Follow-up system inadequate, experts say

PUBLISHED : Monday, 10 May, 2010, 12:00am
UPDATED : Monday, 10 May, 2010, 12:00am

An incomprehensive follow-up system where social and health workers seek out psychiatric patients who fail to turn up for appointments could create violent 'time bombs', psychiatrists and patients' groups say.

They blame the high doctor-to-patient ratio and short consultation time for follow-up medical visits by mental patients for the Kwai Chung chopper tragedy that left two neighbours dead and three seriously injured on Saturday.

With only 200-300 psychiatrists in public hospitals tending to 150,000 new mental patients every year, psychiatrist Dr Ben Cheung Kin-leung said each consultation for a follow-up visit lasted only five to 10 minutes.

'A patient has to repeat his problem once again to a new doctor who might not be able to fully grasp the extent of his illness purely based on medical records written by his predecessors,' he said.

Kwai Chung and Castle Peak public hospitals specialise in the provision of psychiatric services, with hospitals across local districts having specialised departments in psychiatry with outpatient clinics.

If a patient fails to turn up for a scheduled appointment, a nurse will inform the doctor who will initiate the triage mechanism, and classify the patient as being anything from low to high risk. For those which may pose a threat to society, social or health workers would be sent to the patient's home to provide help.

But problems can arise in cases where no one answers the door and no further follow-up is conducted, or when the doctor has made a professional misjudgment at the triage stage, Cheung said.

Cheng Chung-yan, an adviser with the Amity Mutual Support Society, a self-help group of 300 former mental patients, said doctors were sometimes too busy. 'For fear of being confined in hospitals, many patients lie about their condition even if they do have suicidal tendencies and hallucinations. The doctors might not detect the lies and classify them as being low-risk.'

The Social Welfare Department is to launch a scheme in July in which medical help centres will be set up across 18 districts in Hong Kong where mental patients and their neighbours can seek help.

But Cheng said the scheme had run into opposition from residents.

Tsang Kin-ping, chairman of the Alliance for Patients' Mutual Help Organisations, said the government must send specialist staff to track down patients who fail to turn up for appointments. 'Otherwise, similar tragedies involving such potential time bombs are bound to happen in future,' he said.

Permanent Secretary for Labour and Welfare Paul Tang Kwok-wai said the social welfare department had offered immediate counselling to the families of the victims. 'We have set up special booths inside the housing estate to provide psychological counselling for residents,' he said.

He stressed the individual nature of the incident, saying such incidents were inevitable.

Tang said: 'We have already increased the support for the mentally ill over the past several years.'