community treatment of mental illness in hong kong 香港社区精神治疗 : rehabilitation...

Community Treatment of Mental Illness in Hong Kong香港社区精神治疗 :

Rehabilitation Programmes in Kwai Chung Hospital:From A to H 葵涌医院之经验

Medical Service Development Committee 1999

医疗服务及发展委员会报告书 Aim of Psychiatric Services in HA医管局精神科服务之目标

• Enable patients to return to community as soon as possible after treatment and rehabilitation让病人接受医治及复康治疗后尽早回归社区

MSDC paper 1999医疗服务及发展委员会报告书 1999 HA Psychiatric Services: target at more serious and complex mental illness 医管局精神科服务 : 目标对象是严重及复杂之精神病人•In-patient 住院服务 •Ambulatory 流动服务

– OPD 门诊服务 – Day hospital 日间医院

•Community 社区服务 – CPS (Community Psychiatric Services) 社区精神科服务 – CPGS (Community Psycho-Geriatric Services) 社区老龄精神

科服务

MSDC paper: Service Development in HA• Shorten hospitalization through enhancing Communi

ty Psychiatric Services and commence Rehabilitative process immediately upon admission 从入院日起经加强社区精神科服务及精神科复康服务而缩减住院日数

• Provide suitable and sufficient social care facilities 提供适切之社会福利服务

• Use of new medications 使用新药 • Sufficient ambulatory support and facilities 足够的流

动精神科服务 • Better balance between HA and other service provider

s: General Practitioners, Social Welfare Department and Non-Government-Organizations 适当地平衡医管局与其它服务机构之服务 : 普通科医生 , 社会福利署 , 非政府组织等

MSDC paper1999:Proposed reorganization of Psych Services• In-patient 住院服务

– Reduction of beds by 500 by 2004/5 & Resources thus generated redirected to develop CPS 减少 500 张病床并将资源用于发展社区精神科服务

– Cluster-based gazetted beds in 10 years 发展联网医院精神科病床

• Out-patient 门诊服务 – Improve defaulter tracing and triage referrals 追踪不

到诊者之及为新症分流 – Educational centres for families and carers 为家庭及照

顾者建立教育中心 – Extended hours 延长服务时间 – New drugs 使用新药 – Hospital and Cluster based 与地区医院联网

MSDC paper1999: Reorganization of Services 重组服务

• Day Hospitals 日间医院 – closer liaison with other service providers to

avoid service duplication 减少 ( 与其它服务组织 ) 之服务重迭

– Integrated into inpatient care 与住院服务融合 • Community Services 社区精神科服务

– Enhance Community Psychiatric Nursing Service 增强精神科社康护理服务

– Integrate CPNS & Community Psychiatric Team into Community Psychiatric Services (CPS)

Deinstitutionalization Projects in KCH• Assertive Community Bridging Project 康桥计划

Deinstitutionalization Project 去院舍化计划 • Exiters Project 毅置安居计划 • Follow up treatment of control group of D project 去院舍化计划之跟进

• Gateway to Rehab Project 离院门户计划 • LSCH waitlistee rehab project 长期护理院出院计划

ACBP( 康桥计划 ): The Pilot Proj

ect

ACBP: background 康桥计划之背景

• An outcome focused project, to discharge long stay psychiatric patients from hospital and to reintegrate them to community 目标为本之计划

• Resources: 9 additional Registered Nurses to be trained as community psychiatric nurses

• Case-management model of care 个案管理 • Psychiatric rehabilitation Psycho-educatio

nal package (PREP) 心理教育讲座 • Collaborative effort from all the rehabilitati

on wards, and multi-disciplinary inputs 多病房及跨专业之合作

ACBP4 stage programme 4 阶段

1. Stage 1– Survey the profile of long stay patients in KCH

调查住院病人之概况

2. Stage 2– Identify dischargeable patients and tagging of

these patients 验明并标签有机会出院之病人

3. Stage 3– Intensive rehabilitation, community re-entry

& aftercare programme 加强复康 , 社区复进及出院续顾服务

4. Stage 4– Evaluation & outcome 结果及评价

ACBP Stage 1 第一阶段 • Check the number of patient with LOS b

etween 300days & 5 years 住院日数 300日至 5 年间之病人数目 :

422• Diagnosis 病症 :

– Schizophrenia 精神分裂症 30%– Mood Disorder 情绪病症 16%– Mental Handicap 弱智 47%– Dementia 痴呆症 24%– Others 其它 28%

