around two-thirds were men. Their primary diagnoses were schizophrenia-spectrum disorders (45.6%), substance use disorders (22.8%) and depression (20.2%). Nearly 30% of the patients reported experiencing leverage. Financial leverage was the most commonly reported (22.8%), followed by housing leverage (11.4%). Patients who reported experiencing leverage were younger when they first contacted with mental health service (P < 0.001) and first admitted to psychiatric hospital (P < 0.01), and their interval period between outpatient follow-up were longer (P < 0.05). Conclusions.– The use of leverage is as common in Hong Kong as reported in other countries. Whether it improves adherence to psychiatric treatment warrants further investigation.