LC Q13:Early identification of youths with mental problems

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Following is a question by the Hon Law Chi-kwong and a written reply by the Secretary for Health and Welfare, Dr E K Yeoh, in the Legislative Council today (October 31):

Question:

Regarding the early identification of children and youths with mental health problems, and the number of such persons, will the Government inform this Council:

(a) of the total number of children and youths aged under 15 who have received treatment for mental health problems at various out-patient clinics and assessment centres under the Hospital Authority and Department of Health in each of the past three fiscal years, together with a breakdown of these numbers by the type of mental health problems and patient acuity;

(b) whether the number of such persons is on the rise in recent year and if so, of the reasons for that;

(c) whether it knows the percentages of persons with mental health problems in the total population of children and youths in countries whose levels of development are comparable to that of Hong Kong, and of the percentages of such persons who have not received any treatment;

(d) making projections on the basis of the percentages mentioned in (c), of the estimated number of children and youths who have mental health problems but have not received any treatment in Hong Kong at present; and

(e) of the measures in place to enhance communication and cooperation among health care institutions, social welfare services providers, schools and parents, with a view to early identification of children and youths with mental health problems so that treatment can be provided and assistance offered to their parents at the earliest opportunity?

Reply :

Madam President,

(a) The term "mental health problems" refers to a range of conditions which may vary widely in terms of severity and need for medical treatment. Broadly speaking, cases handled by the Department of Health (DH) or Hospital Authority (HA) are related to "disorders", a term used to describe those on the severe end of the spectrum.

The Maternal and Child Health Centres (MCHCs), Student Health Service Centres (SHSCs) and Child Assessment Centres (CACs) of DH provide health assessment services to facilitate early identification of children and youths with growth, developmental or behavioural problems such as autistic disorder, attention-deficit hyperactivity disorder, disorders of psychological development, or behavioural and emotional disorders. Children and adolescents found to exhibit mental health disorders would be referred to the HA for further assessment and treatment. The number of children and adolescents identified or assessed with growth, developmental or behavioural problems by DH in the past three years are as follows:

Service Children and

Centre Youths Served 1998/99 1999/2000 2000/01

MCHCs# Children Not available 413 356

up to 5

SHSCs* Children and 132 176 192

youths studying

in primary and

secondary schools

CACs Children under 12 295 434 424

#For MCHCs, children with emotional and behavioural problems may be referred to either DH's CACs or HA's specialist clinics for further assessment.

*For SHSCs, statistics on referrals are based on school year (ie from September in one year to August in the following year) instead of financial year.

No further breakdown by type of mental health disorders and severity of diseases is available from the statistics routinely captured by DH.

The number of children and adolescents aged under 15 who have received treatment for mental health problems at HA's outpatient clinics, with breakdown by type of mental health problem in the past three years are as follows:

Diagnosis Category 1998/1999 1999/2000 2000/2001

Developmental Disorders 450 579 815

Behavioural Disorders 326 470 700

Emotional and Neurotic

Disorders 107 105 155

Others 472 524 651

Total: 1 355 1 678 2 321

HA captures disease data by reference to the International Classification of Mental and Behavioural Disorders (ICD-10) which does not provide further breakdown by degree of severity for mental illness for children and youths. As such, statistics on breakdown by severity of diseases is not available.

(b) The number of children and adolescents treated for mental health problems has been on the increase. This is due to better public awareness of mental health problems, especially the need for early intervention, increased willingness to seek treatment, improved accessibility of mental health service, and awareness of availability of such services. In this connection, HA and DH have in recent years stepped up public education activities to increase public awareness of mental health problems in children and adolescents. Also, HA has been convening regular meetings and seminars with teachers, social workers and Non-Government Organizations (NGOs) to encourage them to refer children with mental health problems for treatment.

(i) Studies on prevalence of mental disorders usually cover all mental disorders ranging from autism to problems such as significant stuttering or enuresis. As such, medical intervention may not be required for each and every case.

(ii) Apart from ICD-10, different countries may adopt different disease classification systems. As such, a child with a certain degree of over-activity may be classified as having a disorder under one system, but not in the other.

(iii) Children and adolescents are going through rapidly changing developmental stages. As such, the boundaries between normality and abnormality for children and adolescents are even less clear than those in adulthood.

(iv) As regards treatment of young persons with mental problem, it should be borne in mind that many of the less severe mental problem cases are often not seen by psychiatrists, but instead are handled by other professionals such as social workers, counselors, clinical psychologists, teachers, primary care physicians and family doctors.

Studies on mental health of children and adolescents in the USA, UK, Canada and Australia showed that the prevalence of mental disorders ranged from 10% to 21%, with a 10% prevalence rate for the UK, at least 12% for Australia, 18% for Ontario and 21% for the USA. According to a recent report published by the US Department of Health and Human Services, 27% of young people aged 9 to 17 in the US who have mental disorder receive treatment in the health sector and an additional 20 % of children and adolescents with mental disorder use mental health services only in their schools. The 1999 survey of the mental health of children and adolescents in England and Wales found that about one quarter of the children with mental disorders had used the specialist health care services, one half had seen someone from the educational services and one fifth had contact with social services.

(d) Studies conducted by the Chinese University of Hong Kong in 1988 estimated the community prevalence of childhood psychiatric disorders in Hong Kong to be 16.3%, and another study conducted in 1997 found a prevalence rate of 18% among Form 1 students. As evidenced in (c) above, treatment figures for US and UK vary considerably. For the reasons set out in (c) above, it is inappropriate to make projections on the number of children and youths in Hong Kong who have mental health problems but have not received any treatment on the basis of overseas experience.

(e) There has been close collaboration among HA, DH, Social Welfare Department (SWD) and Education Department (ED) in providing various services for the education, detection, referral and treatment of children and adolescents with mental health problem. Examples of the concerted efforts among different service providers, teachers and parents for the early identification of children and youths with mental problems include :

(i) Four early intervention teams have been set up by HA in July 2001 for the early detection and treatment of young people with psychotic problems through collaboration with the primary care providers, education and welfare agencies. Seminars, specially designed training sessions and workshops, briefings and discussion forums have been organized for primary health doctors, teachers, parents, social workers and NGOs to educate them on the early symptoms of mental illness so that they can identify and refer potential cases of psychotic illness for early treatment.

(ii) The 15 centres of School Health Services under DH have been providing comprehensive check up service, including psychological and behavioural assessment, for primary and secondary students. Students with psychological development problems will be referred for treatment by HA and/or counselling services by social service organisations.

(iii) DH's School Health Services have in collaboration with the Steering Committee of School Social Work Service under SWD developed a structured referral system to establish a referral network among the SHSCs, school guidance teachers/officers, school social workers, NGOs providing youth and children services, and family service centres of SWD. The referral system will be implemented in the second term of the 2001/02 school year. Under the system, students identified with psychosocial health problems will receive appropriate services (such as counselling services and medical services) from the participating service providers promptly.

(iv) DH will start the implementation of a comprehensive parenting education programme in 2002-03 in MCHCs to enable parents to detect signs of developmental abnormality and to effectively manage child behaviour.

(v) ED's Psychological Services Division has been providing services to students with learning, behavioural or emotional problems. Students with autism, attention-deficit hyperactivity disorder, or other mental health problems will be referred to health care institutions for assessment and treatment.

END/Wednesday, October 31, 2001

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