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Following is a question by the Hon Christoper Chung and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (November 11):
Question:
Earlier on, two incidents happened consecutively in which a man with mental illness records allegedly killed a family member and another stabbed passers by. These incidents have aroused concerns about the potential threats posed to the public by mentally ill patients with a propensity to violence living in the community. In this connection, will the Government inform this Council:
(1) of the number of cases, in each of the past 10 years, in which mentally ill and ex-mentally ill persons assaulted others; the resultant casualties of such cases, with a breakdown by whether or not the victim(s) and the assaulter knew each other;
(2) of the number and age distribution of new patients diagnosed with mental illnesses in each of the past three years and, among them, the number of those identified as having a propensity to violence;
(3) of the current situation of psychiatric specialist services of public hospitals, including the respective numbers of outpatient clinics, hospital beds and psychiatrists;
(4) whether it has reviewed if the existing public psychiatric services can identify mentally ill patients with a propensity to violence so that appropriate treatments and support can be provided for such patients;
(5) of the existing criteria for discharging mentally ill patients from hospitals, and whether it will review such criteria; and
(6) of the measures in place to strengthen support for mentally ill patients living in the community who have a propensity to violence or records of wounding others?
Reply:
President,
(1) The Police and the Hospital Authority (HA) do not maintain statistics on the number of cases in the past 10 years in which mentally ill and ex-mentally ill persons assaulted others, the resulting casualties of such cases, and whether or not the victims and the assaulters knew each other.
(2) The total number of patients (by age group) receiving different kinds of treatment in psychiatric units of the HA is listed in Annex.
The HA does not maintain the statistics on the number and age distribution of new patients diagnosed with mental illnesses each year nor the number of those identified as having a propensity to violence among them.
(3) The psychiatric specialist service of the HA is operated in an integrated and multi-disciplinary mode. A medical team comprising psychiatrists, psychiatric nurses, clinical psychologists, medical social workers and occupational therapists provides patients with the appropriate treatment and follow-up care, including hospitalisation, specialist out-patient consultation, daytime rehabilitative training and community support service, in accordance with their acuity and clinical needs. As at March 31, 2015, there were 333 doctors working in the psychiatric specialist departments of the HA, providing comprehensive psychiatric specialist service for patients. Besides, there are a total of 18 psychiatric specialist out-patient clinics under the HA and 3 607 psychiatric beds in 10 public hospitals, providing patients with the appropriate treatment.
(4) To facilitate early identification and follow-up of mentally ill patients with propensity to violence or record of criminal violence in a more effective manner, the HA has earlier reviewed and enhanced the priority follow-up system, which was established years ago, and already adopted a more comprehensive special care system. Under the new system, patients are categorised into different risk groups according to their clinical conditions and the severity of their past propensity to violence or record of criminal violence. The multi-disciplinary team comprising different healthcare professionals will draw up appropriate care plans and follow up the cases according to the needs and risk profiles of patients. At present, the HA provides psychiatric service to more than 210 000 patients, about 7 000 of whom are put under the special care system for further follow-up.
(5) To help patients, who have a history of or disposition to commit criminal violence but are currently in stable conditions, to reintegrate into the community, attending doctors may allow them to be discharged subject to specific conditions under the Mental Health Ordinance (Cap. 136) ("conditionally discharged"), including residing at a specified place, receiving follow-up care in the community and regular follow-up consultation, and taking medication as prescribed by a medical practitioner.
Regarding "conditional discharge" cases, if a patient fails to comply with any condition imposed on him/her, and if 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 and his/her condition warrants 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).
The HA issues guidelines on the operation and administration of in-patient service (including in-patient psychiatric service) from time to time so as to improve the management of the service. The HA will monitor the operation and arrangement concerned, and conduct evaluation as and when necessary.
(6) The HA and the Social Welfare Department (SWD) has been taking measures over the years to enhance community support for mentally ill patients (including patients with propensity to violence or record of criminal violence), so as to facilitate their recovery and re-integration into the community. The details are as follows:
Integrated Community Centre for Mental Wellness
Medical social workers of the SWD stationed in the psychiatric hospitals and clinics of HA provide support services for mentally ill patients. Where patients are assessed to be fit for discharge, medical social workers will provide counselling service for those in need and their families to cope with issues such as emotional and family relationship problems and assist them in applying or referring them for rehabilitation and community services provided by service units like Integrated Community Centres for Mental Wellness (ICCMWs). Currently, there are 24 ICCMWs across the territory, providing one-stop, district-based community support services ranging from prevention to risk management for discharged mentally ill patients, persons with suspected mental health problems, their families/carers and residents living in the districts. These services include outreaching visits, casework counselling, therapeutic and supportive groups, social and recreational activities, day training and public education programmes. The ICCMWs will also maintain contact with the HA to follow up on cases in need.
Case Management Programme
Since April 2010, the HA has launched a Case Management Programme to proactively provide intensive, continuous and personalised support for patients with severe mental illness living in the community. The case managers under the programme will work closely with service providers, particularly the ICCMWs set up by the SWD, to provide community support to target patients. The programme has been extended to cover all 18 districts in the territory since 2014-15 to benefit more patients. In 2015-16, the HA will introduce a peer support element into the programme to further enhance community support for patients with severe mental illness.
Intensive Care Teams
In order to enhance the capacity to provide rapid response for emergency referrals in the community, Intensive Care Teams were set up by the HA in all the seven clusters in 2011-12 to strengthen the intensive support and long-term care for high-risk mentally ill patients residing in the community.
Mental Health Direct
The HA has established a 24-hour psychiatric hotline "Mental Health Direct" to provide support for mentally ill patients and their carers. The hotline is operated by professional psychiatric nurses, who will give advice on mental health issues to patients, their carers and other stakeholders. The psychiatric nurses will also take the initiative to contact rehabilitated service users with a view to facilitating their reintegration into the community.
The HA and the SWD will duly review and monitor the services provided and assess the manpower requirements to ensure that their services can cope with the needs of mentally ill and ex-mentally ill patients.
Ends/Wednesday, November 11, 2015
Issued at HKT 16:37
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