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Following is a question by the Hon Alice Mak and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December 19):
Question:
It has been learnt that several incidents in which persons suspected of suffering from mental illnesses wounded other people have happened recently. Although the Hospital Authority (HA) has, in recent years, allocated additional resources to strengthen mental health services and implemented the Case Management Programme for people with severe mental illness (the Programme) since 2010-2011, incidents involving mentally-ill persons wounding other people still happen, arousing public concern about whether community support provided by the authorities to the mentally-ill and the ex-mentally-ill remains inadequate. In this connection, will the Government inform this Council:
(a) whether the authorities have compiled statistics on the number of mentally-ill persons in the territory; whether they know, apart from some 187 000 mentally-ill persons currently receiving psychiatric specialist services provided under HA, the number of mentally-ill persons currently receiving treatment (including medical treatments and psychotherapy) in other medical institutions; of a breakdown of the current number of mentally-ill persons, by the type of mental illness and risk level, who have undergone risk assessment by HA's multi-disciplinary team of healthcare personnel and been considered suitable for discharge from hospital to continue to receive treatment and rehabilitation in the community;
(b) whether it knows, the number of mentally-ill persons currently waiting for HA's psychiatric out-patient services and their average waiting time; the respective numbers of psychiatrists, psychiatric nurses and psychiatric medical social workers currently employed by HA;
(c) whether it knows, the respective numbers of case managers and community nurses currently involved in implementing the aforesaid Programme, and the respective average numbers of mentally-ill persons followed up by each case manager and each community nurse; whether the authorities have assessed the effectiveness of the Programme; if they have, of the assessment results; if not, the reasons for that;
(d) whether it knows, the number of requests for help received by the 24-hour mental health hotline provided by HA to West Kowloon since the service was launched in January this year, and the number of persons who had been referred to receive psychiatric treatment; whether HA has plans to expand such service to cover other districts;
(e) given that the turnover of psychiatric nurses in public hospitals has been on the rise in the past five years, whether the authorities have plans to step up recruitment and training of psychiatric nurses so as to maintain service quality; if they have, of the details; if not, the reasons for that; and
(f) given that the authorities had indicated earlier that, at district level, the Social Welfare Department and HA maintained close liaison with other related government departments (including the Hong Kong Police Force and the Housing Department), whether the authorities have assessed the effectiveness of the existing inter-departmental communication mechanism established to provide support for mentally-ill persons; if they have, of the assessment results; if not, the reasons for that; of the measures taken by the authorities to further strengthen HA's cooperation with relevant government departments, so as to follow up mentally-ill persons' rehabilitation in the community more effectively?
Reply:
President,
The Government is committed to promoting mental health of the public, and will adjust the mode for delivery of mental health services having regard to social needs and international development. It is the international trend to gradually focus on community and ambulatory services in the treatment of mental illness, and to allow the early discharge of mental patients when their conditions are stablised for treatment in the community. Hence, in recent years the Government has strengthened its community psychiatric services in line with this direction in an effort to allow more patients who are suitable for discharge to receive treatment in the community, so that they can re-integrate into the community and start a new life as early as possible. The Government has increased the funding allocation for mental health services on a continuous basis. The actual expenditure in 2011-12 increased by about 30% when compared with that in 2007-08, with the total amount of expenditure for the past five years exceeding $19 billion.
My reply to the various parts of the question is as follows:
(a) At present, about 187 000 patients with varying degree of mental health problems are receiving psychiatric specialist services provided by the Hospital Authority (HA). The more common types of mental disorders among the patients currently followed up by HA can be broadly classified in Annex.
To facilitate early identification and appropriate follow-up of mental patients with special needs, HA will, according to the clinical conditions of individual patients (including their medical history, existing mental conditions, whether there is adequate support for the patients in the community, etc), broadly categorise them into three types according to their risk level: (i) for patients assessed to be of higher risk, such as those with greater propensity to violence or record of severe criminal violence, HA will arrange community nurses or case managers with experience in community mental health service to follow up on their cases continuously, closely and in an intensive manner, including making arrangements for them to be admitted into hospital for treatment where necessary; (ii) for patients assessed to be of medium risk, e.g. those with general severe mental illness, their case managers will provide them with continuous and personalised support according to their clinical conditions so as to help them recover and re-integrate into the community when their conditions are stabilised; (iii) for those assessed to be of low risk, such as those with common mental disorders, attending doctors will provide them with suitable treatment, including providing them with vocational rehabilitation services, etc. according to their clinical needs. In addition, the multi-disciplinary teams of psychiatric departments will review each case on a regular basis having regard to the needs of individual patients and their risk profiles, to ensure that the patients are given suitable and comprehensive support.
We do not have statistics on the number of mental patients receiving treatments or follow-ups within the private medical sector.
