LCQ5: Supporting children and adolescents with mental health needs
3.5.2023

âFollowing is a question by the Hon Chan Pui-leung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 3): Question: In recent years, the Government has successively introduced measures targeted at improving child and adolescent mental health, such as the Student Mental Health Support Scheme (the SMHS Scheme) and the Pilot Scheme on New Service Protocol for Child and Adolescent with Attention Deficit Hyperactivity Disorder and Comorbidity (the Pilot Scheme). In this connection, will the Government inform this Council: (1) of the number of participants in the SMHS Scheme in each of the past five school years, and set out in the table below a breakdown by profession (i.e. (i) psychiatrist, (ii) psychiatric nurse, (iii) school social worker, (iv) clinical psychologist, (v) educational psychologist, (vi) occupational therapist and (vii) designated teacher); School year (i) (ii) (iii) (iv) (v) (vi) (vii) 2017-2018 ...... 2021-2022 (2) whether it assessed the effectiveness of the SMHS Scheme and the Pilot Scheme in the past three years; of the extent to which such Schemes were affected by the COVID-19 epidemic, and whether the Government provided relevant support for students during the suspension of school classes; if so, of the details; if not, the reasons for that; (3) as the Chief Executive proposed in the 2022 Policy Address that the multi-disciplinary SMHS Scheme would be enhanced with a view to identifying students in need and arranging for them to receive professional support as early as possible, how the Government will enhance the Scheme, and of the relevant implementation details; (4) as there are views that with the service mode of the Pilot Scheme being mainly diversified group training, the service effectiveness for individual cases is relatively low, whether the Government will review and improve the service mode of the current Scheme; if so, of the details; if not, the reasons for that; and (5) as there are views pointing out that currently, quite a number of professional bodies and non-governmental organisations have launched mental health support programmes which are targeted at children and adolescents and are relatively well-developed, whether the Government will consider strengthening collaboration with such bodies or organisations in the district health centres across the territory, as well as setting up funding schemes to promote mental health among grass-roots children and adolescents and strengthen the mental health support services for cases with stable conditions of illness; if so, of the details; if not, the reasons for that? Reply: President, In consultation with the Education Bureau (EDB), the Social Welfare Department (SWD) and the Hospital Authority (HA), the consolidated reply to the question raised by the Hon Chan Pui-leung is as follows: The Government's policy on mental health is to adopt an integrated approach to promote mental health of the public (including children and adolescents). Services provided include prevention, early identification, as well as timely intervention, treatment and various community rehabilitation and support services for persons in need. The Government seeks to provide cross-disciplinary and cross-sectoral services to persons with mental health needs through collaboration and co-operation among the Health Bureau (HHB), the Labour and Welfare Bureau, the EDB, the Department of Health, the SWD, the HA, non-governmental organisations and other stakeholders in the community. The Advisory Committee on Mental Health (ACMH), comprising persons from various relevant professions and sectors, also had in-depth discussion on the means of promoting mental health more effectively with a cross-disciplinary and cross-sectoral approach and provided valuable views to the Government. (1) The HA delivers mental health services using an integrated and multi disciplinary approach with a multi-disciplinary team involving psychiatrists, psychiatric nurses, clinical psychologists, medical social workers and occupational therapists, etc., so as to allow flexible deployment of manpower to cope with service needs and operational requirements. As healthcare professionals would usually need to provide support for a variety of psychiatric services, the manpower for supporting individual psychiatric services (including the Student Mental Health Support Scheme (SMHSS)) cannot be separately quantified. (2) to (4) SMHSS The former Food and Health Bureau (currently HHB), in collaboration with the HA, the EDB and the SWD, launched the SMHSS starting from the 2016/17 school year. Based on a medical-educational-social collaboration model, a multi-disciplinary team comprising psychiatric nurse of HA, designated teacher and school social worker, was formed in each participating school. The team worked closely with the psychiatric team of HA, the school-based educational psychologist, teachers and social workers from relevant social service units to provide support services to students with mental health needs in the school setting. Impacted by the COVID-19 epidemic, on-campus services of SMHSS were suspended due to the suspension of face-to-face classes for schools. During the period, multi-disciplinary teams of SMHSS continued to conduct case conferences to discuss the latest development of cases and provide students with practicable support according to their situation, such as following up with students' conditions via telephone communication. Guidelines on telehealth services provided by SMHSS under the epidemic were also formulated. If necessary, the HA might arrange suitable students being supported by the SMHSS to receive support services by telehealth if circumstances permit and with the consent of the participating students/their parent(s). The HHB had commissioned the Chinese University of