Following is a question by Dr the Hon Tik Chi-yuen and a reply by the Secretary for Education, Dr Choi Yuk-lin, in the Legislative Council today (June 5):
 
Question:
 
     Last year, the number of suspected student suicide cases reported to the Education Bureau (EDB) by primary and secondary schools in Hong Kong remained high and even hit a record high in the past five years. In addition, self-‍administered questionnaires were collected from 330 000 primary and secondary school students attending the Student Health Service Centres of the Department of Health in the 2022-2023 school year, with results indicating that 1.3 per cent of the students had attempted suicide in the past 12 ‍months. In this connection, will the Government inform this Council:
 
(1) as the Government implemented a Three-Tier School-based Emergency Mechanism in all secondary schools in Hong Kong in December last year to address the problem of student suicide, how the EDB assists schools in identifying at an early stage students with mental health needs, and of the number of referral cases received so far by the off-campus support network team and the follow-up situations; whether it has assessed the effectiveness of these two tiers under the mechanism;
 
(2) of the number of students with severe mental health needs who were referred by school principals under the aforesaid mechanism to receive psychiatric specialist services of the Hospital Authority in the past six months, and the follow-up situations of such cases; and
 
(3) given the EDB's call for active participation from primary and secondary schools in the 4Rs Mental Health Charter to be launched in the next school year to enhance students' mental health, of the number and percentage of schools signing up for joining the charter before the deadline last month?
 
 
Reply:
 
President,
 
     Nurturing students with proper values and a positive attitude has all along been the objective of education, and "leading a healthy lifestyle" is one of the goals of school curriculum. The Education Bureau (EDB) attaches great importance to the physical and psychological well-being of students. Through cross-departmental and cross-sectoral collaboration with the Health Bureau (HHB), Department of Health (DH), Social Welfare Department (SWD), Hong Kong Police Force and other non-government organisations (NGOs), we work together to provide support for schools, students and parents. With the efforts of all parties, we can build a more robust safety net for students.
 
     In consultation with the HHB and SWD, my consolidated reply to the question raised by Dr the Hon Tik Chi-yuen is as follows:
 
(1) and (2) In view of the upward trend of suspected student suicide cases in 2023, the Government has implemented the Three-Tier School-based Emergency Mechanism (the Three-Tier Mechanism) in all secondary schools in Hong Kong from December 2023 to December 2024 through the cross-departmental collaboration of the EDB, HHB and SWD so as to provide support for students with higher risk as early as possible.
 
     Under the Three-Tier Mechanism, schools will give priority to caring for and counselling students with higher risk and will provide timely assistance and seek professional counselling or treatment services for them through the school's interdisciplinary team in the first-tier. The EDB urges school personnel to refer to A Resource Handbook for Schools: Detecting, Supporting and Making Referral for Students with Suicidal Behaviours published by the EDB to preliminarily identify the more vulnerable students and pay attention to whether they have displayed related warning signs. If necessary, schools may arrange students with higher risk to conduct a preliminary mental health screening by using screening tools, such as Self-test Station: Depressive Mood from the DH and Kessler Psychological Distress Scale (K10) from "Shall We Talk". The interdisciplinary team in schools, which consists of guidance masters/mistresses, guidance personnel, school social workers and school-based educational psychologists, will prioritise and launch follow-up services for students with higher risk. School personnel are recommended to refer to the Guidelines on How Schools can Help Students with Mental Health Problems published by the EDB to provide support to students as soon as possible. In order to strengthen school personnel's early identification of and support for students with suicidal tendencies, apart from providing guidelines and a 60-hour thematic course on "gatekeeper" training for teachers every year, the EDB also organised online "gatekeeper" training courses for primary and secondary schools in December 2023. About 1 000 school personnel enrolled for the online training course. In addition, the EDB organised more than 40 additional training courses and workshops early this year, with an enhanced focus on enriching school personnel's knowledge and skills in caring for students with mental health needs. The courses benefited about 2 200 school personnel.
 
