香港精神健康服務 檢討現在，展望將來 MENTAL HEALTH SERVICES IN HONG KONG PRESENT AND FUTURE BY 陳仲謀醫生 Dr. CHAN CHUNG MAU 精神科專科醫生 SPECIALIST IN PSYCHIATRY 香港精神健康議會召集人 CONVENOR , HONG KONG MENTAL HEALTH COUNCIL 香港精神健康促進會主席 CHAIRMAN, HONG KONG ASSOCIATION FOR THE PROMOTION OF MENTAL HEALTH 日期 Date: 11-01-2014

全球現況 GLOBAL SITUATION AT PRESENT 1. 世界衛生組織於2000年預料抑鬱症將於2020年躍升為人類第二位殺手(2000年為第四位) W.H.O. POSTULATED AT YEAR 2000 THAT DEPRESSION WILL BECOME THE SECOND MOST COMMON ILLNESS AT YEAR 2020. (IT WAS THE 4TH AT YEAR 2000) 2. 多國專家認為精神病會成為全球最多人患上的疾病 MANY HEALTH EXPERTS BELIEVE THAT MENTAL DISORDERS WILL BECOME THE MOST COMMON ILLNESS IN THE WORLD.

精神病引起的問題 PROBLEMS ARISING FROM MENTAL DISORDERS 2A 顯性 NOTICEABLE -自殺(SUICIDE) -暴力行為(VIOLENCE)

2B 隱性 SUBTLE I. 身障調整壽命年數 DALYS (DISABILITY ADJUSTED LIFE YEARS)

2B 隱性 SUBTLE II. 經濟損失 FIANACIAL LOSS U.S.A. 1990 美國於1990 : Direct & indirect cost of depression = US$43.7 billion : 年用於抑鬰症之直接和間接支出 高達437億美元 U.S.A. 2003 美國於2003 : Costing the United States an estimated US$26.1 billion annually in medical care and $44 to $51.5 billion annually in terms of lost productivity : 每年用於醫療的支出 約261億美元 每年約440至515億美元生產力損失 總數 : 約701至776億美元

3. 世衛總幹事陳馮富珍女士最近發表建議，呼籲世界各國對精神健康提高警覺，積極改善精神健康服務，並訂下路線圖和時間表，強調「沒有精神健康就沒有健康」 MENTAL HEALTH MATTERS : REMARKS BY DR. MARGRET CHAN, W.H.O. DIRECTOR – GENERAL, AT THE LAUNCH OF COMPREHENSIVE MENTAL HEALTH ACTION PLAN 2013-2020 IN GENEVA, SWITZERLAND, ON 7th OCTOBER 2013. “NO HEALTH WITHOUT MENTAL HEALTH”

香港現況 PRESENT SITUATION IN HONG KONG 14.5% SIGNIFICANT EMOTIONAL PROBLEMS 6% ANXIETY DISORDERS 4% DEPRESSION >2% MORE THAN ONE EMOTIONAL / MOOD PROBLEMS

世衛建議(W.H.O. RECOMMENDATION) 香港精神健康服務有「四不」困難 THERE ARE FOUR AREAS OF INADEQUACY IN THE MENTAL HEALTH SERVICES IN HONG KONG 3A 不足 軟硬件均嚴重不足 SERIOUS INSUFFICIENCY IN SOFTWARE & HARDWARE (i) 精神科專科醫生 VS 人口比例 PSYCHIATRISTS VS GENERAL POPULATION RATIO 香港(H.K) 1:30,000 to 35,000 英國(U.K) 1:12,000 澳洲(AUSTALIA) 1 :8,000 美國(U.S.A) 世衛建議(W.H.O. RECOMMENDATION) 1:10,000

據香港精神科醫學院估計，香港二十年後精神科醫生對市民的比例仍未能達到世界衛生組織的標準。 Expert warns that HK’s shortage of psychiatrists could last for two decades

3A 不足 (ii) 投放於精神健康服務資源不足 INADEQUATE FUNDING IN MENTAL HEALTH SERVICES 香港精神健康服務有「四不」困難 THERE ARE FOUR AREAS OF INADEQUACY IN THE MENTAL HEALTH SERVICES IN HONG KONG 3A 不足 (ii) 投放於精神健康服務資源不足 INADEQUATE FUNDING IN MENTAL HEALTH SERVICES 香港(H.K) 0.24 G.D.P. 英國(U.K) 0.58 G.D.P. 澳洲(AUSTRALIA) 0.88 G.D.P

