Provisional Legislative Council
Panel on Health Services

Meeting on 9 December 1997

Information Paper on

Medical Rehabilitation Services for Ex-mental Patients

Introduction

Mental illness is chronic in nature and requires long-term treatment, which includes in-patient psychological and drug treatment, community care, psychological counselling and skills training after discharge from hospital, as well as continual medication to control mental condition. The Government provides two broad categories of services for ex-mental patients, namely medical rehabilitation and social rehabilitation. This paper informs Members of the medical rehabilitation services provided by the Hospital Authority (HA) for ex-mental patients.

In-patient Services

2.HA operates three psychiatric hospitals and psychiatric wards in seven other hospitals. The services provided by these hospitals have been much improved over the past few years. Bed places have increased from 4 100 in March 1992 to 5 000 in November 1997. The number of psychiatrists and psychiatric nurses have also increased from 100 and 1 600 in 1992 to 170 and 2 000 respectively in 1997. Our current plan is to provide an additional 670 psychiatric beds over the next five years.

3. Looking ahead, HA will continue to expand and improve its in-patient services for the mentally ill. With the completion of phase I of the major redevelopment project of Castle Peak Hospital, the commissioning of phase II is now under way. Upon completion of the whole programme, the ward environment in Castle Peak Hospital will be greatly improved to give patients more activity space. Medical facilities will also be upgraded. 4.At present, counselling services are provided to patients before discharge by medical and nursing staff and medical social workers in all hospitals. This aims to assist discharged patients in strengthening social ties, developing self-care capability as well as upgrading social and living skills for better re-adjustment to life in the community.

Day Hospital Services

5.Day hospital services are offered to patients who have been discharged but are in need of continuous day nursing care and domiciliary or occupational counselling. The provision of day hospital services will enable patients to integrate more easily into the community by maintaining their social ties. Cases of prolonged hospitalisation are also reduced so that hospital beds can be better utilised. This year a total of 600 day hospital places are provided by the psychiatric units of our hospitals. The number of these places will increase to 720 over the next five years according to our current plan.

Out-patient Services

6.For patients who do not need treatment at hospitals, including discharges, out-patient services are available at the 17 psychiatric specialist clinics run by HA. The average waiting time for first appointments in these clinics is ten weeks whereas the waiting time for follow-up appointment normally ranges from four to 12 weeks, depending on patients' conditions. Under the triage system now in place, patients in more serious condition will be given an earlier first appointment. If patients fail to keep their appointments, HA will contact them by telephone, in writing or through home visits to ensure that their progress is monitored by doctors for proper and timely treatment.

7.Starting from this month, the Kwai Chung Hospital, Pamela Youde Nethersole Eastern Hospital and United Christian Hospital will provide services for mental patients during public holidays on a trial basis for the convenience of both patients and their families. The trial scheme will be reviewed in six months.

8.HA has set up a 24-hour telephone enquiry hotline on mental illness. The hotline is manned by medical and nursing staff who will offer appropriate advice to patients and their families calling to seek assistance. In the Accident and Emergency Departments of all public hospitals, experienced medical and nursing staff are always available to attend to mental patients requiring urgent treatment.

Community Care

9.Apart from the provision of psychiatric in-patient, out-patient and day hospital services, HA also makes continued efforts to deliver a variety of post-discharge community care and outreaching services to help ex-mental patients re-integrate into society. The 13 community psychiatric nursing service centres under HA pay home visits and provide rehabilitative care to the ex-mental patients referred from hospitals and out-patient clinics. Community nurses will assess patients' conditions and provide follow-up nursing care such as checking if patients are on medication as directed. They will also educate ex-mental patients and their families on mental health. Outreaching Services

10.HA has set up five community psychiatric teams which are composed of psychiatrists, community nurses, psychotherapists, occupational therapists and medical social workers. They make regular visits to the ex-mentally ill whose condition is relatively unstable, and provide them with appropriate and comprehensive treatment as well as assistance like occupational therapy and psychological counselling. These teams also visit regularly the homes, half-way houses, sheltered workshops and work places of ex-mental patients to monitor their progress. With the consent of the patients, team members will keep in touch with the family members, employers, housing managers and co-tenants of the patients when necessary to give patients the appropriate support. To cater for the special needs of elderly patients, HA has also established eight community psychogeriatric teams to deliver related services to the mentally-ill elderly and their carers in the community. Funds have been earmarked by the Government for HA to set up another community psychogeriatric team in 1998/99.

11.The outreaching services have been introduced for only four years and are expanding gradually. HA will review regularly the scope and coherence of the community-based services to ensure the effective use of resources. The Government is closely monitoring the demands of ex-mental patients for such services and will allocate additional resources to extend the services when necessary.

Success Rate of Rehabilitation

12.According to the information provided by HA, the rate of re-admission of ex-mental patients due to relapse within 28 days of discharge has remained at 3% in recent years. This ratio is comparable to that of countries with more developed psychiatric services. The successful rehabilitation of mental patients depends not only on the medical rehabilitation services provided by HA, but also on good social rehabilitation services as well as care and support from the patients' family members and the community after their discharge from hospital. In this connection, we do not consider it appropriate to set a standard success rate for medical rehabilitation.

Hospital Authority
December 1997