     In the second-tier of the mechanism, if the schools consider that they need to seek extra support subsequent to the identification and school-based intervention in the first-tier mechanism, they may seek assistance from the off-campus support network (support network) co-ordinated by the SWD. The SWD has engaged five NGOs to form the support network to provide extra support to schools. Upon receiving referrals, the support network team would contact the students concerned as soon as possible and arrange follow-up services, including emergency intervention services covering assessments, support and counselling through individual, group or online format; and would also refer the students to other services such as the Integrated Family Services, the Integrated Community Centre for Mental Wellness and the Integrated Children and Youth Services Centre according to their individual needs. As of March 2024, the support network team has received a total of 69 referral cases. Besides, the EDB has also collaborated with the SWD to arrange the support network team to visit about 150 secondary schools to organise mental health activities since February this year, with a view to enhancing students' awareness of mental health, as well as strengthening their adaptability and awareness of help-seeking.
 
     In the third-tier of the mechanism, school principals may refer students with severe mental health needs to the psychiatric specialist services of the Hospital Authority (HA). After triage and screening, the HA will accord priority to students in urgent cases. Furthermore, the HA has set up a telephone consultation hotline specifically to provide professional advice for school principals. As of March 2024, the HA's psychiatric specialist services received a total of 168 referrals and 75 telephone enquiries from school principals through the Three-Tier Mechanism. Among the referred cases, around 3 per cent were Priority 1 (urgent) category, while about 40 per cent were Priority 2 (semi-urgent) category. The remaining cases were either Routine (stable) or were already being followed up by the HA's psychiatric specialist services.
 
     Based on our understanding and communication with schools, with the concerted efforts of schools and various stakeholders, school personnel's awareness on students' mental health has enhanced in general, being able to early identify and support students with higher risk. The operations of the second-tier and third-tier of the Mechanism are smooth, providing timely and appropriate counselling and treatment to students in need. The Government will closely monitor the operation of the Three-Tier Mechanism and engage a consultant to evaluate its effectiveness.
 
(3) The EDB launched the 4Rs Mental Health Charter (4Rs Charter) in April this year and invited all public sector and Direct Subsidy Scheme (DSS) schools in Hong Kong to join. The 4Rs cover four important elements in fostering students' mental health, namely Rest, Relaxation, Relationship and Resilience. We hope that the stakeholders' awareness on mental health will be enhanced and they will work together and take actions through the promotion of 4Rs Charter. Schools participating in the 4Rs Charter are required to set practical and feasible goals and take concrete actions to promote students' physical and psychological well-being. Schools joining the 4Rs Charter must also pledge to join the Mental Health Workplace Charter, which is jointly implemented by the DH, the Labour Department and the Occupational Safety and Health Council, as well as the Whole School Health Programme launched by the DH, so as to carry on with their school-based health promotion efforts in a more comprehensive and effective manner. The EDB has also been engaging NGOs as partner organisations of the 4Rs Charter to provide schools with additional services, activities and courses to enhance students' health. As of May 31 2024, a total of 340 primary and secondary schools have applied to join the 4Rs Charter, accounting for 34 per cent of all public sector schools and DSS schools in Hong Kong. We will continue to encourage more schools to join the 4Rs Charter, so as to cultivate a healthy environment that is conducive to students' growth.

     The EDB will continue to work with various stakeholders to promote mental health in a more comprehensive manner, jointly establish a support network and create a caring culture, so as to promote students' physical and psychological well-being.