ACBP: Stage 1 第一阶段 • Behavior 行为 :

– No undesirable behavior 无不良行为 157– Bizarre behavior but not harmful 行为古怪但无害 152– Antisocial behavior 反社会行为 113

• Physical violence 身体暴力 61• Verbal aggression 语言暴力 28• Sexual misdemeanour 越轨性行为 6• Drug/Substance Abuse 滥药 4• Suicidal threats 自杀 14

• Self-Care 自理能力 – Independent 独立 175– Semi-independent 半独立 169– Highly dependent 极度依赖 77

• Attitude towards Discharge 对离院之态度 – Yes 想出院 144– Marginal 不确定 174– No 不想出院 103

ACBP: Stage 2 第二阶段 • Identify patients with:

– 18<Age<65 年龄介于 18 至 65 岁 – Not MR, Dementia 非弱智 , 痴呆 – No violence, Sexual misbehavior 无暴力或越轨性

行为 – No severe physical illness 无严重身体疾病 – Self care not highly dependent 自理不需高度依赖

他人 • 146 patients were selected and tagged with score </= 12:

选出 146 病人 • Eventually 130 were recruited, remaining 14 was in pers

istent unstable mental condition and 2 deceased before recruitment 最后招募了 130 人 , 其余 14 人因精神状况持续不稳及 2 人因病去世而不能入选

ACBP : Profile of SubjectsAge年龄

Sex 性別 TotalMale 男 Female 女

15 – 25 4 2 626 – 35 14 11 2536 – 45 28 17 4546 – 55 10 15 2556 – 65 20 8 28> 65 0 1 1Total 76 54 130

Marital Status 婚姻状况 No.

Single 独身 Married 已婚 Cohabited 同居 Separated/Divorced 离婚 /分居 Widowed 鰥 / 寡Unknown 不知

901601662

Total 130

Clinical Profile of ACBP subjects Onset of Illness 开始病发年龄 :

~ Aged 11 - 62

~ 42.6% at 21 - 30

Diagnosis : Schizophrenia ~ 84.6%

Duration of Illness 持续期间 :

38.3% over 20yrs Average Length of Stay at Hospital 平均住院时间 :

4.5 yrs Number of Previous Admission 曾入院次数 :

~ 0 (17.4 %)~ 2 to 3 (28.1%)~ > 10 (9.8%)

ACBP: Stage 3 第三期

• Predischarge Annex (PDA) 葵康居 • PREP (Psychoeducational package) 心理教育讲座 • Supported living services 住宿支持服务 • Community re-entry 辅助重入社区生活 • Family work 家庭工作• New atypical drugs 使用新药 • Tele-care 电话关怀服务 • Upon discharge

– Frequent CPN visits 社康护士频密探访 – Home visits and crisis intervention for def

aulters, early relapses

ACBP: Stage 4 第四阶段

Evaluation and Result 结果及评审 • Administrative data

– Rate of discharge, rate of readmission, Defaulters etc 　出院率，再入院率，不覆诊率

• Clinical data– Mental state 　精神状况 – ADL & level of functioning 　日常生活能

力– Quality of Life 　生活质素

ACBP: Stage 4 第四阶段 Result as at 1.5 year follow up 治疗 1 年半后之结果 Discharges 87 (10 readmit

ted)– Home with relatives 与家人同住 24– Home alone 独居 23– Half way houses 中途宿舍 21– Old age homes 老人院 12– Long stay care homes 长期护理院 2– Private hostel 私营院舍 4– Lai Chi Kok Hospital 茘枝角医院 1

ACBP: Stage 4 第四阶段 Result as at 1.5 year follow up 治疗 1 年半后之结果 Good compliance to medication and Follow Up 定时服药及覆诊 Criminal charges 刑事案 : 3 (1 possession of drugs 拥有毒品 , 2 indecent assault 非礼 )

Murder 谋杀 0Suicide 自杀 0

Death 死亡 1 (Nasopharyngeal Carcinoma 鼻咽癌 )Employment 职业 :

Full Time 全职 2

Part Time 兼职 1Supported Employment 辅助就业 4Shelter Workshop 疪护工场 10Day Hospital 日间医院 13

ACBP Result as at 1.5 year follow up : BPRSBPRS: Initial Score (total) 8.49

(11.65)BPRS: 6 month Post-discharge (total) 5.14 (5.05)

t = 2.825Significance = 0.005

There is significant improvement in mental state 6 month post-discharge, but no difference between different residential placement with regards to – Living with relatives.– Living alone at Public Housing Unit.– Living alone at private/rental flat.– Living alone in rented room, singleton hostel.– Living in HWH/LSCH– Others.

