New order proposed for mental patients

PUBLISHED : Wednesday, 04 August, 2010, 12:00am
UPDATED : Wednesday, 04 August, 2010, 12:00am

A 'community treatment order', which would impose mandatory non-hospital treatment, should be created for mental patients whose conditions are not severe enough for a court-imposed hospital order.

This was one of five recommendations aimed at improving mental health services made yesterday by a Hospital Authority review committee set up after a mentally ill man chopped two people to death at Kwai Shing East Estate three months ago.

The committee, led by Professor John Leong Chi-yan, recommended a personalised care programme, which it pointed out was already under way, with the authority planning to hire about 400 psychiatric nurses, occupational therapists and social workers as case managers over three years to monitor 20,000 mental patients living in the community.

It also called for stronger multidisciplinary teams of doctors, nurses, allied health professionals and medical social workers to share information and regularly review patients' conditions; improved communication between departments, such as the police, Housing Department, Social Welfare Department and Hospital Authority; and public education to help families spot any irregularities in patients for early intervention.

Leong said community treatment orders, a milder alternative to hospital orders, were used in many places, such as the US, Britain, Australia and Canada, where responses were positive. He did not see any difficulty in adopting them in Hong Kong.

Such an order targets patients who do not need a hospital stay but need treatment and close monitoring. It requires patients to live with family, attend doctor consultations and rehabilitation services, and receive visits by community nurses.

Leong said introduction of community treatment orders required legislation, which would take at least a year or two to pass.

Authority director Cheung Wai-lun said the authority needed to strike a balance between the public interest and patient privacy and would seek advice from the Privacy Commissioner.

He said the authority launched a case management programme this year to follow up on mental patients in Kwai Ching, Yuen Long and Kwun Tong, and it would be expanded to all 18 districts by 2012. So far, about 30 case managers had been hired, but Cheung estimated another 70 would be hired to serve about 5,000 patients in the three districts. By 2012, the authority would recruit a total of 400 to take care of 20,000 mental patients.

Chinese University psychiatry professor Lee Sing estimated about 60,000 patients with severe mental illness were living in the community, which meant the authority's plan would only cover about a third. Lee said the government should conduct a comprehensive review of mental care, instead of coming up with piecemeal policies.

Lee, director of the university's mood disorders centre, also queried whether the recommendations were practical given the workload on existing medical staff and social workers.

'Frontline medical and social workers have been overwhelmed by the heavy caseloads of mental patients,' Lee said. 'I just wonder how they can squeeze extra time to hold regular interdepartmental and extra multidisciplinary meetings as suggested by the committee.'

On May 8, a 42-year-old man with a history of mental illness attacked neighbours with a chopper, killing a man and woman and injuring three. He lived alone on the estate and was classified as a high-risk patient. He had received regular treatment at Kwai Chung Hospital, from which he was discharged in 2004. There was no dispute between him and his victims.