****************************
Following is a question by the Hon Cheung Kwok-che and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 27):
Question:
It has been reported that on May 3, this year, a man suffering from mental illness suddenly became agitated at home and killed his family members before jumping off a building to his death. Subsequently it was confirmed that the man, who suffered from schizophrenia, had not participated in the Case Management Programme for people with severe mental illness after being discharged from the hospital, and had stopped visiting the clinics in public hospitals for follow-up consultations since September last year. Although hospital staff had contacted him, he refused treatment and tragedy eventually happened. The Hospital Authority (HA) published in 2010 the Report of the Review Committee on the Management and Follow-up of Mental Patients, which recommended, among other things, a study on whether Hong Kong should follow the practice of the United Kingdom and Australia to legislate on the introduction of Community Treatment Orders (CTOs). The CTOs in such countries require people with severe mental illness, but not to the extent of requiring hospitalisation, to receive treatment in community and regularly attend follow-up consultations as well as participate in community activities, and those who breach such orders may be subject to mandatory hospitalisation. In this connection, will the Government inform this Council:
(a) given that the Food and Health Bureau (FHB) has started to study overseas experience and relevant legislation regarding the issue of CTOs since 2010, as well as to explore whether it is suitable to implement CTOs in Hong Kong, but after such a protracted study, FHB has not reached a conclusion yet, of the reasons for that; when it can introduce the relevant bill to this Council for discussion;
(b) how it prevents the refusal of treatment by people with mental illness and the recurrence of similar tragedies; how it conducts public education to promote public understanding of the needs of the people recovering from mental illness and the proposal to introduce CTOs so that the public will support the proposal; and
(c) given that it has been reported that in order to save manpower, HA intends to slow down the development of new services (e.g. the expansion of psychiatric outreach services and case manager services for following up psychiatric patients), and among the more than 170 000 people seeking consultation from the psychiatric units of HA at present, 40 000 are severe cases, whether it knows the detailed reasons for HA slowing down the expansion of psychiatric services under such circumstances; how the Government assists HA in expediting the recruitment of psychiatrists and stepping up staff training to meet the urgent need of treating people with mental illness?
Reply:
President,
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. As the mental health policy and provision of related service programmes involve a number of policy bureaux and government departments, the Food and Health Bureau assumes the overall responsibility of co-ordination and works in close collaboration with the Labour and Welfare Bureau (LWB), Department of Health (DH), Hospital Authority (HA), Social Welfare Department (SWD) and other relevant government departments.
(a) A Community Treatment Order (CTO) requires persons with mental illness to receive designated treatment while living in the community. As the proposal of implementing a CTO in Hong Kong will have far-reaching implications on both patients and 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. The Working Group of Mental Health Services under the chairmanship of the Secretary for Food and Health has set up a Focus Group on Community Treatment Order in 2010 to study the experience and the relevant legislation of overseas jurisdictions in detail and the applicability of CTO in the local context. As the study is still in progress, we are unable to set out an exact timetable for the legislation.
(b) The existing Mental Health Ordinance, as well as the medical and rehabilitation services and follow-up models provided by various departments through multi-disciplinary and cross-sectoral collaboration, have effectively ensured that patients are given timely treatment and proper care in the course of recovery. When providing medical services and treatment to patients, healthcare professionals must take into account patients' preferences and rights. Doctors of public hospitals and clinics have upheld professional ethics and spirit, which require them to seek consent from patients for treatment and respect patients' decision of not receiving treatment. However, the Mental Health Ordinance provides that where a patient is suffering from mental disorder of a nature or degree which warrants his/her detention in a mental hospital for observation; and ought to be so detained in the interests of his/her own health or safety or with a view to the protection of other persons, a court may order a patient to receive compulsory treatment in a mental hospital.
Besides, HA also has an established mechanism in place to conduct risk assessment for patients of out-patient psychiatric clinics who fail to attend follow-up consultations as scheduled, so as to determine the appropriate follow-up actions and support for the patients. If these patients are high-risk patients who are categorised as priority follow-up cases, HA will arrange community psychiatric nurses to conduct outreach visits in order to provide special follow-up for them.
As thorough consideration and extensive consultation is necessary to assess the applicability of CTO in the local context, our main task currently is to enable the public to understand the various service models and directions for the treatment of mental illness and support for mental patients and ex-mentally ill persons, as well as the importance of prevention and early treatment. We also endeavour to promote public acceptance of ex-mentally ill persons and enhance community support for them.
Towards this end, HA promotes mental health through its psychiatric departments to raise public awareness of the importance of mental health. Its "Child and Adolescent Mental Health Community Support Project" promotes mental health among youngsters and their parents through the schools and community youth centres. DH has included mental health in its public health education programme, whereas SWD also conducts community mental health educational activities through the Integrated Community Centres for Mental Wellness.
(c) In view of the steadily increasing public demand for psychiatric services, the Government and HA have continuously allocated additional resources and manpower to meet the service needs. In the past five years, the Government has increased funding allocation for mental health services by about 30%, from $3.39 billion in 2007-08 to $4.58 billion in 2011-12. Out of these expenditures, total government expenditure on the provision of HA's psychiatric services (including in-patient services, specialist out-patient services, community outreach services and day hospital services) has increased from $2.67 billion in 2007-08 to over $3.52 billion in 2011-12, representing an increase of nearly 32%; and total government expenditure on the provision of SWD's community rehabilitation services (including residential care services, community support services, day training and vocational rehabilitation services for ex-mentally ill persons) has also increased from $720 million to $1.06 billion during the same period, representing an increase of 47%.
On the manpower of psychiatric services, the net growth rate of manpower of the multi-disciplinary teams of HA's mental health services (including doctors, nurses and allied health professionals) was over 400 in the past five years, representing an increase of about 18%.
In respect of the Case Management Programme, HA has extended the programme from three districts to five more districts in 2011-12 and plans to further extend it to four more districts (Kowloon City, Southern, Central and Western and Islands) in 2012-13. As at the end of March 2012, HA has employed a total of 155 healthcare and allied health personnel with experience in community mental health services as case managers for the provision of intensive and personalised community support to some 10 000 patients with severe mental illness living in these districts.
Looking ahead, HA will continue to deploy and adjust its manpower flexibly and devise service planning, having regard to the development of psychiatric services, so as to meet the community needs for mental health services.
Ends/Wednesday, June 27, 2012
Issued at HKT 12:43
NNNN