Result : QOL Paired-sample t-testPaired-sample t-test

Domain N Mean (SD) t Sign

Physical0

6 month Post-discharge

60 12.54 (2.24)12.85 (1.79)

- 1.421 0.161

Psychological health

06

60 12.36 (2.71)13.41 (3.71)

- 2.405 0.019

Social 06

60 12.42 (2.55)13.58 (3.17)

- 3.137 0.003

Environment06

60 12.80 (2.29)13.67 (2.28)

- 3.023 0.004

QOL 6 months post-discharge were significantly better in psychological health, social relationship and environment.

ANOVA of data showed no difference in all 4 domains of QOL questionnaire in patients discharged different residential placements

Result : SLOFSLOFDomain

N Mean (SD) t Sign

1 Physical functioning0 6

6524.1824.63

(2.75)(1.22)

- 1.388 0.170

2 Personal Care 65 33.0639.75

(3.15)(4.86)

- 1.083 0.283

3 Interpersonal Relationship

65 23.8925.40

(5.60)(5.32)

- 4.475 0.000

4 Social Acceptability

65 31.9531.17

(2.93)(2.51)

- 4.389 0.000

5 Community Living Activities

65 45.7747.48

(8.91)(7.71)

- 3.516 0.001

6 Work Skill 65 19.3124.97

(5.03)(3.71)

- 1.211 0.230

7 Total 65 177.46185.54

(20.17)(20.54)

- 6.444 0.000

Significant improvement in (3), (4), (5), (7).

No difference in SLOF between patients discharge to different residential placement

ACBP: Positive Support / Feedback 正面的回应

• Continuity of care 可以对病人提供持续性的照顾

• Appreciation from patients/relatives 病人及家人的感谢说话

• Successful integration of service elements and multidisciplinary efforts 成功地融合跨专业的服务以达到治疗目的

• Team building and job satisfaction amongst staff 成功建立团队

• Accumulation of skills and confidence in rehab of difficult patients 积聚对治疗复杂病人之技巧及信心

• Training opportunity for new staff 为新员工之培训

Deinstitutionalization (D) PROJECT去院舍化计划

The 2nd Deinstitutionalization Project for SMI patients in KCH: a Randomized Controlled Trial (RCT) (D) 去院舍化计划 :一个随机对照实验

2 components 2 个元素 :1. Service component 服务部分

– All front line and managerial staff of CMT5

– All CPN / case managers– All staff of PDA, RAC, M7

2. Research component 研究部份– CCLee, SNChiu, Betty Ku, KennyWong, O

WChan, WFLee, CWWong, GemmaWong, ChristinaNgan, KeyLai, CorinaFung, JuliaLam, staff of CND

– Supported by HSRC Grant of HK Government

由香港政府 HSRC 研究基金资助

D-Project: Design• Randomized Controlled Trial 随机对照实验

• Intention to Treat Analysis 治疗意向分析法

• Testing rehabilitation efficacy of 2 interventions 测试以下两种介入治疗之成效 - Case Management 个案管理 (CM) - Psychoeducational package 心理教育讲座 (PREP)

• 3 Groups, each 70 subjects 3 组病人 - (A) CM + PREP- (B) CM - (C) (Control) Conventional rehabilitation in original ward

D-Project: Plan of Investigation 研究计划

• Identify about 400 severe MI patients with LOS > 2 years 识别大约 400 住院期长达 2 年之严重精神病患者

• Exclusion criteria 拒绝准则 :– Age > 65 年龄大过 65 岁 – Suffered from Dementia or MR 痴呆或弱智患者

– Cases regarded unsuitable for open ward management 不适合居住于开放式病房

• Number of subjects needed: n = 210

D-Project: DesignRandomization procedure 随机步骤

• Performed by independent party (CND)• Potential subjects identified• Mentally fit to transfer to open ward• Consent obtained• Each patient given a priority number• Block randomization procedure • Each block consisted of 3 subjects each randomly

assigned to A, B or C(control)• Subject in A & B groups admitted to the rehabilita

tion wards according to the priority number, 2 to 3 patients per week, subject to available of bed spaces

• Subject in C group will be admitted after all A & B subjects had completed the 2 year rehab programme

D-Project: Design

Case Management 个案管理之内容 : (3.18 compliance rating according to Dartmouth Assertive Community

Treatment Scale)– Each subject assigned a case manager (CPN) who act as a broker 代

