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Admission Rates and Psychiatric Beds in Hong Kong, 1999–2014: A Population-Based Study

2016; American Psychiatric Association; Volume: 67; Issue: 5 Linguagem: Inglês

10.1176/appi.ps.201600026

1557-9700

Edwin Lee, Hon‐Cheong So, Eric Chen,

Mental Health Treatment and Access

Back to table of contents Previous article Next article LettersFull AccessAdmission Rates and Psychiatric Beds in Hong Kong, 1999–2014: A Population-Based StudyEdwin Ho-Ming Lee, M.B.Ch.B., M.Sc., Hon-Cheong So, M.B.B.S., Ph.D., Eric Yu-Hai Chen, M.D.Edwin Ho-Ming Lee, M.B.Ch.B., M.Sc., Hon-Cheong So, M.B.B.S., Ph.D., Eric Yu-Hai Chen, M.D.Published Online:28 Apr 2016https://doi.org/10.1176/appi.ps.201600026AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail TO THE EDITOR: For the past 15 years, Hong Kong has been reducing the number of psychiatric beds and developing community mental health services. However, the effect on admission rates is unknown. This study examined trends in psychiatric admission rates in relation to the number of psychiatric beds.The study was a retrospective analysis of data (1999 to 2014) from a population-based registry. Data on the total number of psychiatric admissions (involuntary, voluntary, and informal) and psychiatric beds were obtained from the Hospital Authority register through the Clinical Data Analysis and Reporting System (1). Involuntary and voluntary admissions refer to patients admitted under the Mental Health Ordinance. Informal admissions refer to patients admitted voluntarily but not under the ordinance; they may leave at any time that they request a discharge. Pearson correlation analysis was used to investigate associations between annual changes in the number of psychiatric beds and admission rates, with a time lag of zero, one, or two years.Between 1999 and 2014, the overall admission rate increased by 32.0%, from 175.2 to 231.2 per 100,000 population per year, and the total number of psychiatric beds in Hong Kong decreased by 39.8%, from 93.1 to 56.0 per 100,000 population. During the same period, the involuntary admission rate increased by 5.4%, from 36.8 to 38.8 per 100,000 population per year. The voluntary admission rate increased by 68.4%, from 33.9 to 57.1 per 100,000 population per year. The informal admission rate increased by 29.3%, from 104.6 to 135.3 per 100,000 population per year. Overall, the number of admissions per psychiatric bed increased by 2.2-fold. No significant association was found between changes in the number of psychiatric beds and admission rates when a time lag of zero, one, or two years was introduced.The relatively small change in the involuntary admission rate may suggest the effect of community mental health services (2), which focus on patients who require monitoring and supervision in the community. However, the marked increase in voluntary and informal admissions suggests that a large number of patients cannot be managed by psychiatric outpatient services. Currently, primary care doctors receive little training and support to manage patients with mental illness. Therefore, psychiatric outpatient services are mostly supported by the Hospital Authority. In addition, high consultation fees of private psychiatrists and the need for long-term care have made public psychiatric services the only choice for most patients.Chinese people with mental illness and their family members may delay seeking help because of stigma. When the condition worsens to the extent that family members cannot handle it, patients are admitted to a hospital because outpatient clinics are overcrowded and clinicians offer only brief consultations (3). Reductions in the number of psychiatric beds may have helped mobilize resources and manpower to community-based services; however, this may have led to a shortage of acute beds and problems of overcrowding. Simultaneous development of community-based services, including public education, training of primary care professionals, and expansion of outpatient psychiatric care, are all needed. In countries that have a hospital-based care system, provision of psychiatric beds must be carefully planned to avoid such complications.Dr. Lee and Dr. Chen are with the Department of Psychiatry, University of Hong Kong, Hong Kong, China (e-mail: [email protected]). Dr. So is with the School of Biomedical Sciences, Chinese University of Hong Kong, Hong Kong, China.Dr. Chen has served on an advisory board or has received research funding or an educational grant from AstraZeneca, Eli Lilly, Janssen-Cilag, Otsuka, Pfizer, and Sanofi-Aventis. The other authors report no financial relationships with commercial interests.References1 Cheung NT, Fung V, Wong WN, et al.: Principles-based medical informatics for success: how Hong Kong built one of the world's largest integrated longitudinal electronic patient records. Studies in Health Technology and Informatics 129:307–310, 2007Medline, Google Scholar2 Chen EY, Tang JY, Hui CL, et al.: Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Early Intervention in Psychiatry 5:315–323, 2011Crossref, Medline, Google Scholar3 Hui CL, Wong GH, Lam CY, et al.: Patient-clinician communication and needs identification for outpatients with schizophrenia in Hong Kong: role of the 2-COM instrument. East Asian Archives of Psychiatry 18:69–75, 2008Google Scholar FiguresReferencesCited byDetailsCited byExpert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data24 December 2021 | Frontiers in Psychiatry, Vol. 12Analysis of involuntary admissions in Korea through the admission management information systemInternational Journal of Law and Psychiatry, Vol. 68Suicide Rates, Psychiatric Hospital Bed Numbers, and Unemployment Rates From 1999 to 2015: A Population-Based Study in Hong KongEdwin Ho Ming Lee, M.Sc., M.B.Ch.B., Christy Lai Ming Hui, Ph.D., Pik Ying Chan, M.Sc., Wing Chung Chang, M.B.Ch.B., Sherry Kit Wa Chan, M.Phil., M.B.B.S., Eric Yu Hai Chen, M.D.1 March 2018 | American Journal of Psychiatry, Vol. 175, No. 3Understanding Pregnancy's Protective Effect on Drug Use Within a Developmental FrameworkSuena H. Massey, M.D., Katherine L. Wisner, M.D., M.S.1 March 2018 | American Journal of Psychiatry, Vol. 175, No. 3 Volume 67Issue 5 May 01, 2016Pages 579-579 Metrics PDF download History Published online 28 April 2016 Published in print 1 May 2016