Table_1_Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders’ opinions.DOCX

BackgroundMultiple studies have examined the effects of compulsory community treatment (CCT), amongst them there were three randomized controlled trials (RCT). Overall, they do not find that CCT affects clinical outcomes or reduces the number or duration of hospital admissions more than voluntary care does. Despite these negative findings, in many countries CCT is still used. One of the reasons may be that stakeholders favor a mental health system including CCT.AimThis integrative review investigated the opinions of stakeholders (patients, significant others, mental health workers, and policy makers) about the use of CCT.MethodsWe performed an integrative review; to include all qualitative and quantitative manuscripts on the views of patients, significant others, clinicians and policy makers regarding the use of CCT, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane CENTRAL Register of Controlled Trials (via Wiley), and Google Scholar.ResultsWe found 142 studies investigating the opinion of stakeholders (patients, significant others, and mental health workers) of which 55 were included. Of these 55 studies, 29 included opinions of patients, 14 included significant others, and 31 included mental health care workers. We found no studies that included policy makers. The majority in two of the three stakeholder groups (relatives and mental health workers) seemed to support a system that used CCT. Patients were more hesitant, but they generally preferred CCT over admission. All stakeholder groups expressed ambivalence. Their opinions did not differ clearly between those who did and did not have experience with CCT. Advantages mentioned most regarded accessibility of care and a way to remain in contact with patients, especially during times of crisis or deterioration. The most mentioned disadvantage by all stakeholder groups was that CCT restricted autonomy and was coercive. Other disadvantages mentioned were that CCT was stigmatizing and that it focused too much on medication.ConclusionStakeholders had mixed opinions regarding CCT. While a majority seemed to support the use of CCT, they also had concerns, especially regarding the restrictions CCT imposed on patients’ freedom and autonomy, stigmatization, and the focus on medication.

背景：众多研究已探讨强制社区治疗（CCT）的影响，其中包含三项随机对照试验（RCT）。总体而言，研究并未发现CCT相较于自愿护理更能影响临床结果或减少住院次数及持续时间。尽管这些负面发现存在，但在许多国家CCT仍然被广泛采用。原因之一可能是利益相关者倾向于包含CCT的心理卫生体系。目标：本综合综述旨在探究利益相关者（患者、重要他人、心理健康工作者和政策制定者）对CCT使用的观点。方法：我们进行了一项综合综述；为了纳入所有关于患者、重要他人、临床医生和政策制定者对CCT使用观点的定性及定量文献，我们检索了MEDLINE、EMBASE、PsycINFO、CINAHL、Web of Science核心合集、Cochrane中央对照试验注册（通过Wiley）和Google Scholar。结果：我们发现了142项研究，其中55项被纳入。在这55项研究中，29项包括患者观点，14项包括重要他人观点，31项包括心理健康工作者观点。我们未发现包括政策制定者观点的研究。在三个利益相关者群体中的大多数（亲属和心理健康工作者）似乎支持使用CCT的体系。患者则表现得较为犹豫，但他们普遍更倾向于选择CCT而非住院。所有利益相关者群体均表达出矛盾的态度。他们的观点在有无CCT使用经验的人之间并未明显区分。提及最多的优势包括护理的便捷性和与患者保持联系的方式，尤其是在危机或恶化时期。所有利益相关者群体提到最多的劣势是CCT限制了自主性且具强制性。其他提到的劣势包括CCT具有污名化性质且过分关注药物治疗。结论：利益相关者对CCT持有复杂观点。虽然大多数似乎支持CCT的使用，但他们也表达了担忧，特别是关于CCT对病人自由和自主性的限制、污名化以及过分关注药物治疗等问题。