Psychiatric HospitalizationNCT07097623
Optimal Acute Adult Psychiatric In-patient Care in Hong Kong
An observational study of Psychiatric Hospitalization, run by The Hong Kong Polytechnic University.
Trial summary
This mixed-method study aims to evaluate the optimal number of hospital beds and quality of acute adult psychiatric inpatient care in Hong Kong using online Delphi surveys for psychiatric nurses and individual interviews for service users with mental health conditions and family caregivers. Read more about this study
- Who is it for?
- Ages 18 to 64 years
- Conditions the study is for
- Psychiatric Hospitalization
- What is being tested?
- respond to 3 rounds of online Delphi surveys and attend an individual semi-structured interview
- How many people
- 160 participants
- Where
- No sites listed yet
- Study dates
- 4 Aug 2025to 31 Aug 2026
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 64 years
- All sexes
- Adult
Study population: Participants will be recruited from the psychiatric departments within four clinical clusters of the Hong Kong Hospital Authority.
Who may be able to join
- working in the Hospital Authority on a full-time basis,
- with ≥ 10 years post-registration experience, and
- able to read and understand English
- aged 18-64
- able to read and communicate in Cantonese, and
- being discharged within a year
- aged 18 or above, and
- able to read and communicate in Cantonese
Who cannot join
- without working experience in adult psychiatry
- Service users
- having a co-morbidity of learning disability, organic/neurological conditions, or substance misuse disorder
- Family caregivers
- having active psychiatric conditions
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Optimal Acute Adult Psychiatric In-patient Care in Hong Kong: a Mixed-method Study
This mixed-method study aims to evaluate the optimal number of hospital beds and quality of acute adult psychiatric inpatient care in Hong Kong using online Delphi surveys for psychiatric nurses and individual interviews for service users with mental health conditions and family caregivers. The main question it aims to answer is:
What are the consensus points for quality acute adult psychiatric inpatient care in Hong Kong from psychiatric nurses, service users, and caregivers?
Psychiatric nurses will respond to three rounds of online Delphi surveys, while service users and caregivers will attend individual semi-structured interviews.
Read the detailed description
The deinstitutionalisation movement has been implemented since the 1950s, particularly in the UK and the US. Evidence of psychiatric community care has been well-documented, showing improvements in quality of life, increased autonomy, a reduction in psychiatric readmissions, and a shorter length of hospitalisation. However, this movement has not been universally adopted, and a few drawbacks have emerged in the past decade. Increased social risk aversion, such as homicides and a higher incidence of comorbidity of severe mental illnesses and substance abuse, has led to a growing demand for psychiatric inpatient services. Additionally, insufficient long-term community residential care was associated with untreated service users living in prisons or experiencing homelessness. The reduction in psychiatric beds was also associated with an increased prison population in the UK, Central and Eastern Europe, Central Asia, and South America.
From 2000 to 2014, 55% of 161 nations had stable or increasing levels of institutionalisation (> 1% annually). Several national characteristics, for example, population density and the percentage of the population living in urban areas, were negatively associated with deinstitutionalisation. The findings argued that the development of deinstitutionalisation should carefully consider the maturity of local psychiatric facilities and systems; otherwise, achieving a balance of optimal psychiatric inpatient care and deinstitutionalisation may be difficult. This imbalance can lead to a shift of service users into the criminal justice system. Moreover, deinstitutionalisation was positively associated with acute admission rates and bed occupancy. A viewpoint published in JAMA discussed the dilemma of psychiatric inpatient care versus community psychiatric development in the US, calling for integrated, patient-centred long-term psychiatric hospital and outpatient care for individuals with chronic, serious mental health conditions.
Since 2010, the Hong Kong government has made extensive efforts and committed significant resources to community psychiatric care, including the extended hospital community psychiatric services (CPS) and district-based community mental health centres. However, these initiatives led to a reduction in emergency psychiatric admissions, which is one of the key quality indicators of community mental health care, for neuroses, but not for other diagnoses of mental health conditions, particularly for severe mental illnesses. A balanced mental health system that integrates psychiatric inpatient and CPS care, especially for severe mental illnesses with notable risks of violence and suicide, should be actively reconsidered. As psychiatric inpatient service capacity decreases during active deinstitutionalisation, optimal psychiatric inpatient care has often been overlooked, which may hinder the development of specialised inpatient services and pose risks to clinical quality and safety due to overcrowded ward environments and increased admission turnover rates, commonly known as the 'revolving door' effect.
