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Following is a question by the Hon Miriam Lau and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 10):
Question:
On May 29 this year, a man suspected to have a mental illness seizure was alleged to have chopped a three-year-old toddler to death, while the toddler's father was also chopped and seriously injured. It is learnt that this was the sixth wounding case involving mental patients in the past 11 months and also the third fatal case involving mental patients since May this year. The authorities have indicated that the existing policy on the treatment of mental patients is to allow patients with stable conditions to return to the community and be controlled by medications and followed up by healthcare staff and social workers. Yet, the policy cannot give a 100% guarantee that similar incident will not occur. It has been reported that about 140,000 out of the 150,000 mental patients in Hong Kong are currently living in the community, but the number of healthcare staff and social workers providing the relevant support services is inadequate. In this connection, will the Government inform this Council:
(a) whether it will re-examine the policy of allowing mental patients to return to the community; if so, of the details; if not, the reasons for that;
(b) whether it has assessed if the existing manpower and resources for providing follow-up services to mental patients after their discharge and return to the community are adequate; whether the authorities have set the ratios of discharged mental patients to psychiatrists, nurses and medical social workers stationed in hospital; if so, of the details; if not, the reasons for that;
(c) given that the authorities have indicated that the Working Group on Mental Health Services (Working Group), chaired by the Secretary for Food and Health, is reviewing the mental health policies in Hong Kong and will complete its report as soon as possible, but the Working Group has not reported on the work progress since its establishment in 2006, of the number of meetings held by the Working Group so far, as well as the work progress, the review direction and outcome; and
(d) given that the review of the Rehabilitation Programme Plan in Hong Kong completed by the Rehabilitation Advisory Committee in 2007 has set out strategic directions for the development of rehabilitation services including those for ex-mentally ill persons, whether the Working Group will correspondingly expedite the progress in reviewing the mental health policies and set a timetable for completing the report; when the authorities will fully implement the medical and rehabilitation programme for mental patients?
Reply:
President,
(a) In general, most mental patients have no propensity for violence and only a very limited number of them have been involved in serious violent cases. For mental patients living in the community, their life may be affected by various factors, such as employment, community life and family relationship. As such, even if they are provided with sufficient medication and regular follow-up support services, such as community psychiatric outreach service, the conditions of individual patients may still undergo unforeseeable changes. The recent incident involving a mental patient is grievous.
According to the research findings and the accumulated experience of international and local experts in psychiatry, allowing the early discharge of mental patients in stabilised condition to receive rehabilitation service in the community can facilitate their rehabilitation and reduce the chance of relapse of their illness. It is therefore the international trend to focus on community and ambulatory services in the treatment of mental illness. Under this direction, the Hospital Authority (HA) has in recent years kept its in-patient psychiatric services under review and launched various new programmes to enhance its community psychiatric services. These programmes (such as the Early Assessment and Detection of Young Persons with Psychosis (EASY) and the Extending Care Patients Intensive Treatment, Early Diversion and Rehabilitation Stepping Stone (EXITERS)) aim to progressively allow more suitable psychiatric patients to receive treatment in the community, thereby enhancing their prospect of re-integration into the community after rehabilitation. HA and psychiatric experts constantly review the details and arrangements regarding the implementation of the policy in light of the needs of mental patients for treatment and rehabilitation in the community.
(b) HA, the Social Welfare Department (SWD) and non-governmental organisations have been working closely together on the provision of rehabilitation service to discharged mental patients.
HA provides medical rehabilitation and community psychiatric services for discharged patients to facilitate their rehabilitation and re-integration into society. These services are delivered mainly through its integrated and multi-disciplinary community psychiatric teams comprising psychiatrists, community psychiatric nurses, clinical psychologists, medical social workers, occupational therapists, etc. The range of services provided includes risk management, home visit, telephone consultation and follow-up service. On the other hand, community psychiatric nurses of HA follow up on the discharged patients through regular visits to patients' home, half-way house or other residential places to monitor the progress of their treatment or rehabilitation. In addition, medical social workers stationed by SWD in HA psychiatric hospitals and specialist out-patient (SOP) clinics provide counselling service as well as financial and housing assistance to discharged patients and their families to help them deal with various problems arising from their illness.
