Editorial | Hong Kong mental health moves must consider rights of patients and society

Mental issues do not get the attention they deserve. On occasion, sadly, it can take a horrific, inexplicable event to spark public debate. The recent random stabbing murders of two women in a Hong Kong shopping centre, for which the alleged assailant has been brought before the courts, is a case in point.

Every time mental services come up there is consensus on the need for more treatment and follow-up services to meet demand. The government has set targets to improve service delivery. But ultimately the argument this time is no different from when the sensitive issue was debated in 2012, and again in 2017. It revolves around the rights of a psychiatric patient being treated in the community. The question is how far does society go to ensure he or she continues medical treatment deemed to minimise the risk of self-harm or harm to others, or faces compulsory hospitalisation through so-called community treatment orders.

Health authorities have revealed plans to review the need for these orders, which have been rejected twice before. They would replace the current conditional discharge system, which applies only to those with violent tendencies discharged from a psychiatric facility. Currently those involuntarily admitted are typically offenders, have no understanding of their mental illness, reject outpatient treatment and could be a risk to themselves or others. That leaves a loophole, which would be closed under community treatment orders, for others who continue to receive care.

Wong Yan-lun, a former justice minister who is now chairman of the government’s advisory committee on mental health, says it is important to balance the personal rights of patients. Community treatment orders had not been given high priority in 2017, “but this time we would give it a comprehensive review, with all the potential problems taken into consideration”. Meanwhile the Hospital Authority is reviewing the current conditional discharge rules.

Hopefully they will act quickly on service improvements because the ageing of society is accelerating, adding to the burden on services, carers and families. They should seriously consider introducing community orders or strengthening the current conditional discharge orders. Community orders are, after all, increasingly used in other countries including Britain and Australia.

There may be understandable worries about patients’ rights and pressure on doctors. Indeed, these issues have prevailed in the past. But there is a need to strike a balance with community interests. The planned improvements to services are welcome, but would be even more so with a proper accounting of whether stronger, more enforceable community treatment measures will be adopted.