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Following is a question by the Hon Regina Ip and a written reply by the Secretary for Education, Mr Eddie Ng Hak-kim, in the Legislative Council today (May 25):
Question:
Recently, some members of the public have relayed to me that students have to wait for an extremely long time for diagnostic services of mental health experts provided by the Government or the Hospital Authority. In reply to a question raised by me at the meeting of this Council of January 27, 2016, the authorities indicated that the Department of Health had implemented the Student Health Service since the 1995-1996 school year, under which annual check-ups (which included examination related to psychological health and behavior etc) were arranged for primary and secondary school students at student health service centers, and students in need were referred to the special assessment centre, specialist clinics (including psychiatric clinics), schools or social welfare organisations for detailed assessment and follow-up. Regarding the mental health problems of students, will the Government inform this Council:
(1) whether it knows the more common types of mental illnesses among primary and secondary school students in the past three school years, and the respective numbers of primary and secondary school students suffering from those illnesses;
(2) whether the Education Bureau (EDB) requires schools to notify it after learning that a student has been diagnosed with mental illness; if EDB does, of the number of such cases in the past three school years and, among these cases, the number of those diagnosed by psychiatrists in private practice;
(3) of the measures in place to support schools in taking care of students suffering from mental illnesses; and
(4) whether it knows, in respect of the new cases of the psychiatric specialist outpatient clinics in public hospitals in each of the past three years, (i) the overall average waiting time of such cases and (ii) the average waiting time of new cases involving persons aged 18 or below?
Reply:
President,
My reply to the Hon Regina Ip's question is as follows:
(1) Mental illness covers a range of types, including Depression, Anxiety Disorders and Psychosis. Each has different symptoms, and its presenting problems can have different manifestations and cover various aspects such as mental state, thinking, social interaction, emotion and behaviour. Students with mental illness are mainly attended by psychiatrists and followed up by paramedical professionals such as clinical psychologists and medical social workers. According to the statistics of the Hospital Authority (HA), the number of students aged under 18 receiving child and adolescent (C&A) psychiatric services in the HA, including Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder, Behavioural and Emotional Disorders, and other psychiatric diagnosis, by age in the past three years is set out at Annex 1.
(2) and (3) As stated in the School Administration Guide (SAG), schools should solicit parents' cooperation in reporting the medical history of their children. They should keep students' health records properly for reference, which should not be divulged to other parties without the consent of the parents concerned. According to the existing mechanism, the Education Bureau (EDB) does not require schools to submit data and information of individual students with mental illness (including Depression, Anxiety Disorders and Psychosis).
With regard to identification and assessment, the EDB encourages schools to adopt a Three-tier Support Model to provide different levels of identification and support by teachers, guidance personnel and professional staff respectively to help students with mental illness. If teachers suspect that any of their students may have mental illness and are in need of professional assessment or consultation services, they may approach professionals in their schools, such as school social workers, who will communicate with the students and their parents, and if necessary, refer the students to psychiatrists for diagnosis or medication.
Students with mental illness need treatment and follow-up by medical professionals. The roles of schools are to help these students re-enter school and adapt to school life after treatment, in tandem with the medical treatment and rehabilitation requirements.
The EDB has laid down in the SAG a guideline entitled "How Schools can Help Students with Mental Health Problems" for schools' reference. To support students with mental illness, the student support teams will maintain communication with the students concerned and their parents to understand their needs. The teams will plan and evaluate the support strategies for the students according to their adjustment conditions in schools. There will also be regular monitoring, review and evaluation of the students' conditions as well as the effectiveness of the support rendered. Subject to the consent of parents, schools will arrange multi-disciplinary case conferences where necessary for psychiatrists, clinical psychologists, medial social workers, educational psychologists (EPs), or relevant professionals to discuss appropriate support measures for the students. These include creating a caring learning environment, making accommodations on teaching and learning, adjusting class arrangements, and providing emotional counselling and peer support, etc. We also encourage parents to discuss the particular needs of their children with schools so that appropriate support will be offered in accordance with the student's conditions and needs.
For students with severe emotional and behavioural problems induced by their mental illness, the EDB will consider providing their schools with a time-limited grant where appropriate for employing teaching assistants to help the students concerned follow classroom routines and learn effectively.
In terms of teacher training, the EDB has commissioned annually a tertiary institution to run a 120-hour thematic course on Effective Strategies for Managing Students' Challenging Behaviour: A Psychological Approach. The main objective and contents of the course are to enhance teachers' understanding of students' developmental needs, including students' deviant and unruly behaviour, low self-esteem and some common emotional and psychiatric problems. Through theoretical discussions and case analysis, the course helps teachers develop positive attitudes and effective strategies for supporting students in handling potential crises in different stages of development. From the 2011/12 to 2014/15 school years, the EDB and HA jointly organised a number of talks and workshops on various types of mental illness, such as Psychosis, Depression, Anxiety Disorders, for student guidance teachers/personnel. Psychiatrists, EPs and social workers were invited to share their views on supporting students with mental illness.
The EDB has been working closely with the HA to review and discuss ways to strengthen the existing notification, referral and support mechanism to ensure effective cross-disciplinary collaboration and communication. We have already reached a consensus with the seven district centres of the Early Assessment Service for Young People (E.A.S.Y.) under the HA, in which schools may call the respective district service centres direct for expert advice and support, including assessment, thematic seminars/workshops and ongoing treatment services. In order to ensure appropriate and timely treatment and support services provided to students with mental illness, prior to referring the students concerned to the C&A psychiatric services under the HA for assessment, the school or EP will obtain parental consent for making the referral and psychiatric evaluation, as well as parental consent for the HA to pass the psychiatric report to the school or EP for follow-up actions after the assessment.
The multi-disciplinary team of the psychiatric department under the HA offers students with mental illness a series of relevant services, including inpatient, specialist outpatient, day training and community outreaching services. The team also provides parents and carers of the students concerned with suitable support and training to raise their understanding of the symptoms and treatment needs of the students. In addition, the professional team maintains close liaison with related organisations, such as schools to make referrals and provide support as appropriate according to the developmental needs of the students.
Cross-sector collaboration plays an important role in the support for students with mental illness. Hence, we will continue to collaborate with relevant government departments and organisations concerned, including the HA, Department of Health, Social Welfare Department to review and enhance the existing referral and support mechanism, as well as the collaboration platform in order to facilitate schools to provide timely and appropriate services for students with mental illness, and help them adapt to school life.
(4) The median waiting time of new cases at the psychiatric specialist outpatient clinics (SOPCs) and C&A psychiatric SOPCs of the HA is tabulated at Annex 2.
Ends/Wednesday, May 25, 2016
Issued at HKT 17:29
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