- Conditions
- Psychiatric Hospitalization
- Being tested
- respond to 3 rounds of online Delphi surveys, attend an individual semi-structured interview
- Keywords
- adult psychiatric inpatient care, optimal bed number
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
respond to 3 rounds of online Delphi surveysOther
In the first round, the responses of the participants will be collected, coded, and categorised into several themes/factors anonymously. In the second round, the participants will obtain the controlled feedback of all other participants and rate the level of agreement of the factors using a 5-point Likert scale ('strongly agree', 'agree', 'neither agree or disagree', 'disagree', and 'strongly disagree'; or 'essential', 'important', 'don't know/depends', 'unimportant', and 'should not be considered'). In the third round, the participants will rank the importance of the factors. In each round, the participants will be expected to complete the survey within one month.
attend an individual semi-structured interviewOther
The individual semi-structured interview will be audio-recorded, last for 45 minutes at maximum, and carried out by a trained and independent research assistant in a meeting room of PolyU or a room affiliated with the respective acute wards of the participating hospitals.
| Study group | Role | What they receive |
|---|---|---|
| Psychiatric nurses | Not described Receives: Other: respond to 3 rounds of online Delphi surveys | |
| Service users | Not described Receives: Other: attend an individual semi-structured interview | |
| Family caregivers | Not described Receives: Other: attend an individual semi-structured interview |
What is being measured
The primary outcome is the main question the study is designed to answer.
consensus on the optimal number and minimum number of psychiatric inpatient beds as assessed using two numeric questions in the Delphi survey
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
Measured: 3-6 months
consensus on the optimal nurse-patient ratio as assessed using a numeric question in the Delphi survey
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
Measured: 3-6 months
consensus on the optimal length of stay by diagnoses as assessed using a numeric question in the Delphi survey
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
Measured: 3-6 months
consensus on factors contributing to the optimal numbers of psychiatric inpatient beds as assessed using four open-ended questions in the Delphi survey
To reach an expert consensus, ≥ 85% agreement with the two favourable responses (e.g., 'strongly agree' and 'agree') on items is achieved
Measured: 3-6 months
consensus on recommendations for achieving optimal acute adult psychiatric inpatient services as assessed using five open-ended questions in the Delphi survey
To reach an expert consensus, ≥ 85% agreement with the two favourable responses (e.g., 'strongly agree' and 'agree') on items is achieved
Measured: 3-6 months
experience and expectation of optimal adult psychiatric inpatient care as assessed using individual interviews
certain themes will be generated by thematic analysis
Measured: 1-3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Jul 2025
- Study start4 Aug 2025 (estimated)
- Primary completion31 Aug 2026 (estimated)
- Study completion31 Aug 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Psychiatric HospitalizationStudies of the same condition, open and under way.
- More trials run by The Hong Kong Polytechnic UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Other
- Time perspective
- Prospective
- Enrolment
- 160 participants (estimated)
Sponsor and investigators
- Lead sponsor
- The Hong Kong Polytechnic University
- Sponsor type
- University, hospital or other
- Collaborators
- Nethersole Institute of Continuing Holistic Health Education (NICHE)
- Responsible party
- Principal investigator, Dennis Chak Fai Ma, The Hong Kong Polytechnic University
- Investigators
- Dennis Chak Fai Ma, PhD, Principal investigator, School of Nursing, The Hong Kong Polytechnic University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07097623
- Sponsor's protocol ID
- HSEARS20231025005
- Status last verified
- Jul 2025
- First submitted
- 23 Jul 2025
- Last updated
- 31 Jul 2025
- Results posted
- No
Study at a glance
From the registry record, last updated by the sponsor on 31 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimal Acute Adult Psychiatric In-patient Care in Hong Kong: a Mixed-method Study
- ClinicalTrials.gov ID
- NCT07097623
- Acronym / sponsor ID
- HSEARS20231025005
- Conditions
- Psychiatric Hospitalization
- Keywords
- adult psychiatric inpatient care, optimal bed number
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 160 participants (estimated)
- Lead sponsor
- The Hong Kong Polytechnic UniversityUniversity, hospital or other
- Collaborators
- Nethersole Institute of Continuing Holistic Health Education (NICHE)
- Study start
- 4 Aug 2025 (estimated)
- Primary completion
- 31 Aug 2026 (estimated)
- Study completion
- 31 Aug 2026 (estimated)
- First posted
- 31 Jul 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This mixed-method study aims to evaluate the optimal number of hospital beds and quality of acute adult psychiatric inpatient care in Hong Kong using online Delphi surveys for psychiatric nurses and individual interviews for service users with mental health conditions and family caregivers. The main question it aims to answer is:
What are the consensus points for quality acute adult psychiatric inpatient care in Hong Kong from psychiatric nurses, service users, and caregivers?
Psychiatric nurses will respond to three rounds of online Delphi surveys, while service users and caregivers will attend individual semi-structured interviews.
Detailed description
The deinstitutionalisation movement has been implemented since the 1950s, particularly in the UK and the US. Evidence of psychiatric community care has been well-documented, showing improvements in quality of life, increased autonomy, a reduction in psychiatric readmissions, and a shorter length of hospitalisation. However, this movement has not been universally adopted, and a few drawbacks have emerged in the past decade. Increased social risk aversion, such as homicides and a higher incidence of comorbidity of severe mental illnesses and substance abuse, has led to a growing demand for psychiatric inpatient services. Additionally, insufficient long-term community residential care was associated with untreated service users living in prisons or experiencing homelessness. The reduction in psychiatric beds was also associated with an increased prison population in the UK, Central and Eastern Europe, Central Asia, and South America.
