published_or_final_version / Public Health / Master / Master of Public Health

Background and Objectives The prevalence of child and adolescents mental health problems has been increasing in Hong Kong and is comparable to that of the world. It is estimated that the mental health problems of the future generations would account for 15% to 30% of their disability-adjusted life years (DALYs) and become a healthcare burden on societies in the near future. Therefore, it is necessary to address their mental healthcare needs now. The objective of the project is to review how the mental health services for children and adolescents have been changing in Hong Kong throughout the past few decades and to assess whether the local services have improved. While the service advancement in adult and old age (for example dementia) psychiatry has been significant, the children and adolescent mental health services would be reviewed by using the Donabedian framework. Based on some local and western models, the project will also address what the local healthcare providers can do for the children and adolescents with the capacity of developing multi-disciplinary and community-based integrated care as well as primary care and prevention. Service gap and areas of improvement on addressing the healthcare needs would be identified for the consideration of policymakers. Methods This project is a literature review. Archives of the Hong Kong College of Psychiatrists and Paediatricians, PubMed, PsycInfo, World Psychiatry, Lancet, etc have been searched with keywords including “children”, “adolescents”, “mental health services”, “child psychiatry” and “Hong Kong”. Journals from 1991 to 2011 have been retrieved. Publications and official sites of Hospital Authority and government organizations have also been searched. 52 journals, articles and online sources have been searched. 38 papers are identified and 19 are providing relevant materials. Studies with aggregated population level data rather than clinical studies which focus on symptoms and treatment of individuals are much more useful and providing more relevant information to this project. Results Secondary and tertiary care, in terms of screening, detection, in-patient and out-patient setting and rehabilitation services have been developed in Hong Kong since the 1980s whilst there are rooms for further development on primary care and prevention. An integrated approach, which emphasizes early identification and treatment by specialists-led multi-disciplinary professionals, has been more prominent. The stigmatization, which would result in reluctance of treatment, should also be addressed by enhancing the public understanding and awareness on the mental healthcare needs of children and teenagers. Conclusions It is necessary to work on the improvement of child and adolescent mental health in the primary, secondary and tertiary care in Hong Kong at present. Policymakers shall consider strengthening the support for child and adolescent psychiatry services in addition to the adults’. / published_or_final_version / Public Health / Master / Master of Public Health

The changes in the health care system have been remarkable over the past decades, along with the rapid economic development of China. The overall living standard of rural residents has generally improved; however, health expenses still make up a large part of their annual expenditure. During the new reform period, the importance of the village doctor has been emphasized by many scholars, and yet there are few studies conducted from the perspective of interactions between health administration, village doctor and rural resident to discover the invisible factors that influence the delivery of the health care service. Thus, this study aims to explore the street-level bureaucracy within the rural health care sector and its impact on rural residents. Guided by the Street-level Bureaucracy Theory and its application in public agency research, this study explores street-level bureaucracy in the grassroots health care sector in terms of health care regulation and provision before and after the recent series of health care reforms, and evaluates its impact on rural residents by analyzing health equity in terms of health care access, and the actual working and living conditions of the village doctor were identified. Apart from the official statistical data from document analysis and internet resources, the voices and advice of village doctors and rural residents in Jiangsu Province were also obtained from in-depth interviews, which provided the qualitative information for this study. There are four findings. First, as a typical street-level bureaucrat in the grassroots sector, the working condition of the village doctor has become more stable and their discretionary control has been enhanced greatly after the reforms, due to the implementation of specific rules and regulations and the changes in payment methods; Second, despite the fact that many regulations have been put into effect, compared to the supervision of the health administration, the payment method plays a significant role in the promotion of service equity; Third, village doctors regard their social reputation as important as their income, for they live in a small community network. Although the role of village doctor has been emphasized in the new reform, improvements in health equity are still not obvious and have had limited effect; Fourth, the function of the village doctor is not fully utilized, even though the coverage of current health insurance in rural areas has been tremendously expanded in the past decade. Accordingly, policy implications regarding the understanding of the work and social environment of village doctors in rural areas, especially on the future exploration of their function related to further reforms, are identified in the final chapter. Additionally, the theoretical and practical significances of this study have also been presented. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

No description available.

Background Persons with severe mental illness (SMI) are vulnerable to mental health (MH) crises in the community. These crises often resulted in costly hospital admissions. Crisis Resolution Team (CRT) was implemented based on limited empirical evidence to address this problem. In 2001, UK implemented a national policy making CRT mandatory nationwide. Since then, more studies were performed on the effectiveness of CRT. It appeared CRT is cost effective in reduction of admissions. There was evidence of positive clinical outcome in comparison with standard care. Hong Kong does not have a specific community crisis program for people with SMI. It is desirable for policy makers to consider alternatives to reduce hospital admissions and to strengthen community support for people with SMI. Aims To evaluate the feasibility on the implementation of CRT Model in Hong Kong as a service to reduce hospital admissions. Method A review of current evidence on the effectiveness of CRT model and assess the feasibility and desirability of such model for implementation in Hong Kong. Results Evidence from observational studies and randomized controlled trials show CRT to be effective in the reduction of hospital admissions and inpatient days in the UK. CRT is also associated with higher acceptance from patients and family members than from standard care. CRT appears to be feasible against other service to address the acute needs of persons with SMI in reducing hospitalization. Conclusion A preliminary assessment ruled out a number of alternatives in dealing with mental health crises in the community. Preliminary results suggested the CRT model might be a feasible and desirable solution. There is evidence on the effectiveness of such teams in the UK. Successful implementation of CRT service in Hong Kong will be a challenge for stakeholders of the mental health system. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Administration / Master / Master of Social Sciences

published_or_final_version / Psychology / Master / Master of Philosophy