LCQ4: Mental health services

     Following is a question by the Hon Albert Ho Chun-yan and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (May 30):


     The authorities have indicated that it is the international trend to gradually focus on community and ambulatory services in the treatment of mental illness, and therefore the Government has allowed more patients to receive treatment in the community in recent years.  In this connection, will the Government inform this Council:

(a) whether it knows the respective numbers of people suffering from various types of mental illnesses in Hong Kong in the past five years, and among them, the number of those who had received treatment in the community; the number of psychiatric patients discharged from hospitals under the Hospital Authority each year, and among them, the number and percentage of those who directly returned to and lived in the community; among them, the respective numbers of those who were arranged to live alone in public housing units, as well as those who rented and lived in private housing units and paid the rents with Comprehensive Social Security Assistance payments; the respective numbers of patients who had, after being discharged from hospitals, lived in various types of subsidised and private residential institutions, as well as those who then left the residential institutions and lived on their own; of the respective turnover rates of the places of various types of residential institutions; if it knows, list the information in table form; if not, how the authorities assess the demand for and effectiveness of various types of community mental health services; whether they will conduct longitudinal studies and set up a comprehensive database;

(b) regarding the suggestion by a Member of this Council on formulating a community treatment order to require discharged mental patients who pose a threat to the community to receive medication and therapy, counselling, follow-up care and supervision, of the progress and specific timetable of the authorities to conduct detailed study in this regard; whether it knows the manpower required for service provision and case management after a community treatment order is formulated; based on the existing manpower and service capacity of the Integrated Community Centre for Mental Wellness and case managers, whether it is sufficient for providing such services and dealing with the follow-up work; and

(c) given that the Equal Opportunities Commission (EOC) has over the years continuous to advocate the establishment of a high powered and broad based Mental Health Council, preferably taken charge by the Chief Secretary for Administration, with a view to coordinating and monitoring mental health support services, and formulating and implementing both short-term and long-term policies and action plans, but the proposal has not been accepted by the Government, and in September this year, the United Nations Committee on the Rights of Persons with Disabilities (UNCRPD) will examine the report of the Hong Kong Special Administrative Region in implementing the United Nations Convention on the Rights of Persons with Disabilities, whether it knows if EOC will relay the relevant proposal to UNCRPD?



     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, 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.

     My reply to the various parts of the question is as follows:

(a) In the past five years, the total number of persons receiving various psychiatric services (including inpatient, specialist outpatient, day hospital and psychiatric community services) provided by the Hospital Authority (HA) each year varied from some 148 000 to some 187 000 as at present.  Among them, the number of psychiatric inpatients is relatively stable, with the number standing at about 14 000 each year.  The number of non-inpatients who received various psychiatric services provided by HA ranged from some 133 000 to some 173 000 as at present.  As to the number of discharges and deaths in respect of psychiatric inpatients, the figure for each year is roughly the same at about 16 000.  The relevant figures are set out at Annex.

     Under general circumstances, patients (including psychiatric patients) are not required, upon their discharge from hospital, to provide HA with information about their place of residence after discharge from hospital.  If families with members discharged from hospitals are in financial hardship, they may consider applying for the Comprehensive Social Security Assistance (CSSA) to meet basic needs.  The CSSA rent allowance is payable to eligible families to cover housing expenses, but the Social Welfare Department (SWD) does not have information on whether or not any members of such families (whether or not they are renting private housing) are mental patients.

     For patients who are assessed to be suitable for discharge, depending on their welfare needs, HA will refer individual cases to medical social workers for follow-up.  Having regard to the situation of individual patients, medical social workers will refer them to apply for various welfare services, such as services of the Integrated Community Centre for Mental Wellness, residential care services, financial assistance and housing assistance, etc.  At present, SWD provides a total of about 3 100 subvented residential care places for ex-mentally ill persons, including places of long stay care home, half-way house and supported hostel.  SWD will continue to steadily increase the places for these residential care services.  Moreover, as at April 2012, SWD has purchased 202 residential care places under the Pilot Bought Place Scheme for Private Residential Care Homes for Persons with Disabilities for persons waitlisting for subvented homes (including long stay care home).

     As for the proposal of setting up a database for data on the illnesses of persons with mental illness, we must consider it with care.  In particular, we need to consider whether the database will pose a labelling effect on persons with mental illness, as well as the issue of privacy of patients involved.  The Food and Health Bureau (FHB) has commissioned the Department of Psychiatry of the Chinese University of Hong Kong, in association with the Department of Psychiatry of the Hong Kong University and the mental health services unit of HA, to conduct a study on community mental health of Hong Kong, covering the prevalence of mental illness in Hong Kong.  In addition, HA has commissioned the University of Hong Kong to study and assess the implementation and effectiveness of the Case Management Programme for persons with severe mental illness introduced in 2010.  The findings of this study are expected to be released in 2013.

(b) There is suggestion that the Government should introduce a Community Treatment Order (CTO) to require persons with mental illness to receive designated treatment while living in the community.  A Focus Group on Community Treatment Order has been set up by the Working Group of Mental Health Services under my chairmanship in 2010 to study the experience and the relevant legislation of overseas jurisdictions in detail and the applicability of CTO in the local context.  Since the relevant proposals will have far-reaching implications on both patients and the society in a number of aspects, such as protection of patients' personal data and privacy, as well as human rights and the scope of authority of healthcare professionals, thorough consideration and extensive discussion by the public is necessary.  As the study is still in progress, we are unable to assess at this stage the actual implications on the manpower and service capacity of the Integrated Community Centres for Mental Wellness (ICCMWs) and the Case Management Programme should CTO be implemented, and the legislative timetable.

(c) The United Nations Committee on the Rights of Persons with Disabilities will consider the initial report of the People's Republic of China (including the Hong Kong Special Administrative Region) under the United Nations Convention on the Rights of Persons with Disabilities. We note that the Equal Opportunities Commission will submit its opinions on the rehabilitation services (including mental health services) provided by the Hong Kong Special Administrative Region Government.

     There is suggestion that a Mental Health Council should be established to coordinate and monitor mental health services.  As a matter of fact, a similar mechanism has already been in place.  FHB assumes the responsibility of coordinating mental health policies and initiatives by working closely with the relevant Government departments including the Labour and Welfare Bureau, Department of Health, HA and SWD as well as other relevant departments and non-governmental organisations to provide persons with mental illness with medical and rehabilitation services through an integrated and multi-disciplinary mode of service delivery.  On the policy level, we have the Working Group of Mental Health Services to keep the current services under review.  On the level of service implementation, we have in 2010 set up a central coordination group co-chaired by representatives from SWD and HA to monitor the effectiveness of ICCMWs and the Case Management Programme, and to review cross-sectoral collaboration amongst stakeholders on community mental health services.  At the district level, District Task Groups on Community Mental Health Support Services (DTGs) were set up across the territory to develop strategies and resolve district-based operational issues.  These DTGs are co-chaired by the respective cluster representatives of psychiatric services of HA and District Social Welfare Officers of SWD, and comprise representatives of ICCMW operators and relevant government departments, such as Housing Department and the Police. The above mechanism is now in effective operation.  We will continue to strengthen our coordination to ensure that persons with mental illness will be provided with coordinated and holistic services.

     Thank you, President.

Ends/Wednesday, May 30, 2012
Issued at HKT 13:08