Hong Kong Journal of Mental Health Copyright © 2017 by 2017, 43(1), 27-34 The Mental Health Association of Hong Kong Changes in Mental Health Care Delivery over the Past 50 Years in Hong Kong - with a Note on Future Direction W H Lo President, The Mental Health Association of Hong Kong Mental Health Service Before 1950s However, admissions were restricted to Non- Chinese patients. This asylum was 5 years In order to have an idea of the foundations later relocated to a new site in Hospital Road on which the psychiatric services in the past near the Government Civil Hospital and 50 years were built it is best to begin by remained in use until 1885 when the purpose- describing very briefly the earliest development built European Asylum situated at the of the care for the mentally ill. An excellent present site of David Trench Rehabilitation description is contained in the Annual Report Centre in Bonham Road opened. It had a of the Medical Department 1893 written by bed complement of 8. At its lower site and Dr Phillip Ayres, Colonial Surgeon from 1873 extending to High Street was built in 1891 the to 1897 which I quote: “...In 1873 no lunatic Chinese Lunatic Asylum at the present site of asylum existed. Chinese lunatics were sent to the Eastern Street Methadone Centre. It had the Tung Wah Hospital and European lunatics 16 beds. A few years late the two asylums were confined into the Gaol till they could be merged into one which had a bed complement sent to their native places. At the end of 1874 of 23. a European female lunatic was sent into the Gaol. This young person was very noisy and There was consistent overcrowding of slept little, day and night her singing, laughter the asylum and in 1894 the Government and shouting were to be heard if she was in arranged with the authorities in Canton good temper which she usually was but if to accept transfers of Chinese patients to she was not her howling and screaming was a mental institution in Fong Chuen. Non- something appalling. This kept most of the Chinese patients were repatriated to their own prisoners awake... but it annoyed the whole countries. neighbourhood among others two unofficial members of the Council who lived close by In 1928 the term “lunatic asylum” was and who forcibly in Council backed up my substituted by “mental hospital” in official representation that the Gaol was not a fit place reports. In 1938 the Government converted for the detention of lunatics. So the half of part of the staff quarters in High Street, which a building consisting of two semi-detached previously belonged to the Government Civil houses was fitted up as a Lunatic Asylum ...In Hospital and now occupied by the Sai Yin Pun 1873 Chinese lunatics were confined in dark Community Complex into psychiatric wards and dreary cells in the Tung Wah Hospital increasing the bed complement of the mental under Chinese native doctor’s supervision and hospital to 84. those who were violent were chained up in those cells like wild beasts...” In 1947 the population in Hong Kong was one and a half million but the only psychiatric This temporary lunatic asylum located facility we had was this old mental hospital in Hollywood Road was opened in 1875. with an average of 107 inpatients. Based on presentation at the 50th Anniversary of The Mental Health Association of Hong Kong Lecture on Mental Health Development: The Past 50 Years and Beyond at Hotel Miramar on 31st March, 2004. Source: Hong Kong Journal of Mental Health, 2004, 33(1 & 2), 8-19 27 Hong Kong Journal of Mental Health W H Lo In 1948 Dr. P.M. Yap, a British trained which was manned mostly by untrained staff. psychiatrist was appointed Medical Superintendent of the mental hospital. Nevertheless, modern psychiatry could be said to start in the 1950s because there Mental Health Care in the 1950s were major changes and improvements in the treatment methods for mental disorders. Since I In the 1950s mental health was a joined the Government Mental Health Service mysterious subject to the people of Hong in 1959 I had the opportunity to witness such Kong. There was misconception about mental changes and improvements. Table 1 shows illness and strong stigma attached to it. It was that the phenothiazine tranquillizers, the fortunate therefore that Dr. Yap could find benzodiazepines, the tricyclic antidepressants support from a few influential members like and the monoamine oxidase inhibitors were Dr. Irene Cheng and Dr. David Mackenzie. Dr. all introduced in the 1950s and early 1960s. Cheng, a senior education officer, together with These medications were more efficacious and Dr. Yap and a few others founded the Mental safer than those used earlier. Some treatment Health Association of Hong Kong