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Following is a question by the Hon Leung Kwok-hung and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (November 11):
Question:
It was reported that another tragedy involving a mental patient happened earlier in Hong Kong in which a mentally ill man stabbed his ex-wife to death at a Light Rail stop. A number of similar tragedies have happened since January this year, and after each incident, the authorities indicated that mental health services would be strengthened. However, it has been reported that the shortage of psychiatrists in Hong Kong will persist in the next five to 10 years. In this connection, will the Government inform this Council:
(a) whether it knows the amount of funding and other resources allocated by the Hospital Authority (HA) to the psychiatric department of each public hospital in each of the past three years, together with a detailed breakdown of the amount of funding by expenditure item, including the salaries of healthcare personnel and other staff, as well as the expenses on drugs and medical facilities, etc.;
(b) whether it knows if HA has set any cap on the costs of psychiatric drugs to be provided by each hospital; if it has, of the details of such limits;
(c) whether it knows the respective numbers, calculated on the basis of the needs of the current population in Hong Kong, of hospital beds and healthcare personnel needed in various specialties (including child and adolescent psychiatry, psychogeriatry, community psychiatry and forensic psychiatry) in the psychiatric departments of public hospitals, and how these numbers compare to the current numbers concerned;
(d) whether it knows the proportion of the patients being re-admitted among those who were discharged in the past three years from the various specialties in the psychiatric departments in (c);
(e) whether it knows the average number of hours spent in the past three years by the relevant healthcare personnel on following up each case of a mental patient after his discharge from hospital, and the average number of times and hours per week each case was followed up by community psychiatric nurses;
(f) whether it knows the average number of ex-mental patients in the past three years whom each community psychiatric nurse needed to follow up;
(g) of the respective numbers of meetings convened by the Working Group on Mental Health Services (the Working Group), which was set up by the former Health, Welfare and Food Bureau in August 2006, and its subgroup and expert groups, their latest membership lists and the attendance rates of their members; and
(h) what mental health policy and specific recommendations have been proposed by the Working Group after working for more than three years, as well as of the resources needed and the timetable for implementing such policy and recommendations?
Reply:
President,
(a) In the past few years, the resources allocated by the Hospital Authority (HA) on mental health services each year has been increasing and the annual expenditure is over $2.5 billion. The expenditure of various hospital clusters on mental health services in the past three years with breakdown by item is shown in Annex 1.
(b) The cost of drugs is not a major consideration of HA in the prescription of drugs. Decisions in regard to the prescription of psychiatric drugs are made on the basis of patients' clinical conditions and treatment needs with a view to enhancing treatment outcome and facilitating the early recovery of the patient. The psychiatric department of various hospital clusters will prescribe drugs to patients having regard to their conditions and the relevant prescription guidelines. In recent years, the Government has provided HA with additional recurrent allocation of a total of $95 million to provide new psychiatric drugs to more patients in need.
(c) In planning for its psychiatric services and manpower requirements, HA takes into account various factors including demographic changes and past trends in service demand of each hospital cluster. In recent years, HA has actively increased the manpower of its psychiatric departments. The number of psychiatrists has increased from 212 in 2001-02 to 288 in 2008-09 and the number of psychiatric nurses has increased from 1,797 to 1,880 during the same period. As at March 31, 2009, HA provided a total of 4,000 psychiatric beds.
The scope of work of psychiatric healthcare staff covers different service areas including in-patient service, specialist out-patient (SOP) service and community outreach service. The condition and needs of patients also vary. As such, HA does not set a fixed staff establishment for the provision of services for individual subspecialties under the psychiatric departments. Instead, the manpower within the psychiatric departments is deployed and adjusted flexibly in accordance with the operational needs and service demand of hospitals in different districts. As for forensic psychiatric service, it is a special service unit mainly involved in providing services to the Siu Lam Psychiatric Centre of the Correctional Services Department as well as forensic psychiatric service to all hospital clusters. The unit currently has 7 doctors and 87 nurses.
(d) According to HA's records, the rate of re-admission of mental patients via the Accident and Emergency Departments within 28 days after discharge in the past three years is as follows:
Re-admission rate of mental patients via Accident and
Emergency Departments within 28 days after discharge
2006-07 6.0%
2007-08 6.0%
2008-09 6.3%
(e) HA provides medical rehabilitation and community psychiatric services to 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, which comprise psychiatrists, community psychiatric nurses, clinical psychologists, medical social workers, and occupational therapists etc. The range of services provided includes risk management, home visit, telephone consultation and follow-up service. In 2008-09, the number of outreach service attendances provided by the community psychiatric teams is 104,753. 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 2008-09, the total number of cases followed up by community psychiatric nurses is 9,245. The frequency and duration of the follow-up service depend on the needs and condition of individual patients. For non-urgent cases in general, community psychiatric nurses conduct home visit approximately once a month.
(f) In the past three years, the average number of cases followed up by each community psychiatric nurse is as follows:
Average number of cases followed up by each community psychiatric nurse per year
2006-07 68
2007-08 71
2008-09 70
(g) The Working Group on Mental Health Services (Working Group) set up by the Food and Health Bureau is chaired by me and comprises Government representatives, mental health professionals from the healthcare and social welfare sectors and academics. It assists the Government in reviewing existing mental health services. The Working Group has set up a Sub-group, which is co-chaired by two members of the Working Group and comprises professionals from the healthcare and social welfare sectors, to conduct in-depth study on the demand for mental health services and the relevant policy measures. Meanwhile, there are three expert groups under the Sub-group comprising experts with relevant service experience to study the service needs of three different age groups (children and adolescents, adults and elders). The membership list of the Working Group, Sub-group and expert groups are at Annex 2, Annex 3 and Annex 4 respectively.
The Working Group and its Sub-group have each held four meetings so far and the average attendance rates of members are 90.4% and 100% respectively. The expert groups have held a total of nine meetings so far and the average attendance rate of members is 84.5%. Besides, members of the expert groups also deliberate and exchange their views through emails.
(h) Since their establishment early this year, the expert groups under the Working Group have conducted preliminary studies on the needs for mental health service of various target groups in Hong Kong. They have affirmed the importance of early identification and treatment as well as the service direction of enhancing community care for patients. They have also suggested that the Government adopt appropriate service strategies according to the needs of patients and provide them with the appropriate support. Other service improvement measures put forward by the expert groups include strengthening the training for primary and community care personnel for assisting in the intervention of mental health problems, shortening the waiting time for psychiatric SOP service and enhancing in-patient care and various community outreach and residential services.
Having considered the views of the Working Group and its Sub-group and expert groups, we will launch two new initiatives through HA in 2010-11 to provide support to persons with severe mental illness and persons with common mental disorders respectively. With regard to persons with severe mental illness, HA will pilot a case management programme in individual districts and train up healthcare staff as case managers to provide continuous and personalised intensive support to patients in the community settings. For people with common mental disorders, HA will foster closer collaboration between its psychiatric SOP service and primary care service in order to provide these patients with the appropriate assessment and treatment services.
The work of the Working Group in assisting the Government in reviewing existing mental health services in Hong Kong is an ongoing and long-term process and has to be carried out on a step by step basis in a practicable and sustainable manner. We will continue to prioritise the service improvement measures in the light of the views of the Working Group and its Sub-group and expert groups. We will also continue to allocate additional resources on prevention, early intervention, treatment and rehabilitation services to further improve our mental health services.
Ends/Wednesday, November 11, 2009
Issued at HKT 14:40
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