     Following is a question by the Hon Chan Hoi-yan and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (June 5):

Question:

     It has been reported that earlier on, there were overseas cases of kidney ailments and deaths after consuming health food products. While the company involved claimed that the products concerned had not been imported to Hong Kong, they may possibly appear in the market as parallel-imported products (parallel imports). Moreover, there are views that there is no well-established regulatory mechanism for health food products available in the market in Hong Kong, which are respectively regulated under various legislations such as the Pharmacy and Poisons Ordinance (Cap. 138), the Chinese Medicine Ordinance (Cap. 549) and the Undesirable Medical Advertisements Ordinance (Cap. 231). In this connection, will the Government inform this Council:

(1) given that in its reply to a question raised by a Member of this Council on April 24 this year, the Government indicated that it did not keep statistics on the number of health food products available in the market, of the reasons for that; whether it has plans to conduct the relevant statistical work;

(2) of the number of complaints related to health food products received by the Department of Health in the past three years and, among them, the respective numbers of cases in which warnings were issued and prosecutions were instituted;

(3) whether it (i) educated members of the public on the points to note when purchasing health food products, and (ii) assisted health food product manufacturers in understanding the contents of the relevant legislation and upgrading the quality of their products, in the past three years; if so, of the details, and whether it has plans to step up the relevant work;

(4) whether it has considered conducting a comprehensive review of the relevant regulation under Cap. 231 concerning health claims of health food products, so as to ensure that the ordinance can keep pace with the market development and protect the rights and interests of consumers; if so, of the details; if not, the reasons for that;

(5) in the light of the new means of shopping such as online shopping, shopping agents and parallel imports shops, of the work the Government will undertake to protect members of the public and prevent them from buying health food products with potential risks; and

(6) whether it has considered formulating a registration system or a similar mechanism for health food products, so as to delineate the responsibilities of manufacturers and importers, and facilitate the work of tracing and recalling in the event of occurrence of incidents; if so, of the details; if not, the reasons for that?

Reply:

President,

     In consultation with the Environment and Ecology Bureau, the Commerce and Economic Development Bureau, and the Department of Health (DH), the reply to the question raised by the Hon Chan Hoi-yan is as follows:

(1), (3), (4) and (6) There are many types of "health food products" with different ingredients and properties. The international community has no consistent definition and regulation of "health food products". Such products may contain different names, e.g. dietary supplements, nutraceuticals, natural health products. Indeed, the nature and risks associated with different types of "health food products" differ. Different regions have adopted various practices as to whether to adopt more specific regulatory regimes for "health food products". 

     The Hong Kong Special Administrative Region (HKSAR) Government has been adopting a multi-pronged strategy in regulating these products. In Hong Kong, depending on their individual nature, composition, content of the claims made, usage, dosage, packaging specifications, etc, such products are regulated under different legislations and respective government departments, including the Pharmacy and Poisons Ordinance (PPO) (Cap. 138), the Chinese Medicine Ordinance (CMO) (Cap. 549), the Undesirable Medical Advertisements Ordinance (UMAO) (Cap. 231), the Trade Descriptions Ordinance (TDO) (Cap. 362) and the Public Health and Municipal Services Ordinance (Cap. 132).

     Food in general is regulated under relevant provisions of the Public Health and Municipal Services Ordinance. The Centre for Food Safety under the Food and Environmental Hygiene Department, as the enforcement agency, carries out relevant work to ensure that relevant food is fit for human consumption, and is in compliance with relevant food safety standards and food labelling requirements. The relevant requirements also apply to those "health food products" which fall within the definition of "food".

     In addition, the claims of "health food products"in licensed broadcasting services are subject to regulation by the relevant provisions or codes under the Broadcasting Ordinance (Cap. 562) and the Broadcasting (Miscellaneous Provisions) Ordinance (Cap. 391). The Communications Authority will continue to take enforcement and regulatory actions in accordance with the relevant provisions and codes.

