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Following is a question by the Hon Albert Ho and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 2):
Question:
A number of serious incidents of mental patients injuring others or themselves occurred in the community in recent years. In addition, there have been comments that while the Government puts emphasis on community care for such people, there is a lack of complementary comprehensive planning and community support. Regarding the support services provided to mental patients and people recovering from mental illness, will the Government inform this Council:
(a) of the respective resources allocated by the Government to the Hospital Authority (HA), the Social Welfare Department (SWD) and non-government organisations in the past five years for supporting mental patients and people recovering from mental illness, as well as the respective increase in their expenditure in each year;
(b) given that under the newly launched Case Management Programme, case managers are supervised by health grade personnel, of the mechanism in place to ensure that case managers are capable of assessing the needs of their patients in areas other than health care such as community and social life; the mechanism in place on the operational level to enable case mangers who work under HA to coordinate and arrange for the provision of appropriate services to the patients they take care of by various government departments such as SWD, etc. especially when some rehabilitation services (e.g. residential places) are in acute shortage; and
(c) whether it knows in each of the past five years, the respective median in-patient bed-days of mental patients, the respective numbers of persons with severe mental illness or those recovering from severe mental illness in the community, as well as the respective numbers of serious incidents in which such persons injured themselves or others; whether the authorities have explored if the occurrence of such wounding incidents is related to the authorities reducing psychiatric beds as well as their putting emphasis on community care without complementary comprehensive planning and community support; which areas need improvement most urgently; whether they will invite a specialist consultant to thoroughly review mental health policy and services, and prepare a white paper on the mental health policy to consult various sectors?
Reply:
President,
(a) We are committed to promoting mental health and catering for the needs of mental patients in a comprehensive manner through the provision of a series of mental health services. At present, the Hospital Authority (HA) provides various medical services for mental patients, including inpatient, outpatient, medical rehabilitation and community support services. The Social Welfare Department (SWD) provides ex-mentally ill persons and their families with a series of social rehabilitation services, including residential care, day-time training, vocational training and community support services. This is to help ex-mentally ill persons adapt to community life and reintegrate into the society.
The resources we allocated to mental health services have been increasing in recent years. The expenditures of HA and SWD on mental health services in the past five years (i.e. 2005-06 to 2009-10) are shown in Annex Table 1.
Moreover, to further strengthen mental health services, we have provided additional funding of over $100 million to HA in 2010-11 for launching two new programmes to strengthen the support for two major groups of mental patients. For persons with severe mental illness, HA has implemented the Case Management Programme on a pilot basis with healthcare personnel taking up the role as case managers to provide these patients with intensive, continuous and personalised support. The amount of expenditure involved is $78 million. As for persons with common mental disorders, HA has set up Common Mental Disorder Clinics to provide them with more timely assessment and consultation services and will introduce an Integrated Mental Health Programme later this year to engage the primary care services in supporting these patients. The amount of expenditure involved is $31 million. Besides, HA will also expand the use of new psychiatric drugs with proven effectiveness on patients under suitable clinical conditions. The amount of expenditure involved is $10 million.
SWD will expand the service model of the Integrated Community Centres for Mental Wellness across the territory in 2010-11 and strengthen the manpower of these centres to provide comprehensive and accessible services to those in need. Additional funding allocation of $70 million has been provided to SWD for implementation of the initiative.
(b) Under the Case Management Programme for persons with severe mental illness implemented in 2010-11, HA will arrange for case managers to receive structured training on case management, including intensive classroom teaching, workshops and practicum with supervision. The content of the training includes assessment of the medical needs of patients as well as their needs in various other aspects (such as their community life and social interaction). This is to ensure that the case managers are capable of arranging the provision of appropriate support services having regard to the medical and non-medical needs of patients. The case managers will work closely with various service providers, including the Integrated Community Centres for Mental Wellness.
To implement the Case Management Programme and relevant initiatives more effectively, HA and SWD will establish a new communication platform on top of the existing communication channels to further enhance the collaboration among various sectors and disciplines at different levels.
At the central coordination level, the HA Head Office and SWD Headquarters as well as non-governmental organisations will discuss the coordination of the overall service strategies and explore effective models of collaboration on a continuous basis. At the district coordination level, the Chiefs of Service of the Department of Psychiatry in various clusters of HA and District Social Welfare Officers of SWD will set up a district-based communication platform. The purpose is to liaise regularly with service providers in the district and relevant government departments and organisations for coordination of community support services in the district. Adjustment will also be made to the service model having regard to the demographic characteristics and service demand in the district. At the service delivery level, case managers of HA will maintain liaison with other service providers, including staff of the Integrated Community Centres for Mental Wellness for discussion and coordination on matters as case referral and arrangements for rehabilitation services as necessary.
(c) In the past five years (i.e. from 2005-06 to 2009-10), the average length of stay of mental patients of HA in hospitals and the number of mental patients receiving HA's services are as shown in Annex Table 2.
At present, around 40,000 people are diagnosed with severe mental illness (such as psychosis) in HA.
The number of suicide cases involving mental patients has notably reduced in the past few years. The number of suicide cases involving patients who had used the psychiatric inpatient or outpatient services of HA within one year before they died in suicide from 2004 to 2008 are set out in Annex 3. At present, HA does not have statistical data on mental patients inflicting harm on other people but will collect data in this respect.
In the light of the international trend to shift the focus of the treatment of mental illness from inpatient care to community and ambulatory services, HA has been reviewing its inpatient psychiatric services in recent years and has launched a number of new programmes to enhance its community psychiatric services (such as the "Extended care patients Intensive Treatment, Early diversion and Rehabilitation Stepping Stone (EXITERS) Project", pilot programme to provide post-discharge community support to frequently readmitted psychiatric patients, and the Recovery Support Programme). These programmes progressively allow more mental patients with stabilised conditions to receive treatment in the community, thereby enhancing their prospect of reintegration into the community after rehabilitation. With the provision of various community support services, the demand for inpatient services has been decreasing. In the past few years, the occupancy rate of HA's psychiatric beds was less than 80%. Therefore, HA has gradually closed down unused psychiatric beds in recent years and redeployed the resources for enhancement of other mental health services. HA has no plan to further reduce its psychiatric beds in 2010-11 and will keep in view the demand for inpatient psychiatric services.
The Government keeps its mental health services under review and makes adjustment and enhancement to the services having regard to changes in social circumstances and service needs. The Working Group on Mental Health Services (Working Group) is chaired by the Secretary for Food and Health and comprises academics and relevant professionals and service providers as members. There is a subgroup under the Working Group to study in-depth the demand for mental health services and the relevant policy measures. The subgroup is supported by three expert groups comprising professionals with relevant service experience to study the service needs of different age groups (children and adolescents, adults, and elderly). After discussion, the Working Group has formulated a framework on mental health policy and services setting out the general principles, goals and directions. The Working Group will continue to review, on the basis of the above framework, mental health services on an ongoing basis and explore new mental health service initiatives including the coordination of various community support services and the follow-up on patient.
To enhance the mental health services in response to the needs of the community in a more systematic manner, we are developing a mental health service plan for adults for the coming years, including setting out the service objectives and priorities for various actions. In formulating the service plan, we will take account of the views of the relevant experts and service providers and consult patients, carers and other stakeholders. Meanwhile, we will continue to make reference to the deliberations in the Working Group and consider developing service plans in future for other age groups.
Ends/Wednesday, June 2, 2010
Issued at HKT 16:11
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