Replies to LegCo questions
LCQ4: Hospital Authority psychiatric services
Following is a question by the Hon Wong Sing-chi and a reply by the Secretary
for Food and Health, Dr York Chow, in the Legislative Council today (May 27):
Question:
Recently, a woman suspected to have a mental illness seizure was alleged to have
killed her mother at home. In October last year, a mentally ill woman killed
herself after killing her son and daughter. Although the mental patient in the
latter case had been assessed to be of high risk by social workers,
psychologists and occupational therapists, the attending doctor permitted the
patient to be discharged without notifying the medical social worker concerned,
which eventually led to the tragedy. In this connection, will the Government
inform this Council:
(a) whether it knows the current number of mental patients and, among them, the
number of hospitalised patients; of the average cumulative duration of
hospitalisation of each patient (in terms of months); the respective current
numbers of doctors, social workers, psychologists and occupational therapists in
public medical institutions who provide services for mental patients; and the
number of mental patients in the past five years who had killed themselves or
committed the offences of inflicting harm on other people, murder or
manslaughter within one year from discharge from hospital;
(b) how the systems which respectively provide psychiatric treatment and social
rehabilitation service coordinate with each other in making arrangements for
mental patients about to be discharged, including the procedures involved, the
criteria for determining whether the patients may be discharged, as well as the
communication on the provision of the follow-up services needed by the patients;
and how many mental patients who had been assessed to be of high risk were
discharged from hospital in the past five years; and
(c) given that in reply to a question raised by a Member of this Council on 4
February this year, the authorities advised that during the period from
2001-2002 to 2008-2009, the Government provided additional funding to the
Hospital Authority and the Social Welfare Department to support a number of
initiatives to improve the treatment and rehabilitation services for mental
patients, of the relevant details and the number of personnel deployed to
undertake the follow-up work; and the latest progress in the implementation of
the policy decisions on the rehabilitation services for ex-mentally ill persons
set out in the White Paper on Rehabilitation?
Reply:
President,
(a) The number of psychiatric patients (including inpatients, patients at
specialist out-patient (SOP) clinics and day hospitals) and the number of
psychiatric inpatients of the Hospital Authority (HA) in the past five years
(i.e. from 2004-05 to 2008-09) are shown in Annex 1.
Psychiatric inpatients of HA can be classified as acute patients and those in
other categories (including non-acute patients, new long-stay patients and old
long-stay patients). In 2008-09, the overall average length of stay of
psychiatric inpatients was around two months. For acute psychiatric inpatients,
the average length of stay was less than a month and for psychiatric inpatients
in other categories, the average length of stay was around 14 months. HA does
not have statistics on psychiatric patients who committed suicide or committed
the offence of inflicting harm on other people, murder or manslaughter within a
year after discharge from hospital. HA is currently exploring the establishment
of a database to collect data in this respect.
Psychiatric services provided by HA include inpatient, SOP, day hospital and
community outreach services. As at March 31, 2009, the healthcare staff
providing psychiatric services in HA comprises 288 psychiatrists, 1 880
psychiatric nurses, 37 clinical psychologists, 131 occupational therapists and
197 medical social workers stationed in various public hospitals and SOP clinics
by the Social Welfare Department (SWD).
(b) Before the discharge of psychiatric inpatients, a pre-discharge risk
assessment is conducted by HA's psychiatric healthcare staff. The scope of the
assessment covers the extent of the patients' recovery, their propensity to
violence, suicidal tendency, their compliance in drug taking and attending
follow-up consultations, and the availability of family and community support
etc.
Generally, if patients are assessed to be suitable for discharge, the hospital
will arrange for the patient to receive community rehabilitation support service
to help them adapt to community life. Follow-up treatment at psychiatric SOP
clinics or psychiatric day hospitals or visits by psychiatric community nurses
will be arranged for them by HA's healthcare staff having regard to their
treatment and rehabilitation needs. Referrals to medical social workers will
also be made in the light of their welfare and other needs. Medical social
workers will provide counselling service for needy patients and their families
to help them cope with emotional, family, caring support and interpersonal
relationship problems arising from their illnesses, and refer them for
application for various rehabilitation services and community support services
such as the Community Mental Health Link and Community Mental Health Care.
As for high-risk psychiatric patients who are categorised for priority
follow-up, the hospital will assign senior psychiatrists to review the
recommendations for their discharge. These patients will only be discharged
after the senior psychiatrist has endorsed the recommendations for their
discharge and completed the review process. HA will arrange community
psychiatric nurses to provide special post-discharge follow-up services,
including advanced home visits, to these high-risk patients categorised for
priority follow-up. Besides, arrangements will also be made for senior
psychiatrists to attend their follow-up consultation sessions at psychiatric SOP
clinics as far as possible so as to enhance the support for these discharged
high-risk patients. The approximate number of high-risk psychiatric inpatients
who were categorised for priority follow-up during their stay in hospital and
who required community follow-up by community psychiatric nurse between 2004-05
and 2008-09 are shown in Annex 2.
(c) From 2001-02 to 2008-09, the Government has provided a total of $250 million
additional recurrent funding to HA and $76.1 million to SWD to support a number
of new initiatives to improve the treatment and rehabilitation services for
mental patients. To further strengthen the community psychiatric services and
community support for newly discharged psychiatric patients, HA has launched the
Recovery Support Programme for psychiatric patients in the community in 2009-10.
Under this Programme, hospital clusters are provided with additional community
psychiatric nurses to provide community support to discharged psychiatric
patients through a case management approach so as to facilitate their early
recovery and integration into the community. New service initiatives launched by
HA and SWD since 2001-02 are detailed in Annex 3.
The latest implementation progress of HA and SWD of the recommendations on
rehabilitation services for ex-mentally ill persons as set out in the White
Paper on Rehabilitation since the publication of the paper in 1995 is in Annex
4. In the light of the change in social circumstances such as population,
livelihood and economic changes, the Rehabilitation Advisory Committee has
completed the review of the Rehabilitation Programme Plan (the Plan) in 2007 to
set out and update the strategic directions for the development of
rehabilitation services in different areas (including rehabilitation services
for ex-mentally ill persons). Relevant policy bureaux/government departments and
organisations will continue to implement the recommendations in the Plan.
Ends/Wednesday, May 27, 2009
Issued at HKT 12:49
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