Replies to LegCo questions

LCQ2: Services for ex-mentally ill patients

Following is a question by the Hon Lau Wong-fat and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (October 31):

Question:

As cases have occurred from time to time in which ex-mental patients, who have returned to the community but still need to take medication regularly, injuring themselves or other people because they were in emotional distress or did not take medication according to schedule, will the Government inform this Council:

(a) of the current number of ex-mental patients who have returned to the community but still need to take medication regularly;

(b) of the measures to ensure that the above persons will take medication according to schedule as prescribed by medical practitioners; and

(c) what counselling services are currently provided for the above persons by the Government and the Hospital Authority (HA), and the ratio of the number of ex-mental patients to the number of government and HA staff providing counselling services to them, broken down by 18 District Council districts?

Reply:

Madam President,

(a) After receiving treatment at the psychiatric hospitals of the Hospital Authority (HA) and upon return to the community, all mental patients are arranged to receive follow-up consultations at the psychiatric specialist out-patient clinics of the HA. In general, all ex-mentally ill persons who have returned to the community have to receive follow-up consultations at psychiatric specialist out-patient clinics and take medications regularly. In 2006-07, the number of discharged patients of HA's psychiatric hospitals was about 12,000. In the same year, the number of attendances at HA's psychiatric specialist out-patient clinics was about 136,000, including patients of first attendance and patients of follow-up attendance. The attendance of HA's psychiatric day hospital was about 180,000 in 2006-07.

(b) HA's doctors explain in detail to mental patients and ex-mentally ill persons the clinical conditions and treatment of their mental illness, advising them of the importance of taking medication according to schedule. The community psychiatric nurses of the HA's psychiatric outreach service also follow up the cases of ex-mentally ill persons through home visits and reminding the ex-mentally ill persons to attend follow-up consultations and take medications according to schedule. If clinical diagnostic information shows that individual ex-mentally ill persons have not complied with the drug regimen, healthcare personnel of the outreach service would step up their monitoring efforts and urge the patients to take medications according to doctors' instructions. Where necessary, doctors may prescribe medications for injection instead of oral consumption to ensure that the patients would receive the necessary drug treatment.

In addition, the HA organises talks and disseminates pamphlets on psychiatric drugs to raise the awareness of patients, their families and carers on psychiatric drugs as well as the importance of taking medication according to schedule. The HA also encourages mental patients and ex-mentally ill persons to join patients' mutual support groups. These support groups hold educational talks regularly for mental patients and ex-mentally ill persons, providing them the guidance to take medication according to schedule.

(c) Prior to the return of the ex-mentally ill persons to the community, a multi-disciplinary team comprising doctors, medical social workers, clinical psychologists and community psychiatric nurses etc. would determine the suitable discharge arrangements for these persons, having regard to a number of factors such as the mental conditions of the patients, their compliance with the drug regimen, their self-care ability as well as the availability of community support. At present, rehabilitation and counselling services are provided in the community by the HA, Social Welfare Department (SWD) and non-government organisations (NGO) to cater for the different needs of ex-mentally ill persons.

The HA hospital clusters arrange for community psychiatric nurses to pay home visits to ex-mentally ill persons at their homes or half-way houses to monitor the progress of their rehabilitation. If necessary, the HA may also refer ex-mentally ill persons to psychiatric day hospitals for specialist assessment, continued care and rehabilitation services to facilitate their re-integration into the community. HA hospital clusters currently have a total of 118 community psychiatric nurses. In 2006-07, the community psychiatric nurses have provided a total of about 88,000 outreach attendances.

Relevant key services provided by the SWD and NGOs include:

(i) Community support services, such as Community Mental Health Link Services, Community Mental Health Care Services and Community Rehabilitation Day Services;

(ii) Training and Activity Centre for Ex-mentally Ill Persons;

(iii)Vocational rehabilitation and training and placement services, such as sheltered workshops, supported employment services, integrated vocational rehabilitation centre, On-the-job Training Programme for People with Disabilities and Sunnyway - On the job Training Programme for Young People with Disabilities; and

(iv) Residential service, including supported hostels, half-way houses and long stay care homes.

Social workers and counselling staff responsible for taking care of the above-mentioned ex-mentally ill persons provide appropriate and timely counselling services to them and their families, helping them cope with the problems they encounter in their daily life so as to facilitate their re-integration into the community. In general, the number of counselling staff of the SWD and NGOs providing the aforesaid services is about 1,580, whereas the number of ex-mentally ill persons being served is about 16,200.

The SWD has also deployed Medical Social Workers (MSWs) at the psychiatric department of various public hospitals and clinics to provide, on referrals by doctors, support to mental patients and ex-mentally ill persons with welfare needs who are under hospitalisation, pending for discharge or under follow-up treatments. The MSWs will provide the mental patients and ex-mentally ill persons as well as their families with counselling services, financial and housing assistance, and assist them to address emotional, family, caring and interpersonal problems arising from illness, trauma or disability. The MSWs also collaborate with other medical, nursing and allied health personnel to develop discharge plans for patients, assess patients' psychological health and refer patients and their families to apply for rehabilitation services and related community resources. At present, the SWD has a total of 193 psychiatric medical social workers. In 2006-07, medical social workers have provided services for 60,543 cases. Over the past few years, along with the increasing number of MSWs, the number of cases being followed up by a MSW at a given point in time has been decreased from 81 in 2003-04 to 73 at present.

The number of mental patients and the services provided for them are not distributed by districts of the 18 District Councils. As such, we do not have relevant data and ratio of the number of ex-mentally ill persons to the number of staff providing counselling services to them in each district.


Ends/Wednesday, October 31, 2007
Issued at HKT 13:15

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