Multipronged approach needed to expand HK's mental health workforce

This article appeared originally in China Daily on 20 June, 2023.
Authors: Dicky Chow, Researcher and Nan Xia, Assistant Researcher at Our Hong Kong Foundation

The mental health crisis in Hong Kong is a real threat, with a series of tragedies having rocked the city. The incidents involving people with suspected mental health problems, a chronic social issue that has challenged the metropolis for years, have put mental health in the spotlight, with the government being urged to take swift and solid action to address public concerns.

According to Mind HK, a local mental health charity, 53 percent of secondary school students have displayed symptoms of depression. In pre-pandemic years, local research in 2019 found that 61 percent of adults in Hong Kong suffered from poor mental health. The 3-year pandemic has taken a toll on the public’s mental health, with up to 1.7 million local residents, or one in four people, having a diagnosable mental health problem.

To make things worse, governmental support is far from adequate due to limited resources. The Hospital Authority recorded a near-50 percent increase in the median wait time for psychiatric outpatient services for stable new cases, from 27 weeks in 2019-20 to 40 weeks in 2022-23.

Shortage of psychiatrists

In response to the recent unfortunate events, the Advisory Committee on Mental Health held an urgent meeting and launched 10 measures to improve the mental health of citizens. Although the tragedies may not have been related to any specific shortcomings in follow-up or monitoring of symptoms due to resources or manpower constraints, it is widely acknowledged that Hong Kong lacks sufficient psychiatrists or clinical psychologists to meet the surging demand. According to the World Health Organization, the psychiatrist-to-population ratio should be at least 1 to 10,000. 

For Hong Kong’s population of around 7.3 million people, this means the city should have at least 730 psychiatrists. However, according to the list of registered medical practitioners, the number of psychiatrists is only 456, which falls well below the standard. Furthermore, according to Our Hong Kong Foundation, Hong Kong lags far behind the Organization for Economic Co-operation and Development (OECD) average of 1.8 psychiatrists per 10,000 population.

In order to expand the workforce, the government and the Hospital Authority (HA) have implemented several measures. On May 16, the government announced the expansion of the Talent List, which covers 51 professions, including the 13 healthcare professions, such as doctors, nurses, and dentists, that are subject to statutory registration. The expansion of the Talent List simplifies the immigration process for applicants, but non-locally trained psychiatrists still need to meet local registration requirements to provide services in Hong Kong, which creates a significant barrier for them. 

Meanwhile, the HA has been recruiting nonlocally trained doctors, including psychiatrists, from overseas. However, the HA has not disclosed the specialties of these recruits. Therefore, it remains unclear how effectively these measures can address the shortage of psychiatrists.

In parallel to attracting nonlocally trained psychiatrists to expand mental health services in Hong Kong, the government should also explore ways to increase the local supply of psychiatrists. According to the Legislative Council papers, the government has commissioned the HA to project the supply and demand of healthcare professionals, and the exercise is expected to be completed before the end of 2023. It is hoped the results will accurately reflect the shortage of mental health workers, including psychiatrists, and encourage the government to review its training strategies and arrangements accordingly.

Leveraging family doctors and allied healthcare professionals

In addition to addressing the shortage of psychiatrists, the government should better leverage the current workforce to provide mental health services to the public. In 2022, the HA introduced the Co-care Service Model in psychiatric outpatient clinics, allowing patients to receive mental health services in the community at the primary care level. The government can adopt the strategic purchasing framework to systematically evaluate and improve the service model. This could hopefully reduce the strain on public services and ensure that people in need receive timely services.

With the recent introduction of the 10 enhanced measures to support people in mental recovery or with mental health needs, it is foreseeable that the service demand will increase, as well as the requirements for manpower. To overcome this challenge and ride on the momentum of promoting the concept of a “Family Doctor for All” highlighted in the Primary Healthcare Blueprint, the government should consider enhancing the role of family doctors in the community.

The government has long recognized the need to empower primary care professionals to address the public’s mental health needs, and rolled out the Integrated Mental Health Program (IMHP) as early as 2010 to provide treatment for people with common mental disorders in primary care settings. The program was supported by multidisciplinary teams led by HA family medicine specialists in collaboration with allied healthcare professionals, including social workers, occupational therapists, and psychiatric nurses. 

The program has shown promising clinical results, demonstrating the potential of involving family physicians and allied health professionals in providing mental health services. In light of this, the government should consider providing incentives for family doctors to receive mental health training and provide mental health services to residents in the community.

The World Health Organization emphasizes that “there is no health without mental health”. Hong Kong should step up efforts to expand its mental health workforce to support a primary care-led and person-centered service model to ensure more timely access to mental health care. Notably, community resources should be better leveraged to optimize service accessibility and meet the emerging needs. Multidisciplinary and cross-sectoral efforts will be crucial to optimize residents’ health status to a holistic physical, mental and social well-being.