Hong Kong’s mental healthcare system must be expanded to meet residents’ growing needs

This article appeared originally in the China Daily on 18 January, 2023.
Authors: Pamela Tin, Head of Healthcare and Social Development, and Danting Liu, Assistant Researcher at Our Hong Kong Foundation.
 

At the end of 2022, the government released the Primary Healthcare Blueprint, taking a decisive step in developing Hong Kong’s health system after years of challenges.

Yet, a glaring healthcare gap remains; little attention has been paid to Hongkongers’ growing mental health needs. In particular, the fragmented nature of mental healthcare dilutes the government’s capacity to serve patients holistically.

In line with the blueprint’s aim of integrating different elements of the health system and facilitating multidisciplinary collaboration, there is a critical need to restructure the mental health ecosystem to meet the needs of the public.

In a local survey conducted during the fifth wave of Covid-19, almost half the respondents reported symptoms of mild to severe depression. Meanwhile, public-sector specialist mental health services are overburdened, with the lowest mean waiting time for stable cases in a psychiatric specialist outpatient clinic being 14 weeks.

In its latest health policy report, “Towards a Fit-for-Purpose Mental Health System”, Our Hong Kong Foundation (OHKF) suggests that many mental health needs can be addressed outside the specialist setting. As such, it proposes that patients be offered a greater variety of community-based services.
These would span both the medical and social sectors, relying on general practitioners and family medicine doctors, psychological well-being practitioners and social workers, among others, to provide care to patients with stable mental health conditions.

This “stepped care” model would mirror the structure of the United Kingdom’s Improving Access to Psychological Therapies programme. However, Hong Kong’s current approach differs markedly from that of the UK.

While the UK has both a centralised and well-established system in its National Health Service, Hong Kong’s primary care ecosystem is not yet fully developed, and suffers from fragmentation.

Here, care providers and professionals in the medical and social sectors tend to offer mental health services independently of each other. Current efforts to centralise the system, particularly by the Advisory Committee on Mental Health, are often limited by insufficient powers.

Decentralised planning and implementation have resulted in service funding that is often separated by sector, leading to limited scaling-up of innovative services.

If we want to better implement a stepped-care approach, there must be a mechanism for centralised policymaking and execution. One such approach is OHKF’s suggestion of a functional mental health unit, a body that would span and have policymaking discretion across relevant sectors.

This concept is not unique to Hong Kong. Introduced by the World Health Organization, the aim of such a unit is to promote centralised cross-disciplinary care so policies and resource allocation are well organised and integrated.

Within Hong Kong, a centralised policymaking unit could perform three core functions for the city’s mental health system: delineate clear roles and points of responsibility; coordinate budgeting and financing; and, formalise multidisciplinary collaboration mechanisms. These functions often go hand in hand.

For instance, a centralised policymaking unit can coordinate mental health programmes across sectors, delineate how different service providers would participate in these programmes, and ensure they are well-funded for long-term sustainability.

While many have acknowledged the need for these functions, the fragmented nature of the mental health system has long been a barrier to further development. Inconsistencies in data-sharing mechanisms, uneven funding for services and, ultimately, dissimilar visions preclude the development of a comprehensive mental health system.

A collaborative and multidisciplinary mental health system would link services between different sectors so patient experiences are streamlined and they can get faster, more efficient access to care without having to go through repetitive treatments or repeat their medical history.

Despite policy innovations in the health system, particularly in primary healthcare development, Hong Kong must pay further attention to its mental healthcare service ecosystem. To meet the growing demand for mental healthcare, the government should empower a policymaking and implementation unit that can centrally plan and develop the ecosystem.

This is critical for creating the multidisciplinary services needed for a stepped-care approach that offers patients a greater variety of care within a non-specialist, community setting.

The realisation of such a system will require government support, as well as top-down efforts to empower cross-sector collaboration. This is a noteworthy goal for the new year and for Hong Kong’s evolving healthcare system.