(b) As at the end of September 2012, the median waiting time for first appointment at psychiatric specialist out-patient clinics under HA is around seven weeks, and the number of persons waiting for treatment is about 13 000. At present, there are about 330 psychiatrists, 2 160 psychiatric nurses and 240 psychiatric medical social workers providing services for patients at psychiatric specialist out-patient clinics under HA.
(c) To enhance the community support services for mental patients, HA first launched a Case Management Programme in three districts (Kwun Tong, Kwai Tsing and Yuen Long) for patients with severe mental illness in April 2010. The case managers under the programme work closely with various service providers, particularly the Integrated Community Centre for Mental Wellness (ICCMWs) set up by the Social Welfare Department (SWD), in providing intensive, continuous and personalised support to patients with severe mental illness living in the community. Besides, case managers also provide support for the patients' families so as to help patients reintegrate into the community in all dimensions. By 2012-13, HA has progressively extended the Programme to a total of 12 districts (namely, Eastern, Wan Chai, Southern, Central and Western, Islands, Kwun Tong, Sham Shui Po, Kowloon City, Kwai Tsing, Sha Tin, Tuen Mun and Yuen Long) to benefit more patients. As at the end of September 2012, HA employed a total of 195 healthcare and allied health personnel with experience in community mental health services as case managers for the provision of intensive and personalised community support to over 11 000 patients living in these districts.
Currently, each case manager is providing community support to some 50 to 60 patients. The workload varies from one case manager to another, depending on factors such as patients' clinical conditions and degrees of risk, etc. HA will continue to recruit more case managers to further strengthen its manpower as well as deploying and adjusting its manpower flexibly having regard to the operational needs and service demands in order to meet the needs of various districts.
Regarding assessment of the Programme, HA has commissioned the Department of Psychiatry of the University of Hong Kong to undertake a detailed study and analysis of the implementation and effectiveness of the Case Management Programme. The findings of the study are expected to be released in mid 2013.
(d) The Mental Health 24-hour Hotline service has been in operation for more than 30 years with the whole local population as its service targets. Since January 2012, HA has further strengthened the service by deploying psychiatric nurses to provide telephone psychiatric support service to members of the public from various districts in the territory, and named the hotline as "Mental Health Hotline". As at the end of September 2012, the "Mental Health Hotline" handled a total of over 11 300 phone calls. Most of the users of the service were patients currently receiving psychiatric services provided by HA while the rest were family members of patients as well as members of the public.
(e) The turnover rate of HA's psychiatric nurses has remained stable at 2% - 3% over the past three years. In recent years, tremendous efforts have been made by HA to recruit psychiatric nurses. In the past three years, the number of psychiatric nurses recruited increased from 48 in 2009-10 to 99 in 2011-12.
On the training front, we anticipate that in the coming years, there will be some 160 newly graduated psychiatric nurses each year. The Institute of Advanced Nursing Studies of HA will run three to four psychiatric training courses each year and it is expected that these courses will on average produce over 140 psychiatric nurses each year between 2012-13 and 2015-16. Looking ahead, HA will continue its efforts to recruit and train more nurses to meet the service demand.
(f) As the mental health policy and provision of related service programmes involve a number of policy bureaux and government departments, the Food and Health Bureau assumes the overall responsibility of co-ordination and works in close collaboration with the Labour and Welfare Bureau, Department of Health, HA, SWD and other relevant government departments. The directions of our mental health policy is to adopt a multi-disciplinary and cross-sectoral team approach in delivering a comprehensive range of mental health services which are accessible by people in need on a continuous basis. We have also put in place a platform for communication and a mechanism for co-ordination at various levels to foster collaboration between the medical and social service sectors.
At the level of policy formulation, we have a Working Group on Mental Health Services chaired by the Secretary for Food and Health and comprised of stakeholders with relevant service experience from the medical, social service and other related sectors to assist in the formulation and review of our mental health policy and services.
At the level of service delivery, SWD Headquarters and HA Head Office have, since 2010, set up a Central Co-ordinating Group in collaboration with the non-governmental organisations operating ICCMW to discuss the co-ordination of the service strategies and explore more effective models of collaboration.
At district level, District Social Welfare Officers of SWD and the Chiefs of Service of the Department of Psychiatry in various HA clusters hold working group meetings at regular intervals to maintain close liaison with psychiatric medical social workers and ICCMWs in the respective districts as well as other relevant Government departments, including the Police and the Housing Department. When handling cases involving mental patients, various departments will hold case conferences where necessary in order to formulate rehabilitation plans for the patients. The existing multi-disciplinary team approach and the inter-department communication mechanism are functioning effectively. We will continue to strengthen our co-ordination role and provide more comprehensive and intensive support for mental patients.
Ends/Wednesday, December 19, 2012
Issued at HKT 15:24
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