理人 for patient– Predischarge assessment– Planning assessment and arrangement for appropriate residential pl

acement– Negotiation and coordination with family and NGO– Monitoring of mental state, evaluate clinical outcome– Advocate related rehab services for subjects and carers– Education and surveillance of treatment compliance

PREP 心理教育讲座内容 – Psychoeducational sessions, in 10 areas of potential handicap

(mental state and behavior, domestic activities, work and day time activities etc)

– Delivered after an Individual Care Plan assessment

D-Project: DesignMeasures and Instruments 評估之工具

Demographic Data 人口统计数据 : Age, Sex etc

Administrative and Clinical Data 行政及临床数据 :Diagnosis, co-morbidity, Duration of illness, Length of stay in hospi

tal in different periods, Physical health, Type of residence upon discharge, employment status

Outcome data 结果数据 :Rate of discharge, Rate of readmission, criminal conviction, violenc

e, suicides

Others 其它 :BPRS (Brief Psychiatric Rating Scale)SAPS (Scale for the Assessment of Positive Symptoms)SANS (Scale for the Assessment of Negative Symptoms)WHOQOL-BREF (World Health Organization Quality of Life Hong K

ong Brief Version)SLOF (Specific Level of Functioning), etc

Eligible PatientsN = 352

Exclusion CriteriaAge > 65 n = 2M.R. N = 41

Unfit to open ward n = 92Refused to participate n = 28

Randomized and PrioritizedBlock randomization in cohort of 3

n = 189

Group ACM + PREPn = 63

Group BCM n = 63

Group Cn = 63

1 year FUn = 63

2 year FUn = 621 death

2 year FU n = 621 death

1 year FUn = 63

1 year FUn = 558 refused to participate

2 year FUn = 528 refused to participate3 death

D-Project: Result 结果 189 subjects recruited, 63 in each group

征募病人数目 :189 ，每组 63 人 No statistical difference in 3 groups in following variables 以下变量于开始介入研究时并无统计学上分别 :

– Sex 性別– Age 年龄 – Diagnosis 断症 – Marital status 婚姻状况 – Age of onset 病发年龄 – Duration from present admission to p

roject 由入院至征募入研究之时间 – No. of previous admission 曾入院次数

Variables A B C Statistics P-value

SexMaleFemale

3330

3825

3033

X2= 2.08 0.353

Age (mean) 47.0 46.2 45.2 F=0.657 0.519

DiagnosisSchizophreniaOthers

612

612

585

X2= 2.1 0.35

Marital statusSingleMarriedOthers

44136

46413

43713

X2=8.42 0.077

Age of onset 21.1 23.9 23.2 F=1.904 0.285

Duration from admission to project(days)

2750 2462 2215 F=1.904 0.285

No. of previous admissions 5.3 4.6 5.1 F=0.457 0.634

PFUT+STNon PFU

855

1152

1152

X2= 0.713 0.7

Source (Team)12345

17201772

1982493

151223103

X2= 8.2 0.414

EducationPrimarySecondaryOthers

31266

25344

16434

X2= 9.535 0.049*

Comparison of clinical parameters on admissionVariable A

(N = 51 for QOLN= 63 for

others)

B(N = 49 for

QOL,N=63 for others)

C(N = 44 for

QOL,N=55 for others))

F Sign

QOL PhysicalQOL PsychologicalQOL Social Acceptability

QOL Environment

22.76 (7.18)26.14 (8.93)13.29 (3.76)23.49 (7.08)

23.86 (4.80)27.53 (6.79)13.98 (3.30)25.41 (5.82)

22.16 (3.40)25.07 (5.15)12.54 (3.14)23.22 (5.26)

1.1741.3662.0291.803

0.3120.2590.1350.169

BPRS (Total) 13.68 (7.15)

13.12 (7.02)

14.58 (7.21)

0.617 0.540

SLOF Physical functioning

24.11(1.05) 24.00 (2.02)

24.33 (1.35)

0.684 0.506

SLOF Personal Care

29.83 (3.89)

28.56 (5.36)

30.55 (2.68)

3.467 0.033

SLOF Interpersonal Relationship

18.79 (3.75)

18.29 (4.50)

18.20 (3.50)

0.400 0.671

SLOF Social Acceptability

33.32 (1.95)

33.06 (2.53)

32.35 (2.55)

2.662 0.073

SLOF Act. 38.40 (7.40)

38.70 (8.36)

37.39 (5.96)

0.507 0.603

SLOF Work 14.16 (3.02)

14.08 (3.70)

14.25 (2.58)

0.045 0.956

SLOF (Total) 158.43 (16.11)

156.60 (20.68)

157.27 (13.10)

0.184 0.832

D-Project: Result of primary data at 2 year (ITT analysis)

Variables A B C Statistics P-value

No. of Discharge (Death)

44 (1) 54 (1) 18 (3) X2= 46.403 P=0.000

Total in-patient days spent in project (s.d.)

