Replies to LegCo questions

LCQ16: Mental health services of Hospital Authority

Following is a question by the Dr Hon Chiang Lai-wan and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (June 25):

Question:

In 2012-2013, the public hospitals and psychiatric specialist out-patient clinics (SOPCs) of the Hospital Authority (HA) provided treatment and support services to more than 195 000 persons with mental health problems. As at March 31, 2013, there were 334 doctors (including psychiatrists) in the psychiatric service departments of HA, and the doctor-to-patient ratio was 1 to 583. There are views that the ratio reflects a serious manpower shortage of psychiatrists. Regarding public mental health services, will the Government inform this Council:

(1) whether it knows the respective numbers of serving psychiatrists and vacancies of psychiatrists in HA, as well as the changes in the number and percentage in the manpower of psychiatrists in each of the past 10 years, with a tabulated breakdown by rank and hospital cluster; whether HA has any plan to fill the aforesaid vacancies and provide additional resources for the training of psychiatrists; if HA has, of the details; if not, the reasons for that;

(2) whether it knows the number of psychiatric patients seeking medical treatment from public hospitals or SOPCs in each of the past 10 years, with a tabulated breakdown by year, type of services (in-patient services, out-patient services and day services) and hospital cluster;

(3) whether it knows the criteria adopted by SOPCs for determining the seriousness and urgency (i.e. priority 1, priority 2 and routine category) of psychiatric cases;

(4) whether it knows the number of cases, in each of the past five years, in which the mental patients no longer needed further treatment after treatment;

(5) of the procedures adopted by the authorities for following up the reports made by members of the public on nuisances caused by persons suspected to be mental patients or by persons with erratic behaviours; and the measures in place to prevent such persons from causing further nuisances to others when they refuse to receive treatment or follow-up services;

(6) whether it knows if HA's psychiatric community outreach services have taken the initiative to reach out for suspected mental patients and provide them with suitable services at the earliest opportunity; if they have, of the details; if not, the reasons for that;

(7) whether it has studied the feasibility of introducing a registration system for clinical psychologists and counsellors, with a view to enhancing the professional services provided to people suffering from emotional problems and reducing their prospect of developing mental illnesses; if it has, of the details; if not, the reasons for that; and

(8) given that recently, there have been several homicide cases allegedly committed by persons suspected to be suffering from seizures of mental illness (e.g. cases of shooting in Kai Ching Estate, a mother hacking her daughter to death at Wing Cheong Estate, and a chair falling from height in Mong Kok causing the death of a pedestrian), whether the authorities will conduct a comprehensive review on the services currently available to psychiatric patients (including interventions and rehabilitation treatments), and expedite the study on the need and feasibility of introducing community treatment orders for protection of public safety; if they will, of the details; if not, the reasons for that?

Reply:

President,

(1) The Hospital Authority (HA) adopts an integrated approach in providing a wide range of mental health services, including in-patient, out-patient, day hospital and community psychiatric services, through multi-disciplinary teams comprising psychiatrists, clinical psychologists, occupational therapists, psychiatric nurses, community psychiatric nurses and medical social workers, etc.

With a growing and ageing population, there is an increasing demand for frontline public healthcare services, including mental health services. The HA will increase healthcare manpower where necessary to meet service demand. At present, there are 337 psychiatrists under the HA. The turnover rate of full-time psychiatric doctors ranged from 2% to 5% in the past five years. The HA will continue to closely monitor the manpower situation and make the necessary planning and deployment arrangements to cope with service demand.

Over the years, the HA has put in place a number of measures to enhance training for doctors, such as enhancing simulation training, funding doctors to receive overseas training as well as sponsoring overseas doctors to provide training in local hospitals. The HA will continue to implement such measures to improve its service quality.

(2) The number of patients receiving various types of psychiatric services provided by the HA in the past five years (2009-10 to 2013-14) is set out in the Annex.

(3) The psychiatric specialist out-patient clinics (SOPCs) under the HA adopt a triage system for handling new cases to ensure that patients with urgent healthcare needs are attended to within reasonable time. Under the triage system, SOPCs will arrange medical appointments for new patients based on the urgency of their clinical conditions, which is determined with regard to the patients' clinical history and presenting symptoms. The triage system groups patients into priority 1 (urgent), priority 2 (semi-urgent) and routine categories. The target of the HA is to maintain the median waiting time for cases in the priority 1 and priority 2 categories within two weeks and eight weeks respectively. In 2013-14, the median waiting time for the first appointment of priority 1 and priority 2 cases at psychiatric SOPCs was around one week and four weeks respectively.

(4) The HA does not have the figures and information requested in Part 4 of the question.

(5) and (6) Any member of the public who discovers any person with suspected mental health problems in the community may, with the consent of the person concerned, seek help from the Integrated Community Centres for Mental Wellness (ICCMWs) of the Social Welfare Department in the various districts. The ICCMWs will provide appropriate community support for the person concerned, including referring him to the psychiatric services of the HA in different hospital clusters.

Besides, according to section 31 of the Mental Health Ordinance (Cap. 136), an application may be made by the HA to a District Judge or magistrate for detention of a patient who is suffering from mental disorder of a nature or degree which warrants his detention in a mental hospital for at least a limited period for observation, in the interests of the patient's own health or safety or with a view to the protection of other persons.

Patients who are recovering from severe mental illness and living in the community are provided with intensive, continuous and personalised support under the Case Management Programme of the HA. For patients assessed to be at high risk, including those with propensity to violence or record of severe criminal violence, the crisis intervention teams of the HA will provide them with special outreach service and timely intervention including referrals to appropriate treatment.

The HA has also established a 24-hour psychiatric hotline - Mental Health Direct - to support patients with mental illness and their carers. The hotline is operated by professional psychiatric nurses who will provide support to patients, their carers and other stakeholders on mental health issues.

(7) To ensure public health and protect members of the public against health hazards due to improper or sub-standard healthcare services, the Government has in the past enacted different legislation to regulate the relevant healthcare personnel and institutions, the sale of drugs, undesirable medical advertisements as well as unfair trade practices. Moreover, the Department of Health has promulgated various guidelines and codes of practice and put in place monitoring and reporting system, market assessment, risk monitoring and reporting measures to monitor different areas of healthcare services. Healthcare disciplines currently not subject to statutory regulation are also regulated by the relevant legislation.

The Food and Health Bureau (FHB) is conducting a strategic review on healthcare manpower planning and professional development which covers the direction for future development of healthcare professions. We will take this opportunity to consider whether regulation of healthcare professions currently not subject to statutory registration requirements should be enhanced in one form or another.

(8) To ensure that our mental health regime can rise up to the challenges of a growing and ageing population, FHB has embarked on a review of the existing mental health policy and services through the setting up of a Review Committee on Mental Health in May 2013, with a view to mapping out the future development of mental health services in Hong Kong. The review committee will also consider necessary changes to the Mental Health Ordinance, including the need and feasibility of introducing community treatment order in Hong Kong having regard to overseas experiences and local circumstances. It should be noted that the introduction of community treatment order in other jurisdictions had aroused much controversy in local community. Due to its complexity in operation, the involvement of such issues as patients' rights and human rights, and that the efficacy of community treatment order remains to be proved by scientific evidence, the review committee needs to carefully study and balance all relevant considerations before making objective recommendations that suit local circumstances.

Ends/Wednesday, June 25, 2014
Issued at HKT 16:21

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LCQ16 Annex