The Mental Health Service of Hong Kong

W H Lo Consultant Psychiatrist in charge of Mental Health Service, Hong Kong Government

History Active planning was then started and there has been an orderly expansion of the Mental Before 1949 there was no special Health Service, providing mental health care treatment for the mentally ill in Hong Kong. for a rapidly growing population. The change Patients were sent to the “lunatic asylum” in administrative policy and the introduction which provided only custodial care, and the of modern methods of treatment, especially problem of overcrowding was solved by with the advent of psychotropic drugs, have periodic transfer of patients to China. This demonstrated the value of psychiatry which was brought to an abrupt end by the founding has gradually won acceptance both from of the People’s Republic of China in 1949. At Government and the public. this time a qualified psychiatrist, the late Prof. Structure of the Mental Health Service P.M. Yap became available and was appointed the first Medical Superintendent of the Mental The psychiatric facilities in Hong Kong are Hospital. cutlined below in Table 1.

Taken from a handout of Mental Health Service, M.H.G. 61/76 (revised). Source: W H Lo (1976). In W H Lo, W Chan, K S Ma, A Wong, K K Yeung (Ed.), Perspective in Mental Health: Hong Kong, 1976 (pp. 6-9).

13 Hong Kong Journal of Mental Health W H Lo

The great majority of the facilities are Lai Chi Kok Hospital was until very directly administered by the Mental Health recently an infectious disease hospital. Service, a sub-department of the Government Following the transfer of its infectious Medical and Health Department. Generally disease unit to the Princess Margaret speaking, psychiatric services are provided Hospital, Lai Chi Kok Hospital has been used along the same lines as in western countries. as a psychiatric hospital to accommodate The main difference is the relative lack of the overflow of patients from Castle Peak psychiatric staff in Hong Kong. Hospital. About 100 long-stay psychiatric patients requiring minimal nursing care were Psychiatric Hospitals transferred there in late 1974, and more will be transferred in early 1976 up to a maximum Castle Peak Hospitals was opened in 1961. of about 300 patients. It was originally designed to accommodate 1,000 patients, divided approximately equally between Mental Health Centres the sexes. In 1967 the bed complement was increased to 1,242 to meet the growing need The Hong Kong Psychiatric Centre in for in-patient treatment. The hospital is up-to- which is located the Headquarters of the date and one of the few psychiatric hospitals in Service provides treatment for both day- the world built after the Second World War. The patients and out-patients including follow- buildings are located in spacious grounds and up cases from Castle Peak Hospital. It is the all the wards have their own gardens. reference centre on Hong Kong Island for the majority of voluntary patients for admission. It is still the only hospital in Hong Kong The Centre moved into its present modern for the full-time care of all types of psychiatric premises in 1971. patients. Except for two wards in which patients involved in court proceedings are The Yaumatei Psychiatric Centre opened in detained, all the wards are in various degrees 1967 provides similar services in Kowloon. Its ‘open’. Convalescent patients are allowed to facilities include a part-time child psychiatric move freely within the hospital. Some patients clinic. travel daily to work in factories while some others work in the adjacent New Life Farm. Psychiatric Units

All methods of psychiatric treatment are The Kowloon Hospital Psychiatric Unit administered. Psychopharmacotherapy and was opened in 1971. It is located in the new electroplexy as well as social measures and wing of the Kowloon Hospital and provides a work therapy remain the mainstay of treatment. comprehensive psychiatric service in a general Multi-disciplinary approach is emphasized hospital setting, with an out-patients’ section, with teamwork consisting of doctors, nurses, a day centre and an in-patients’ section. occupational theraphists, social workers and Admission and discharge procedures are on clinical psychologists. A variety of social informal basis. and recreative activities are organized for the patients. They have their own social club and Psychiatric Clinics recently publish their own magazines at regular intervals. Full-time out-patient sessions are held in the Mental Health Centres and Kowloon In the first few years it provided a Drug Hospital Psychiatric Unit. Part-time clinics Addiction Centre which pioneered a voluntary are also available in various parts of Hong system of treatment of narcotic addiction. Kong.

Hong Kong Journal of Mental Health 14 The Mental Health Service of Hong Kong

Professional Personnel working in the Mental Of the 33 psychiatrists, 10 hold psychiatric Health Service (excluding Queen Mary Hospital qualifications, M.R.C. Psych. and/or D.P.M. - Psychiatric Unit and United Christian Hospital all from England. Apart from these, there are 4 Psychiatric Unit) psychiatrists in private practice and 8 in non- Government psychiatric departments. Year: 1975 Psychiatrists: 33 Demand for Mental Health Care Clinical Psychologists: 3 Social workers: 18 The increasing demand for mental health Occupational therapists: 8 care provided by the Mental Health Service is Nurses (including student nurses): 570 shown below in Table 2.

Calculated from these figures, it can Training in psychiatric nursing is based be seen that in the past 25 years new out- on Castle Peak Hospital and the Diploma in patients have increased 10 times (by 987%), Mental Health Nursing is recognized in the new admissions 4.5 times (by 446%) and re- United Kingdom. There is in-service training admissions 18 times (by 1,821%). During this for social workers and the medical staff also period the population increase was only 2.3 give lectures to health visitors, general nurses, times (229%). paramedical professionals or even teachers.

Teaching and Training Liaison with other Government Departments and Voluntary Groups The Mental Health Service works in close cooperation with the University Psychiatric The Mental Health Service works closely Department and offers valuable clinical with a number of Government Departments, facilities and personnel in the training of particularly the Social Welfare Department and medical students. The post-graduate training the Special Education Section of the Education in Castle Peak Hospital and Kowloon Department. Hospital Psychiatric Unit is recognized by the Examining Board, England for D.P.M., and The Mental Health Service also works in psychiatric trainees with 3 years’ experience close co-operation with a number of voluntary are eligible for taking M.R.C. Psych. bodies that have their main interest in some examination. aspect of psychiatry. These include the Society

15 Hong Kong Journal of Mental Health W H Lo for the Aid and Rehabilitation of Drug Addicts, Patients are admitted either voluntarily or the New Life Psychiatric Rehabilitation compulsorily, and in recent years about Association, the Mental Health Association of half belong to each category. The continued Hong Kong, and the Hong Kong Psychiatric detention of most patients admitted compulsorily Association which functions as the professional is on a voluntary basis. Informal admission society in Hong Kong for psychiatrists and and hospitalization is, however, practiced in medical men interested in psychiatry. The New psychiatric units in the general hospitals. Life Psychiatric Rehabilitation Association provides for discharged mental patients a The Mental Health Ordinance has farm, two half-way houses for both men and improved the proceedings in dealing with the women and a sheltered workshop. The Mental criminally insane as well as with mentally Health Association of Hong Kong operates a disordered person’s property. male half-way house and is engaged in mental health education of the public. Research

Legislation Research work mainly centres on comparative psychiatry, descriptive psychiatry Legislation relevant to psychiatric practice and follow-up study. Published papers include in Hong Kong is contained in the Mental those on latah, Koro, the possession syndrome, Health Ordinance, Cap. 136. This is modelled suicide and drug addiction in Hong Kong, in the main on the Mental Health Act 1959 the natural history of obsessional illness in in England. The main effect of the Ordinance Chinese, on Huntington’s Chorea, Gilles de is simplification of admission and discharge la Tourette’s disease, tuberose sclerosis and procedures in the gazetted psychiatric hospital. clinical trials of psychotropic drugs.

Hong Kong Journal of Mental Health 16