Case system makes crisis hard to spot
Anita Lam, Agnes Lam and Dennis Chong
Under current policy, social workers are assigned to individuals and not whole family
Three social workers had followed the case of the family involved in yesterday's apparent murder-suicide, but none of them had grasped the magnitude of the problem that led to the tragedy.
The Social Welfare Department said Mak Fuk-tai, the mentally ill mother, was followed by one social worker; Chan Kai-lam, her terminally ill husband, by another; and their two children, whom Mak is believed to have pushed from their 24th-floor flat in Tin Yiu Estate, by a third.
But under the current system, the family's problem had not been referred to any of the three integrated family service centres in the district, where a single case manager would be assigned to oversee the family.
A spokeswoman for the department said yesterday that the tragedy was more the result of a relapse of mental illness than a long-term family dispute.
'The woman was treated and discharged by Castle Peak Hospital,' she said. 'There are social workers in schools to take care of the children's emotional problems, but sometimes a tragedy is an accident that can't be prevented despite all precautionary measures.'
But welfare sector legislator Fernando Cheung Chiu-hung said cases of this type could be better assessed if the government at least adopted a case management system in which a social worker is assigned to follow cases on a family basis, rather than the current 'fragmented' system where separate social workers tend to individuals' problems.
'A family on social subsidies whose mentally ill mother needs to support two children with little assistance from her terminally ill husband who lies in hospital ... how can anyone not find this a high-risk case urgently in need of support?'
Sam Leung Kin-hung, chairman of the department's social workers' union, said each medical social worker handles an average of 450 cases every year, and together they simply cannot afford to offer long-term after-care services to these patients.
'A medical social worker can only handle at most 60 cases at the same time, which means they would need to keep closing old files if they need to handle all 450 cases referred to them by doctors in one year,' Mr Leung said.
By closing files, they would assess if the patient has other problems in need of attention from different family centres, but Mr Leung said in many cases they may not be able to identify the gravity of the problem if the patient failed to say anything that raises a mental alert.
Latest figures by the Social Welfare Department show that the number of comprehensive social security allowance cases on ill health has risen steadily from 23,855 in September 2005 to 24,221 one year later, and continued to climb to 24,563 in September this year.
Even though there was no breakdown by the type of illness, Yuen Long district councillor Leung Che-cheung said the number of mental patients on social welfare in Tin Yiu Estate was on the rise.
'There is at least one case every month involving domestic violence or disturbances to the neighbourhood by mental patients, but police can do nothing as they cannot force them to see the doctor.'
The department said it would start a pilot scheme with NGOs and the Hospital Authority within a month to identify mental patients who refuse to seek treatment.
An outreach team of medical officers and social workers would offer free counselling to these patients upon referral from doctors, community centres or social workers.