Replies to LegCo questions
LCQ11: Hospital Authority mental health services
Following is a question by the Hon Leung Kwok-hung and a written reply by the
Secretary for Food and Health, Dr York Chow, in the Legislative Council today
(November 11):
Question:
It was reported that another tragedy involving a mental patient happened earlier
in Hong Kong in which a mentally ill man stabbed his ex-wife to death at a Light
Rail stop. A number of similar tragedies have happened since January this year,
and after each incident, the authorities indicated that mental health services
would be strengthened. However, it has been reported that the shortage of
psychiatrists in Hong Kong will persist in the next five to 10 years. In this
connection, will the Government inform this Council:
(a) whether it knows the amount of funding and other resources allocated by the
Hospital Authority (HA) to the psychiatric department of each public hospital in
each of the past three years, together with a detailed breakdown of the amount
of funding by expenditure item, including the salaries of healthcare personnel
and other staff, as well as the expenses on drugs and medical facilities, etc.;
(b) whether it knows if HA has set any cap on the costs of psychiatric drugs to
be provided by each hospital; if it has, of the details of such limits;
(c) whether it knows the respective numbers, calculated on the basis of the
needs of the current population in Hong Kong, of hospital beds and healthcare
personnel needed in various specialties (including child and adolescent
psychiatry, psychogeriatry, community psychiatry and forensic psychiatry) in the
psychiatric departments of public hospitals, and how these numbers compare to
the current numbers concerned;
(d) whether it knows the proportion of the patients being re-admitted among
those who were discharged in the past three years from the various specialties
in the psychiatric departments in (c);
(e) whether it knows the average number of hours spent in the past three years
by the relevant healthcare personnel on following up each case of a mental
patient after his discharge from hospital, and the average number of times and
hours per week each case was followed up by community psychiatric nurses;
(f) whether it knows the average number of ex-mental patients in the past three
years whom each community psychiatric nurse needed to follow up;
(g) of the respective numbers of meetings convened by the Working Group on
Mental Health Services (the Working Group), which was set up by the former
Health, Welfare and Food Bureau in August 2006, and its subgroup and expert
groups, their latest membership lists and the attendance rates of their members;
and
(h) what mental health policy and specific recommendations have been proposed by
the Working Group after working for more than three years, as well as of the
resources needed and the timetable for implementing such policy and
recommendations?
Reply:
President,
(a) In the past few years, the resources allocated by the Hospital Authority
(HA) on mental health services each year has been increasing and the annual
expenditure is over $2.5 billion. The expenditure of various hospital clusters
on mental health services in the past three years with breakdown by item is
shown in Annex 1.
(b) The cost of drugs is not a major consideration of HA in the prescription of
drugs. Decisions in regard to the prescription of psychiatric drugs are made on
the basis of patients' clinical conditions and treatment needs with a view to
enhancing treatment outcome and facilitating the early recovery of the patient.
The psychiatric department of various hospital clusters will prescribe drugs to
patients having regard to their conditions and the relevant prescription
guidelines. In recent years, the Government has provided HA with additional
recurrent allocation of a total of $95 million to provide new psychiatric drugs
to more patients in need.
(c) In planning for its psychiatric services and manpower requirements, HA takes
into account various factors including demographic changes and past trends in
service demand of each hospital cluster. In recent years, HA has actively
increased the manpower of its psychiatric departments. The number of
psychiatrists has increased from 212 in 2001-02 to 288 in 2008-09 and the number
of psychiatric nurses has increased from 1,797 to 1,880 during the same period.
As at March 31, 2009, HA provided a total of 4,000 psychiatric beds.
The scope of work of psychiatric healthcare staff covers different service areas
including in-patient service, specialist out-patient (SOP) service and community
outreach service. The condition and needs of patients also vary. As such, HA
does not set a fixed staff establishment for the provision of services for
individual subspecialties under the psychiatric departments. Instead, the
manpower within the psychiatric departments is deployed and adjusted flexibly in
accordance with the operational needs and service demand of hospitals in
different districts. As for forensic psychiatric service, it is a special
service unit mainly involved in providing services to the Siu Lam Psychiatric
Centre of the Correctional Services Department as well as forensic psychiatric
service to all hospital clusters. The unit currently has 7 doctors and 87
nurses.
