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.

  1. 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.
  2. 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).
  3. 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.
  4. 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.
  5. 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.
  6. Examples of shortcomings
    1. 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.
    2. In the Comprehensive Child Development Service, the exclusion of mothers with known mental illness because of low resource is a serious omission.
    3. 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.
    4. 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?
    5. Despite identifying the needs, there appears to be little concrete commitment for engaging youth with mental health problems.
    6. 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.
    7. 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.

     
    香港精神科醫學院為精神健康檢討(MHR)2017年報告作以下回應:

  7. 本學院歡迎該報告,我們認為這是香港政府對持續發展精神健康服務的一個承諾,為未來服務發展奠下基石。
     
    惟我們仍認為報告有以下不足之處:

    1.報告強調香港提供精神健康服務的整體不足,惟目標與具體細節之間仍存在巨大差距。未有任何承諾去填補其中之距離。

    2.人力和培訓整體短缺未有提供實質解決方法。目前香港精神科醫生的數目是經合組織國家的三分之一,其他相關專業人士同樣處於嚴重短缺狀況。這是真正落實建議方向的關鍵。

    3.在這個具有挑戰性的需求情況下,令人驚訝的是,沒有具體提及公私營醫療保健之接合。香港的精神科醫生人數之中約三分之一是私人執業的。報告並沒有提到如何更好地利用這寶貴的資源。

    4.報告也未有提到對精神健康與身體健康的平等尊重,去確保精神健康狀況得到同等的的醫療保險保障。

    5.報告中列出了許多現有服務,但卻沒有解決其中質量的不足之處。理論上,香港有很多優秀的精神健康計劃的慨念。但實際上經常面對資金不足,人力耗盡的問題。這些都是患者和專業人員反映的經驗,但在報告中未有提及處理的具體細節。
     
    例子:
     
    1.香港的個案經理個案總量為1:50,在發達國家和新加坡,這數字是 1:20-30。另外,65歲以上的精神病患者目前沒有相應服務,忽略了存在大量復雜精神科個案的需要。

    2.在綜合兒童發展服務,部分已知患有精神疾病的母親因資源不足而被排除在服務之外。

    3.在老年人的精神健康方面,只有認知障礙症被涵蓋,而忽視了其他精神疾病(如嚴重抑鬱症和思覺失調)在老年人口中正逐漸增加。

    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。

    5.儘管確定了需求,但對於患有精神健康問題的青少年只有少許具體的承諾。

    6.儘管兒童精神科等候名單不斷增加,7個聯網醫院中只有5個提供服務。在醫管局各區醫院內增加兒童精神科的迫切需要並未有提及。

    7.只有相對較小規模的試點項目正視兒童時期和老年時期不斷增長的精神健康問題,但缺乏關於評估和全面推出這些試點項目的細節和承諾

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