From 2000 to 2014, 55% of 161 nations had stable or increasing levels of institutionalisation (> 1% annually). Several national characteristics, for example, population density and the percentage of the population living in urban areas, were negatively associated with deinstitutionalisation. The findings argued that the development of deinstitutionalisation should carefully consider the maturity of local psychiatric facilities and systems; otherwise, achieving a balance of optimal psychiatric inpatient care and deinstitutionalisation may be difficult. This imbalance can lead to a shift of service users into the criminal justice system. Moreover, deinstitutionalisation was positively associated with acute admission rates and bed occupancy. A viewpoint published in JAMA discussed the dilemma of psychiatric inpatient care versus community psychiatric development in the US, calling for integrated, patient-centred long-term psychiatric hospital and outpatient care for individuals with chronic, serious mental health conditions.
Since 2010, the Hong Kong government has made extensive efforts and committed significant resources to community psychiatric care, including the extended hospital community psychiatric services (CPS) and district-based community mental health centres. However, these initiatives led to a reduction in emergency psychiatric admissions, which is one of the key quality indicators of community mental health care, for neuroses, but not for other diagnoses of mental health conditions, particularly for severe mental illnesses. A balanced mental health system that integrates psychiatric inpatient and CPS care, especially for severe mental illnesses with notable risks of violence and suicide, should be actively reconsidered. As psychiatric inpatient service capacity decreases during active deinstitutionalisation, optimal psychiatric inpatient care has often been overlooked, which may hinder the development of specialised inpatient services and pose risks to clinical quality and safety due to overcrowded ward environments and increased admission turnover rates, commonly known as the 'revolving door' effect.
Study design
- Observational model
- Other
- Time perspective
- Prospective
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Psychiatric nurses | – | Other: respond to 3 rounds of online Delphi surveys |
| Service users | – | Other: attend an individual semi-structured interview |
| Family caregivers | – | Other: attend an individual semi-structured interview |
Who may qualify
- Ages
- 18 to 64 years
- Sex
- All
- Age groups
- Adult
- Study population
- Participants will be recruited from the psychiatric departments within four clinical clusters of the Hong Kong Hospital Authority.
Key inclusion criteria (8 listed)
- working in the Hospital Authority on a full-time basis,
- with ≥ 10 years post-registration experience, and
- able to read and understand English
- aged 18-64
- able to read and communicate in Cantonese, and
Key exclusion criteria (5 listed)
- without working experience in adult psychiatry
- Service users
- having a co-morbidity of learning disability, organic/neurological conditions, or substance misuse disorder
- Family caregivers
- having active psychiatric conditions
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| respond to 3 rounds of online Delphi surveysIn the first round, the responses of the participants will be collected, coded, and categorised into several themes/factors anonymously. In the second round, the participants will obtain the controlled feedback of all other participants and rate the level of agreement of the factors using a 5-point Likert scale ('strongly agree', 'agree', 'neither agree or disagree', 'disagree', and 'strongly disagree'; or 'essential', 'important', 'don't know/depends', 'unimportant', and 'should not be considered'). In the third round, the participants will rank the importance of the factors. In each round, the participants will be expected to complete the survey within one month. | Other | Psychiatric nurses |
| attend an individual semi-structured interviewThe individual semi-structured interview will be audio-recorded, last for 45 minutes at maximum, and carried out by a trained and independent research assistant in a meeting room of PolyU or a room affiliated with the respective acute wards of the participating hospitals. | Other | Family caregivers, Service users |
Primary outcome
consensus on the optimal number and minimum number of psychiatric inpatient beds as assessed using two numeric questions in the Delphi survey
Time frame: 3-6 months
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
consensus on the optimal nurse-patient ratio as assessed using a numeric question in the Delphi survey
Time frame: 3-6 months
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
consensus on the optimal length of stay by diagnoses as assessed using a numeric question in the Delphi survey
Time frame: 3-6 months
To reach an expert consensus, ≥ 85% of numeric responses fall within the first and third quartiles of the responses
consensus on factors contributing to the optimal numbers of psychiatric inpatient beds as assessed using four open-ended questions in the Delphi survey
Time frame: 3-6 months
To reach an expert consensus, ≥ 85% agreement with the two favourable responses (e.g., 'strongly agree' and 'agree') on items is achieved
consensus on recommendations for achieving optimal acute adult psychiatric inpatient services as assessed using five open-ended questions in the Delphi survey
Time frame: 3-6 months
To reach an expert consensus, ≥ 85% agreement with the two favourable responses (e.g., 'strongly agree' and 'agree') on items is achieved
experience and expectation of optimal adult psychiatric inpatient care as assessed using individual interviews
Time frame: 1-3 months
certain themes will be generated by thematic analysis
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 Jul 2025.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Dennis Chak Fai Ma, PhD principal investigator
School of Nursing, The Hong Kong Polytechnic University
Questions about this trial
What is this clinical trial studying?
An observational study of Psychiatric Hospitalization, run by The Hong Kong Polytechnic University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 31 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Dennis Chak Fai Ma, PhD (852-27666555, dennis.cf.ma@polyu.edu.hk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
consensus on the optimal number and minimum number of psychiatric inpatient beds as assessed using two numeric questions in the Delphi survey (time frame: 3-6 months). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Jul 2025.