Replies to LegCo questions

LCQ20: Community support services for patients with mental illness

Following is a question by the Hon Chu Hoi-dick and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December 14):

Question:

It has been reported that the estimated number of patients with mental illness in Hong Kong ranges between 1 million and 1.7 million at present, with around 200 000 of them suffering from severe mental illness (SMI). Besides, there are about 48 000 people diagnosed as having schizophrenia and such number shows an upward trend. The Social Welfare Department (SWD) re-organised its mental health support services in October 2010 by setting up 24 Integrated Community Centres for Mental Wellness (ICCMWs) in various districts across the territory. Moreover, since April 2010, the Hospital Authority (HA) has implemented in phases the comprehensive case management programmes in different districts across the territory for patients with SMI considered suitable for treatment in community settings. However, some mental illness concern groups have pointed out that the community support services cannot cater for the needs of patients, especially those who suffered from schizophrenia. Such patients, during convalescence, usually take oral medication to control their conditions over a long period of time. Since some of them do not take medication on time, nor do they attend regular follow-up consultations at clinics, the treatment procedures become less effective and the patients relapse. Those concern groups have also pointed out that in recent years, quite a number of overseas places have administered the second generation anti-psychotic injection drugs (injection drugs) which have effectively reduced the chances of relapse and relieved the pressure on the healthcare facilities and services related to mental illness. Regarding the provision of support services for patients with mental illness, will the Government inform this Council:

(1) of the following information in respect of each of the ICCMWs in each of the past three years: (i) the staffing establishment and the number of staff, broken down by rank, (ii) the amount of funding received, (iii) the number of members broken down by type of mental illness (including schizophrenia), (iv) the number of cases handled and (v) the respective numbers of family members and carers of patients with mental illness for whom services were provided;

(2) given that SWD in the past did not have information on cases handled by ICCMWs in respect of patients with SMI or general mental illness, whether SWD will expeditiously collect such information to facilitate follow-up actions; if SWD will, of the details; if not, the reasons for that;

(3) whether it knows the following information in respect of each of the comprehensive case management programmes implemented by HA in each of the past three years: (i) the staffing establishment and the number of staff, broken down by rank, (ii) the amount of funding received and (iii) the number of cases handled broken down by type of mental illness;

(4) whether it knows, among the existing patients with schizophrenia at convalescence stage, the number and percentage of those who have relapsed and the relevant reasons; the percentage of cases in which the relapse is attributable to discontinuation of follow-up treatment or medication on patients' own initiative in the total number of relapse cases; whether HA has put in place specific measures to ensure that patients receive follow-up treatment on a regular basis and take medication on time; if HA has, of the details; whether HA has assessed the effectiveness of such measures; if HA has assessed, of the criteria adopted;

(5) as HA's guidelines provide that (i) patients with schizophrenia will first be prescribed new oral medication, (ii) and if they are found to have failed to take medication according to instructions, they will be prescribed the first generation injection drugs, (iii) but if they suffer from prominent side effects after taking the first generation injection drugs, they will be prescribed the second generation injection drugs which have less side effects, whether the Government knows, among the patients with schizophrenia at convalescence stage in the past three years, the number and percentage of those who were prescribed the second generation injection drugs on a regular basis; whether it has studied if that percentage is lower than those in advanced countries; if it has studied and the outcome is in the affirmative, of the reasons for that;

(6) whether it knows the expenditures incurred by HA in the past three years on prescribing the second generation injection drugs; whether HA has assessed (i) the clinical outcome and (ii) the short, medium and long term cost-effectiveness, of prescribing that type of injection drugs; if HA has, of the details; if not, the reasons for that;

(7) whether it knows if HA will allocate additional resources so that all patients with schizophrenia at convalescence stage may be prescribed the second generation injection drugs; if HA will, of the details; if not, the reasons for that; whether HA will include the second generation injection drugs in its Drug Formulary so that more patients can receive appropriate treatment; and

(8) whether it has plans to conduct studies on the mental health conditions of members of the public; if it does, of the details; if not, the reasons for that?

