Early intervention for psychosis patients cuts suicide risk by half, 12-year study in Hong Kong finds

An early intervention programme to support Hongkongers suffering from psychosis in the first two years after diagnosis could cut their suicide rate by half, according to a study of more than 1,000 patients over 12 years.

Those with symptoms such as hallucinations or delusions were placed on a fast track to see a psychiatrist within two weeks as part of a public hospital scheme that began in 2001. The treatment included follow-ups with a dedicated case manager to help them cope with the challenges of daily life.

The suicide rate for these patients was more than 50 per cent lower than that for the average psychosis sufferer in Hong Kong. However, it was still more than double the international average. 

The study, the first of its kind in Hong Kong, highlighted the need for policymakers to enhance patient treatment amid a severe shortage of psychiatrists and mental health professionals in the city.

Psychosis patients are most likely to commit suicide in the first three years after diagnosis. The researchers said most deaths arose because the patients lacked the skills to cope with their illness.

A report on the study was published on Thursday by the American Medical Association in the journal JAMA Psychiatry.

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“While it is encouraging to confirm that the early intervention approach is effective, I think we should also look at ways to improve and enhance existing services,” said clinical assistant professor Sherry Chan Kit-wa of the University of Hong Kong’s psychiatry department.

There is a citywide shortfall of about 400 psychiatrists when measured by the standard recommended by the World Health Organisation. Each case manager is caring for up to 80 patients, compared with 10 to 20 in some countries.

The lifetime risk of suicide among individuals with schizophrenia or other psychotic conditions was 4 to 6 per cent, which is 12 times higher than that for the general population, the study found.

Hong Kong’s launch of the early intervention study in 2001 put the city at the forefront of psychiatric care for patients aged 15 to 25, Chan said. 

Australia was the first to put in place such a programme.

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Patients received relatively intense treatment in the first two years and were followed less closely in later years when their conditions became more stable. That period was expanded to three years in 2011 and to cover patients between 15 and 65 years old.

The study followed 1,234 patients for 12 years in total, during which time 77 died, 73 of whom took their own lives.

The standardised mortality ratio (SMR) for the group that did not get early care was 44.66, while the group that did receive help saw a ratio of just 28.01.

The mean ratio internationally was 43.47 and the median ratio 12.86.

“So Hong Kong is doing OK because it is below the mean ratio, but it is still much higher than the median,” Chan said. “That means there is room for improvement.”

The study identified risk factors for suicide to be poor drug regime adherence, depression, early relapse, and hospital admission, among others.

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“The number of patients who committed suicide in the first three years was equal to the number doing so in the following nine years,” Chan said. 

“It is usually very difficult for an individual to struggle through when they first find out about their illness.

“They might feel depressed and helpless due to their symptoms, which could include seeing things or hearing voices. This is why the role of case managers is so important. They can help patients understand their illness and teach them how to cope.”

Another study reported by the Post in January found that hazy and gloomy weather was more likely to trigger suicide among those with mental health conditions such as dementia, bipolar disorder and depression.

Patients were 16.4 to 26.5 per cent more likely to die on a day with severe air pollution, according to the Hong Kong Polytechnic University report.

Last year a committee tasked by the government’s Food and Health Bureau with reviewing the city’s mental health policy warned of an increasing demand for psychiatric services – especially among children – and a rising need to treat cases of dementia as the population aged.

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The overall number of mental health patients in Hong Kong increased by between 2 and 4 per cent each year from 2011 to 2016. The figure stood at 187,000 in the 2011-12 financial year and reached 226,000 by 2015-16.

The increase among children was as high as 5 per cent annually.

According to the Hospital Authority, between 70,000 and 200,000 people in the city are believed to suffer from severe mental illness. Of those, 40,000 have been diagnosed with schizophrenia.