(d) According to HA's records, the rate of re-admission of mental patients via
the Accident and Emergency Departments within 28 days after discharge in the
past three years is as follows:
Re-admission rate of mental patients via Accident and
Emergency Departments within 28 days after discharge
2006-07 6.0%
2007-08 6.0%
2008-09 6.3%
(e) HA provides medical rehabilitation and community psychiatric services to
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, which comprise psychiatrists,
community psychiatric nurses, clinical psychologists, medical social workers,
and occupational therapists etc. The range of services provided includes risk
management, home visit, telephone consultation and follow-up service. In
2008-09, the number of outreach service attendances provided by the community
psychiatric teams is 104,753. 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 2008-09, the total number of cases
followed up by community psychiatric nurses is 9,245. The frequency and duration
of the follow-up service depend on the needs and condition of individual
patients. For non-urgent cases in general, community psychiatric nurses conduct
home visit approximately once a month.
(f) In the past three years, the average number of cases followed up by each
community psychiatric nurse is as follows:
Average number of cases followed up by each community psychiatric nurse per year
2006-07 68
2007-08 71
2008-09 70
(g) The Working Group on Mental Health Services (Working Group) set up by the
Food and Health Bureau is chaired by me and comprises Government
representatives, mental health professionals from the healthcare and social
welfare sectors and academics. It assists the Government in reviewing existing
mental health services. The Working Group has set up a Sub-group, which is
co-chaired by two members of the Working Group and comprises professionals from
the healthcare and social welfare sectors, to conduct in-depth study on the
demand for mental health services and the relevant policy measures. Meanwhile,
there are three expert groups under the Sub-group comprising experts with
relevant service experience to study the service needs of three different age
groups (children and adolescents, adults and elders). The membership list of the
Working Group, Sub-group and expert groups are at Annex 2, Annex 3 and Annex 4
respectively.
The Working Group and its Sub-group have each held four meetings so far and the
average attendance rates of members are 90.4% and 100% respectively. The expert
groups have held a total of nine meetings so far and the average attendance rate
of members is 84.5%. Besides, members of the expert groups also deliberate and
exchange their views through emails.
(h) Since their establishment early this year, the expert groups under the
Working Group have conducted preliminary studies on the needs for mental health
service of various target groups in Hong Kong. They have affirmed the importance
of early identification and treatment as well as the service direction of
enhancing community care for patients. They have also suggested that the
Government adopt appropriate service strategies according to the needs of
patients and provide them with the appropriate support. Other service
improvement measures put forward by the expert groups include strengthening the
training for primary and community care personnel for assisting in the
intervention of mental health problems, shortening the waiting time for
psychiatric SOP service and enhancing in-patient care and various community
outreach and residential services.
Having considered the views of the Working Group and its Sub-group and expert
groups, we will launch two new initiatives through HA in 2010-11 to provide
support to persons with severe mental illness and persons with common mental
disorders respectively. With regard to persons with severe mental illness, HA
will pilot a case management programme in individual districts and train up
healthcare staff as case managers to provide continuous and personalised
intensive support to patients in the community settings. For people with common
mental disorders, HA will foster closer collaboration between its psychiatric
SOP service and primary care service in order to provide these patients with the
appropriate assessment and treatment services.
The work of the Working Group in assisting the Government in reviewing existing
mental health services in Hong Kong is an ongoing and long-term process and has
to be carried out on a step by step basis in a practicable and sustainable
manner. We will continue to prioritise the service improvement measures in the
light of the views of the Working Group and its Sub-group and expert groups. We
will also continue to allocate additional resources on prevention, early
intervention, treatment and rehabilitation services to further improve our
mental health services.
Ends/Wednesday, November 11, 2009
Issued at HKT 14:40
NNNN