Government must boost investment in mental health care
Only a substantial increase in recurrent expenditure on psychiatrists, psychiatric nurses and social workers can service demand without undue stress on the system, let alone meet the needs of an ageing population
Caring for the mentally ill within the wider community where possible, rather than restricting them to institutions, has long been accepted in advanced societies on both clinical and humanitarian grounds. But that calls for greater investment in specialist medical, nursing and social welfare support at the community level. In this respect, care of the mentally ill in Hong Kong remains woefully inadequate. A weak link in the chain of treatment and follow-up, such as failure to take medication that controls violent or self-destructive behaviour, can have tragic consequences, as evidenced by random violent incidents we report from time to time.
Nonetheless, a review committee has recommended that the government should not make it a legal requirement for people diagnosed with mental disorders to be subject to a community treatment order, because of moral and human rights concerns. It could also discourage some patients from seeking help when they need it. An existing alternative – conditional discharge and regular surveillance of patients who can be forcibly hospitalised for skipping medication or behaving violently – therefore remains preferable. But as a government source rightly says, without a compulsory treatment order, it is important to strengthen psychiatric services in the interests of patient safety and the community’s peace of mind.
Separately, the review committee warned of an increasing demand for services – especially for children – as well as a rising need for treatment of dementia as the city’s population ages. The gravity of the shortage of resources is demonstrated by an international benchmark for the number of psychiatrists for the city’s population – more than 700, compared with 330 in our public hospitals.
There is a role for private or family doctors in treating mental illnesses such as insomnia or mild phobia, as suggested by the Public Doctors’ Association, to ease pressure on public hospitals. At the end of the day, however, only a substantial increase in recurrent expenditure on psychiatrists, psychiatric nurses and social workers can service demand without undue stress on the system, let alone meet the needs of an ageing population.