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Following is a question by the Hon Wong Sing-chi and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (May 27):
Question:
Recently, a woman suspected to have a mental illness seizure was alleged to have killed her mother at home. In October last year, a mentally ill woman killed herself after killing her son and daughter. Although the mental patient in the latter case had been assessed to be of high risk by social workers, psychologists and occupational therapists, the attending doctor permitted the patient to be discharged without notifying the medical social worker concerned, which eventually led to the tragedy. In this connection, will the Government inform this Council:
(a) whether it knows the current number of mental patients and, among them, the number of hospitalised patients; of the average cumulative duration of hospitalisation of each patient (in terms of months); the respective current numbers of doctors, social workers, psychologists and occupational therapists in public medical institutions who provide services for mental patients; and the number of mental patients in the past five years who had killed themselves or committed the offences of inflicting harm on other people, murder or manslaughter within one year from discharge from hospital;
(b) how the systems which respectively provide psychiatric treatment and social rehabilitation service coordinate with each other in making arrangements for mental patients about to be discharged, including the procedures involved, the criteria for determining whether the patients may be discharged, as well as the communication on the provision of the follow-up services needed by the patients; and how many mental patients who had been assessed to be of high risk were discharged from hospital in the past five years; and
(c) given that in reply to a question raised by a Member of this Council on 4 February this year, the authorities advised that during the period from 2001-2002 to 2008-2009, the Government provided additional funding to the Hospital Authority and the Social Welfare Department to support a number of initiatives to improve the treatment and rehabilitation services for mental patients, of the relevant details and the number of personnel deployed to undertake the follow-up work; and the latest progress in the implementation of the policy decisions on the rehabilitation services for ex-mentally ill persons set out in the White Paper on Rehabilitation?
Reply:
President,
(a) The number of psychiatric patients (including inpatients, patients at specialist out-patient (SOP) clinics and day hospitals) and the number of psychiatric inpatients of the Hospital Authority (HA) in the past five years (i.e. from 2004-05 to 2008-09) are shown in Annex 1.
Psychiatric inpatients of HA can be classified as acute patients and those in other categories (including non-acute patients, new long-stay patients and old long-stay patients). In 2008-09, the overall average length of stay of psychiatric inpatients was around two months. For acute psychiatric inpatients, the average length of stay was less than a month and for psychiatric inpatients in other categories, the average length of stay was around 14 months. HA does not have statistics on psychiatric patients who committed suicide or committed the offence of inflicting harm on other people, murder or manslaughter within a year after discharge from hospital. HA is currently exploring the establishment of a database to collect data in this respect.
Psychiatric services provided by HA include inpatient, SOP, day hospital and community outreach services. As at March 31, 2009, the healthcare staff providing psychiatric services in HA comprises 288 psychiatrists, 1 880 psychiatric nurses, 37 clinical psychologists, 131 occupational therapists and 197 medical social workers stationed in various public hospitals and SOP clinics by the Social Welfare Department (SWD).
(b) Before the discharge of psychiatric inpatients, a pre-discharge risk assessment is conducted by HA's psychiatric healthcare staff. The scope of the assessment covers the extent of the patients' recovery, their propensity to violence, suicidal tendency, their compliance in drug taking and attending follow-up consultations, and the availability of family and community support etc.
Generally, if patients are assessed to be suitable for discharge, the hospital will arrange for the patient to receive community rehabilitation support service to help them adapt to community life. Follow-up treatment at psychiatric SOP clinics or psychiatric day hospitals or visits by psychiatric community nurses will be arranged for them by HA's healthcare staff having regard to their treatment and rehabilitation needs. Referrals to medical social workers will also be made in the light of their welfare and other needs. Medical social workers will provide counselling service for needy patients and their families to help them cope with emotional, family, caring support and interpersonal relationship problems arising from their illnesses, and refer them for application for various rehabilitation services and community support services such as the Community Mental Health Link and Community Mental Health Care.
As for high-risk psychiatric patients who are categorised for priority follow-up, the hospital will assign senior psychiatrists to review the recommendations for their discharge. These patients will only be discharged after the senior psychiatrist has endorsed the recommendations for their discharge and completed the review process. HA will arrange community psychiatric nurses to provide special post-discharge follow-up services, including advanced home visits, to these high-risk patients categorised for priority follow-up. Besides, arrangements will also be made for senior psychiatrists to attend their follow-up consultation sessions at psychiatric SOP clinics as far as possible so as to enhance the support for these discharged high-risk patients. The approximate number of high-risk psychiatric inpatients who were categorised for priority follow-up during their stay in hospital and who required community follow-up by community psychiatric nurse between 2004-05 and 2008-09 are shown in Annex 2.
(c) From 2001-02 to 2008-09, the Government has provided a total of $250 million additional recurrent funding to HA and $76.1 million to SWD to support a number of new initiatives to improve the treatment and rehabilitation services for mental patients. To further strengthen the community psychiatric services and community support for newly discharged psychiatric patients, HA has launched the Recovery Support Programme for psychiatric patients in the community in 2009-10. Under this Programme, hospital clusters are provided with additional community psychiatric nurses to provide community support to discharged psychiatric patients through a case management approach so as to facilitate their early recovery and integration into the community. New service initiatives launched by HA and SWD since 2001-02 are detailed in Annex 3.
The latest implementation progress of HA and SWD of the recommendations on rehabilitation services for ex-mentally ill persons as set out in the White Paper on Rehabilitation since the publication of the paper in 1995 is in Annex 4. In the light of the change in social circumstances such as population, livelihood and economic changes, the Rehabilitation Advisory Committee has completed the review of the Rehabilitation Programme Plan (the Plan) in 2007 to set out and update the strategic directions for the development of rehabilitation services in different areas (including rehabilitation services for ex-mentally ill persons). Relevant policy bureaux/government departments and organisations will continue to implement the recommendations in the Plan.
Ends/Wednesday, May 27, 2009
Issued at HKT 12:49
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