Police could force high-risk mental patients to comply with treatment programmes under a proposal being considered after a fatal attack by a schizophrenic patient. It is one of a number of recommendations that may be made by a Hospital Authority committee which is reviewing the management of mental patients after the attack in Kwai Chung, in which the patient chopped two people to death. Under a proposed community treatment order (CTO), police and doctors would be empowered to impose involuntary treatment on patients in the community. In an extreme case, police would be able to break into premises to take a patient to hospital if such an order was breached. In May, a 42-year-old man, who lived alone on the Kwai Shing East public housing estate, chopped two people to death and injured three others at the Kwai Chung estate. He has been charged with murder and wounding. The man was classified as 'high-risk' and had received regular treatment at Kwai Chung Hospital, a centre for psychiatric care, since it discharged him in 2004. However, he repeatedly refused visits from a community nurse. Hong Kong has been promoting community care for the mentally ill, but how these patients - especially some of the 40,000 schizophrenics - can be adequately supported, and neighbourhoods protected, has been a pressing social issue. The seven-member committee, whose chairman is Professor John Leong Chi-yan, president of the Open University, noted that the May incident had increased the need for involuntary treatment of patients in the community. In Hong Kong, psychiatrists can apply to a court to have high-risk mental patients admitted to hospital only when there is enough evidence to show they pose a danger to themselves or the public. Doctors do not have the power to compel treatment for a patient in the community. The proposed order aims to plug this loophole. Some countries that promote community care for mental patients, including the US, Britain and Canada, have introduced compulsory treatment to ensure patients see doctors and receive medication regularly. In Canada, for example, doctors can issue a CTO if specific legal conditions are met and consent given by a patient. The patient must have a serious mental illness and have been in a psychiatric institute two or more times, or for a total of 30 days, in the previous three years. If the patient withdraws consent for the order, the doctor must then review the patient's condition within 72 hours to decide whether a continued stay in the community is advisable. If patients fail to comply with the order, doctors, helped by police, can take them for assessment and detain them in a psychiatric facility. In Australia, the legal criteria for making such an order include that a person's mental illness requires immediate treatment; that involuntary treatment is necessary for a patient's safety or for the protection of the public; and the person has refused or is unable to consent to treatment. Australia does not allow the use of physical force to impose treatment in any community setting, such as the patient's residence or clinics. If such coercion is necessary, the order should be revoked and the person must be admitted to hospital. The Australian model emphasises more the prevention of a possible relapse or deterioration in a patient's condition. It also aims to provide involuntary treatment in a restrictive environment. In Hong Kong, the idea of a CTO was also mentioned by the College of Psychiatrists - the top training body for specialists in psychiatry in the city - after a mental patient chopped a three-year-old boy to death in Sham Shui Po in May last year. Tim Pang Hung-cheong, spokesman for the Patients' Rights Association, said the issue must be carefully examined because it would be a serious breach of human rights. 'We worry that there could be abuse by doctors, so there must be checks and balances. We do not have high expectations of [the committee's] report, as most of its recommendations will be on the operational level,' he said. The committee has looked at the difficulties various public agencies face in sharing patients' information. Public hospitals cannot pass the names and addresses of discharged mental patients to the Social Welfare Department or the Housing Department, owing to privacy concerns. There have been calls by patients' rights activists and psychiatrists for a mental health commission to be established.