LCQ13: Treatment and support for patients with mental illness
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Question:
Regarding the provision of treatment and support for various types of patients with mental illness and the relevant public education efforts, will the Government inform this Council:
(1) whether it knows, in each of the past five years, (i) the respective numbers of attendances for the psychiatric treatment services provided by public and private medical institutions (broken down by type of mental illness), and (ii) the respective numbers of patients with mental illness, who were being treated by public and private medical institutions, committed violent acts allegedly due to bouts of illness, as well as the numbers of such cases and the resultant casualties;
(2) whether it knows the number and age distribution of new patients diagnosed with mental illness in each of the past five years and, among them, the number of those identified as having a propensity to violence;
(3) whether it knows, in each of the past five years, (i) the quantity of psychiatric drugs prescribed by the psychiatric specialist services under the Hospital Authority (HA) and the expenditure so incurred, as well as the changes in the number of outpatient clinics and the number of healthcare staff for psychiatric specialist services, and (ii) the respective numbers of service units and staff members under HA and the Government providing psychological counselling services for patients with mental illness;
(4) whether it knows the following information concerning the psychiatric specialist services provided respectively by non-profit making organisations and private medical institutions in each of the past five years: (i) the quantity of psychiatric drugs prescribed and the expenditure so incurred, (ii) the number of outpatient clinics, (iii) the number of beds, (iv) the number of institutions and staff members providing psychological counselling services, and (v) the number of psychiatric specialist healthcare staff members;
(5) whether it knows the number of ex-mentally ill persons for whom public medical institutions and non-profit making organisations provided home visit services in each of the past five years;
(6) of the authorities' existing policy on identifying and giving support to "hidden" patients with mental illness, and the unit costs of such kind of services;
(7) whether it has studied how (i) the ratios of psychiatrists and other staff members in the public healthcare system providing psychological counselling services to patients with mental illness, as well as (ii) the data relating to the provision of psychiatric drugs and psychological counselling services for such patients compare with those in other places (e.g. Australia and Japan); if so, of the outcome; and
(8) of the measures taken by the authorities in the past five years to promote public awareness and prevention of mental illness and to mitigate the discrimination of mentally ill and ex-mentally ill persons by members of the public, as well as the manpower and expenditure involved; the specific effectiveness evaluation indicators and the future improvement plans?
Reply:
President,
Currently, the treatment and support services for various types of patients with mental illness, as well as the related public education work, are mainly the responsibilities of the Food and Health Bureau and the Labour and Welfare Bureau. My reply to the various parts of the question is as follows:
(1) The table below sets out the number of psychiatric patients receiving treatment in the Hospital Authority (HA) (including in-patient, patients at specialist out-patient clinics (SOPCs) and day hospitals), and among them, the number of patients diagnosed as suffering from severe mental illness in each of the past five years:
| Year | Number of psychiatric patients receiving treatment in the HA (Note) | Number of patients diagnosed as suffering from severe mental illness (Note) |
| 2012-13 | 197 600 | 45 500 |
| 2013-14 | 208 100 | 46 500 |
| 2014-15 | 217 400 | 47 500 |
| 2015-16 | 228 700 | 48 200 |
| 2016-17 (provisional figure) |
240 900 | 49 000 |
The Government does not keep statistics on the number of patients receiving psychiatric treatment in private medical institutions, or the number of patients with mental illness committed violent acts allegedly due to bouts of illness, who were being treated by the HA and private medical institutions.
(2) The table below sets out the number of new cases for psychiatric specialist out-patient service of the HA in each of the past five years:
Year |
Number of new cases (Note) |
| 2012-13 | 47 200 |
| 2013-14 | 47 500 |
| 2014-15 | 48 000 |
| 2015-16 | 48 500 |
| 2016-17 (provisional figure) |
48 800 |
The Government does not maintain the number of patients identified as having a propensity to violence among the above new cases of the psychiatric service of the HA. Nor does the Government keep the statistics on the number of new psychiatric patients in Hong Kong each year.