Reply:

President,

My reply to the various parts of the question is as follows:

(1) According to the information provided by the Labour and Welfare Bureau, in each of the the past three years, the resources allocated to Integrated Community Centres for Mental Wellness (ICCMWs) by the Government is as follows:

	2013-14 (Actual)	2014-15 (Actual)	2015-16 (Revised Estimate)
Amount of Funding ($ million)	221.6	254.8	281.1

According to the Funding and Service Agreements of ICCMWs, the essential staffing requirements of ICCMWs include social workers, psychiatric nurses and occupational therapists. The existing manpower of a notional team of ICCMW comprises 26 posts, including 17 social workers, two psychiatric nurses, one occupational therapist and six supporting staff. However, under the Lump Sum Grant Subvention System, ICCMWs have the flexibility to deploy the subvention in arranging suitable staffing, which includes essential staff to ensure service quality to meet service needs. As the size of population served by the 24 ICCMWs varies, the team size and the allocation that they obtain are therefore different.

The statistics on the number of members, number of cases and number of family members/carers served by the 24 ICCMWs in the past three years are tabulated below:

24 ICCMWs	2013-14	2014-15	2015-16
Number of members served *	24 294	25 662	26 524
Number of cases served (as at the end of March of the financial year)	12 108	12 593	12 435
Number of family members/carers served	3 395	2 587	3 069

* The Social Welfare Department (SWD) does not maintain information on members classified by the types of their mental illnesses

(2) The caseworkers at ICCMWs will collect information on service users' diagnosis in handling cases, seek information from the Hospital Authority (HA) on their medical conditions to facilitate assessment, and formulate appropriate care and follow-up plans according to the background and needs of the service users. ICCMWs will continue to collect such information for caseworkers to follow up individual cases. As ICCMWs can, on the basis of the aforementioned information collected and make reference to the number of psychiatric cases in Hong Kong (including figures on both general and severe mental illness cases) provided by HA, follow up individual cases and service planning, the SWD does not have plan to separately collect information on cases in respect of patients with severe mental illness or general mental illness handled at ICCMWs.

(3) and (4) Since the 2010-11 financial year, the HA has rolled out the Case Management Programme (CMP) in different districts of Hong Kong by phases for patients with severe mental illness. Under the Programme, case managers (including psychiatric nurses, occupational therapists and registered social workers, etc.) work closely with other service providers, particularly ICCMWs set up by the SWD, in providing intensive, continuous and personalised support for patients with severe mental illness. In the 2014-15 financial year, the Programme was extended to cover all 18 districts across the territory to benefit more patients. As at March 31, 2016, the HA employed a total of 327 case managers to provide personalised and intensive community support for over 15 400 patients with severe mental illness.

The respective numbers of case managers and cases handled under the CMP in the past three years are tabulated below:

Financial year	Number of case managers (as at March 31 of the year)	Number of cases handled (as at March 31 of the year)
2013-14	260	14 600
2014-15	301	15 600
2015-16	327	15 400

As at March 31, 2016, the staffing establishment of case managers for the CMP is tabulated below:

Professional discipline	Number of staffs
Psychiatric Nurses	240
Occupational Therapists	62
Registered Social Workers	24
Others	1

From the 2015-16 financial year onwards, the HA introduced a peer support element into the CMP to enhance community support for patients with severe mental illness. The HA currently employs a total of 10 rehabilitated ex-service users to serve as peer supporters, who help patients with severe mental illness achieve their individual rehabilitation goals and acquire the skills to manage their mental health problems.

As some of the resources for the CMP is shared with other services, the relevant expenditure for the services provided under the CMP cannot be calculated separately.

