Replies to LegCo questions
LCQ14: Mental health services
Following is a question by the Hon Alice Mak and a written reply by the
Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today
(December 19):
Question:
It has been learnt that several incidents in which persons suspected of
suffering from mental illnesses wounded other people have happened recently.
Although the Hospital Authority (HA) has, in recent years, allocated additional
resources to strengthen mental health services and implemented the Case
Management Programme for people with severe mental illness (the Programme) since
2010-2011, incidents involving mentally-ill persons wounding other people still
happen, arousing public concern about whether community support provided by the
authorities to the mentally-ill and the ex-mentally-ill remains inadequate. In
this connection, will the Government inform this Council:
(a) whether the authorities have compiled statistics on the number of
mentally-ill persons in the territory; whether they know, apart from some 187
000 mentally-ill persons currently receiving psychiatric specialist services
provided under HA, the number of mentally-ill persons currently receiving
treatment (including medical treatments and psychotherapy) in other medical
institutions; of a breakdown of the current number of mentally-ill persons, by
the type of mental illness and risk level, who have undergone risk assessment by
HA's multi-disciplinary team of healthcare personnel and been considered
suitable for discharge from hospital to continue to receive treatment and
rehabilitation in the community;
(b) whether it knows, the number of mentally-ill persons currently waiting for
HA's psychiatric out-patient services and their average waiting time; the
respective numbers of psychiatrists, psychiatric nurses and psychiatric medical
social workers currently employed by HA;
(c) whether it knows, the respective numbers of case managers and community
nurses currently involved in implementing the aforesaid Programme, and the
respective average numbers of mentally-ill persons followed up by each case
manager and each community nurse; whether the authorities have assessed the
effectiveness of the Programme; if they have, of the assessment results; if not,
the reasons for that;
(d) whether it knows, the number of requests for help received by the 24-hour
mental health hotline provided by HA to West Kowloon since the service was
launched in January this year, and the number of persons who had been referred
to receive psychiatric treatment; whether HA has plans to expand such service to
cover other districts;
(e) given that the turnover of psychiatric nurses in public hospitals has been
on the rise in the past five years, whether the authorities have plans to step
up recruitment and training of psychiatric nurses so as to maintain service
quality; if they have, of the details; if not, the reasons for that; and
(f) given that the authorities had indicated earlier that, at district level,
the Social Welfare Department and HA maintained close liaison with other related
government departments (including the Hong Kong Police Force and the Housing
Department), whether the authorities have assessed the effectiveness of the
existing inter-departmental communication mechanism established to provide
support for mentally-ill persons; if they have, of the assessment results; if
not, the reasons for that; of the measures taken by the authorities to further
strengthen HA's cooperation with relevant government departments, so as to
follow up mentally-ill persons' rehabilitation in the community more
effectively?
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. It is the international trend to gradually
focus on community and ambulatory services in the treatment of mental illness,
and to allow the early discharge of mental patients when their conditions are
stablised for treatment in the community. Hence, in recent years the Government
has strengthened its community psychiatric services in line with this direction
in an effort to allow more patients who are suitable for discharge to receive
treatment in the community, so that they can re-integrate into the community and
start a new life as early as possible. The Government has increased the funding
allocation for mental health services on a continuous basis. The actual
expenditure in 2011-12 increased by about 30% when compared with that in
2007-08, with the total amount of expenditure for the past five years exceeding
$19 billion.
My reply to the various parts of the question is as follows:
(a) At present, about 187 000 patients with varying degree of mental health
problems are receiving psychiatric specialist services provided by the Hospital
Authority (HA). The more common types of mental disorders among the patients
currently followed up by HA can be broadly classified in Annex.
To facilitate early identification and appropriate follow-up of mental patients
with special needs, HA will, according to the clinical conditions of individual
patients (including their medical history, existing mental conditions, whether
there is adequate support for the patients in the community, etc), broadly
categorise them into three types according to their risk level: (i) for patients
assessed to be of higher risk, such as those with greater propensity to violence
or record of severe criminal violence, HA will arrange community nurses or case
managers with experience in community mental health service to follow up on
their cases continuously, closely and in an intensive manner, including making
arrangements for them to be admitted into hospital for treatment where
necessary; (ii) for patients assessed to be of medium risk, e.g. those with
general severe mental illness, their case managers will provide them with
continuous and personalised support according to their clinical conditions so as
to help them recover and re-integrate into the community when their conditions
are stabilised; (iii) for those assessed to be of low risk, such as those with
common mental disorders, attending doctors will provide them with suitable
treatment, including providing them with vocational rehabilitation services,
etc. according to their clinical needs. In addition, the multi-disciplinary
teams of psychiatric departments will review each case on a regular basis having
regard to the needs of individual patients and their risk profiles, to ensure
that the patients are given suitable and comprehensive support.