香港精神健康服務有「四不」困難 THERE ARE FOUR AREAS OF INADEQUACY IN THE MENTAL HEALTH SERVICES IN HONG KONG 3B 不均 UNEVEN DISTRIBUTION OF SERVICES 香港精神科的治療服務主要由醫管局負責 然而醫管局轄下有7個聯網各自負責當區的精神科服務， 而各個聯網服務質素不一，例如：市民輪候精神科門診 的排期時間在不同聯網差異很大 MENTAL HEALTH SERVICES IN H.K. ARE MAINLY PROVIDED BY THE HOSPITAL AUTHORITY WHICH IS DIVIDED INTO SEVEN CLUSTERS. THE SERVICES PROVIDED BY DIFFERENT CLUSTERS ARE NOT THE SAME EG: WAITING TIME IS VERY DIFFERENT FOR NEW PATIENTS IN DIFFERENT CLUSTERS.

3C 不準 INACCURATE RESOURCES DISTRIBUTION 香港精神健康服務有「四不」困難 THERE ARE FOUR AREAS OF INADEQUACY IN THE MENTAL HEALTH SERVICES IN HONG KONG 3C 不準 INACCURATE RESOURCES DISTRIBUTION A GREAT PROPORTION OF RESOURCES IS PUT INTO TREATMENT OF MENTAL DISORDERS , PART INTO REHABILITATION AND VERY LITTLE INTO PREVENTION (PROMOTION OF MENTAL HEALTH) PREVENTION IS ALWAYS THE FIRST LINE TREATMENT OF ANY DISEASES AND IS MOST COST-EFFECTIVE

香港精神健康服務有「四不」困難 THERE ARE FOUR AREAS OF INADEQUACY IN THE MENTAL HEALTH SERVICES IN HONG KONG 3D 不全面 NOT A HOLISTIC APPROACH 香港精神健康服務以醫學模式為中心，不能全面滿足患者及家屬的經濟、居住、就業、法律及其他方面的種種需要。 MENTAL HEALTH SERVICES ARE MAINLY MEDICALLY ORIENTATED; THEREFORE, PATIENTS AND THEIR RELATIVES’ SOCIOECONOMIC , RESIDENTIAL , LEGAL AND OTHER NEEDS ARE NOT ADEQUATELY MET.

如何解決「四不」困局？ HOW TO TACKLE THESE ‘FOUR’PROBLEMS? 「四不」困局成因複雜，亦帶有沉重的歷史包袱，要解決並不能祇用見招拆招、治標不治本的方法。要高瞻遠矚，綜觀全局，訂立一個長遠而有效的策略。 THESE FOUR PROBLEMS HAVE COMPLICATED AND HISTORICAL CAUSES. WE CANNOT SOLVE THEM BY AN AD-HOC APPROACH JUST LIKE WE SHOULD NOT TREAT THE SYMPTOMS ONLY AND FORGET TO DEAL WITH THE CAUSE OF AN ILLNESS. WE SHOULD DEVELOP A LONG TERM, HOLISTIC AND EFFECTIVE APPROACH.

根源問題 FUNDAMENTAL PROBLEMS (A)資源 RESOURCES --不足 INSUFFICIENT --分配不均 UNEVEN DISTRIBUTION --焦點不準 NOT IN FOCUS (B)針對方法不夠全面 --APPROACH NOT COMPREHENSIVE AND HOLISTIC.

基本解決方向 PROBLEM SOLVING APPROACH (1) 增撥資源，培訓人才，增加設施，以解不足 INCREASE FUNDING, INCREASE TRAINING OF SERVICES PROVIDERS AND FACILITIES (2) 全面檢討現行政策，針對不均，不準及不全 面的問題 THOROUGH REVIEW OF PRESENT POLICY AND SERVICES TO SOLVE PROBLEMS OF UNEVEN DISTRIBUTION ,INACCURACY IN FUNDING AND INCOMPREHENSIVENESS.

香港急需一個獨立、有權、有責，可以聯繫各有關部門的機構，才可推行上述的改革。 可參考澳洲、紐西蘭、加拿大的模式，設立 MENTAL HEALTH COMMISSION 精神健康公署。 THE URGENT NEED TO ESTABLISH AN INDEPENDENT BODY WITH FULL AUTHORITY AND RESPONSIBILITY TO MAKE CHANGES TO MEET THE NEEDS. THE ESTABLISHMENT OF “MENTAL HEALTH COMMISSION” IN AUSTRALIA, NEW ZEALAND, CANADA etc SHOULD BE SERIOUSLY CONSIDERED IN HONG KONG.