Compulsory care for high-risk mental patients should be re-examined
The growing problem of mental illness in the community remains mainly out of sight, out of mind, except for victims and their families, and under-resourced health and social workers who have to deal with it. Sadly it is being called to mind more frequently by family tragedies and violent episodes. In one of the latest, a mental outpatient is alleged to have thrown an office chair from the 10th floor of a Mong Kok building, killing a passer-by on the street below. Three days later another mental outpatient threw five chairs from the 33rd floor of a Yau Tong building. Fortunately no one was hurt.
Both men had been receiving visits from psychiatric nurses and attending consultations. But senior psychiatrists say the Hospital Authority is short of nurses to maintain visits to mental outpatients and that a psychiatrist has to see at least 30 patients in a three-hour session of consultations in a public hospital. As a result he or she might overlook or underestimate an illness.
Mental health must compete with other community services for a share of taxpayer funding. But the government should consider a recent call from the Hong Kong Mental Health Council to set up a commission to manage long-term patients, who can be neglected under a policy that focuses on medical services. Council convenor Dr Chan Chung-mau said recently there was one mental health-care doctor for every 30,000 people, far less than the median rate of one to 10,000 in high-income countries, according to a World Health Organisation survey. He said this, and a lack of co-ordination among government departments, made services less effective.
Empowerment of police and doctors to impose compulsory treatment on high-risk mental patients was proposed by the Hospital Authority two years ago in the wake of a fatal attack. This approach has long been adopted overseas. But it involves sensitive issues like personal freedom and privacy, so it needs public support and safeguards against abuses. As a result, little progress has been made, but yet another tragedy should prompt serious consideration and wider debate.