Breaking point: Hong Kong’s overburdened mental health care system in need of a fix
A plan for psychiatrists in the private sector to take on more patients and ease the strain on the public health system has been welcomed by the profession. But is the issue of treating mental illness just a question of resources?
A growing number of patients and a shortage of medical resources has created a ticking time bomb when it comes to treating mental illness in Hong Kong.
As the number of cases being diagnosed steadily rises, concerns have been raised about the capacity of the already overburdened public health care system to support patients – and their families. To compound the problem, the sluggish pace at which public hospitals can handle new cases of psychiatric patients is exacerbated by a shortage of doctors.
The most recent Hospital Authority estimates suggest up to 1.7 million Hongkongers suffer from different types of mental illnesses, with 70,000 to 200,000 of them considered to have severe conditions.
The number of new psychiatric cases registered in the specialist outpatient clinics in public hospitals has grown from 39,770 in 2009/2010 to 47,958 in 2014/2015.
Waiting times for mental health treatment are the longest of all the specialist services offered in the public health system. The longest waiting time among the seven hospital districts now stands at 166 weeks, or more than three years, for psychiatric patients in Hong Kong West to see a doctor in a public hospital.
The situation has led the government to announce its intention to explore extending the public-private partnership model, which has been operating in general outpatient clinics, to “suitable and stable” psychiatric patients for follow-up to relieve the heavy burden on the public sector.
The concept was outlined in the Legislative Council in November and has received a positive reception from the health sector, with the caveat that the quality of care must not be compromised.
The patient-doctor ratio in Hong Kong is already much lower than many other developed countries. The ratio is about 4.5 psychiatrists per 100,000 people, with only 330 working in the public sector. The United Kingdom has 14.63 psychiatrists per 100,000 people, and Australia has 9.16 psychiatrists per 100,000, according to 2014 World Health Organisation data.
At the end of September last year, 315 case managers, mainly psychiatric nurses and occupational therapists with knowledge in mental health services, were taking care of more than 14,700 patients with severe mental illness being treated in Hong Kong’s public sector.
The Society of Psychiatrists represents the bulk of private psychiatrists in Hong Kong. Its chairman, Dr Leung Wai-ching, says private psychiatrists do not object to taking in more patients but there are limitations to the help they can provide.
“If the patient is mild and just requires regular prescription, such as drugs for sleeping ... and does not need counselling, it is fine for us,” he says.
Private doctors make up one-third of psychiatrists in the city and many see a possibility to expand further to take up more patients. Psychiatrist Dr Ivan Mak Wing-chit, who works in the private sector, says the sector only handles about 10 per cent of patients.
“There is space [to grow] in the private market. It depends on how the partnership can be done better. It’s not only a matter of money.”
He agrees that bringing more patients to the private sector is an important trend, but highlights the need for genuine discussion between the government and the private sector.
However, simply having more doctors might not be sufficient as comprehensive care is required for psychiatric patients.
Leung says patients in public hospitals, who are mostly suffering from schizophrenia and early psychosis, require regular visits from community nurses after being discharged.
Sania Yau Sau-wai, chief executive of the New Life Psychiatric Rehabilitation Association, says community support services, which are equally important to patients’ recovery, also suffer from a shortage.
“We are 20 per cent short of frontline caregivers ... while fewer people are joining the sector, demand [for services] keeps on rising,” Yau says.
Following suggestions from a review committee on mental health formed in 2013, the government has started to increase manpower for the psychiatric health care team and the number of psychiatric beds in the past few years.
However, instead of adding resources infinitely to support patients, Yau suggests more preventive work should be done as mental illness is more common in highly urbanised environments, where people tend to face more pressure and have less space.
“Now most of our resources have been given to people who have fallen ill. We should strengthen [mental health promotion] and let others know mental health is everybody’s business,” says Yau.