LCQ12: Provision of mental health services for children and adolescents
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Question:
A study has pointed out that nearly half of all mental illnesses begin by the age of 14, and most cases are not detected and intervened in a timely manner. There are views that as mental health services are currently provided for children and adolescents in need through a stepped care model, if access to primary mental health care under the model can be enhanced, early intervention can be facilitated and patients' demand for psychiatric specialist services can be reduced. In this connection, will the Government inform this Council:
(1) whether it knows the number of new case bookings for child and adolescent psychiatric specialist out-patient (SOP) service under the Hospital Authority (HA), and the average waiting time for such service, in each of the past five years, with a breakdown by the type of mental illness and degree of urgency of the patients;
(2) whether it has studied how the waiting time for the child and adolescent psychiatric SOP service can be shortened; if so, of the details; if not, the reasons for that;
(3) whether it knows the number of patients admitted to the child and adolescent psychiatric wards under HA, and the number of hospital beds provided in various hospitals, in each of the past five years; whether it has assessed the demand for and supply of the services concerned; if so, of the details; if not, the reasons for that;
(4) of the plans in place to enhance the access to primary mental health care to facilitate early detection of children and adolescents with higher mental health risks, with a view to allowing them to receive intervention treatment; and
(5) whether it will consider setting up a matching fund to subsidise children and adolescents in families with financial difficulties in receiving psychiatric treatment services provided by private healthcare institutions; if so, of the details; if not, the reasons for that?
Reply:
President,
In consultation with the Labour and Welfare Bureau (LWB), Education Bureau (EDB), Department of Health (DH), Social Welfare Department (SWD) and Hospital Authority (HA), the consolidated reply to the question raised by the Hon Martin Liao is as follows:
(1) The table below sets out the number of child and adolescent (C&A) psychiatric specialist outpatient new cases of the HA triaged as Priority 1 (Urgent), Priority 2 (Semi-urgent) and Routine (Stable) cases as well as their respective median waiting time from 2017-18 to 2021-22. The HA does not maintain the respective numbers according to the categories of the patients’ mental disorder.
| Financial year | Priority 1 (Urgent) |
Priority 2 (Semi-urgent) |
Routine (Stable) |
|||
| Number of new cases | Median waiting time (week(s)) | Number of new cases | Median waiting time (week(s)) | Number of new cases | Median waiting time (week(s)) | |
| 2017-18 | 239 | 1 | 907 | 5 | 9 571 | 85 |
| 2018-19 | 282 | 1 | 930 | 4 | 10 751 | 82 |
| 2019-20 (Note 1) | 355 | 1 | 912 | 3 | 10 568 | 80 |
| 2020-21 (Note 1) | 447 | 1 | 948 | 3 | 9 674 | 64 |
| 2021-22 (Note 1) | 313 | 1 | 952 | 3 | 12 245 | 79 |
(2)　The HA’s C&A psychiatric specialist outpatient clinics (SOPCs) adopt a triage system to ensure patients with urgent medical conditions who require early treatment are accorded with priority in treatment and follow-up. Generally speaking, psychiatric SOPCs will classify patients with urgent medical needs as Priority 1 (Urgent) cases for follow-up so as to ensure they will receive treatment within reasonable time. Patients may return to their respective psychiatric specialist outpatient services to receive assessment again if their mental conditions have changed during the waiting time, so that an assessment could be made as to whether there is a need to advance their consultation, or they may consider seeking treatment from the accident and emergency services.
The HA’s targets are to maintain the median waiting time for Urgent and Semi-urgent cases within two and eight weeks respectively. As reflected by the reply to sub-question (1), in 2017-18 to 2021-22, the aforementioned targets were successfully met.
In view of the constant increase in demand for C&A psychiatric services, the HA had already implemented a cross-disciplinary collaborative service model between the specialities of paediatrics and C&A psychiatry in 2020-21. Under this collaborative model, paediatricians and paediatric nurses will provide services for attention deficit/hyperactivity disorder (ADHD) patients with relatively mild and stable conditions with the support of the C&A psychiatric team.