On the other hand, the HA has established a psychiatric advisory hotline, namely Mental Health Direct, since January 2012 to further enhance mental health services and strengthen support for ex-mentally ill patients and their carers. The hotline is operated 24-hour by professional psychiatric nurses, who answer calls from patients with mental illness, carers, relevant stakeholders and the public, to provide professional advice on mental health issues and arrange timely referrals for them. Aside from advisory service, the Mental Health Direct also provides telecare service whereby psychiatric nurses will approach rehabilitated ex-mentally ill patients to follow up their conditions and help them better adapt to community life. Moreover, for those patients with mental illness failing to show up for scheduled consultations, a follow-up service under the Mental Health Direct has been rolled out in phases in all hospital clusters, through which such patients will be approached and new appointment for follow-up consultation will be made for them. The service has now been extended to most of the psychiatric specialist out-patient clinics.

The HA provides continuous and personalised follow-up services for patients with severe mental illness. As the needs of these patients may vary in different stages and there is no single clinical definition of "relapse", the HA does not have relevant figures of relapse cases.

The HA will continue to review and monitor its services to ensure that they suit the needs of patients.

(5), (6) and (7) Over the years, the HA has been making every effort to increase the use of new generation psychiatric drugs which have proven effectiveness with fewer side effects, including antipsychotic drugs, antidepressant drugs, and drugs for dementia and attention deficit/hyperactivity disorder. Taking the patients' wish into account, psychiatrists will provide necessary drug treatment for patients as appropriate, having regard to their clinical needs and in accordance with the clinical treatment protocol. The number of patients prescribed with the new generation antipsychotic drugs at public hospitals has increased from about 39 200 in the 2010-11 financial year to 67 000 in the 2014-15 financial year, representing an increase of 70 per cent.

In the 2014-15 financial year, the HA repositioned the new generation oral antipsychotic drugs (save for Clozapine due to its more complicated side effects) from the special drug category to the general drug category in its Drug Formulary so that all these drugs could be prescribed as first-line drugs.

The new generation long-acting antipsychotic ampoule is currently incorporated into the special drug category of HA's Drug Formulary. Psychiatrists will provide necessary drug treatment for patients as appropriate, having regard to their clinical needs and in accordance with the clinical treatment protocol. The number of patients who received the new generation long-acting antipsychotic injections at public hospitals in the past three years and the expenditure involved are tabulated below:

Financial year	Number of patients who received the new generation long-acting antipsychotic injections	Expenditure involved ($ million)
2013-14	1 500	43
2014-15	1 900	56
2015-16	2 200	72

Besides, the HA has put into place an established mechanism under which experts will examine and review regularly the treatment options and drugs for patients with adjustments made as appropriate, taking into account factors like scientific evidences, clinical risks and treatment efficacy, technological advancement and views of patient groups, etc. The HA will continue to closely monitor the latest development of the clinical and scientific evidences of new psychiatric drugs. It will also continue to review and introduce new drugs, and formulate guidelines for clinical use of such drugs in accordance with the established mechanism having regard to the principle of optimising the use of limited public resources and providing appropriate treatment for as many needy patients as possible.

(8) In January 2016, the Department of Health (DH) launched a three-year territory-wide public education and publicity programme named Joyful@HK. Joyful@HK Campaign aims to increase public engagement in promoting mental well-being and to enhance their knowledge and understanding on mental health. Under the Campaign, the DH commissioned the Department of Psychiatry of the Chinese University of Hong Kong to conduct a Mental Health and Well-being Survey, with a view to examining the mental health status of the public, the public's awareness of symptoms of common mental health problems, willingness towards seeking help, and the attitude and practice of the public on pro-mental well-being lifestyle activities.

The DH will continue to promote mental health among various groups of citizens and conduct health education on common mental health problems through the Joyful@HK Campaign. The aim is to enable members of the public to integrate three key elements of the Campaign, namely "Sharing", "Mind" and "Enjoyment", into their daily lives for enhancing their mental well-being, and encouraging them to seek help from professionals when necessary.

Ends/Wednesday, December 14, 2016
Issued at HKT 17:05
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