We do not have statistics on the number of mental patients receiving treatments
or follow-ups within the private medical sector.
(b) As at the end of September 2012, the median waiting time for first
appointment at psychiatric specialist out-patient clinics under HA is around
seven weeks, and the number of persons waiting for treatment is about 13 000. At
present, there are about 330 psychiatrists, 2 160 psychiatric nurses and 240
psychiatric medical social workers providing services for patients at
psychiatric specialist out-patient clinics under HA.
(c) To enhance the community support services for mental patients, HA first
launched a Case Management Programme in three districts (Kwun Tong, Kwai Tsing
and Yuen Long) for patients with severe mental illness in April 2010. 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. Besides, case managers also provide support for the patients'
families so as to help patients reintegrate into the community in all
dimensions. By 2012-13, HA has progressively extended the Programme to a total
of 12 districts (namely, Eastern, Wan Chai, Southern, Central and Western,
Islands, Kwun Tong, Sham Shui Po, Kowloon City, Kwai Tsing, Sha Tin, Tuen Mun
and Yuen Long) to benefit more patients. As at the end of September 2012, HA
employed a total of 195 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 over 11 000 patients living in
these districts.
Currently, each case manager is providing community support to some 50 to 60
patients. The workload varies from one case manager to another, depending on
factors such as patients' clinical conditions and degrees of risk, etc. HA will
continue to recruit more case managers to further strengthen its manpower as
well as deploying and adjusting its manpower flexibly having regard to the
operational needs and service demands in order to meet the needs of various
districts.
Regarding assessment of the Programme, HA has commissioned the Department of
Psychiatry of the University of Hong Kong to undertake a detailed study and
analysis of the implementation and effectiveness of the Case Management
Programme. The findings of the study are expected to be released in mid 2013.
(d) The Mental Health 24-hour Hotline service has been in operation for more
than 30 years with the whole local population as its service targets. Since
January 2012, HA has further strengthened the service by deploying psychiatric
nurses to provide telephone psychiatric support service to members of the public
from various districts in the territory, and named the hotline as "Mental Health
Hotline". As at the end of September 2012, the "Mental Health Hotline" handled a
total of over 11 300 phone calls. Most of the users of the service were patients
currently receiving psychiatric services provided by HA while the rest were
family members of patients as well as members of the public.
(e) The turnover rate of HA's psychiatric nurses has remained stable at 2% - 3%
over the past three years. In recent years, tremendous efforts have been made by
HA to recruit psychiatric nurses. In the past three years, the number of
psychiatric nurses recruited increased from 48 in 2009-10 to 99 in 2011-12.
On the training front, we anticipate that in the coming years, there will be
some 160 newly graduated psychiatric nurses each year. The Institute of Advanced
Nursing Studies of HA will run three to four psychiatric training courses each
year and it is expected that these courses will on average produce over 140
psychiatric nurses each year between 2012-13 and 2015-16. Looking ahead, HA will
continue its efforts to recruit and train more nurses to meet the service
demand.
(f) 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, Department of Health,
HA, SWD and other relevant government departments. The directions of our mental
health policy is to adopt a multi-disciplinary and cross-sectoral team approach
in delivering a comprehensive range of mental health services which are
accessible by people in need on a continuous basis. We have also put in place a
platform for communication and a mechanism for co-ordination at various levels
to foster collaboration between the medical and social service sectors.
At the level of policy formulation, we have a Working Group on Mental Health
Services chaired by the Secretary for Food and Health and comprised of
stakeholders with relevant service experience from the medical, social service
and other related sectors to assist in the formulation and review of our mental
health policy and services.
At the level of service delivery, SWD Headquarters and HA Head Office have,
since 2010, set up a Central Co-ordinating Group in collaboration with the
non-governmental organisations operating ICCMW to discuss the co-ordination of
the service strategies and explore more effective models of collaboration.
At district level, District Social Welfare Officers of SWD and the Chiefs of
Service of the Department of Psychiatry in various HA clusters hold working
group meetings at regular intervals to maintain close liaison with psychiatric
medical social workers and ICCMWs in the respective districts as well as other
relevant Government departments, including the Police and the Housing
Department. When handling cases involving mental patients, various departments
will hold case conferences where necessary in order to formulate rehabilitation
plans for the patients. The existing multi-disciplinary team approach and the
inter-department communication mechanism are functioning effectively. We will
continue to strengthen our co-ordination role and provide more comprehensive and
intensive support for mental patients.
Ends/Wednesday, December 19, 2012
Issued at HKT 15:24
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LCQ14 Annex