     Pharmaceutical products that fall within the definition under the PPO and proprietary Chinese medicine (pCm) under the CMO must comply with the respective regulatory requirements for safety, quality and efficacy and be registered before they can be sold and supplied in Hong Kong. The PPO and the CMO also stipulate the licensing and practicing requirements for drug dealers. The DH has a market surveillance mechanism in place to monitor the safety, efficacy and quality of drugs. To protect the public from being induced by medical or health claims and thereby seeking improper self-medication that may result in delay in seeking medical treatment, the Government also regulates the labelling and promotion of products with medical or health claims (including products that are not pharmaceutical product or pCm) through the UMAO. 

     To further regulate the advertisement and promotion of orally consumed products, the scope of regulation of the UMAO has been extended by the Government to cover the advertising of six groups of health claims (Note) specified in Schedule 4 since June 2012, thereby safeguarding public health. The Customs and Excise Department (C&ED), as the principal enforcement agency of the TDO, will take enforcement actions against unfair trade practices (including false trade descriptions) prohibited under the Ordinance. 

     The DH has all along been adopting a multi-pronged approach to disseminate safety messages about drugs (not including "health food products" that are not drugs) to the general public, the sector and other stakeholders through various channels, such as publicity, education, promotion, legislation and regulation, to strongly urge members of the public not to buy products of unknown or doubtful composition, or to consume products from unknown sources as their safety, quality and efficacy are not guaranteed. The approach includes issuing safety alerts and announcements on drugs which do not comply with the relevant requirements, preparing safety messages about the purchase and use of medicines, including "Be Cautious when Buying Medicines on Internet", "General Knowledge on Registered Medicines", and "Points to note when buying proprietary Chinese medicines", for consumers and upload to the websites of the Drug Office or the Chinese Medicine Regulatory Office. In addition, the DH conducts briefing sessions on the UMAO on a regular basis and has prepared the Guidelines on UMAO (including the Supplementary Guidelines on Regulation of Six Groups of Health Claims of Orally Consumed Products) and the Frequently Asked Questions for the trade’s reference on the Drug Office’s website.

    The Government will continue to closely monitor the latest international regulatory developments and the market situation for "health food products", conduct risk assessments and review the relevant legislation and regulatory arrangements in a timely manner. At this stage, the Health Bureau is of the view that, from the risk perspective, the safety of the products concerned has already been appropriately regulated under the prevailing framework, and that it would be more appropriate to strengthen relevant public education and publicity as well as the provision of information than to directly regulate the health claims of "health food products".

(2) & (5) As mentioned above, the HKSAR Government has been adopting a multi-pronged regulatory strategy, depending on their individual nature, composition, content of the claims made, usage, dosage, packaging specifications, etc, "health food products" are regulated under different legislations and respective government departments.

     The DH has been monitoring the safety, efficacy and quality of drugs (not including "health food products" that are not drugs) through an established market surveillance mechanism. The DH collects samples of products in the market from various channels (including the Internet) for drug-related testing. If a product is found to have failed to comply with relevant statutory requirements (such as not being registered, or being found to have quality defects or adulterated with harmful substances), the DH will issue a press release as soon as possible to safeguard public health. Upon receipt of reports of suspected contravention of drug-related ordinances, including suspected illegal sale or possession of unregistered pharmaceutical products or pCm, the DH will follow up on the cases immediately. If any contravention is found, the DH will take enforcement action and conduct joint enforcement operations with the C&ED or the Hong Kong Police Force, or refer the cases to other law enforcement departments for follow-up actions.

     In the past three years (from 2021 to 2023), the DH conducted about 27 410 inspections against Authorized Sellers of Poisons (commonly known as pharmacies) and Listed Sellers of Poisons (commonly known as medicine stores), and about 23 400 test purchase operations (which included about 16 800 test purchase operations against pharmacies). In addition, the DH also conducted a total of about 17 600 inspections against licensed Chinese herbal medicines retailers. During the same period, the DH handled 74 conviction cases involving unregistered pharmaceutical products, with the highest penalty of an imprisonment of 10 months or a fine of up to HK$70,000. There were also three other cases involving unregistered pCm, and the maximum fine was HK$6,000. The above 74 convictions involving unregistered pharmaceutical products included three cases in which the products claimed to be "health food products" were actually found to contain controlled drug ingredients. Furthermore, the DH has put in place an established mechanism to frequently monitor advertisements published via different media in Hong Kong and take enforcement actions against individuals who have breached relevant ordinances. In the past three years (from 2021 to 2023), the DH screened 128 365 advertisements and issued 1 344 warning letters.