In recent years, HA has enhanced the support for mental patients who are about to be discharged or newly discharged and for their families through various programmes. Since 2001, HA has launched the EXITERS to provide intensive rehabilitation training for long stay mental patients so as to facilitate their early discharge and integration into the community. The scheme also provides follow-up and support services to discharged patients. In 2008-09, HA has set up community psychiatric support teams in Kowloon West Cluster and New Territories East Cluster to provide support for frequently readmitted psychiatric patients through a case management approach so that effective follow-up care can be provided in a timely manner.
In addition, the Government has allocated an additional recurrent funding of $38.66 million to HA since 2009-10 to implement new initiatives to strengthen mental health services, including the implementation of the Recovery Support Programme for discharged mental patients in the community. The programme provides community support to needy discharged mental patients through a case management approach and involves an additional recurrent expenditure of $23.6 million. Besides, HA will set up triage clinics at the psychiatric SOP clinics in five hospital clusters (Hong Kong East, Kowloon East, Kowloon West, New Territories East and New Territories West), involving an additional recurrent expenditure of $6.8 million, to provide consultation services for new patients triaged as routine cases at psychiatric SOP clinics.
Meanwhile, SWD also provides funding to non-governmental organisations to support the provision of a range of community support services to mental patients. These community support services, which include residential care service, the Community Mental Health Link, Community Rehabilitation Day Services, Community Mental Health Care Programme, and Resource and Service Centres for families of the ex-mentally ill, aim to help discharged mental patients build up their interpersonal network and acquire daily life skills etc.
As regards manpower, HA has employed additional psychiatric staff in recent years to strengthen the support for various mental health services. For example, the number of psychiatrists in HA has increased from 212 in 2000-01 to 288 in 2008-09. The number of psychiatric nurses has also increased from 1 797 to 1 880 during the same period. The number of psychiatric medical social workers has increased from 166 in 2005-06 to 197 in 2008-09.
HA and SWD will conduct manpower planning for mental health services in the light of staff wastage and new service programmes. HA will continue to work with the Hong Kong College of Psychiatrists to strengthen the training of psychiatrists. As regards nurses, HA will also actively recruit nursing staff from graduates of university psychiatric nursing programmes and former psychiatric nurses who have left service in recent years.
The establishment of HA's healthcare staff and SWD's social workers for the provision of mental health services, including inpatient, SOP and community outreach/support services, is worked out on the basis of service demand and operational needs. Mental health services are delivered using an integrated and multi-disciplinary approach to allow flexibility in the deployment of human resources. HA and SWD have no fixed manpower ratios of patient to psychiatrist, psychiatric nurse or medical social worker in the delivery of the services.
(c) & (d) The Working Group on Mental Health Services (the Working Group) set up by the Food and Health Bureau is chaired by me and comprises professionals providing medical and rehabilitation services to mental patients, academics, representatives of the Labour and Welfare Bureau, HA and SWD. The purpose of the Working Group is to assist the Government in reviewing existing mental health services. This is a long-term and ongoing process.
The Working Group has set up a sub-group, which is tasked to study in-depth the demand for mental health services and the relevant policy measures. The sub-group is co-chaired by two members of the Working Group and comprises professionals from the healthcare and social welfare sectors. The sub-group has drawn up a preliminary framework on the objectives and directions of the mental health policy in Hong Kong. The three expert groups under the sub-group are now studying the service needs of three different age groups (adults, adolescents and elders) with a view to making proposals for service improvement in the relevant areas. The Working Group, sub-group and expert groups have held a total of 13 meetings so far.
Since mental illness is a complex health problem and mental health services cover both healthcare and rehabilitation services, I will work closely with the Secretary for Labour and Welfare and adjust or enhance the services in response to service needs. The long-term development of mental health services will be considered and formulated under the overall framework of the healthcare reform.
In the short and medium term, we will allocate additional resources on prevention, medical treatment and rehabilitation services to further improve our mental health services and enhance the community support for mental patients, so as to facilitate their early recovery and re-integration into the society. From 2001-02 to 2008-09, the Government has provided an additional recurrent funding of $250 million to HA and $86.3 million to SWD to support a number of initiatives to improve the treatment and rehabilitation services for mental patients, including various community support services.
Ends/Wednesday, June 10, 2009
Issued at HKT 14:27
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