Replies to LegCo questions
LCQ14: Mental health services
Following is a question by the Hon Miriam Lau and a written reply by the
Secretary for Food and Health, Dr York Chow, in the Legislative Council today
(June 10):
Question:
On May 29 this year, a man suspected to have a mental illness seizure was
alleged to have chopped a three-year-old toddler to death, while the toddler's
father was also chopped and seriously injured. It is learnt that this was the
sixth wounding case involving mental patients in the past 11 months and also the
third fatal case involving mental patients since May this year. The authorities
have indicated that the existing policy on the treatment of mental patients is
to allow patients with stable conditions to return to the community and be
controlled by medications and followed up by healthcare staff and social
workers. Yet, the policy cannot give a 100% guarantee that similar incident will
not occur. It has been reported that about 140,000 out of the 150,000 mental
patients in Hong Kong are currently living in the community, but the number of
healthcare staff and social workers providing the relevant support services is
inadequate. In this connection, will the Government inform this Council:
(a) whether it will re-examine the policy of allowing mental patients to return
to the community; if so, of the details; if not, the reasons for that;
(b) whether it has assessed if the existing manpower and resources for providing
follow-up services to mental patients after their discharge and return to the
community are adequate; whether the authorities have set the ratios of
discharged mental patients to psychiatrists, nurses and medical social workers
stationed in hospital; if so, of the details; if not, the reasons for that;
(c) given that the authorities have indicated that the Working Group on Mental
Health Services (Working Group), chaired by the Secretary for Food and Health,
is reviewing the mental health policies in Hong Kong and will complete its
report as soon as possible, but the Working Group has not reported on the work
progress since its establishment in 2006, of the number of meetings held by the
Working Group so far, as well as the work progress, the review direction and
outcome; and
(d) given that the review of the Rehabilitation Programme Plan in Hong Kong
completed by the Rehabilitation Advisory Committee in 2007 has set out strategic
directions for the development of rehabilitation services including those for
ex-mentally ill persons, whether the Working Group will correspondingly expedite
the progress in reviewing the mental health policies and set a timetable for
completing the report; when the authorities will fully implement the medical and
rehabilitation programme for mental patients?
Reply:
President,
(a) In general, most mental patients have no propensity for violence and only a
very limited number of them have been involved in serious violent cases. For
mental patients living in the community, their life may be affected by various
factors, such as employment, community life and family relationship. As such,
even if they are provided with sufficient medication and regular follow-up
support services, such as community psychiatric outreach service, the conditions
of individual patients may still undergo unforeseeable changes. The recent
incident involving a mental patient is grievous.
According to the research findings and the accumulated experience of
international and local experts in psychiatry, allowing the early discharge of
mental patients in stabilised condition to receive rehabilitation service in the
community can facilitate their rehabilitation and reduce the chance of relapse
of their illness. It is therefore the international trend to focus on community
and ambulatory services in the treatment of mental illness. Under this
direction, the Hospital Authority (HA) has in recent years kept its in-patient
psychiatric services under review and launched various new programmes to enhance
its community psychiatric services. These programmes (such as the Early
Assessment and Detection of Young Persons with Psychosis (EASY) and the
Extending Care Patients Intensive Treatment, Early Diversion and Rehabilitation
Stepping Stone (EXITERS)) aim to progressively allow more suitable psychiatric
patients to receive treatment in the community, thereby enhancing their prospect
of re-integration into the community after rehabilitation. HA and psychiatric
experts constantly review the details and arrangements regarding the
implementation of the policy in light of the needs of mental patients for
treatment and rehabilitation in the community.
(b) HA, the Social Welfare Department (SWD) and non-governmental organisations
have been working closely together on the provision of rehabilitation service to
discharged mental patients.
HA provides medical rehabilitation and community psychiatric services for
discharged patients to facilitate their rehabilitation and re-integration into
society. These services are delivered mainly through its integrated and
multi-disciplinary community psychiatric teams comprising psychiatrists,
community psychiatric nurses, clinical psychologists, medical social workers,
occupational therapists, etc. The range of services provided includes risk
management, home visit, telephone consultation and follow-up service. On the
other hand, community psychiatric nurses of HA follow up on the discharged
patients through regular visits to patients' home, half-way house or other
residential places to monitor the progress of their treatment or rehabilitation.
In addition, medical social workers stationed by SWD in HA psychiatric hospitals
and specialist out-patient (SOP) clinics provide counselling service as well as
financial and housing assistance to discharged patients and their families to
help them deal with various problems arising from their illness.
