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Following is a question by the Dr Hon Pan Pey-chyou and a written reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (November 3):
Question:
It has been reported that in quite a number of past tragedies relating to psychiatric patients, the patients had not been categorised by the Hospital Authority (HA) as priority follow-up cases and therefore, healthcare and social workers could not make early intervention and prevent the tragedies from happening. In this connection, will the Government inform this Council:
(a) whether it knows the current number of cases put under the priority follow-up system; among such cases, the number of those in which the patients were "conditionally discharged" under the Mental Health Ordinance (Cap. 136); among the cases under the priority follow-up system, the respective numbers of cases categorised as priority follow-up and as secondary target for priority follow-up;
(b) whether it knows the increase in the numbers of cases in the past five years in respect of priority follow-up and secondary target for priority follow-up respectively, as well as the respective numbers of cases removed from these two categories; and whether a case needs to go through an established procedure before it is removed; if so, the details of the procedure; if not, why the authorities have not drawn up such a procedure; and
(c) whether the authorities and HA have drawn up guidelines on how to take care of or monitor those cases categorised as priority follow-up or as secondary target for priority follow-up, including how to deal with situations where such patients suddenly refuse to comply with the conditions for their "conditional discharge", such as refusing follow-up care, drug therapy or visits by healthcare professionals, etc.?
Reply:
President,
Patients receiving psychiatric services from the Hospital Authority (HA) are broadly categorised into three types according to their risk level:
(1) mental patients without propensity to violence or record of criminal violence are categorised as "ordinary patients";
(2) mental patients with propensity to violence or record of criminal violence are generally categorised into the "target group"; and
(3) patients with greater propensity to violence or record of severe criminal violence and assessed to have higher risk are categorised into the "sub-target group".
To facilitate early identification and follow-up of mental patients with propensity to violence or record of criminal violence, HA adopts a priority follow-up system to follow up on patients in the "target group" and "sub-target group".
In general, the attending doctors will categorise patients into the "target group" or "sub-target group" according to the severity of their past propensity to violence or record of criminal violence. Patients who have committed less serious offences before (such as common assault, fighting, disorder in public place, possession of offensive weapons) are categorised into the "target group". Those who have committed more serious offences before (such as serious wounding or assault, murder or manslaughter, serious criminal intimidation) are categorised into the higher-risk "sub-target group".
The reply to various parts of the question is as follows:
(a) At present, HA provides psychiatric services to more than 160,000 patients, about 5,500 of whom are put under the priority follow-up system. The breakdown is shown in Annex 1.
Besides, to help patients who have a history of criminal violence or disposition to commit such violence but are in stable conditions to reintegrate into the community, the attending doctors may allow them to be discharged subject to specific conditions under the Mental Health Ordinance (Cap. 136), including residing at a specified place, receiving follow-up in the community and regular follow-up consultation, and taking medication as prescribed by a medical practitioner etc. According to HA's statistics, there are currently about 650 cases of patients who were "conditionally discharged".
(b) The increase in the number of people in respect of "target group" and "sub-target group" under the priority follow-up system as well as the number of people removed from these two groups on average each year are shown in Annex 2.
Established procedures are in place in HA to assess whether patients are suitable for being removed from the priority follow-up system. The multi-disciplinary healthcare team (including the attending doctor and his/her supervisor, nurse, psychologist, social worker and occupational therapist etc) will conduct in-depth assessment on the risk and ability to live independently of a patient. The assessment covers mental conditions, risk factors, living environment and family support, follow-up and medication record, history of drug abuse and alcoholism, ability to live independently and reoffending risk etc. HA may consider removing a patient from the system if the patient has good community living skills and has remained in satisfactory conditions (i.e. without act of violence and propensity to violence, in stable mental conditions, and having good community support and regular follow-up and medication record) for three years (applicable to "target group") or seven years (applicable to "sub-target group"), after a decision made by a multi-disciplinary medical conference.
(c) The multi-disciplinary team comprising different healthcare professionals will draw up relevant care plans according to the needs and risk profile of patients. At present, all patients in the "sub-target group" are provided with long-term follow-up by community nurses or medical social workers. As for patients in the "target group", the attending doctors will arrange appropriate support for them according to their needs and risk profile. Care plans for the "target group" and "sub-target group" are shown in Annex 3.
If a patient under the priority follow-up system suddenly refuses to accept the care plan, the attending doctor will make appropriate arrangements, such as enhancing support by community nurses and increasing the number of visits, according to the prevailing mental conditions and risk level of the patient.
Regarding the "conditional discharge" cases, if a patient fails to comply with any condition imposed on him/her, and the attending doctor is of the opinion that it is necessary in the interests of the patient's health or safety, or for the protection of other persons, to recall the patient to a mental hospital, the doctor can recall the patient to the mental hospital under section 42B of the Mental Health Ordinance (Cap. 136). If the patient does not fall into the "conditional discharge" category but his/her condition warrants his/her detention in a mental hospital for observation (or observation followed by medical treatment) and such detention is in the interests of his/her own health or safety or for the protection of other persons, the Court can make an order to authorise the detention of the patient in the mental hospital for observation and medical treatment under section 31 of the Mental Health Ordinance (Cap. 136).
In addition, HA has piloted in 2010-11 a Case Management Programme in three districts (Kwai Tsing, Yuen Long and Kwun Tong) to provide intensive, continuous and personalised community support to 5,000 higher-risk patients with severe mental illness. At present, patients under the priority follow-up system in these three districts have been followed up by case managers. HA will roll out the programme to five more districts (Eastern, Sham Shui Po, Sha Tin, Tuen Mun and Wan Chai) in 2011-12 to provide services to an additional 6,000 patients. When this programme is extended to all districts in Hong Kong, patients under the priority follow-up system will be followed up through a case management approach on a long-term basis.
Ends/Wednesday, November 3, 2010
Issued at HKT 17:47
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