     In addition, the DH has also established a surveillance mechanism against online sales platforms and social media platforms. In the past three years (from 2021 to 2023), the DH detected about 11 534 Internet links that might involve suspected illegal sale of controlled drugs and about 329 Internet links involving suspected illegal sale of unregistered pCm. The relevant platforms have removed the problematic links as requested by the DH.

     Other relevant bureaux and departments do not keep the information relating to "health food products" as mentioned in the questions.

Note: The six groups of claims included (1) prevention, elimination or treatment of breast lumps; (2) regulation of the function of the genitourinary system; (3) regulation of the endocrine system; (4) regulation of body sugar or glucose; (5) regulation of blood pressure; and (6) regulation of blood lipids or cholesterol.

     In response to the Japanese Government's plan to discharge nuclear-contaminated water at the Fukushima Nuclear Power Station, the Director of Food and Environmental Hygiene issued a Food Safety Order which prohibits all aquatic products, sea salt and seaweeds originating from the 10 metropolis/prefectures, namely Tokyo, Fukushima, Ibaraki, Miyagi, Chiba, Gunma, Tochigi, Niigata, Nagano and Saitama, from being imported into and supplied in Hong Kong.
 
     For other Japanese aquatic products, sea salt and seaweeds that are not prohibited from being imported into Hong Kong, the Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department will conduct comprehensive radiological tests to verify that the radiation levels of these products do not exceed the guideline levels before they are allowed to be supplied in the market.
 
     As the discharge of nuclear-contaminated water is unprecedented and will continue for 30 years or more, the Government will closely monitor and step up the testing arrangements. Should anomalies be detected, the Government does not preclude further tightening the scope of the import ban.
 
     From noon on June 4 to noon today (June 5), the CFS conducted tests on the radiological levels of 239 food samples imported from Japan, which were of the "aquatic and related products, seaweeds and sea salt" category. No sample was found to have exceeded the safety limit. Details can be found on the CFS's thematic website titled "Control Measures on Foods Imported from Japan" (www.cfs.gov.hk/english/programme/programme_rafs/programme_rafs_fc_01_30_Nuclear_Event_and_Food_Safety.html).

     In parallel, the Agriculture, Fisheries and Conservation Department (AFCD) has also tested 50 samples of local catch for radiological levels. All the samples passed the tests. Details can be found on the AFCD's website (www.afcd.gov.hk/english/fisheries/Radiological_testing/Radiological_Test.html).
 
     The Hong Kong Observatory (HKO) has also enhanced the environmental monitoring of the local waters. No anomaly has been detected so far. For details, please refer to the HKO's website
(www.hko.gov.hk/en/radiation/monitoring/seawater.html).
 
     From August 24 to noon today, the CFS and the AFCD have conducted tests on the radiological levels of 56 727 samples of food imported from Japan (including 36 677 samples of aquatic and related products, seaweeds and sea salt) and 14 188 samples of local catch respectively. All the samples passed the tests.

     In response to the Japanese Government's plan to discharge nuclear-contaminated water at the Fukushima Nuclear Power Station, the Director of Food and Environmental Hygiene issued a Food Safety Order which prohibits all aquatic products, sea salt and seaweeds originating from the 10 metropolis/prefectures, namely Tokyo, Fukushima, Ibaraki, Miyagi, Chiba, Gunma, Tochigi, Niigata, Nagano and Saitama, from being imported into and supplied in Hong Kong.
 
