According to the Review on Mental Health published by the Legislative Council Panel on Health Services in April, the number of cases handled by the Hospital Authority (HA)’s child and adolescent psychiatric teams has skyrocketed for more than 50 per cent from 18,900 in 2011 to 28 800 in 2016.

Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) were amongst the major disorders present in these children, making up over half of the caseload.

Caseload of HA’s Child and Adolescent Psychiatric Services. Some patients were categorised into more than one disease group in the same year. (Source: Hospital Authority)
Caseload of HA’s Child and Adolescent Psychiatric Services. Some patients were categorised into more than one disease group in the same year. (Source: Hospital Authority)

Another disquieting observation that is equally on the rise is the waiting time for the government’s psychiatric services. Based on government’s data submitted to the legislative council, the median waiting time of new cases at the child and adolescent (C&A) psychiatric specialist outpatient clinics (SOPCs) has gone up from 34 weeks in 2013 to 58 weeks in 2015—indicating children have to wait for more than a year to be diagnosed and treated.

The median waiting time of new cases at the SOPCs and C&A psychiatric SOPCs of the Hospital Authority (Source: Hospital Authority)
The median waiting time of new cases at the SOPCs and C&A psychiatric SOPCs of the Hospital Authority (Source: Hospital Authority)

Hong Kong’s mental health care services fall short with adolescents’ rising demand


“If these children do not receive treatment in time, their behaviour can deteriorate. It could affect their growth development. They may lose interest in their studies, and some may even end up giving up on school,” asserted Dr Phyllis Kwok-Ling Chan, spokesperson for the Hong Kong College of Psychiatrists.

A 5-year cohort study published in the Hong Kong Medical Journal also confirmed that these children are exposed to an increased risk of multiple forms of adolescent maladjustment—e.g. involvement in crimes and use of illicit drugs.

The study reassessed a total of 150 children after they were diagnosed with ADHD six years ago. Compared to their peers, the study found out these children and adolescents are eight times more likely to smoke. The developmental disability also affects their academic performance – and more importantly the relationship with their family members. As compared to the control group, they tend to perceive their families as more subject to conflicts and less cohesive.

Currently, there are about 330 psychiatrists serving in Hong Kong’s public hospitals, way below the suggested number of 400 psychiatrists by the World Health Organisation (WHO). What makes this more disturbing is that amongst the 330 psychiatrists, only around 20 of which are working in the child and adolescent team.

> Read more: Mental health in Hong Kong: failing system and its consequences


Being aware of the situation, 12 private psychiatrists decided to volunteer their services to help ease the burden. Since August last year, they have offered mental health care to over 61 patients. The service is sponsored by Variety, a charity group to support disadvantaged children in Hong Kong.

“Children from low-income families can be referred to the programme by doctors or social workers. And we are happy to treat them for free,” remarked Dr May Mei-Ling Lam, Director of the group. She estimated that the scheme could run for at least 3 years, offering help to over 400 children.

Misconceptions towards developmental disabilities still linger


ASD and ADHD are both classified as neurodevelopmental disorders in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) of the American Psychiatric Association. ASD is defined by the qualitative abnormalities in social interactions whereas ADHD is characterised by a combination of inattention, distractibility, with or without hyperactivity.

> Read more: Lifestyle modification and behavioural intervention recommendations in treating ADHD


According to a household survey published by the Census and Statistics Department in 2008, approximately 90% of the surveyed population was aware of autism as a type of childhood developmental disability. Amongst the group, 74% of them knew that a lack of interaction with parents does not cause ASD. Additionally, 85% of them recognised that a lack of discipline was not the reason behind ADHD.

However, the survey also revealed several misconceptions. Amongst them were the tendency to assume that an autistic child prefers to be a loner, and a child with ADHD would ‘recover’ when they grow up.

Misconceptions also affect children who are not diagnosed with any developmental disabilities. Over the last five years, the number of parents demanding developmental tests for their children has risen nearly 20%. Whether or not this has to do with increased awareness or anxiety towards developmental disabilities—parents have been cautioned against having unrealistic expectations for their children.

”Some kids studying in elite schools might just be underperforming in studies and were found to be normal after tests... but parents still asked for medication,” said developmental behavioural paediatrician Dr Fanny Wai-Fan Lam. MIMS

Read more:
Is happiness in our genes?
Internet gaming disorder (IGD) – when there is no 'Game Over'
Overworked and Underpaid: The Shortage of Paediatricians in China

Sources:
http://emedicine.medscape.com/article/289350-overview
http://emedicine.medscape.com/article/912781-overview
http://www.fhs.gov.hk/english/health_professional/OMP_eNewsletter/enews_20140717.html
http://www.scmp.com/news/hong-kong/health-environment/article/2093309/charity-offers-low-income-hong-kong-children
http://www.scmp.com/news/hong-kong/health-environment/article/1953927/hong-kong-children-wait-more-year-mental-health
http://www.hkmj.org/system/files/hkm1008p257.pdf
http://www.scmp.com/news/hong-kong/health-environment/article/1936750/hong-kong-parents-soaring-demand-learning
http://www.legco.gov.hk/yr16-17/english/panels/hs/papers/hs20170425cb2-1220-1-e.pdf
http://gia.info.gov.hk/general/201605/25/P201605250619_0619_166864.pdf
http://www.info.gov.hk/gia/general/201605/25/P201605250619.htm