香港有怎樣的精神健康服務 ? 香港人真的快樂嗎 ? What kind of Mental Health Services do we have? Are People of Hong Kong Really Happy?

1. 香港有怎樣的精神健康服務?香港人真的快樂嗎?What kind of Mental Health Services do we have?Are People of Hong Kong Really Happy? 香港醫學會會董 復康委員會主席 陳以誠醫生 Chairman of Rehabilitation Committee and Council Member of The Hong Kong Medical Association Dr.CHAN Yee Shing, Alvin MBBS(HK), FRCP(Edin), MRCP(UK), DCH(Glass), FHKAM(Paediatrics), FHKCPaed, MRCPCH

2. According to WHO, worldwide 0.45 billion people suffered from psychiatric illnesses (WHO, The world health report 2001 ) • Disability due to depression ranks 4th in global diseasesburden,  2nd in 2020 • Depression : the most costly of all health problems to employers and economy (Wang, 2007) • 世界衛生組織在2001年報告指出全球約有4.5億人口患有不同種類的精神病患 • 抑鬰症引致的殘疾是全球整體疾病負坦中排名第四 • 預計於2020年上升至第二名 • 抑鬰症亦是眾多疾病之中對顧主搆成最大打擊及最影響經濟收益的

3. Survey in Dec 2007: 71% of HK people are more optimistic about the future than the past year • But, 11% of interviewees expected that individual development worse than last year (3% more than last year’s survey) • 12% of interviewees expected that overall development worse than last year (5% more than last year’s survey) • 據2007年 12月 市民樂觀指數統計,71%的人對前景感樂觀 • 但對比去年同期,其實當中預計今年個人發展比去年差的多3%,為11% • 而預計今年整體發展比去年差的則多5%,為12%

4. 單比去年整體樂觀並不表示市民真是快樂 • 其實很多市民還是不開心的!! • Feeling more optimistic than last year does not mean that people are really happy • Indeed, we are still SAD!!

5. 429000 patients visited HA psychiatric clinics in 2000-2001. Increased to 605000 in 2005-2006. 40% increase in 5 years • Death due to committing suicide: 9.6/100000 in 1981,18.2/100000 in 2003. (15/100000 in the world) • Suicide ranks the 6th among the reasons of death, and the leading cause in the youth category in HK • 2000-2001年到醫管局精神科求診人數為42萬9000人,於2005-2006年度則上升至60萬5000人,升幅超過四成 • 由1981年每10萬人有9.6人死於自殺,至2003年上升至18.2,而全球的比例為只是15 • 自殺是是眾多死亡原因中排名第六 • 在年輕人的死因當中,自殺則位列榜首

7. 有精神病患的少於一半肯就醫 • 公私營醫療嚴重失衡,就醫的精神病人中有九成在公營醫療接受治療，剩下的一成則在私家診所或醫院醫治 • 公營精神科診所三小時內要看40個舊症及1個新症,每症只看4分半鐘 • Less than half of psychiatric patients are managed by doctors • Imbalance of public-private service: 95% of patients with psychiatric illnesses are treated in public clinic and only 5% in private • A public psychiatric clinic handles 40 old cases and 1 new case in a session of 3 hours. Only 4.5 minutes are spent in each case

8. 精神問題可分三層次3 Degrees of Psychiatric illness • Mild: emotional and psychological disorders can be handled by psychologists family doctors, social workers and support from family and friends • Moderate: curable psychological illnesses can be handled by psychologists, trained family doctors and psychiatrists • Severe: cases like schizophrenia must be treated by psychiatrists and sometime trained family doctors. Hospitalization may be needed • Majority - depression and anxiety • 較輕微的情緒病與心理失衡, 除家庭醫生外, 心理學家支援, 社工輔導, 鄰舍關顧與家庭親朋支持都很重要 • 可有效醫冶的精神病, 如情感性精神病, 可由精神科醫生處理, 部分亦可由受過有關訓練的家庭醫生和有關專家跟進 • 最嚴重的: 如精神分裂, 必需由家庭甚至精神科醫生醫治, 有些要住院, 更可能長期留院 • 抑鬰、焦慮等情緒病是精神病患的絕大部份