(3) and (4) The psychiatric specialist service of the HA adopts a multi-disciplinary approach. Medical teams comprising psychiatric doctors, psychiatric nurses, clinical psychologists and occupational therapists provide patients with the appropriate treatment and follow-up care, including in-patient, specialist out-patient consultation, daytime rehabilitative training and community support service, depending on patients' medical conditions and clinical needs.
The table below sets out the number of psychiatric SOPCs under the HA and the number of psychiatric doctors, psychiatric nurses, clinical psychologists and occupational therapists working in the psychiatric stream in the HA in each of the past five years:
| Year | Number of out-patient clinics | Psychiatric doctors (Note 4) |
Psychiatric nurses (Notes 5 and 6) | Allied health professionals | |
| Clinical psychologists | Occupational therapists | ||||
| 2012-13 (Note 1) | 17 | 332 | 2 296 | 65 | 218 |
| 2013-14 (Note 1) |
18 (Note 3) |
335 | 2 375 | 71 | 227 |
| 2014-15 (Note 1) |
18 | 333 | 2 442 | 77 | 236 |
| 2015-16 (Note 1) |
18 | 344 | 2 472 | 82 | 245 |
| 2016-17 (Note 2) |
18 | 356 | 2 473 | 89 | 256 |
Note 2: As at December 31, 2016.
Note 3: The psychiatric SOPC located in the North Lantau Hospital came into service on September 30, 2013.
Note 4: Psychiatric doctors refer to all doctors working for the specialty of psychiatry except interns.
Note 5: Psychiatric nurses include all nurses working in psychiatric hospitals (i.e. Kwai Chung Hospital, Castle Peak Hospital and Siu Lam Hospital), nurses working in psychiatric departments of other non-psychiatric hospitals, as well as all other nurses in psychiatric stream.
Note 6: Including community psychiatric nurses.
Apart from the above healthcare professionals, medical social workers of the Social Welfare Department (SWD) are also stationed in the psychiatric hospitals and SOPCs of the HA to provide timely psychological and social counselling services as well as financial and housing assistance for patients with mental illness and ex-mentally ill persons, with a view to helping them cope with or solve their emotional, daily living and family problems arising from mental illnesses and facilitating their rehabilitation and re-integration into society. There were 243 SWD psychiatric medical social workers in the past five years.
The table below sets out the expenditure on psychiatric drugs prescribed by the HA in each of the past five years:
| Year | Expenditure on psychiatric drugs ($ millions) |
| 2012-13 | 428 |
| 2013-14 | 423 |
| 2014-15 | 410 |
| 2015-16 | 464 |
| 2016-17 (provisional figure) |
506 |
Besides, the SWD has subvented 11 non-governmental organisations (NGOs) to set up 24 Integrated Community Centres for Mental Wellness (ICCMWs) across the territory. The ICCMWs provide one-stop and district-based community mental health support services and social rehabilitation services for ex-mentally ill persons, persons with suspected mental health problems and their families and carers through professionals such as social workers and psychiatric nurses. Services provided include casework counselling services, outreaching services, and referral of needy cases to the HA for clinical assessment and psychiatric treatment.
Under the Lump Sum Grant subvention system, service operators have the flexibility to deploy resources and arrange suitable manpower. The table below sets out the numbers of social workers and psychiatric nurses working in the ICCMWs in each of the past five years according to the notional staffing establishment provided by the SWD:
Year |
24 ICCMWs (According to the notional staffing establishment) |
|
| Number of social workers |
Number of psychiatric nurses |
|
| 2012-13 | 288 | 43 |
| 2013-14 | 317 | 43 |
| 2014-15 | 339 | 43 |
| 2015-16 | 363 | 43 |
| 2016-17 | 363 | 43 |
The Government does not maintain statistics on the quantity of psychiatric drugs prescribed and the expenditure so incurred, the number of outpatient clinics, the number of beds and the number of psychiatric specialist healthcare staff members in respect of non-profit making organisations and private medical institutions. Nor does the Government keep the statistics on the number of private medical institutions providing psychological counselling services and their staff numbers.