Hong Kong to conduct evaluation on the effectiveness of the SMHSS for the school years of 2016/17 to 2018/19. The outcome showed that the SMHSS was well received by schools while parents and students generally considered the support services provided by SMHSS helpful. Based on the outcome of the evaluation report, the Government expanded the SMHSS from supporting 17 schools in the 2016/17 school year to 210 schools in the 2021/22 school year. The HHB is currently reviewing the existing service model of the SMHSS with the HA, the EDB and the SWD, with a view to enhancing the sustainability of the SMHSS, providing more targeted services, strengthening training and promotion related to mental health in schools, as well as enhancing the support services to students with mental health needs in schools. Pilot Scheme on New Service Protocol for Child and Adolescent with Attention Deficit Hyperactivity Disorder and Comorbidity (ADHD+) The ADHD+ was launched in March 2021. Corresponding to the location of the HA clusters providing child and adolescent psychiatric services, the ADHD+ established multi-disciplinary service platforms in five districts, managed by non-governmental organisations, to provide services for children and adolescents suspected with attention deficit hyperactivity disorder and comorbidity. The core team staff for each service platform comprises clinical psychologist, nurse, occupational therapist and assistant social work officer, providing timely assessment, intervention and support with a medical-social collaboration model for children and youths in need. The face-to-face services of ADHD+ were suspended during the period of mid-January to early May 2022 due to the epidemic. Only emergency phone services and limited online services were maintained. The HHB has commissioned the Department of Psychiatry of the University of Hong Kong to conduct a comprehensive evaluation on the effectiveness of the ADHD+ upon its completion. The evaluation report is expected to be completed by early 2024. In response to the outcome of the evaluation report, the HHB will consider the subsequent arrangements of the ADHD+ upon consultation with the ACMH and its Expert Group on New Service Protocol for Child and Adolescent Mental Health Services. The ADHD+ was originally launched for a period of two years, but in order to ensure the continuity of services, the ADHD+ will be extended to July 2024 before the subsequent arrangements are confirmed. Other support regarding mental health needs of students during class suspension Apart from the SMHSS and the ADHD+, during the suspension of face-to-face classes, professionals of various disciplines in schools (including guidance personnel, school social workers and school-based educational psychologists) kept providing appropriate support to students, such as keeping in contact with and showing concern for students through telephone and electronic communication, closely observing students' performance and enhancing communication with their parents. If students were found to be emotionally disturbed, teachers would refer them to professionals for follow-up in a timely manner. Meanwhile, with a view to addressing the impacts brought to mental health of students by the suspension and resumption of face-to-face classes, the Government disseminated information related to mental health as well as physical and mental development to schools, parents and students through various channels, such as ACMH's mental health promotion and public initiative "Shall We Talk" as well as EDB's one-stop student mental health information website "Mental Health@School" and "Smart Parent Net" website. Furthermore, the EDB has also arranged "gatekeeper" training for teachers, parents and students on a regular basis to strengthen the support for students with mental health needs. (5) With an emphasis on preventive work, the District Health Centres (DHCs) provide disease prevention services at the primary healthcare (PHC) level with a view to enhancing public awareness of personal health management and disease prevention. Among the three levels of prevention, primary prevention provides health educational programmes and preventive promotion with wide coverage, which includes mental health. The DHCs provide basic health risk assessments with an aim to identifying health risk factors at an early stage. If members of the public (including children and adolescents) are found to have emotional problems, nurses and social workers of DHCs will provide them with health consultation and counselling services. The DHCs also serve as district PHC hubs to work with other community partners that provide PHC services and co-ordinate referral services, including mental health support, for members of the public who are in need. Apart from the above services, the Primary Healthcare Office has started examining the need of enhancing services related to mental health in the DHCs and PHC service. The Government's 2020 Policy Address announced that $300 million was earmarked under the Beat Drugs Fund for the aims of providing better support to the needy in the community and raising public awareness of mental health. The Mental Health Initiatives Funding Scheme (the Funding Scheme) was implemented in two phases, i.e. Phase 1 and Phase 2. Under Phase 1 of the Funding Scheme, projects areas that were accorded priority include lay leaders in community (including adolescents) and carer support (including carers of general students and students with special educational needs), with the 70 approved projects implemented in batches since February 2022. As for Phase 2 of the Funding Scheme, project areas that were accorded priority include support for children and adolescents with special educational needs and strengthening of family relationship, with the 102 approved projects implemented in batches since March 2023.