Mental Health Review (MHR) Report 2017
Response from the Hong Kong College of Psychiatrists:
The College welcomes the MHR report, which represents a much appreciated commitment of the Government to development of mental health services in Hong Kong under a coherent plan. The plan stops short of being an overarching mental health policy with sufficient details to provide strategic direction for the future development of services.
There are a number of shortcomings.
- The report highlighted the overall inadequacy in the provision of mental health services in Hong Kong, but the recommendations are relatively few and feeble, and are made without solid commitment. There are huge gaps between the aspirations and specific details. Importantly, there is no commitment to fill the central gap of substantial up-scaling and up-grading of the mental health workforce, which is positioned at the top tier in a stepped care model.
- Overall shortage in manpower and training are not substantively addressed. The number of psychiatrists in Hong Kong is currently at 1/3 of the levels in OECD countries, other professional are likewise in gross shortage. Strengthening the mental health workforce is pivotal to truly implement the suggested directions (such as coordinating service in a stepped-care model with other sectors).
- In the context of this challenging demand it is surprising that there is no specific mention of public-private health care interface. Of the inadequate number of psychiatrist in Hong Kong about 1/3 are in private practice. How to utilize better this precious resource is not mentioned.
- Likewise there is also no mention of honoring the equity of mental health with physical health by ensuring insurance coverage of mental health conditions in medical insurance policies. This is a strategic omission that we hope to see being addressed.
- Many existing services are listed in the report without addressing the inadequacy of quantity and impact. In theory, Hong Kong had many mental health programs with excellent ideas. In practice, they are often poorly funded and depleted in manpower. These are experienced by the patients and professionals, but are reflected only in specific details not dealt within the report.
- Examples of shortcomings
- Case manager caseload in Hong Kong is 1:50, in developed countries, and in Singapore, this figure is 20-30. In addition, currently there is no case manager service for psychiatric patients over 65s, omitting a substantial population with complex psychiatric needs.
- In the Comprehensive Child Development Service, the exclusion of mothers with known mental illness because of low resource is a serious omission.
- In mental health for the elderly, only dementia is covered, ignoring other mental illness (such as severe depression and psychosis), which are also increased in the elderly population.
- The DoH Anti-Stigma campaign (Joyful Hong Kong) has taken the easier path of addressing the less stigmatizing common mental disorders (Anxiety Disorders, Depression and Dementia), and leaving out the more heavily stigmatized conditions such as psychosis and schizophrenia. What will happen to the stigma for Severe Mental Illness during the Joyful Hong Kong Program?
- Despite identifying the needs, there appears to be little concrete commitment for engaging youth with mental health problems.
- Despite there being increasing waiting list for child psychiatry, services is only available in 5 out of 7 cluster hospitals. The urgent need to increase child psychiatry capacity in HA Hospitals in all district is not addressed.
- Reading the details leave one with a realization that only relatively small scale pilot projects are committed to confront the growing mental health problems in childhood and in old age, details and commitments about evaluations and full-scale roll out of these pilot projects are lackng.
4.反歧視運動（如Joyful Hong Kong）採取了較簡單的途徑去處理較少歧視性的常見精神障礙（例如焦慮症，抑鬱症和認知障礙症）但未有提及較具歧視性的疾病如思覺失調和精神分裂症。