431.44 (234.63)

370.56 (215.83)

610.86 (211.29)

F=20.105 P=0.000

Total Day-patient days spent in project (s.d.)

19.33(72.40)

19.94(69.22)

4.29(22.51)

F=1.410 P=0.247

Number of CPN visit 23.92(17.29)

28.11(15.98)

0.16(1.26)

F=77.31 P=0.000

Total OPD attendance

6.35 7.43 2.03 F=15.15 P=0.000

Total No. of subjects readmitted to any psychiatric wards in HK

24 24 17 X2= 2.298 P=0.317

Median in-patient days spent in hospital after readmission

164 182.5 335 X2= 3.676Df=2

P=0.159

Mean episode of readm 0.63 0.84 0.46 F=0.946 0=0.39

(LOS) of discharged cases (total 116 cases)

326.66 (184.84)

323.24 (182.30)

333.22 (217.75)

F=0.019 P=0.981Episodes of readmission: 1X=44, 2X=12, 3X=3, 4X=1, 5X=1, 6X=1, 7X=1, 8X=1, 15X=1, total = 122Death case:

•Group A: coroner case for sudden LOC•Group B: hepatic encephalopathy from HBV carrier•Group C: all 3 cases died of pneumonia, 2 in PMH, one in QEH (discharged to KH)

D-Project: result at 2 year BPRS total score

BPRS A (N=61)

B (N=62)

C (N=54)

0 month12 month24 month

13.70 (6.94)12.56 (7.62)11.28 (8.07)

13.08 (7.07)11.45 (6.69)9.73 (6.49)

14.61 (7.28)13.31 (7.90)11.11 (6.62)

Test of within subjects effects: F=0.272 p=0.896Test of within subjects contrasts

• Linear F=0.404 p=0.668• Quadratic F=0.102 p=0.903

Test of between subjects effect: F=1.053 p=0.351

D-Project: result at 2 year SAPS total score

SAPS total score

A (N=59) B (N=58) C (N=53)


6.29 (5.07)5.41 (4.09)5.47 (3.71)

5.81 (5.32) 5.05 (4.28)4.67 (3.45)

3.57 (3.56)6.32 (3.53)5.72 (3.63)

Time effect: F= 0.564 p=0.569Group effect: F=0.593 p=0.554Time X Group interaction effect F=5.923 p<0.001

Estimated Marginal Means of MEASURE_1

SAPSTT

321

Estim

ated

Mar

gina

l Mea

ns

6.5

6.0

5.5

5.0

4.5

4.0

3.5

3.0

Group

A

B

C


SAPSHA

321

Estim

ated

Mar

gina

l Mea

ns1.7

1.6

1.5

1.4

1.3

1.2

Group

A

B

C

Hallucinations


SAPSDEL

321

Estim

ated

Mar

gina

l Mea

ns

1.8

1.6

1.4

1.2

1.0

.8

Group

A

B

C

Delusions


SAPSBZB

321

Estim

ated

Mar

gina

l Mea

ns

1.2

1.0

.8

.6

.4

.2

Group

A

B

C

Bizarre behaviors


SAPSFTD

321

Estim

ated

Mar

gina

l Mea

ns

2.0

1.8

1.6

1.4

1.2

1.0

.8

.6

Group

A

B

C

Positive formal thought disorder


SAPSAFF

321

Estim

ated

Mar

gina

l Mea

ns

.8

.7

.6

.5

.4

.3

.2

.1

Group

A

B

C

Inappropriate affect

D-Project: result at 2 year SANS total score

SANS total score

A (N=60) B (N=59) C (N=54)


8.72 (6.01)6.32 (4.33)7.00 (4.05)

9.20 (6.24)5.64 (4.13)6.86 (3.71)

5.37 (5.24)6.09 (3.69)6.93 (3.76)

Time effect: F= 9.912 p<0.001Group effect: F=1.931 p=0.148Time X Group effect F=6.556 p0.001 Estimated Marginal Means of MEASURE_1