In recent years, HA has enhanced the support for mental patients who are about
to be discharged or newly discharged and for their families through various
programmes. Since 2001, HA has launched the EXITERS to provide intensive
rehabilitation training for long stay mental patients so as to facilitate their
early discharge and integration into the community. The scheme also provides
follow-up and support services to discharged patients. In 2008-09, HA has set up
community psychiatric support teams in Kowloon West Cluster and New Territories
East Cluster to provide support for frequently readmitted psychiatric patients
through a case management approach so that effective follow-up care can be
provided in a timely manner.
In addition, the Government has allocated an additional recurrent funding of
$38.66 million to HA since 2009-10 to implement new initiatives to strengthen
mental health services, including the implementation of the Recovery Support
Programme for discharged mental patients in the community. The programme
provides community support to needy discharged mental patients through a case
management approach and involves an additional recurrent expenditure of $23.6
million. Besides, HA will set up triage clinics at the psychiatric SOP clinics
in five hospital clusters (Hong Kong East, Kowloon East, Kowloon West, New
Territories East and New Territories West), involving an additional recurrent
expenditure of $6.8 million, to provide consultation services for new patients
triaged as routine cases at psychiatric SOP clinics.
Meanwhile, SWD also provides funding to non-governmental organisations to
support the provision of a range of community support services to mental
patients. These community support services, which include residential care
service, the Community Mental Health Link, Community Rehabilitation Day
Services, Community Mental Health Care Programme, and Resource and Service
Centres for families of the ex-mentally ill, aim to help discharged mental
patients build up their interpersonal network and acquire daily life skills etc.
As regards manpower, HA has employed additional psychiatric staff in recent
years to strengthen the support for various mental health services. For example,
the number of psychiatrists in HA has increased from 212 in 2000-01 to 288 in
2008-09. The number of psychiatric nurses has also increased from 1 797 to 1 880
during the same period. The number of psychiatric medical social workers has
increased from 166 in 2005-06 to 197 in 2008-09.
HA and SWD will conduct manpower planning for mental health services in the
light of staff wastage and new service programmes. HA will continue to work with
the Hong Kong College of Psychiatrists to strengthen the training of
psychiatrists. As regards nurses, HA will also actively recruit nursing staff
from graduates of university psychiatric nursing programmes and former
psychiatric nurses who have left service in recent years.
The establishment of HA's healthcare staff and SWD's social workers for the
provision of mental health services, including inpatient, SOP and community
outreach/support services, is worked out on the basis of service demand and
operational needs. Mental health services are delivered using an integrated and
multi-disciplinary approach to allow flexibility in the deployment of human
resources. HA and SWD have no fixed manpower ratios of patient to psychiatrist,
psychiatric nurse or medical social worker in the delivery of the services.
(c) & (d) The Working Group on Mental Health Services (the Working Group) set up
by the Food and Health Bureau is chaired by me and comprises professionals
providing medical and rehabilitation services to mental patients, academics,
representatives of the Labour and Welfare Bureau, HA and SWD. The purpose of the
Working Group is to assist the Government in reviewing existing mental health
services. This is a long-term and ongoing process.
The Working Group has set up a sub-group, which is tasked to study in-depth the
demand for mental health services and the relevant policy measures. The
sub-group is co-chaired by two members of the Working Group and comprises
professionals from the healthcare and social welfare sectors. The sub-group has
drawn up a preliminary framework on the objectives and directions of the mental
health policy in Hong Kong. The three expert groups under the sub-group are now
studying the service needs of three different age groups (adults, adolescents
and elders) with a view to making proposals for service improvement in the
relevant areas. The Working Group, sub-group and expert groups have held a total
of 13 meetings so far.
Since mental illness is a complex health problem and mental health services
cover both healthcare and rehabilitation services, I will work closely with the
Secretary for Labour and Welfare and adjust or enhance the services in response
to service needs. The long-term development of mental health services will be
considered and formulated under the overall framework of the healthcare reform.
In the short and medium term, we will allocate additional resources on
prevention, medical treatment and rehabilitation services to further improve our
mental health services and enhance the community support for mental patients, so
as to facilitate their early recovery and re-integration into the society. From
2001-02 to 2008-09, the Government has provided an additional recurrent funding
of $250 million to HA and $86.3 million to SWD to support a number of
initiatives to improve the treatment and rehabilitation services for mental
patients, including various community support services.
Ends/Wednesday, June 10, 2009
Issued at HKT 14:27
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