Train GPs to spot problems early, says Hong Kong mental health survey
Family doctors should be enlisted to help diagnose people in the early stages of mental distress, so symptoms can be addressed before the need for a consultation with a psychiatrist. This will give them a better chance of recovery, Hong Kong experts advise.
The authors of a three-year survey of mental health in the city have called for primary care services to be boosted to screen for at-risk patients, and help ease the pressure on government psychiatric services. The full results have just been submitted to the Food and Health Bureau for review.
The bureau funded the HK$7 million Hong Kong Mental Morbidity Survey – the first territory-wide study to examine mental health.
The team interviewed a representative sample of 5,719 men and women aged 16 to 75 between 2010 and 2013. It estimated that 13.3 per cent of the population, or one in seven, suffer from anxiety, depression or other common mood disorders – a level comparable with most developed cities globally.
However, only 26 per cent sought professional help – mainly from psychiatrists – and very few consulted general practitioners. (On the mainland, only 5 per cent of the mentally ill had received treatment, according to a study of 63,000 people in four provinces quoted in the survey.)
More patients may have consulted doctors for physical conditions without recognising the underlying mood problems that affect their health, but the survey does not include such cases.
“Very often, medically unexplained symptoms are related to mood disorders. Patients would just go for a physical check-up and not get proper treatment for their mental health,” says principal investigator Linda Lam Chiu-wah, who also chairs the department of psychiatry at Chinese University.
The small proportion of people who receive treatment for common mood conditions mainly suffer from depression, anxiety or more severe conditions that impair their daily functioning, for example obsessive or panic disorders. They usually turn to psychiatrists or social workers for help.
That three quarters of patients fail to get the help they need can partially be attributed to the lack of mental health services provided in the primary care sector.
According to the survey results, common mood disorders are associated with factors including being separated, lack of regular exercise, stressful life events, alcohol and substance misuse, financial difficulties, living in public housing and chronic illness. Stigmatisation is a barrier to people seeking help.
Hospital Authority statistics show that the number of people seeking treatment at public psychiatric clinics has almost doubled from 111,806 in 2004 to 208,100 in 2014.
A government psychiatrist typically sees an average of 15 to 20 cases in one session of between three and four hours, which works out at about 12 minutes with each patient.
The study argues that developing a broad-based mental health service in the primary sector would encourage those struggling with mental issues to come forward.
Incentives could be offered to general practitioners to train how to diagnose and treat common mental disorders.
“Patients who are diagnosed at the onset of their mood disorders can be treated through various methods without resorting to medication prescription,” Lam says. “They’ll probably recover faster and more easily.”
Community education about mental illness prevention should promote healthy living, Lam says.
Dr Eva Dunn, head of psychiatry of Pamela Youde Nethersole Eastern Hospital, says depression is treatable.
“For mild depression, the patient may recover with family support, resolving the life stress, regular exercise, changing one’s lifestyle or environment.”
Besides evaluating the characteristics of common mood disorders, the survey also examines the issue of people with psychoses.
Patients with psychotic disorders are not merely depressed or anxious, but may lose touch with reality and experience disorganised thinking, delusion or hallucination. Information from the study is critical for establishing early detection and prevention efforts, and devising interventional strategies to prevent suicides.
Researchers believe the survey should be repeated at regular intervals to monitor the state of mental health in the community and adapt services to changing needs in among population.
“Hong Kong’s primary health care should be moving towards a holistic approach which integrates the treatment of patients’ physical and mental health, and especially how they relate to each other,” Lam says.