Control in the community: a qualitative analysis of the experience of persons on conditional discharge in Hong Kong

Abstract

Although Hong Kong does not have a community treatment order regime, its conditional discharge (CD) regime under section 42B of the Mental Health Ordinance is a form of mandatory community treatment that shares similar features, including the requirement to comply with conditions, with recall to hospital in the form of involuntary psychiatric admission as a consequence for non-compliance and deterioration in mental health. Empirical research on how the CD regime operates remains limited. This two-part, cross-sectional study, comprising a self-reported survey and a semi-structured interview, is the first empirical study on the service user perspective on the CD regime in Hong Kong. 47 individuals on CD were surveyed, and 24 of them were interviewed. A brief quantitative analysis of the survey results and an in-depth, thematic analysis of the interviews were conducted. The results demonstrated an alarming lack of understanding about key aspects of the regime, in particular regarding one’s rights under the regime. Key themes arising from the interviews included a pervasive sense of powerlessness, negative sentiments about significant restrictions on their lives, poor attitudes of healthcare professionals and positive sentiments about improvements in their lives. Several other notable observations are also discussed. These findings provide us with valuable insights into the operation of the CD regime on the ground, which is crucial for the evaluation of the design and implementation of the regime, and to consider how the implementation in particular can be improved prior to a comprehensive reform of the legal framework.