in 1954. Dr. methods became obsolete and some others Mackenzie was the Director of Medical and were modified like the electro-convulsive Health Department from 1958 to 1963 and therapy or refined like psychosurgery. These once the President of the Association. treatments especially the psychotropic drugs revolutionized the picture of mental health care Dr. Yap started planning the development and it was timely that Castle Peak Hospital of psychiatric facilities and training of medical which was the first modem mental hospital in and nursing staff but it took time to bear Hong Kong was officially opened in 1961. It fruits and in the 1950s the facilities were still had the first psychiatric nursing school which confined to this overcrowded mental hospital opened in 1959. Hong Kong Journal of Mental Health 28 Changes in Mental Health Care Delivery over the Past 50 Years in Hong Kong - with a Note on Future Direction Mental Health Care in the 1960s and 1970s of our problem. This survey was conducted by an ecological group from the Australian Rapid urbanization and industrialization National University with my collaboration. from the 1950s to the 1970s gave rise to high- Eighty items including two psychiatric scales rise and high density living and changed the were administered to a sample of 3,983 of the socio-economic and family structures which general population. One of the scales used was made it necessary to transform a mental the Langner Scale which is composed of 22 hospital based care delivery system to a questions on specific psychophysiological and more community based system with some psychic symptoms which lead to impairment in specialized services. How this transformation life functioning. It was first used in Midtown came about can be examined from the Manhattan Study and later in several other following perspectives: surveys. The results of these few surveys are shown in Table 2. Based on the finding of a FIRST, Hong Kong had the highest urban parallel study in which I administered this density in the world, which was associated scale to a group of neurotic outpatients I took with a high level of emotional strain. With 7 symptoms as the cut-off point and a person a change in the traditional family structure scored 7 or more symptoms was considered respect for the old was diminishing and since to have ‘fairly certain psychiatric impairment’ parents had to work long hours they couldn’t or minor psychiatric illness. From this survey give children enough care and attention. These 11.8% of the Hong Kong population would factors gave rise to an increase in psychiatric have minor psychiatric disorders. However the morbidity, a crop of problems in the young university and the media took the score of 4 as and in the aged and prevalence of alcohol the cut-off point and this led to the sensational and drug abuse. A psychiatric survey done in reporting that one in 3 of the people in Hong 1974 could give us an idea about the extent Kong was ‘mental’. SECOND, the increasing number of planning ratio for psychiatric beds was then persons suffering from minor psychiatric 1 bed per 1,000 population and we wanted disorders required treatment at outpatient them to be in general hospitals. However, clinics and not in a mental hospital. Also few general hospitals were large enough to Castle Peak Hospital was considered to be too incorporate a psychiatric unit. Thus when such big and too overcrowded and to have harmful a unit was planned too many beds were put in. effects on long-stay patients. All this had to The planning ratio for psychiatric day hospitals be taken into account in our planning. The was 1 per 10,000 population. Since polyclinics 29 Hong Kong Journal of Mental Health W H Lo were built in various parts of the territory it incidence of schizophrenia for that year. I was was logical to have a mental health centre in most concerned with schizophrenia because each of them. Each centre consisted of a full- schizophrenics then constituted 75% of our time out-patient clinic and a day hospital of 50 inpatients and 60% of outpatients. For 1980 places and was manned by a permanent set of the total number of new schizophrenic patients psychiatric staff. This spread of mental health was 2,216 and the treatment incidence of centres was well received by the community schizophrenia was 44/100,000 population. I because both patients and relatives found it applied this to calculate the number of new convenient to attend. It was cost-effective schizophrenic patients year by year back to because one shift of staff could practically 1961 when the first census became available. render the same treatments available in a The number of new schizophrenic patients psychiatric unit.