Replies to LegCo questions
LCQ5: HA psychiatric specialist outpatient clinics
Following is a question by the Dr Hon Fernando Cheung and a reply by the
Secretary for Health, Welfare and Food, Dr York Chow, in the Legislative Council
today (November 2):
Question:
Regarding the psychiatric specialist services provided at public hospitals, will
the Government inform this Council:
(a) of the average number of new cases handled last year by each out-patient
clinic, and the respective longest waiting time for new cases involving the
elderly, adults and adolescents;
(b) of the average number of out-patients treated per hour by a doctor last
year, and the average and maximum number of cases handled by the psychiatric
medical social workers; and
(c) whether the authorities have concrete plans to increase the staffing of
psychiatric specialist doctors and social workers, so as to shorten patients'
waiting time, extend the time for each consultation and reduce the caseload of
these staff; if they have, of the details and the implementation timetable of
the plans; if not, the reasons for that?
Reply:
Madam President,
(1) In the financial year of 2004/05, the total number of first attendance at
the psychiatric specialist outpatient clinics under the Hospital Authority (HA)
was 25, 676. The numbers of first attendance at HA's various clusters are shown
in Table 1.
In the financial year of 2004/05, the waiting time of new patients is set out in
Table 2.
Through public education of the Government and non-governmental organisations,
Hong Kong citizens' positive understanding about mental illness has greatly
increased. With a better understanding of mental illness, citizens are more
ready to take the initiative to seek diagnosis and treatment from public
hospitals or private-practised psychiatrists, when they are aware that they may
have mental illness. Under such circumstances, the number of psychiatric
outpatient attendance at the psychiatric specialists outpatient clinics in
public hospitals recorded an increase of 5.03% from the financial year of
2002/03 to that of 2004/05.
In response to the service demand, HA started to implement a triage system at
its psychiatric specialist outpatient clinics. Under this mechanism, conditions
of patients will be assessed by experienced psychiatric nurses based on a set of
standard criteria. The assessment results will then be reviewed by
psychiatrists. Patients assessed to have urgent clinical needs will be arranged
to have earlier appointments. These patients usually can receive treatment
within two weeks. Those whose assessment results show that their clinical needs
are urgent but not as much as those at the first category will be arranged an
appointment within eight weeks. Cases that are assessed to be non-urgent will
have to wait for a longer time.
Cases with long waiting time usually include those that are already under the
care of other health care professionals. Other non-urgent cases include chronic
insomnia, anxiety symptoms related to work stress or financial problems, etc.
These cases, if assessed to have low risk for violence and suicide under the
triage system, would usually have longer waiting time. Some of the cases on a
longer waiting list may seek alternative sources for help, or their conditions
may improve and therefore might not turn up for their first scheduled
appointment. In the financial year of 2004/05, the rate of defaulted appointment
was about 18%.
Patients may return to the psychiatric specialist clinics for re-assessment any
time should their condition deteriorates. Separately, specialist clinics also
provide a list of private-practiced psychiatrists for patients on waiting list.
(2) In the financial year of 2004/05, the number of cases handled at each
doctor's session (about three to four hours long) at psychiatric specialist
outpatient clinics was 15.1. In general, a doctor usually has one new case and
15 to 25 follow-up cases in each session. The consultation of each new patient
lasts for 45 minutes to one hour, while that for each old patient would take
five to ten minutes.
There are a total of 170 psychiatric medical social workers (including 14
officers-in-charge and the rest are case medical social workers). They serve
psychiatric hospitals, clinics and special projects of the Hospital Authority in
psychiatric services, such as the expanded Community Psychiatry Teams (CPT),
Elderly Suicide Prevention Programme (ESPP), Early Assessment Services for Young
People with Psychosis (EASY) and the Extended-care patients Intensive Treatment,
Early Diversion and Rehabilitation Stepping-stone (EXITERS) Project.
As at August 2005, there were a total of 13, 892 cases being handled, including
2,935 inpatients and 10,957 specialist outpatient cases. Each case medical
social worker handles about 90 cases on average.
(3) In response to increasing service demand, HA has hired additional staff in
the past few years. For example, the number of psychiatrists increased from 212
in year 2000/01 to 258 in 2004/05; and psychiatric nurses also increased from
1797 to 1910 during the same period. In addition, the Government also allocated
additional resources, amounted to over $140 million for HA's recurrent
expenditure, to help HA improve its psychiatric services. Funded initiatives
include EASY, EXITERS, purchasing new generation psychiatric drugs and enhancing
community psychiatric services, etc.
HA will continue to review the staff of its psychiatric services. Since the
abovementioned longer waiting time occurs only in a small number of psychiatric
clinics, HA has planned to rationalize the staffing of its various psychiatric
clinics to shorten the waiting time. In parallel, HA will also attempt to refer
some of the cases of its specialist outpatient clinics to general clinics or
private practitioners.
As regards the time for each consultation, it is determined by psychiatrists
based on each patient's specific conditions.
Medical social workers provide timely psychosocial intervention to patients and
their families and help them to cope with personal and social problems arising
from mental illness. Intervention approach and time spent on each case depend on
the need of individual cases. There is no waiting time for medical social
workers' cases.
In the financial year of 2005/06, we will increase 10 medical social workers to
provide early identification and intervention to young people with early signs
of mental health problems. They will take a proactive approach to outreach to
the community to provide public education on child and adolescent mental health.
Next year, we will further increase the number of medical social workers in
psychiatric services to enhance family support and outreach services.
Ends/Wednesday, November 2, 2005
Issued at HKT 15:25
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Tables 1 & 2 to LCQ5