LCQ20: Providing consultation and treatment for psychiatric patients
5.7.2023

Following is a question by Dr the Hon Priscilla Leung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (July 5): Question: It has been reported that between October 2021 and September 2022, there were more than 48 000 new case bookings for psychiatric specialist outpatient (SOP) services in public hospitals, with the median waiting time concerned ranging from 14 to 63 weeks, and the longest waiting time even exceeding 90 weeks (i.e. nearly two years). As a result, some psychiatric patients were unable to receive timely treatment. In this connection, will the Government inform this Council: (1) given that the Hospital Authority (HA) will set clear indicators for the median waiting time for new case bookings for psychiatric SOP services, whether it knows when such indicators will come into force and when HA will conduct a review on these indicators, with a view to providing treatment to psychiatric patients more expeditiously; (2) whether it knows the number of new case bookings for psychiatric SOP services in public hospitals since January this year and the manpower for the provision of such services; and (3) whether it knows how HA monitors psychiatric patients with a propensity to violence to ensure that they take medications and attend follow-up consultations as scheduled after being discharged from hospitals? Reply: President, In consultation with the Hospital Authority (HA), the reply to the question raised by Dr the Hon Priscilla Leung is as follows: (1) The Government announced ten enhanced measures on June 9, 2023, to support persons in mental recovery and with mental health needs, including the HA setting clearer targets for the median waiting time for new cases at psychiatric specialist outpatient (SOP) clinics, with median waiting time for Priority 1 (urgent) cases be kept within one week and that for Priority 2 (semi-urgent) cases be kept within four weeks. The relevant targets are now in effect. The HA will conduct review in a timely manner to ensure that patients with urgent conditions and requiring early treatment receive follow-up and treatment with priority. (2) From January 1 to May 31, 2023, there were 21 182 new case bookings at psychiatric SOP clinics (provisional figure). On the manpower providing psychiatric SOP services, the HA delivers mental health services through an integrated and multi-disciplinary approach, with a team consisting of psychiatric doctors, psychiatric nurses, clinical psychologists, occupational therapists and medical social workers, etc. The HA adopts a multi-disciplinary team approach to allow flexible deployment of staff to cope with service needs and operational requirements. As healthcare professionals are usually required to support a variety of psychiatric services, the manpower involved in supporting new cases at psychiatric SOP clinics cannot be separately quantified. In 2022-23 (as of March 31, 2023), there was a total of 381 psychiatric doctors, 3 015 psychiatric nurses, 111 clinical psychologists and 302 occupational therapists working in the psychiatric stream of the HA (Note 1) (Note 2). (3) According to section 42B of the Mental Health Ordinance (Cap. 136), if a patient who is for the time being liable to be detained has a medical history of criminal violence or a disposition to commit such violence, but may safely be discharged subject to conditions to be specified, the patient may be discharged subject to the imposition of certain specified conditions. Hence, if the patient's condition is stable, the HA may conduct a multi-disciplinary case conference during which relevant professionals (such as the case doctor, medical social worker, case manager, nurse and allied health professional, etc.) will together discuss and decide whether the patient could be discharged subject to the imposition of certain specified conditions. Such conditions may require the patient to reside at a specified place (such as residence, Halfway House, Residential Care Home for Persons with Disabilities and Long Stay Care Home, etc.), to receive follow-up consultation at a specified out-patient department of a hospital, to take medication as prescribed by a medical practitioner, and to be under the supervision of the Director of Social Welfare. The multi-disciplinary team of the HA's community psychiatric service will provide appropriate community support, including disease management and medication management, according to the severity of the condition and clinical needs and risks of the persons in mental recovery living in the community. In general, case managers will understand patients' medication status and remind them to attend regular follow-up appointments during home visits. In addition, the HA's psychiatric SOP clinics or Mental Health Direct hotline will proactively contact defaulted high-risk patients and immediately re-arrange follow-up appointments for them. In any case where a conditionally discharged patient has failed to comply with any condition to which his order for discharge is subject; and in the interests of the patient's health or safety, or for the protection of other persons, the patient can be recalled to the mental hospital by the HA. Note 1: The manpower figures above are calculated on full-time equivalent basis, including permanent, contract and temporary staff, but excluding those in the HA Head Office. Note 2: Psychiatric doctors refer to all doctors working for the psychiatric specialty, except interns.