Moreover, the HA has developed C&A psychiatric services in the Hong Kong East and Kowloon Central Clusters in phases since 2020-21 so as to enhance the support towards children and adolescents with mental health needs.
(3) The table below sets out the number of discharges of the HA’s psychiatric inpatients, as well as the number of psychiatric hospital beds (as at March 31 of each year) in 2017-18 to 2021-22. The HA does not maintain the respective breakdown concerning C&A psychiatric inpatient services.
| Financial year | Number of psychiatric inpatient discharges (Note 2 and 3) | Number of psychiatric hospital beds (as at March 31 of each year) |
| 2017-18 | 17 432 | 3 607 |
| 2018-19 | 17 915 | 3 647 |
| 2019-20 | 16 960 | 3 647 |
| 2020-21 | 16 597 | 3 647 |
| 2021-22 | 16 816 | 3 675 |
Note 3: According to the general data classification of the HA, the number of discharges also includes the number of deaths.
The HA will continue to review and monitor its services to suit the needs of patients, and will make adjustments in a timely manner should the need arises.
(4) The Government adopts a tiered service model in providing primary mental health services for children and adolescents. They are:
(a) Primary prevention: to promote mental health information to children and adolescents and encourage help-seeking through mental health promotion, advisory and counselling services as well as educational programmes, including the “Shall We Talk” mental health promotion and public education initiative; the Student Health Service of the DH; multiple guidance and discipline programmes of the EDB that enhance students’ resilience; and the youth hotline service “Youthline” provided by a SWD-subvented non-governmental organisation which provides suitable counselling and referral services for children and adolescents with mental health needs.
(b) Secondary prevention: to identify children and adolescents with mental health needs in a timely manner to facilitate corresponding intervention and treatment through mental health risk assessment and screening, including the “Comprehensive Child Development Service” jointly implemented by the LWB, EDB, DH, HA and SWD; the free annual health assessment provided by the Student Health Service of the DH to secondary and primary students, including mental health screening; the referral mechanism jointly established by the HA and EDB under which schools or educational psychologists could refer students to receive the HA’s C&A psychiatric services when needed; and the five Cyber Youth Support Teams set up by the SWD in 2018.
(c) Tertiary prevention: to provide services for children and adolescents with mental health needs in the community, including the “Student Mental Health Support Scheme” launched by the Health Bureau (HHB) in collaboration with the HA, EDB and SWD since the 2016/17 academic year to provide support for students with mental health needs in the school setting; the “Pilot Scheme on New Service Protocol for Child and Adolescent with Attention Deficit Hyperactivity Disorder and Comorbidity (ADHD+ Scheme)” launched by the HHB in March 2021 that provides services for children and adolescents suffering from or suspected to be suffering from mild to moderate ADHD and comorbidity; and the inclusion of secondary school students into the service targets of the Integrated Community Centres for Mental Wellness by the SWD since October 2019.
(5) So far, the Government has no plans to set up a matching fund to subsidise children and adolescents from low-income families to receive psychiatric treatment at private healthcare facilities. That notwithstanding, the Government is providing assistance to these children and adolescents through other schemes, one of the examples being that the Government has earmarked $300 million under the Beat Drugs Fund to implement the “Mental Health Initiatives Funding Scheme (Funding Scheme)" for the Advisory Committee on Mental Health to approve funding to strengthen support to persons in need at the community level and enhance public awareness of mental health. The Funding Scheme is implemented in two phases, with approved projects under Phase 1 of the Funding Scheme gradually commencing in the community since February 2022, including provision of subsidy for children and adolescents from low-income families to receive psychiatric treatment at private healthcare facilities so as to ensure that they could receive suitable mental health services while they are waiting for the HA’s C&A psychiatric services.
Ends/Wednesday, October 26, 2022
Issued at HKT 16:40
Issued at HKT 16:40
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