Replies to LegCo questions

LCQ10: Mental Health Service Plan for Adults 2010-2015

Following is a question by the Hon Cheung Kwok-che and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (April 18):

Question:

The recommendations made by the Hospital Authority (HA) in its Mental Health Service Plan for Adults 2010-2015 include: (1) recruiting case managers (CMs) in all HA clusters to provide comprehensive case management for all patients with severe mental illness (SMI) considered suitable for treatment in community settings; (2) carrying out a pilot on setting up community-based multi-disciplinary mental health specialist care teams to provide a full range of psychiatric and mental health services in community settings, and provide links with Integrated Community Centres for Mental Wellness (ICCMW) of the Social Welfare Department; and (3) implementing a new specialist out-patient model based on multi-disciplinary care to patients, so as to improve waiting time, consultation time, service flexibility (particularly for evening clinics) and the range of services provided. In this connection, will the Government inform this Council if it knows:

(a) the number of CMs employed by HA as at the end of March this year; at least how many cases each CM has to handle each year; the actual number of cases currently handled by each CM on average; apart from following up cases, whether CMs are responsible for other duties and activities;

(b) the current number of patients with SMI considered suitable for treatment in community settings according to HA's information, broken down by various districts delineated by HA; the estimated number of CMs that is adequate in the light of such patient number, and the number of additional CMs required to be employed for various districts to meet service demands;

(c) the number of cases referred by CMs to ICCMWs for follow-up in the past two years, broken down by various districts delineated by HA; under what circumstances and based on what criteria CMs will refer the cases; and how they cooperate with the social workers of ICCMWs to assist the patients in their rehabilitation after referring the cases; and

(d) given that some social workers of ICCMWs have reflected that when they refer persons suffering from or suspected to be suffering from mental illness to HA hospitals for treatment, but such persons are not given priority access to specialist out-patient services and still have to undergo general out-patient diagnosis, whether HA will arrange direct treatment by psychiatrists for those patients referred by such social workers, so that they can receive early treatment; if not, the reasons for that, and under what circumstances and through what procedures the patients concerned will be given priority access to specialist out-patient services?

Reply:

President,

The Mental Health Service Plan for Adults 2010-2015 of the Hospital Authority (HA) sets out the objectives of HA's mental health service for adults and the priority of its various service areas. In order to put the above Service Plan into implementation, HA has strived to work closely with the relevant stakeholders and service providers to launch a series of services in phases, including introducing a Case Management Programme for patients with severe mental illness. My reply to the various parts of the question is as follows:

(a) Since April 2010, HA has launched a Case Management Programme in three districts (Kwun Tong, Kwai Tsing and Yuen Long) for patients with severe mental illness. The case managers under the programme work closely with various service providers, particularly the Integrated Community Centre for Mental Wellness (ICCMWs) set up by the Social Welfare Department (SWD), in providing intensive, continuous and personalised support to patients with severe mental illness living in the community. In 2011-12, HA has extended the programme to five more districts (Eastern, Sham Shui Po, Sha Tin, Tuen Mun and Wan Chai) to benefit more patients. As at the end of March 2012, HA employed a total of 155 healthcare and allied health personnel with experience in community mental health services as case managers for the provision of intensive and personalised community support to some 10 000 patients living in these districts, i.e. each case manager is currently providing community support to some 60 patients. In 2012-13, HA will further extend the Case Management Programme to four more districts (Kowloon City, Southern, Central and Western and Islands). It is estimated that an additional 40 case managers will be recruited to provide community support for about 1 900 more patients. HA has implemented the Case Management Programme in various districts throughout the territory in phases since 2010. The case managers to be employed should have experience in community mental health services and attend on-the-job training for six months, including enhancement of case management skills and community psychiatric treatment concept. The role of case managers is to provide all-encompassing and individualised services for case subjects and their families, so as to help them reintegrate into the community. Case managers' work is related to the patients being followed up. The workload varies from one case manager to another, depending on factors such as patients' clinical conditions and degrees of exposure to risk in the community, etc.

(b) HA estimates that there are currently about 16 000 patients with severe mental illness who are suitable for receiving intensive support under the Case Management Programme in community settings. HA has been endeavouring to review the effectiveness and manpower situation of the Case Management Programme. HA will also consider further extending the programme to all districts in Hong Kong in the coming few years. It is expected that this will involve over 300 case managers. HA will continue to recruit more case managers to further strengthen its establishment. As HA does not have the estimated number of additional case managers required for each district, it will deploy and adjust its manpower flexibly having regard to the operational needs and actual service demands of various districts.

(c) Since October 2010, the ICCMWs under SWD have provided one-stop district-based community support services to mental patients, persons with suspected mental health problems, their families/carers, and residents in the district through 24 service points across the territory. These integrated services range from early prevention and intervention to risk management through public education, day training, counselling and outreaching visits, etc. In deciding whether referral should be made for individual cases, case managers of HA will take into account the needs of mental patients and whether the services provided by ICCMWs are appropriate for the actual conditions of the patients. From the commencement of the Case Management Programme in 2010 to the end of March 2012, HA has made a total of 765 case referrals to ICCMWs in eight districts for follow-up services.

(d) Currently, a referral mechanism is in place at HA's psychiatric specialist out-patient (SOP) clinics to accept cases referred by social workers of ICCMWs through registered medical practitioners or community psychiatric services of HA's hospital clusters. HA's community psychiatric service teams, which comprise psychiatrists, psychiatric nurses and allied health professionals, have maintained close liaison with social workers of ICCMWs to provide professional assessments, diagnoses, referrals, outreach community support and crisis management services for community members (including mental patients and persons with suspected mental problems), so as to bring community cases and psychiatric SOP clinics into better integration. To ensure that patients with varying degree of mental health problems are given timely and appropriate treatment, a triage system is implemented for new cases at psychiatric SOP clinics under HA, whereby new patients are classified into the following categories on the basis of the urgency of their clinical conditions: priority 1 (urgent), priority 2 (semi-urgent) and routine categories. Factors to be considered in the triage of new cases include the patient's propensity to violence, risk of committing suicide, degree of depression and whether the patient has carers. Besides, in addition to receiving treatment at SOP clinics, arrangements will also be made for psychiatric patients to receive other services such as day hospital and community support services as required for treatment of their mental illness.


Ends/Wednesday, April 18, 2012
Issued at HKT 11:30

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