Replies to LegCo questions
LCQ9: Mental health services
Following is a question by the Hon Albert Ho and a written reply by the
Secretary for Food and Health, Dr York Chow, in the Legislative Council today
(June 2):
Question:
A number of serious incidents of mental patients injuring others or themselves
occurred in the community in recent years. In addition, there have been comments
that while the Government puts emphasis on community care for such people, there
is a lack of complementary comprehensive planning and community support.
Regarding the support services provided to mental patients and people recovering
from mental illness, will the Government inform this Council:
(a) of the respective resources allocated by the Government to the Hospital
Authority (HA), the Social Welfare Department (SWD) and non-government
organisations in the past five years for supporting mental patients and people
recovering from mental illness, as well as the respective increase in their
expenditure in each year;
(b) given that under the newly launched Case Management Programme, case managers
are supervised by health grade personnel, of the mechanism in place to ensure
that case managers are capable of assessing the needs of their patients in areas
other than health care such as community and social life; the mechanism in place
on the operational level to enable case mangers who work under HA to coordinate
and arrange for the provision of appropriate services to the patients they take
care of by various government departments such as SWD, etc. especially when some
rehabilitation services (e.g. residential places) are in acute shortage; and
(c) whether it knows in each of the past five years, the respective median
in-patient bed-days of mental patients, the respective numbers of persons with
severe mental illness or those recovering from severe mental illness in the
community, as well as the respective numbers of serious incidents in which such
persons injured themselves or others; whether the authorities have explored if
the occurrence of such wounding incidents is related to the authorities reducing
psychiatric beds as well as their putting emphasis on community care without
complementary comprehensive planning and community support; which areas need
improvement most urgently; whether they will invite a specialist consultant to
thoroughly review mental health policy and services, and prepare a white paper
on the mental health policy to consult various sectors?
Reply:
President,
(a) We are committed to promoting mental health and catering for the needs of
mental patients in a comprehensive manner through the provision of a series of
mental health services. At present, the Hospital Authority (HA) provides various
medical services for mental patients, including inpatient, outpatient, medical
rehabilitation and community support services. The Social Welfare Department (SWD)
provides ex-mentally ill persons and their families with a series of social
rehabilitation services, including residential care, day-time training,
vocational training and community support services. This is to help ex-mentally
ill persons adapt to community life and reintegrate into the society.
The resources we allocated to mental health services have been increasing in
recent years. The expenditures of HA and SWD on mental health services in the
past five years (i.e. 2005-06 to 2009-10) are shown in Annex Table 1.
Moreover, to further strengthen mental health services, we have provided
additional funding of over $100 million to HA in 2010-11 for launching two new
programmes to strengthen the support for two major groups of mental patients.
For persons with severe mental illness, HA has implemented the Case Management
Programme on a pilot basis with healthcare personnel taking up the role as case
managers to provide these patients with intensive, continuous and personalised
support. The amount of expenditure involved is $78 million. As for persons with
common mental disorders, HA has set up Common Mental Disorder Clinics to provide
them with more timely assessment and consultation services and will introduce an
Integrated Mental Health Programme later this year to engage the primary care
services in supporting these patients. The amount of expenditure involved is $31
million. Besides, HA will also expand the use of new psychiatric drugs with
proven effectiveness on patients under suitable clinical conditions. The amount
of expenditure involved is $10 million.
SWD will expand the service model of the Integrated Community Centres for Mental
Wellness across the territory in 2010-11 and strengthen the manpower of these
centres to provide comprehensive and accessible services to those in need.
Additional funding allocation of $70 million has been provided to SWD for
implementation of the initiative.
(b) Under the Case Management Programme for persons with severe mental illness
implemented in 2010-11, HA will arrange for case managers to receive structured
training on case management, including intensive classroom teaching, workshops
and practicum with supervision. The content of the training includes assessment
of the medical needs of patients as well as their needs in various other aspects
(such as their community life and social interaction). This is to ensure that
the case managers are capable of arranging the provision of appropriate support
services having regard to the medical and non-medical needs of patients. The
case managers will work closely with various service providers, including the
Integrated Community Centres for Mental Wellness.
