Replies to LegCo questions
LCQ2: Mental health services
Following is a question by the Hon Cheung Kwok-che and a reply by the Secretary
for Food and Health, Dr York Chow, in the Legislative Council today (June 27):
Question:
It has been reported that on May 3, this year, a man suffering from mental
illness suddenly became agitated at home and killed his family members before
jumping off a building to his death. Subsequently it was confirmed that the man,
who suffered from schizophrenia, had not participated in the Case Management
Programme for people with severe mental illness after being discharged from the
hospital, and had stopped visiting the clinics in public hospitals for follow-up
consultations since September last year. Although hospital staff had contacted
him, he refused treatment and tragedy eventually happened. The Hospital
Authority (HA) published in 2010 the Report of the Review Committee on the
Management and Follow-up of Mental Patients, which recommended, among other
things, a study on whether Hong Kong should follow the practice of the United
Kingdom and Australia to legislate on the introduction of Community Treatment
Orders (CTOs). The CTOs in such countries require people with severe mental
illness, but not to the extent of requiring hospitalisation, to receive
treatment in community and regularly attend follow-up consultations as well as
participate in community activities, and those who breach such orders may be
subject to mandatory hospitalisation. In this connection, will the Government
inform this Council:
(a) given that the Food and Health Bureau (FHB) has started to study overseas
experience and relevant legislation regarding the issue of CTOs since 2010, as
well as to explore whether it is suitable to implement CTOs in Hong Kong, but
after such a protracted study, FHB has not reached a conclusion yet, of the
reasons for that; when it can introduce the relevant bill to this Council for
discussion;
(b) how it prevents the refusal of treatment by people with mental illness and
the recurrence of similar tragedies; how it conducts public education to promote
public understanding of the needs of the people recovering from mental illness
and the proposal to introduce CTOs so that the public will support the proposal;
and
(c) given that it has been reported that in order to save manpower, HA intends
to slow down the development of new services (e.g. the expansion of psychiatric
outreach services and case manager services for following up psychiatric
patients), and among the more than 170 000 people seeking consultation from the
psychiatric units of HA at present, 40 000 are severe cases, whether it knows
the detailed reasons for HA slowing down the expansion of psychiatric services
under such circumstances; how the Government assists HA in expediting the
recruitment of psychiatrists and stepping up staff training to meet the urgent
need of treating people with mental illness?
Reply:
President,
The Government is committed to promoting mental health of the public and will
adjust the mode for delivery of mental health services having regard to social
needs and international development. As the mental health policy and provision
of related service programmes involve a number of policy bureaux and government
departments, the Food and Health Bureau assumes the overall responsibility of
co-ordination and works in close collaboration with the Labour and Welfare
Bureau (LWB), Department of Health (DH), Hospital Authority (HA), Social Welfare
Department (SWD) and other relevant government departments.
(a) A Community Treatment Order (CTO) requires persons with mental illness to
receive designated treatment while living in the community. As the proposal of
implementing a CTO in Hong Kong will have far-reaching implications on both
patients and society in a number of aspects, such as protection of patients'
personal data and privacy, as well as human rights and the scope of authority of
healthcare professionals, thorough consideration and extensive discussion by the
public is necessary. The Working Group of Mental Health Services under the
chairmanship of the Secretary for Food and Health has set up a Focus Group on
Community Treatment Order in 2010 to study the experience and the relevant
legislation of overseas jurisdictions in detail and the applicability of CTO in
the local context. As the study is still in progress, we are unable to set out
an exact timetable for the legislation.
(b) The existing Mental Health Ordinance, as well as the medical and
rehabilitation services and follow-up models provided by various departments
through multi-disciplinary and cross-sectoral collaboration, have effectively
ensured that patients are given timely treatment and proper care in the course
of recovery. When providing medical services and treatment to patients,
healthcare professionals must take into account patients' preferences and
rights. Doctors of public hospitals and clinics have upheld professional ethics
and spirit, which require them to seek consent from patients for treatment and
respect patients' decision of not receiving treatment. However, the Mental
Health Ordinance provides that where a patient is suffering from mental disorder
of a nature or degree which warrants his/her detention in a mental hospital for
observation; and ought to be so detained in the interests of his/her own health
or safety or with a view to the protection of other persons, a court may order a
patient to receive compulsory treatment in a mental hospital.
Besides, HA also has an established mechanism in place to conduct risk
assessment for patients of out-patient psychiatric clinics who fail to attend
follow-up consultations as scheduled, so as to determine the appropriate
follow-up actions and support for the patients. If these patients are high-risk
patients who are categorised as priority follow-up cases, HA will arrange
community psychiatric nurses to conduct outreach visits in order to provide
special follow-up for them.
As thorough consideration and extensive consultation is necessary to assess the
applicability of CTO in the local context, our main task currently is to enable
the public to understand the various service models and directions for the
treatment of mental illness and support for mental patients and ex-mentally ill
persons, as well as the importance of prevention and early treatment. We also
endeavour to promote public acceptance of ex-mentally ill persons and enhance
community support for them.
Towards this end, HA promotes mental health through its psychiatric departments
to raise public awareness of the importance of mental health. Its "Child and
Adolescent Mental Health Community Support Project" promotes mental health among
youngsters and their parents through the schools and community youth centres. DH
has included mental health in its public health education programme, whereas SWD
also conducts community mental health educational activities through the
Integrated Community Centres for Mental Wellness.
(c) In view of the steadily increasing public demand for psychiatric services,
the Government and HA have continuously allocated additional resources and
manpower to meet the service needs. In the past five years, the Government has
increased funding allocation for mental health services by about 30%, from $3.39
billion in 2007-08 to $4.58 billion in 2011-12. Out of these expenditures, total
government expenditure on the provision of HA's psychiatric services (including
in-patient services, specialist out-patient services, community outreach
services and day hospital services) has increased from $2.67 billion in 2007-08
to over $3.52 billion in 2011-12, representing an increase of nearly 32%; and
total government expenditure on the provision of SWD's community rehabilitation
services (including residential care services, community support services, day
training and vocational rehabilitation services for ex-mentally ill persons) has
also increased from $720 million to $1.06 billion during the same period,
representing an increase of 47%.
On the manpower of psychiatric services, the net growth rate of manpower of the
multi-disciplinary teams of HA's mental health services (including doctors,
nurses and allied health professionals) was over 400 in the past five years,
representing an increase of about 18%.
In respect of the Case Management Programme, HA has extended the programme from
three districts to five more districts in 2011-12 and plans to further extend it
to four more districts (Kowloon City, Southern, Central and Western and Islands)
in 2012-13. As at the end of March 2012, HA has 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 with severe mental illness living in
these districts.
Looking ahead, HA will continue to deploy and adjust its manpower flexibly and
devise service planning, having regard to the development of psychiatric
services, so as to meet the community needs for mental health services.
Ends/Wednesday, June 27, 2012
Issued at HKT 12:43
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