Replies to LegCo questions
LCQ9: Psychiatric services of Hospital Authority
Following is a question by the Dr Hon Pan Pey-chyou and a written reply by the
Secretary for Food and Health, Dr York Chow, in the Legislative Council today
(November 3):
Question:
It has been reported that in quite a number of past tragedies relating to
psychiatric patients, the patients had not been categorised by the Hospital
Authority (HA) as priority follow-up cases and therefore, healthcare and social
workers could not make early intervention and prevent the tragedies from
happening. In this connection, will the Government inform this Council:
(a) whether it knows the current number of cases put under the priority
follow-up system; among such cases, the number of those in which the patients
were "conditionally discharged" under the Mental Health Ordinance (Cap. 136);
among the cases under the priority follow-up system, the respective numbers of
cases categorised as priority follow-up and as secondary target for priority
follow-up;
(b) whether it knows the increase in the numbers of cases in the past five years
in respect of priority follow-up and secondary target for priority follow-up
respectively, as well as the respective numbers of cases removed from these two
categories; and whether a case needs to go through an established procedure
before it is removed; if so, the details of the procedure; if not, why the
authorities have not drawn up such a procedure; and
(c) whether the authorities and HA have drawn up guidelines on how to take care
of or monitor those cases categorised as priority follow-up or as secondary
target for priority follow-up, including how to deal with situations where such
patients suddenly refuse to comply with the conditions for their "conditional
discharge", such as refusing follow-up care, drug therapy or visits by
healthcare professionals, etc.?
Reply:
President,
Patients receiving psychiatric services from the Hospital Authority (HA) are
broadly categorised into three types according to their risk level:
(1) mental patients without propensity to violence or record of criminal
violence are categorised as "ordinary patients";
(2) mental patients with propensity to violence or record of criminal violence
are generally categorised into the "target group"; and
(3) patients with greater propensity to violence or record of severe criminal
violence and assessed to have higher risk are categorised into the "sub-target
group".
To facilitate early identification and follow-up of mental patients with
propensity to violence or record of criminal violence, HA adopts a priority
follow-up system to follow up on patients in the "target group" and "sub-target
group".
In general, the attending doctors will categorise patients into the "target
group" or "sub-target group" according to the severity of their past propensity
to violence or record of criminal violence. Patients who have committed less
serious offences before (such as common assault, fighting, disorder in public
place, possession of offensive weapons) are categorised into the "target group".
Those who have committed more serious offences before (such as serious wounding
or assault, murder or manslaughter, serious criminal intimidation) are
categorised into the higher-risk "sub-target group".
The reply to various parts of the question is as follows:
(a) At present, HA provides psychiatric services to more than 160,000 patients,
about 5,500 of whom are put under the priority follow-up system. The breakdown
is shown in Annex 1.
Besides, to help patients who have a history of criminal violence or disposition
to commit such violence but are in stable conditions to reintegrate into the
community, the attending doctors may allow them to be discharged subject to
specific conditions under the Mental Health Ordinance (Cap. 136), including
residing at a specified place, receiving follow-up in the community and regular
follow-up consultation, and taking medication as prescribed by a medical
practitioner etc. According to HA's statistics, there are currently about 650
cases of patients who were "conditionally discharged".
(b) The increase in the number of people in respect of "target group" and
"sub-target group" under the priority follow-up system as well as the number of
people removed from these two groups on average each year are shown in Annex 2.
Established procedures are in place in HA to assess whether patients are
suitable for being removed from the priority follow-up system. The
multi-disciplinary healthcare team (including the attending doctor and his/her
supervisor, nurse, psychologist, social worker and occupational therapist etc)
will conduct in-depth assessment on the risk and ability to live independently
of a patient. The assessment covers mental conditions, risk factors, living
environment and family support, follow-up and medication record, history of drug
abuse and alcoholism, ability to live independently and reoffending risk etc. HA
may consider removing a patient from the system if the patient has good
community living skills and has remained in satisfactory conditions (i.e.
without act of violence and propensity to violence, in stable mental conditions,
and having good community support and regular follow-up and medication record)
for three years (applicable to "target group") or seven years (applicable to
"sub-target group"), after a decision made by a multi-disciplinary medical
conference.
(c) The multi-disciplinary team comprising different healthcare professionals
will draw up relevant care plans according to the needs and risk profile of
patients. At present, all patients in the "sub-target group" are provided with
long-term follow-up by community nurses or medical social workers. As for
patients in the "target group", the attending doctors will arrange appropriate
support for them according to their needs and risk profile. Care plans for the
"target group" and "sub-target group" are shown in Annex 3.
If a patient under the priority follow-up system suddenly refuses to accept the
care plan, the attending doctor will make appropriate arrangements, such as
enhancing support by community nurses and increasing the number of visits,
according to the prevailing mental conditions and risk level of the patient.
Regarding the "conditional discharge" cases, if a patient fails to comply with
any condition imposed on him/her, and the attending doctor is of the opinion
that it is necessary in the interests of the patient's health or safety, or for
the protection of other persons, to recall the patient to a mental hospital, the
doctor can recall the patient to the mental hospital under section 42B of the
Mental Health Ordinance (Cap. 136). If the patient does not fall into the
"conditional discharge" category but his/her condition warrants his/her
detention in a mental hospital for observation (or observation followed by
medical treatment) and such detention is in the interests of his/her own health
or safety or for the protection of other persons, the Court can make an order to
authorise the detention of the patient in the mental hospital for observation
and medical treatment under section 31 of the Mental Health Ordinance (Cap.
136).
In addition, HA has piloted in 2010-11 a Case Management Programme in three
districts (Kwai Tsing, Yuen Long and Kwun Tong) to provide intensive, continuous
and personalised community support to 5,000 higher-risk patients with severe
mental illness. At present, patients under the priority follow-up system in
these three districts have been followed up by case managers. HA will roll out
the programme to five more districts (Eastern, Sham Shui Po, Sha Tin, Tuen Mun
and Wan Chai) in 2011-12 to provide services to an additional 6,000 patients.
When this programme is extended to all districts in Hong Kong, patients under
the priority follow-up system will be followed up through a case management
approach on a long-term basis.
Ends/Wednesday, November 3, 2010
Issued at HKT 17:47
NNNN