Long waiting times at Hong Kong public hospitals for mentally ill patients
Low medical manpower coupled with surging demand see wait times of up to more than three years
Patients with mental illness need to wait up to more than three years to see a doctor at public hospitals because medical manpower has failed to meet surging demand for such services.
A review of official statistics for the past five years by the Post found 225,900 psychiatric patients had been treated in public hospitals as of December 2015, a 20 per cent increase, but doctors treating them grew by only 3 per cent to 344 last year.
Furthermore, only two community psychiatric nurses – who received specific psychiatric care training and act as case managers for discharged patients – have been added over the past five years, taking the total number to 127, despite those with severe mental illness climbing 7 per cent from 44,600 in 2011 to 48,000 in 2015. The Hospital Authority, the body in charge of public hospitals, could not provide any patient figures for last year.
Together with other case managers, who are social workers and occupational therapists, each is required to take care of around 50 patients at a time. In Australia, one manager takes care of 20 patients.
It raises questions as to whether such patients are receiving proper care especially after recent tragedies, including the February 10 arson attack on a Tsim Sha Tsui-bound MTR train, involving those with records of mental illness. “New cases have to wait for a long time before meeting the doctor for the first time. Initial treatment might therefore be delayed,” Dr Chiu Siu-ning, spokesman for the College of Psychiatrists, said.
As of last December, patients in stable condition had to wait up to 159 weeks, more than three years, for their first appointment at specialist outpatient clinics in New Territories East. The shortest wait, which was in Kowloon Central, was 38 weeks.
Chiu said only six to eight minutes are given to each patient seeking help at public hospitals.
“Doctors are having less time to understand changes of emotion or sources of pressure in patients,” he said.
World Health Organisation guidelines suggest one psychiatrist serves every 10,000 people, meaning Hong Kong should have more than 700 psychiatrists, instead of just 373, working in the public and private sectors.
The limited number of community psychiatric nurses also undermined patient support, said Dr Eric Chen Yu-hai, college president and a psychiatric professor at the University of Hong Kong.
“It indicates that some [case managers] may not have sufficient experience and training [to follow up on patients],” he said.
Apart from nurses with structured psychiatric training, the authority also recruits social workers and occupational therapists to support those with a history of harming themselves or others, or who receive weaker social support or live with children or the elderly.
Chen said the quality of case managers “had room for improvement” because their level of knowledge varied. “Some cases are complicated to handle but some [managers] do not understand the illnesses well and lack basic knowledge in medication.”
Lawmaker Dr Fernando Cheung Chiu-hung, also a social worker, said the ratio of case managers to patients should be greatly reduced to around 1:25 to improve care for patients with severe mental problems.
“Now a manager may have more than 60 cases on hand and not be able to contact some patients once a month. How can they know [patients’] life changes?” he asked.
Chiu urged the government to come up with a comprehensive mental health policy, which would offer projections on the number of psychiatric patients and allocate manpower to various subspecialties accordingly.
An authority spokesman said it adopted an integrated approach in delivering psychiatric services to patients and attached importance to those who missed appointments at specialist clinics.
The Review Committee on Mental Health, chaired by Secretary for Food and Health Dr Ko Wing-man, is expected to release a report in the next few months mapping out the direction to be taken in mental health policy.