Symposium 7 - Pioneering Mental Health Advancements: From Policy Insights to Understanding Economic Impact and Beyond

The presentation shall discuss on mandatory mental health treatments in the community, stakeholders' perspectives on conditional discharge, and review of the effectiveness of a compulsory intervention, namely "Community Treatment Order" (CTO), which had been implemented in some Western countries.


Conditional discharge (CD) is a legal provision regulated by Section 42B of the Mental Health Ordinance (Cap. 136) and its primary objective is to safeguard the health and safety of patients and others by mandating individuals with mental disorders, who meet certain criteria, to follow a course of treatments after discharge. There are several limitations on the local CD mechanism which restrict the scope of patients to benefit from CD. The Mental Health Review Report under the Health Bureau in 2017 recommended a more effective use of CD and to explore the applicability of CTO in Hong Kong. A working group was formed in the Hospital Authority to review the existing CD mechanism, and it was tasked by the Advisory Committee on Mental Health. 


Focus groups were organised to collect perspectives of relevant stakeholders including patients, care-givers, psychiatrists, nurses and allied health professionals and representatives from Non-Government Organisations. The results highlighted the consensus from stakeholders regarding the benefits of CD on patients' recovery, and suggested a regular review mechanism of the CD status. 


CTO is a mandatory intervention that keeps patients actively engaged in the mental health services outside the hospital settings. The effectiveness of CTO was reviewed through systematic review and meta-analysis on clinical outcomes when patients were in the community, including psychiatric service usage, number of emergency visits and violence. The results included 16 studies and demonstrated statistically significant effects in pre-post design studies, in terms of promoting service contacts, and reducing both emergency visits and violence; while the effects were insignificant in control studies. 

Serial surveys performed in Hong Kong showed that the prevalence of mental disorders in Hong Kong is worsening. For instance, a population-based study showed that around 38% of respondents considered their mental health to be poorer, with approximately 49.4% and 41.3% of the study participants demonstrating symptoms of mild to severe depression and anxiety, respectively [1]. The situation is compounded by the impact of these mental disorders being extended to our younger generation aged 6 to 17 years; a recent study found that 25% of Hong Kong children and adolescents suffered from a mental disorder in the past 12 months [2]. Most patients with mental disorders, including anxiety and depression, are seen in primary care settings by family physicians and allied health professionals. However, the most commonly cited barriers to seek support among these patients included "lack of available mental health services" and 'long waiting times for service" [1]. Besides, it is anticipated that the health service demands for mental problems becomes increasingly substantial. Hence, primary care providers are in a privileged position to provide first-contact, comprehensive, continuous, and tailored intervention to prevent and manage mental health issues in the community and clinic settings.
This seminar will review existing primary care, community resources that could be utilised to manage this increasing healthcare demand. These include: 1). competence and proficiency of family physicians to handle common psychiatric disorders; 2). various self-support groups in non-government organizations; 3). novel digital mental health platforms that could engage patients; 4). telepsychiatry and excellence of family medicine training; and 5). health-social collaboration via multidisciplinary, joint initiatives among key stakeholders in primary care. The talk will also identify the current challenges and opportunities to expand innovative strategies, as well as future perspectives to fund research studies and inform healthcare policy.

Severe mental illness (SMI), including psychotic disorders and bipolar disorder, affects 2-3% of the population and constitutes one of the main causes of disability worldwide. Critically, evidence has shown that people with SMI may exhibit increased premature mortality and physical comorbidity relative to the general population. Such physical-health disparities pose a serious public-health challenge and rectification of such lifespan inequalities is now considered an international health priority. Existing data are mainly derived from western countries, and may unlikely be generalizable to other regions due to substantial cross-regional variation in healthcare systems, sociocultural context and population-health indices. In this regard, we have recently conducted a series of studies, comprising population-based health-record data research and meta-analyses, with an aim to examine the association of SMI with risk of excess mortality, reduced life-expectancy, and physical comorbidity in Hong Kong. Briefly, our findings showed that psychotic disorders and bipolar disorder are associated with approximately 2.5-fold increased all-cause (premature) mortality rate and substantially reduced lifespan (ranged between 7-10 excess life-years lost) compared with the general population, with the excess deaths being mainly attributed to natural (physical) causes, particularly cardiovascular diseases, respiratory diseases and cancers. Such differential mortality gap remains similar over time without improvement. People with acute coronary syndrome (ACS) and schizophrenia had higher 30-day and 1-year mortality rate, lower likelihood to receive revascularization procedures and post-discharge cardioprotective medications than those with ACS only. Schizophrenia patients with acute stroke and co-occurring diabetes were also found to display increased risk of excess mortality relative to those with the respective physical condition but no schizophrenia. Our meta-analyses confirmed our aforementioned findings in Hong Kong, and specifically demonstrated that markedly reduced life expectancy is transdiagnostic in nature across a wide spectrum of mental disorders. These findings provide comprehensive overview of physical health inequalities associated with SMI and would facilitate policy formulation, resource allocation, and healthcare service and treatment optimization to reduce preventable deaths and lifelong burden of poor physical-health among people with mental disorders.