     For other Japanese aquatic products, sea salt and seaweeds that are not prohibited from being imported into Hong Kong, the Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department will conduct comprehensive radiological tests to verify that the radiation levels of these products do not exceed the guideline levels before they are allowed to be supplied in the market.
 
     As the discharge of nuclear-contaminated water is unprecedented and will continue for 30 years or more, the Government will closely monitor and step up the testing arrangements. Should anomalies be detected, the Government does not preclude further tightening the scope of the import ban.
 
     From noon on June 4 to noon today (June 5), the CFS conducted tests on the radiological levels of 239 food samples imported from Japan, which were of the "aquatic and related products, seaweeds and sea salt" category. No sample was found to have exceeded the safety limit. Details can be found on the CFS's thematic website titled "Control Measures on Foods Imported from Japan" (www.cfs.gov.hk/english/programme/programme_rafs/programme_rafs_fc_01_30_Nuclear_Event_and_Food_Safety.html).

     In parallel, the Agriculture, Fisheries and Conservation Department (AFCD) has also tested 50 samples of local catch for radiological levels. All the samples passed the tests. Details can be found on the AFCD's website (www.afcd.gov.hk/english/fisheries/Radiological_testing/Radiological_Test.html).
 
     The Hong Kong Observatory (HKO) has also enhanced the environmental monitoring of the local waters. No anomaly has been detected so far. For details, please refer to the HKO's website
(www.hko.gov.hk/en/radiation/monitoring/seawater.html).
 
     From August 24 to noon today, the CFS and the AFCD have conducted tests on the radiological levels of 56 727 samples of food imported from Japan (including 36 677 samples of aquatic and related products, seaweeds and sea salt) and 14 188 samples of local catch respectively. All the samples passed the tests.

     In response to the Japanese Government's plan to discharge nuclear-contaminated water at the Fukushima Nuclear Power Station, the Director of Food and Environmental Hygiene issued a Food Safety Order which prohibits all aquatic products, sea salt and seaweeds originating from the 10 metropolis/prefectures, namely Tokyo, Fukushima, Ibaraki, Miyagi, Chiba, Gunma, Tochigi, Niigata, Nagano and Saitama, from being imported into and supplied in Hong Kong.
 
     For other Japanese aquatic products, sea salt and seaweeds that are not prohibited from being imported into Hong Kong, the Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department will conduct comprehensive radiological tests to verify that the radiation levels of these products do not exceed the guideline levels before they are allowed to be supplied in the market.
 
     As the discharge of nuclear-contaminated water is unprecedented and will continue for 30 years or more, the Government will closely monitor and step up the testing arrangements. Should anomalies be detected, the Government does not preclude further tightening the scope of the import ban.
 
     From noon on June 4 to noon today (June 5), the CFS conducted tests on the radiological levels of 239 food samples imported from Japan, which were of the "aquatic and related products, seaweeds and sea salt" category. No sample was found to have exceeded the safety limit. Details can be found on the CFS's thematic website titled "Control Measures on Foods Imported from Japan" (www.cfs.gov.hk/english/programme/programme_rafs/programme_rafs_fc_01_30_Nuclear_Event_and_Food_Safety.html).

     In parallel, the Agriculture, Fisheries and Conservation Department (AFCD) has also tested 50 samples of local catch for radiological levels. All the samples passed the tests. Details can be found on the AFCD's website (www.afcd.gov.hk/english/fisheries/Radiological_testing/Radiological_Test.html).
 
     The Hong Kong Observatory (HKO) has also enhanced the environmental monitoring of the local waters. No anomaly has been detected so far. For details, please refer to the HKO's website
(www.hko.gov.hk/en/radiation/monitoring/seawater.html).
 
     From August 24 to noon today, the CFS and the AFCD have conducted tests on the radiological levels of 56 727 samples of food imported from Japan (including 36 677 samples of aquatic and related products, seaweeds and sea salt) and 14 188 samples of local catch respectively. All the samples passed the tests.