9. 衛生署調查2003/2004結果顯示:The results of the survey by Department of Health in2003/2004are as follow:

10. 推動精神健康政策聯席以「抑鬰症指數量表」CES-D調查於2006年的結果顯示:推動精神健康政策聯席以「抑鬰症指數量表」CES-D調查於2006年的結果顯示: • The results of the CES-D Survey are as follow:

11. The above 2 surveys do not cover children under 15 • Children also have emotional problems such as depression, anxiety academic and family problems, personality and peer relationship • Hyper-activity and attention deficit 10%, dyslexia 12% of student population • The earlier the children get psychiatric service and support, the earlier and better they can improve • A team of child neurologists, psychiatrists, community medical and supportive service, teachers and social worker can effectively help these children and families • 以上兩個調查未有涉及15歲以下的兒童 • 兒童也會有抑鬰與焦慮,如學業問題、獨留在家等 • 過度活躍症及專注力不足佔10%、 閱讀書寫障礙佔12% • 這些都是需要精神科服務, 愈早診斷及愈早得到服務與輔導愈好 • 兒童腦科服務、基層醫療與輔助醫療、學校及社工所組成的團隊更加有效

15. In June 2005, HKMA survey within the members for medical Insurance Coverage on mental illness • 18% of doctors: >50% of psychiatric patients asked for medicine treating somatic symptoms and signs • Many of these patients asked for a sick leave with diagnosis other than psychiatric illnesses • 於2005年6月,香港醫學會對會員進行了一個關於醫療保險涵蓋精神病及情緒病的調查發現,有很多基層醫生都照顧很多情緒病人 • 18%受訪的醫生表示,其診治的情緒病病人中,超過5成都常向醫生索取醫治由情緒病引起身體器官失調的藥物 • 不少情緒病病人亦要求醫生寫上身體器官失調病徵作病假原因

16. Stigma 標纖

17. Employees benefits usually do not cover for psychiatric illness • Medical insurance always refuses psychiatric patients • Premiums of those medical insurance plans which cover psychiatric illnesses are extremely high • 公司給予員工的福利通常都不包括精神科疾病 • 醫療保險計劃經常不賠償予精神科病人 • 罕有接受精神科疾病的醫療保險計劃的保費都「天比高」 Equal Opportunities? 平等機會?

18. 只有29%的精神科病人會遵從私家醫生的指示去服藥及跟進,大部分不跟隨醫生指示服藥及跟進的都是因為:只有29%的精神科病人會遵從私家醫生的指示去服藥及跟進,大部分不跟隨醫生指示服藥及跟進的都是因為: -經濟理由 -正接受政府服務長期治療 -認為公私營收費差距太大 -不了解自己的精神病患 • Only 29% of psychiatric patients will follow private primary doctors’ orders in taking medicine and follow up • Reasons are: -economic consideration -treatment by the government service -huge price differential between the public and private medical service -not understanding psychiatric diseases

19. 公私營醫療服務失衡嚴重影響香港的精神健康 • 保險不包括精神科亦是導致香港精神科服務失衡的重要原因 • 不平等之機會不單影響香港的精神病患者,更影響香港之經濟 • The imbalance between the public – private medical service greatly affect the mental health of Hong Kong people • Psychiatric illnesses not covered in medical insurance: contributing to imbalance of psychiatric service in HK • Unequal Opportunities not only upset psychiatric patients, but also upset the economy of Hong Kong

20. 據美國的研究表示,有組織的抑鬰症檢查及加顧療程除在醫療層面上能幫助患者外,更能對顧主及公司有着正面影響及回報據美國的研究表示,有組織的抑鬰症檢查及加顧療程除在醫療層面上能幫助患者外,更能對顧主及公司有着正面影響及回報 • 受治療的員工能增加工作時間及持續就業,有助公司及經濟發展 • Effectiveness trials have demonstrated that organized depression screening and enhanced-care programs not only have positive effect on the patients but also to the employer and company (Wang, 2007) • The increase in working hours and job retention contributed to the development of the company and economy (Wang, 2007)