(5) and (6) The ICCMWs provide outreach support services for persons who have or are suspected to have mental health problems (including "hidden" patients with mental illness). In the past five years, the ICCMWs made an average of about 62 000 outreach visits per year.
Currently, the ICCMWs or social workers may refer their cases to the community psychiatric services in various clusters of the HA for follow-up. The HA's multi-disciplinary community psychiatric teams will provide patients with the appropriate in-patient, out-patient consultation, daytime rehabilitative training and community support services, according to patients' conditions and needs. Professional groups also work closely with the SWD to arrange joint visits on a need basis to offer co-ordinated and personalised community support to patients.
The table below sets out the number of psychiatric outreach attendances of the HA in each of the past five years:
| Year | Number of psychiatric outreach attendances of the HA (Note) |
| 2012-13 | 238 800 |
| 2013-14 | 260 100 |
| 2014-15 | 280 100 |
| 2015-16 | 282 700 |
| 2016-17 (provisional figure) |
290 000 |
As identifying and supporting "hidden" patients with mental illness is part of the on-going duties of the organisations concerned, the manpower and expenditure involved for such duties cannot be identified separately.
(7) The psychiatric specialist service of the HA adopts a multi-disciplinary approach (involving psychiatric doctors, psychiatric nurses, clinical psychologists, medical social workers and occupational therapists), which provides patients with the appropriate treatment and follow-up care, including in-patient, specialist out-patient consultation, daytime rehabilitative training and community support service, depending on patients' conditions and clinical needs. As the psychiatric team also supports other relevant services (e.g. psychiatric consultation-liaison services in Accident and Emergency Department and the Mental Health Direct hotline, etc.), we do not have the statistics on the ratio of healthcare staff providing psychiatric services to patients with mental illness.
(8) The Department of Health (DH) has been promoting mental well-being by enhancing public awareness through education and publicity targeted at people in different age groups via a life-course and setting-based approach and through various channels, such as the Family Health Service, the Student Health Service, the Elderly Health Service, the Primary Care Office and the Central Health Education Unit.
To increase public engagement in promoting mental well-being and increase public knowledge and understanding of mental health, the DH launched a three-year, territory-wide mental health promotion campaign titled "Joyful@HK" in January 2016. It seeks to promote mental health among people from different sectors and conduct health education on common mental health issues through a series of mass media advertisements, publicity activities and community programmes. The aim is to enable the members of the public to integrate the three key elements of the campaign, namely "Sharing", "Mind" and "Enjoyment", into their daily lives for enhancing their mental well-being and encouraging them to seek help from professionals when necessary. Enhancing public understanding on mental health issues is an effective way to help reduce stigmatisation.
The DH has earmarked a total of $30 million for the "Joyful@HK" Campaign for the three financial years of 2015-16, 2016-17 and 2017-18, and has deployed its existing manpower for the implementation of the campaign. The DH has also commissioned a local university to conduct pre- and post-campaign surveys to monitor changes in the public's knowledge, attitude and behaviour related to mental well-being and common mental health problems, as well as to evaluate the effectiveness of the campaign. Based on the evaluation outcome of the campaign, the Government will formulate the way forward for mental health promotion.
In addition, the NGOs operating the ICCMWs are required to organise various types of public education programmes in the community to enhance public understanding on ex-mentally ill persons in a positive manner.
As some of the promotion efforts are the on-going duties of the relevant policy bureaux/departments, the manpower and expenditure involved cannot be identified separately.
The Government will carry out timely review of the effectiveness of various mental health promotion programmes and formulate the way forward based on the review findings.
Ends/Wednesday, April 26, 2017
Issued at HKT 18:00
Issued at HKT 18:00
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