LCQ20: Supporting persons with mental disorders
Following is a question by the Hon Chan Pui-leung and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 22):
Question:
Last year, the Government proposed 10 enhanced measures to support persons in mental recovery who had a history of severe mental disorders and other persons with mental health needs. In this connection, will the Government inform this Council:
(1) whether it knows the following information in respect of (a) traditional oral drugs and (b) long-acting injections for severe mental illness, as well as (c) new generation oral drugs and (d) long-acting injections for severe mental illness procured and prescribed by the Hospital Authority (HA) in each of the past five financial years: (i) the procurement quantity, (ii) the procurement costs, (iii) the number of persons with severe mental disorders (i.e. psychiatric patients with schizophrenic spectrum disorder) prescribed such drugs and injections, and (iv) the quantity of drugs and injections as well as (v) the expenditure involved (set out in the table below);
Financial year: _________
| Information on oral drugs and long-acting injections | (a) | (b) | (c) | (d) |
| (i) | ||||
| (ii) | ||||
| (iii) | ||||
| (iv) | ||||
| (v) |
(2) as one of the aforesaid 10 enhanced measures is that the HA will explore the use of newer medicines with fewer side-effects for psychiatric patients, whether it knows if the HA has formulated relevant performance indicators for prescribing new medicines following such exploration; if the HA has, of the details; if not, the reasons for that;
(3) as the HA has earmarked additional funding of around $127 million in the 2024-2025 financial year to enhance mental health services, and the relevant measures include: (a) enhancing the community psychiatric services by further recruiting additional case managers, (b) strengthening nursing manpower as well as allied health and peer support for psychiatric inpatient and outpatient services, and (c) enhancing the use of long-acting injectable antipsychotics in the treatment of mental illness, whether it knows the details of the funding allocations for the aforesaid three measures;
(4) whether it knows if the HA will explore amending the guidelines to allow earlier prescribing of a new generation of long-acting injections to persons with severe mental disorders, so as to reduce the problems arising from medication non-adherence by such persons or the side-effects they suffer; if the HA will, of the details (including how and when the amendment will be made); if not, the reasons for that; and
(5) whether it knows the following information in respect of the HA's Early Assessment Service for Young People with Psychosis Programme in the past five years: (i) the number of cases received, and among them, of the respective number of cases in which referral, assessment and treatment services were provided for patients, with a breakdown by age group, and (ii) the measures implemented under the programme to enhance public awareness of early psychosis, the number of reaches concerned and the public response respectively, and whether the authorities have assessed the effectiveness of such measures; if the authorities have, of the details; if not, the reasons for that?
Reply:
President,
The reply to the question raised by the Hon Chan Pui-leung is as follows:
(1) The Hospital Authority (HA) Drug Formulary currently contains over 20 psychiatric drugs for the treatment of mental illness and related diseases. The HA will continue to keep abreast of the latest developments of clinical and scientific evidence on psychiatric drugs and review the use of psychiatric drugs in accordance with the established mechanism.
The table below sets out the number of patients prescribed with conventional and new generation antipsychotic drugs (Note 1) and the drug expenditure involved in the HA from 2019-20 to 2023-24 (up to December 31, 2023):
| Conventional antipsychotic drugs | New generation antipsychotic drugs | |||||
| Financial year | Number of patients prescribed with oral drugs | Number of patients prescribed with long-acting injectable antipsychotics | Drug expenditure involved ($ million) | Number of patients prescribed with oral drugs | Number of patients prescribed with long-acting injectable antipsychotics | Drug expenditure involved ($ million) |
| 2019-20 | 35 200 | 9 900 | 42 | 94 400 | 3 700 | 280 |
| 2020-21 | 32 500 | 9 400 | 41 | 99 400 | 4 100 | 313 |
| 2021-22 | 30 300 | 9 000 | 35 | 104 300 | 4 400 | 344 |
| 2022-23 | 28 300 | 8 500 | 42 | 107 300 | 4 600 | 365 |
| 2023-24 (Projection as of December 31, 2023) | 27 200 | 8 300 | 32 | 111 300 | 5 000 | 392 |
Note 1: Figures are rounded to the nearest hundred.