21. 因此,對精神病員工提供醫療保障，及早診斷及治療病患，可視作為增加員工生產力的投資而非支出因此,對精神病員工提供醫療保障，及早診斷及治療病患，可視作為增加員工生產力的投資而非支出 • Thus, medical insurance and treatment to the employees with psychiatric illness can be regarded as investment instead of cost and burden

22. 2005年底, 我們聯同病人組織代表與保險業界代表與陳智思議員會面, 討論精神科缺乏保險保障問題的解決方法 • In the late 2005, the HKMA together with the mental patient groups and insurance representatives had meetings with Councilor Mr. Bernard CHAN on the solutions to the problem of UNEQUAL OPPORTUNITIES TO PSYCHIATRIC PATIENTS

23. 兩年來, 醫學會一年幾次與保險業聯會代表開會硏究理想保單的要素, 以建議給病人與保險業, 並期望讓政府參考醫療融資改革中, 普及醫療保險角色的發展 • 但去年5月之後就再沒有進展,沒有開會 • For the past 2 yeas, the Medical Association have meetings with the representatives from Federation of Insurers few times each year to design ideal plans which are beneficial to the patients and insurance companies • We also hope that the Government can study the role of the medical insurance in the Hong Kong Medial Reform and health financing • However, no meetings since May last year

24. 惠及大多數市民的醫療保險能幫助巿民與政府一起承坦醫療支出, 使社會的健康狀況長遠有良好的發展 • 這種醫保必須包括精神健康 --- 治療與預防惡化 • Medical insurance which can benefit the general public and share the medical burden of the Government is good for the society as a whole • These medical insurance schemes must include mental illnesses for better management and prevention of worsening of mental health

25. 周一嶽局長於零七年一月三十一日曾表示: 大部分精神病問題是可以治療的, 醫藥的改良大大提升效用並減少副作用, 若及早治療, 可大大降低殘廢程度 • 若比較情緖病等精神病者與高血壓及糖尿病等病人, 我們實在要質疑為甚麼那麼多醫療保險計劃不保障精神病患者 • As mentioned by the Secretary for Food and Health Dr. CHOW, SBS, JP on 31st January 2007, most of the psychiatric illnesses can be beneficial and even cured. Development of new medicine not only can reduce their side-effect but also reduce disability. • Why so many medical insurance plans do not cover the patients with psychiatric illness?

26. 國際醫療保險計劃通常都可以接受有精神病患賠償, 但本土的大部分保單都不可以, 公司醫療保險通常都不保障員工精神健康 • 香港是亞洲國際都市嗎? • 不平等之機會不單影響香港經濟及精神病患者,更影響香港的形象及福祉 • International medical insurance plans around the world often compensate for psychiatric illness. In Hong Kong most medical insurance provided by the employers do not protect the mental health of the employees • Is Hong Kong the Asia’s World City? • Unequal Opportunities not only upset Hong Kong economy and psychiatric patients, but also upset the economy, general well-being and image of Hong Kong

27. 預防勝於冶療, 病向淺中醫 • 從醫療融資, 精神健康服務來看: -政府需要增加資源 -政府需要增加對基層醫生的訓練 -政府需要增加精神專科醫生之培訓 -政府需要增加對心理學家及社工與 社區支援的服務 -政府需要明確制定並檢討精神健康政策 • PREVENTION AND EARLY DETECTION • MEDICAL INSURANCE and EQUAL OPPORTUNITIES for PSYCHIATRIC PATIENTS • The Government needs to -increase resource for mental health service -provide more training to primary care doctors -more psychiatrists -more psychologists and social worker -enhance the support to communities -have a definite MENTAL HEALTH POLICY and review it constantly

28. 我們一定會致力於教育,提升市民認知情緒病,消除成見與標纖但亦必須向政府建議: ……政府需要解决保單不保精神病患的問題 • We will put more effort on enhancing the understanding of general public to the psychiatric illness, easing the opposition and label to these patients. • We request the Government to have solutions to the problem which the medical insurance does not cover the psychiatric illness

29. Thank you for your kind attention!