SANSTT

321

Estim

ated

Mar

gina

l Mea

ns

10

9

8

7

6

5

Group

A

B

C


SANSAFF

321

Estim

ated

Mar

gina

l Mea

ns2.4

2.2

2.0

1.8

1.6

1.4

Group

A

B

C

Affective flattening


SANSALG

321

Estim

ated

Mar

gina

l Mea

ns

2.0

1.8

1.6

1.4

1.2

1.0

.8

Group

A

B

C

Alogia


SANSAVOL

321

Estim

ated

Mar

gina

l Mea

ns

2.2

2.0

1.8

1.6

1.4

1.2

1.0

Group

A

B

C

Avolition


SANSAHED

321

Estim

ated

Mar

gina

l Mea

ns

2.2

2.0

1.8

1.6

1.4

1.2

1.0

.8

Group

A

B

C

Anhedonia


SANSATT

321

Estim

ated

Mar

gina

l Mea

ns

1.6

1.4

1.2

1.0

.8

.6

.4

.2

Group

A

B

C

Attention


QOL1

321

Estim

ated

Mar

gina

l Mea

ns14.8

14.6

14.4

14.2

14.0

13.8

Group

A

B

C


QOL2

321

Estim

ated

Mar

gina

l Mea

ns

14.5

14.0

13.5

13.0

12.5

Group

A

B

C


QOL3

321

Estim

ated

Mar

gina

l Mea

ns

14.6

14.4

14.2

14.0

13.8

13.6

13.4

13.2

13.0

Group

A

B

C


QOL4

321

Estim

ated

Mar

gina

l Mea

ns

14.5

14.0

13.5

13.0

12.5

Group

A

B

C

QOL physical health domain QOL psychological health domain

QOL social acceptability domain QOL environment domain

D-Project: result at 2 year SLOF total score

QOL SLOFtt

A (N=61)

B (N=62) C (N=54)


158.44 (16.33)156.82 (22.96)147.25 (22.08)

156.71 (20.83)158.63 (21.74)147.50 (21.96)

157.57 (13.03)148.87 (15.32)140.30 (17.61)Time effect: F=41.723 p<0.001

Group effect F=2.039 p=0.133Time X Group effect: F=2.509 p=0.042


SLOFTT

321

Estim

ated

Mar

gina

l Mea

ns

160

150

140

130

Group

A

B

C

GHQ• Assess general physical and mental

health in family member before/after discharge

• Only 41 members agreed for assessment

• Majority of relatives refused or not traceable

• Eventually 41 (0 month), 5 (12 months) and 8 (24 months) done, from 44 family members

• 23 subjects discharged to home, 1 living with husband, one living with parents and 21 living alone

PAQ Hospital Version Q8: Desire to leave hospital (STATQUO)

• 62/68 non-discharged patient at 2 years responded• 36 indicated strong/qualified desire to leave hospital• 13 preferred to remain in hospital• 8 ambivalent/refused to decide

Group To leave hospital

Ambivalent To remain in hospital

total

A 7 5 4 16

B 3 4 0 7

C 26 4 9 39

36 13 13 62

X2= 10.325

P = 0.035

多过一半未能出院的病人希望可以离开医院

PAQ Community Version Q6: which place do you like better: here or hospital• 84/116 of discharged patients responded• 64 preferred to stay in community• 4 prefer hospital• 16 gave no or unrateable response

Group Prefer community

Prefer hospital Total

A 22 1 23

B 31 3 34

C 11 0 11

64 4 68

X2= 1.317

P = 0.518

大多数已出院病人宁愿选择继续留在社区

D Project: Conclusion 结论 • CM is an effective means to disch

arge long stay SMI patients 个案管理是一个有效让慢性长期住院病人出院的治疗方式

• Effect of psychoeducation not demonstrated by 2 year of intervention 心理教育讲座之效用并未在此研究得到证明

• The mental state, Quality of life and level of function not substantially changed by the different treatment modalities 此研究之治疗形式并不能改变病人之精神状况，生活质素及生活能力

D Project: Limitation 限制• Raters not really blind to assessment 研究助理对病人之组别并非全不知情

• Cohort effect 时间效应 – Availability of new rehab facilities– Use of newer atypicals

• Longer effect from intervention pending更长期之治疗介入效果未知

• Patients were severe medical illness or violence were not recruited 有严重身体疾病或暴力倾向之病人并不被征募

• ? Generalizability

THANK YOU谢谢

community treatment of mental illness in hong kong 香港社区精神治疗 : rehabilitation...

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