To implement the Case Management Programme and relevant initiatives more
effectively, HA and SWD will establish a new communication platform on top of
the existing communication channels to further enhance the collaboration among
various sectors and disciplines at different levels.
At the central coordination level, the HA Head Office and SWD Headquarters as
well as non-governmental organisations will discuss the coordination of the
overall service strategies and explore effective models of collaboration on a
continuous basis. At the district coordination level, the Chiefs of Service of
the Department of Psychiatry in various clusters of HA and District Social
Welfare Officers of SWD will set up a district-based communication platform. The
purpose is to liaise regularly with service providers in the district and
relevant government departments and organisations for coordination of community
support services in the district. Adjustment will also be made to the service
model having regard to the demographic characteristics and service demand in the
district. At the service delivery level, case managers of HA will maintain
liaison with other service providers, including staff of the Integrated
Community Centres for Mental Wellness for discussion and coordination on matters
as case referral and arrangements for rehabilitation services as necessary.
(c) In the past five years (i.e. from 2005-06 to 2009-10), the average length of
stay of mental patients of HA in hospitals and the number of mental patients
receiving HA's services are as shown in Annex Table 2.
At present, around 40,000 people are diagnosed with severe mental illness (such
as psychosis) in HA.
The number of suicide cases involving mental patients has notably reduced in the
past few years. The number of suicide cases involving patients who had used the
psychiatric inpatient or outpatient services of HA within one year before they
died in suicide from 2004 to 2008 are set out in Annex 3. At present, HA does
not have statistical data on mental patients inflicting harm on other people but
will collect data in this respect.
In the light of the international trend to shift the focus of the treatment of
mental illness from inpatient care to community and ambulatory services, HA has
been reviewing its inpatient psychiatric services in recent years and has
launched a number of new programmes to enhance its community psychiatric
services (such as the "Extended care patients Intensive Treatment, Early
diversion and Rehabilitation Stepping Stone (EXITERS) Project", pilot programme
to provide post-discharge community support to frequently readmitted psychiatric
patients, and the Recovery Support Programme). These programmes progressively
allow more mental patients with stabilised conditions to receive treatment in
the community, thereby enhancing their prospect of reintegration into the
community after rehabilitation. With the provision of various community support
services, the demand for inpatient services has been decreasing. In the past few
years, the occupancy rate of HA's psychiatric beds was less than 80%. Therefore,
HA has gradually closed down unused psychiatric beds in recent years and
redeployed the resources for enhancement of other mental health services. HA has
no plan to further reduce its psychiatric beds in 2010-11 and will keep in view
the demand for inpatient psychiatric services.
The Government keeps its mental health services under review and makes
adjustment and enhancement to the services having regard to changes in social
circumstances and service needs. The Working Group on Mental Health Services
(Working Group) is chaired by the Secretary for Food and Health and comprises
academics and relevant professionals and service providers as members. There is
a subgroup under the Working Group to study in-depth the demand for mental
health services and the relevant policy measures. The subgroup is supported by
three expert groups comprising professionals with relevant service experience to
study the service needs of different age groups (children and adolescents,
adults, and elderly). After discussion, the Working Group has formulated a
framework on mental health policy and services setting out the general
principles, goals and directions. The Working Group will continue to review, on
the basis of the above framework, mental health services on an ongoing basis and
explore new mental health service initiatives including the coordination of
various community support services and the follow-up on patient.
To enhance the mental health services in response to the needs of the community
in a more systematic manner, we are developing a mental health service plan for
adults for the coming years, including setting out the service objectives and
priorities for various actions. In formulating the service plan, we will take
account of the views of the relevant experts and service providers and consult
patients, carers and other stakeholders. Meanwhile, we will continue to make
reference to the deliberations in the Working Group and consider developing
service plans in future for other age groups.
Ends/Wednesday, June 2, 2010
Issued at HKT 16:11
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