Mentally ill in Hong Kong need more government support
Wong Kwong-lui says overworked and underfunded psychiatric services are an injustice to the often-marginalised mentally ill, and calls for greater support from both the government and society at large
The MTR arson incident on February 10 was saddening, with many of the injured still in a serious or critical condition. In the aftermath of the tragedy, attention should focus on the need to tangibly increase government support for mental health patients.
Hong Kong currently has 200,000 people suffering from severe mental illnesses, of whom 48,000 have schizophrenia. While the Hospital Authority provides support for those deemed not stable, the case manager to patient ratio is very high. In 2015/2016, there were only 327 case managers for some 15,400 patients, a ratio of 1 to 50. In clusters with more serious staff shortages, the ratio goes up to one per 60 or even 70 patients.
The very heavy caseload means the time given to each patient is, inevitably, extremely limited. In other developed economies such as Australia and the US, the case manager to patient ratio is one to 20 or 25, or half that of our city.
Given the huge pressure on managers, turnover is predictably high, worsening staff shortages. Case managers are needed not only by those requiring special care. Mental patients in stable conditions must also get regular attention, to prevent a relapse or for its early signs to be detected. News reports said the suspect in the MTR incident was a patient with a severe mental illness who appeared stable but did not benefit from the sustained care of a case manager.
It is unrealistic to expect that the number of case managers and related medical staff can be substantially increased within a short time, given that the services required involve specialist training. But the government can improve the situation in the short term by providing new kinds of treatment.
At present, most patients with schizophrenia rely on oral medication to keep their condition under control. However, they often fail to take it regularly, which makes them prone to relapse.
Although there is now a variety of newer generation long-acting antipsychotics to be administered by injection, high costs mean most patients are denied this markedly more effective treatment. If the government could increase spending on more advanced treatments, it would ease the strain on medical staff from treating relapsed patients, and ultimately benefit the overall public health system.
Mental health patients are among the most disadvantaged and forgotten in society. These individuals and their families face untold stress. Instead of the fleeting – and often skewed – media attention that comes when they find themselves at the centre of public incidents, the onus is on the government, and indeed, the whole of Hong Kong society, to extend a meaningful helping hand.
Wong Kwong-lui is a psychiatric nurse and a board member of the Hong Kong Association of Psychosocial Rehabilitation