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Following is a question by the Hon Wong Yuk-man and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 10):
Question:
I have learnt that in recent months, quite a number of members of the public have suffered from depression or other kinds of mental illnesses because they have been hard hit by the financial tsunami or they have incurred great losses in their investments in the Lehman Brothers-related financial products. Yet, the waiting time for first appointment in psychiatric specialist out-patient (SOP) clinics of public hospitals is very long. As a result, the clinical conditions of some patients have deteriorated due to a lack of proper treatment, and some of them even committed suicide. On the other hand, private psychiatric out-patient services are so expensive that the general public are discouraged from seeking consultation. In this connection, will the Government inform this Council:
(a) whether it knows the respective numbers of patients suffering from depression or other kinds of mental illnesses who committed suicide and died in the past three years;
(b) of the average waiting time for first appointment in public psychiatric SOP clinics at present;
(c) given that some depression patients indicated that because the seriousness of their illness had been underestimated, they were classified as the "routine category" with low priority and had to wait for a very long time, and some attempted to commit suicide while waiting, whether the authorities will review the existing triage system for new cases in psychiatric SOP clinics; and
(d) whether the authorities will consider subsidising mental patients with financial difficulties to receive treatment by private psychiatrists, so as to shorten the waiting time for first appointment in psychiatric SOP clinics of public hospitals?
Reply:
President,
(a) The number of suicide cases in Hong Kong, the number of suicide cases involving psychiatric patients of the Hospital Authority (HA) and the number of psychiatric patients of HA in the past three years are shown in Annex.
(b) At present, under the triage system for new appointment at psychiatric specialist out-patient (SOP) clinics at HA, new patients are classified into the following categories on the basis of the urgency of their clinical conditions: priority 1 (urgent), priority 2 (semi-urgent) and routine categories. Factors to be considered for triage of new cases include the patient's propensity to violence, risk of committing suicide, degree of depression and whether the patient has carers.
Patients assessed to have a high risk of committing suicide will be triaged as priority 1 cases or directly referred to the Accident and Emergency (A&E) Departments for hospital admission so as to ensure that these patients with urgent needs can receive timely treatment. Patients who suffer from acute psychiatric conditions and require urgent care could be admitted to hospitals for treatment via the A&E Departments. In 2008-09, the median waiting time for first appointment of priority 1 and priority 2 cases at psychiatric SOP clinics were around one week and three weeks respectively. As for new cases in the routine category, the median waiting time for first appointment was about 17 weeks.
In view of the possible increase in the number of mental patients seeking medical treatment arising from the financial tsunami, HA specially launched a six-month designated mental health clinic service in various clusters starting from January this year. Psychiatrists and psychiatric nurses are stationed at designated general out-patient clinics to provide consultation service to patients referred by general practitioners. Normally, patients referred to the designated clinics receive assessment or treatment within one to two weeks.
To further enhance its services, HA will set up triage clinics at the psychiatric SOP clinics in Hong Kong East, Kowloon East, Kowloon West, New Territories East and New Territories West clusters in July 2009. These triage clinics mainly provide services for new psychiatric SOP patients classified as routine cases so as to shorten the waiting time for these non-urgent new cases. The Government has provided HA with an additional recurrent funding of $6.8 million starting from 2009-10 to recruit additional manpower for this service. It is estimated that the triage clinics will provide 10,500 service attendances for 2,600 patients each year.
Meanwhile, to further strengthen community psychiatric services, the Government will provide additional recurrent funding of $23.6 million and $8.26 million starting from 2009-10 to provide recovery support service for psychiatric patients in the community and further enhance the provision of psychogeriatric outreach service to private residential care homes for the elderly respectively. In addition, HA has introduced the Elderly Suicide Prevention Programme since 2002-03 to provide prompt treatment service for elders suspected to have depression or suicidal tendency. The Social Welfare Department (SWD), voluntary agencies, social workers and doctors can refer elders suspected to have depression or suicidal tendency to the Elderly Suicide Prevention Programme for follow-up. In 2008-09, the programme has provided a total of 37,390 attendances of prompt treatment service. In addition, the programme has provided training to healthcare staff and people who come into contact with elders in their work to help them identify elders with depression or risk of committing suicide and refer the elders to receive necessary services as early as possible.
(c) All new patients at the psychiatric SOP clinics are first assessed by a Nursing Officers/Advanced Practice Nurse to ascertain the severity of their conditions according to the established triage criteria. The assessment outcome will be reviewed by a Senior Medical Officer. The date of medical appointment will then be arranged having regard to the conditions of the patient. Factors to be considered in the triage of new cases include the patient's propensity to violence, risk of committing suicide, degree of depression and whether the patient has carers. Psychiatric SOP clinics also disseminate information to the patients and their family to remind them that they may approach out-patient departments, A&E departments or family doctors for assistance in case there is a change or deterioration in the patient's mental conditions while they are waiting for medical appointment at SOP clinics.
In 2008-09, HA piloted nurse clinic service which provides nursing care support such as mental health education and medication adjustment for patients at psychiatric SOP clinics with a view to providing them with extended nursing care after receiving treatment from doctors. Besides, HA has also introduced the "Early Emotional Assessment and Intervention Programme" under the management of senior occupational therapists in four of its psychiatric SOP clinics since December 2008. This pilot programme targets patients who have emotional problems and are classified as routine cases waiting for psychiatric SOP service. Under the programme, senior occupational therapists provide patients with cognitive behavioural therapy (CBT) after understanding the patients' emotional problems and distress. Through CBT, health education, psychotherapy and life restructuring services will be provided to these patients on a group or individual basis so as to help them adopt a positive attitude, resolve emotional problems and regain a positive life. The service will be launched in the fifth psychiatric SOP clinic in June 2009.
(d) Public healthcare services in Hong Kong are heavily subsidised by the Government and the service fees are affordable by the general public. The Government has also put in place a medical fee waiver mechanism to provide assistance to needy patients. There is at present no plan to subsidise patients with financial difficulties to receive services from psychiatrists in private practice.
The Administration has all along adjusted and enhanced mental health services in light of the service demand in the community. 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 new initiatives to improve the treatment and rehabilitation services for mental patients. We will continue to allocate additional resources on prevention, medical treatment and rehabilitation services to further enhance our mental health services and support for mental patients.
Ends/Wednesday, June 17, 2009
Issued at HKT 12:53
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