Review of home care for mental patients

PUBLISHED : Monday, 28 June, 2010, 12:00am
UPDATED : Monday, 28 June, 2010, 12:00am

When he heard the tragic news about a mental patient chopping two people to death in Kwai Shing East estate last month, Frank Leung was fearful - not for himself, but for his neighbours. 'I worry that one day in the future I will also be a violent attacker,' the 30-year-old schizophrenia patient said.

Leung - and his neighbours - aren't the only ones concerned about the treatment of mentally ill patients; the Hospital Authority has now, for the first time, set down a five-year plan for public mental health services, including setting up a 24-hour helpline to offer immediate advice to mental patients who fear their condition is deteriorating or they may turn violent.

The plan estimates that half of the 40,000 schizophrenic patients in the city will be managed 'exclusively' in the community - in other words, where they live - over the next few years. But psychiatrists and a patients' group want an even higher-level government policy covering all relevant services for the city's mentally ill, who may number 200,000.

To help these patients integrate into the community after leaving hospital care, the authority wants to develop 'innovative' housing. The preliminary idea is to let mentally ill patients live in small clusters in public housing estates for easier follow-up by community nurses or social workers.

But Leung worries that mental patients will have their privacy violated if neighbours see social workers knock on their doors.

'I don't think many ordinary people know enough about mental illnesses. They may call for help every time they see people acting strangely,' he said.

When the helpline begins operating next year, trained nurses manning the phones will advise patients whether they need to go to a hospital accident and emergency department or at an outpatient clinic.

Psychiatrists and the patients' group say that while the government advocates care for the mentally ill in the community, support for them has been inadequate. The helpline plan follows a number of violent incidents involving people with psychiatric illnesses.

Just over a year ago, a schizophrenic chopped to death a neighbour's three-year-old boy at a Sham Shui Po market. The patient had been discharged from Kwai Chung Hospital in 2006 after two years of in-patient treatment.

Most recently came the deaths on the Kwai Shing East estate in Kwai Chung. As well as those killed, three others were seriously injured when a man with a history of mental illness attacked them with a chopper.

The 42-year-old, who lived alone on the public housing estate, was classified as high-risk and had received regular treatment by doctors at the same hospital after his discharge in 2004.

Kwai Chung Hospital's chief executive, Dr Hung Se-fong, said the incident prompted his team to review the management of 80 high-risk patients - those suffering from severe mental illnesses with a history of violence.

'It is always a difficult situation: we have to protect the public and at the same time respect the rights of our patients. We can't lock patients up all the time, we have to give them a chance to rehabilitate in the community,' Hung said.

The helpline is modelled on a successful programme operated by hospitals in the eastern part of Hong Kong Island under which nurses answer queries from newly discharged elderly patients.

Hung said: 'If a nurse answering the mental health helpline believes that a patient needs immediate help, she can arrange a medical consultation for him at a nearby outpatient clinic the next day by contacting related medical workers.'

Still, Leung is worried what people will think if they see a social worker calling at a neighbour's home, and worries about calls to keep a close watch on mental patients. He lives with his family and goes to a public clinic every two months for a consultation.

'I feel like many people are watching me and I hate this. I don't want my neighbours to know I have a mental illness. They will discriminate against me.'

The authority is also reviewing the way doctors assign priorities to cases, which has not changed for 20 years. Lower-priority patients receive less frequent follow-up consultations and home visits.

Following the Kwai Chung incident, working groups comprising doctors, social workers, police and housing officers have been set up in each of the city's 18 districts to allow discussion and exchange of information about patients.

Before this development, Hung said, doctors were unable to liaise directly with Housing Authority staff about individual mental patients because of privacy concerns. Only police officers could ask a hospital if an individual was mentally ill.

On the estate itself, the Social Welfare Department has distributed leaflets appealing to residents to seek help from its integrated family services centre if they have emotional or family problems. The department says social workers will visit the homes of people in need based on reports from members of the public.

'Of course we respect patients' privacy,' a spokesman said.

'The purpose of the social worker's visit is to give help to the needy and to reach out to those who do not know how to get help, especially those who live alone.'

Tim Pang Hung-cheong, spokesman for the Patients' Rights Association, worries that people may overreact and phone up every time they see someone behave in a strange way.

'Some people will overreact and call up the department merely out of fear,' Pang said.

Dr Tsang Fan- kwong, a public hospital psychiatrist who makes home visits to mental patients, said it is a good move for the Social Welfare Department to make its services more accessible to the public.

'People should know where to get help. A social worker's visit can help spot people who may need medical care,' the doctor said. 'Patients' privacy is well protected. Social workers may visit someone to investigate any family violence or child abuse; it does not necessary mean someone is mentally ill.'

Out of hospital

The Hospital Authority treats 40,000 schizophrenia patients

The number the authority envisages treating wholly in the community: 20,000