Note 2: The drugs prescribed may vary from time to time based on the clinical conditions and needs of patients. Some psychiatric patients may be prescribed both oral and injectable psychiatric drugs concurrently.
(2) and (4) The HA has been taking measures to increase the use of new generation psychiatric drugs with fewer side effects and proven clinical efficacy, including antipsychotic drugs, antidepressant drugs, drugs for dementia and attention deficit/hyperactivity disorder. One of the ten enhanced measures announced by the Government in June 2023 is that the HA will also explore prescribing newer oral drugs or injections with fewer side effects for psychiatric patients in need to facilitate better medication compliance of patients.
The curative effects of conventional and new generation psychiatric drugs are similar, but they differ in that they work through different neurotransmitter pathways to achieve the desired effects and have different potency and side effect profiles. Psychiatrists will prescribe the appropriate drugs for patients mainly based on the principle of minimising side effects.
Taking into account the patients' wish, psychiatric doctors will provide patients with the necessary oral drug or long-acting injectable antipsychotic treatment as appropriate, having regard to their individual circumstances and clinical needs (including the patient's drug compliance and drug tolerance). Depending on the clinical conditions and needs of patients, psychiatric patients may be prescribed both oral and injectable psychiatric drugs or not prescribed any drug at all, and the dosage of drugs may change from time to time. Therefore, the HA has not set any relevant indicators for prescribing new drugs.
(3) The HA delivers mental health services through an integrated and multi-disciplinary approach involving psychiatric doctors, psychiatric nurses, clinical psychologists, medical social workers and occupational therapists. The HA adopts this multi-disciplinary team approach to allow flexibility in manpower deployment to cope with service needs and operational requirements. The HA has earmarked an additional funding of about $127 million in the financial year of 2024-2025 for relevant measures to enhance mental health services, of which about $50 million, $15 million and $62 million will be used respectively to further enhance community psychiatric services by further recruiting additional case managers, to strengthen nursing manpower as well as allied health and peer support for psychiatric inpatient and outpatient services, and to enhance the use of long-acting injectable antipsychotics in the treatment of mental illness. As healthcare professionals in the HA usually provide support for a variety of psychiatric services, the manpower and expenditure for supporting individual psychiatric services cannot be separately quantified. The above breakdown is for reference only.
(5) The Early Assessment Service for Young People with Early Psychosis (E.A.S.Y.) Programme of the HA aims to identify patients with psychosis as soon as possible and provide them with intervention services. Multi-disciplinary medical teams provide targeted and continuous support to patients, including psychiatric specialist outpatient services and community support services. The initial service targets of the programme are patients with psychosis aged between 15 and 25, and the service period is the first two years after the onset of the illness. In 2011-12, the HA extended the service targets of the programme to patients aged between 15 and 64, and the service period was extended to the first three years of the onset of the illness, benefiting more patients.
The main services of the E.A.S.Y. Programme include providing case assessment and formulating treatment plans for patients, as well as providing relevant mental health education and organising thematic seminars and workshops to enhance the understanding of psychosis and the E.A.S.Y. Programme among social workers, teachers, parents, etc. Over the past five years, about 1 100 to 1 200 new patients diagnosed with psychosis joined the E.A.S.Y. programme each year.
The table below shows the service attendances of the E.A.S.Y. Programme and number of health education thematic seminars of the HA from 2018-19 to 2022-23:
| Service attendances of the E.A.S.Y. Programme (Note 3) | Number of health education thematic seminars | |
| 2018-19 | 41 000 | 180 |
| 2019-20 | 43 100 | 47 |
| 2020-21 | 46 800 | 9 |
| 2021-22 | 43 600 | 22 |
| 2022-23 | 38 800 | 30 |
Note 3: The number of attendances includes telephone contacts, interviews and community visits with patients. Figures are rounded to the nearest hundred.
Remark:
In view of the COVID-19 epidemic outbreak in Hong Kong in early 2020, the HA has adjusted its services to cope with the outbreak. This should be taken into consideration when comparing the service capacity of the HA in previous years. With the subsiding local COVID-19 epidemic situation and cessation of anti-epidemic measures in early 2023, the HA has been gradually resuming provision of all of its public healthcare services to tie in with the Government's resumption of normalcy measures.