Although it may have been the case that Hong Kong was slower to offer newer anti-psychotic medications than countries in the west, those drugs are now widely available in the public system.
Dr Arthur Mak Dun-ping, associate professor in the Department of Psychiatry at the Chinese University of Hong Kong, says financial constraints are no longer a major consideration. “The patent of new drugs [second-generation antipsychotics] has expired and we can use a fair price to buy them,” Dr Mak says. “To be frank, drugs prescriptions by the public and private hospital doctors are similar now.”
Besides, says Dr Louis Lee Hou-tao, associate consultant in the Department of Psychiatry at Shatin Hospital, doctors will prescribe the medications they think are most suitable for their patients. Both the newer and older medicines have potential side effects. “Second-line drugs were invented to minimise the side effects of first-line drugs, yet they will carry other new side effects,” he says.
For example, second-generation antipsychotics can reduce the frequency of symptoms like involuntary muscle movement, eye-rolling and drooling. However, new problems can arise, such as severe weight gain, uncontrollable blood-sugar levels and, in rare cases, even a sharp decrease in white blood cells.
Just as important as which drugs to prescribe, is the need to explain their effects to patients, to help them achieve better treatment adherence and to have a better insight into their condition.
Insight, in this instance, refers to a patient’s ability to accept their illness and the effects of therapy. Lily Chan Lei-hung, who has lived with bipolar disorder for 16 years, says poor insight will cause patients to have a low level of drug adherence. They will not take the prescribed medications properly and may even discontinue their treatment.
Chan says she once believed she could overcome her bipolar disorder through sheer willpower and unilaterally reduced her dosage of drugs. However, she then experienced a severe relapse and had to be hospitalised. “In the past, there was a very wrong perception that reducing drugs dosage meant I made good progress in my recovery,” Chan says.
Now, Chan works in Castle Peak Hospital as a peer specialist. Peer specialists are recovered mental illness patients who provide counselling services for others in need. Chan uses her personal rehabilitation experience to help patients and their families understand the importance of drugs and de-stigmatisation.
Jolene Mui Hang-chun, nurse consultant of community psychiatry at Castle Peak Hospital, thinks Hong Kong has not done enough work to combat stigma. She recalls the strong opposition to the building of an Integrated Community Centre for Mental Wellness in 2010. Using a Chinese idiom, Mui says people using the services at the centre were treated like they were rats crossing the streets. The local people wanted to sweep them away from their community, if not under the carpet.
As a result of this severe stigmatisation, the patients refused to allow nurses to do home visit. They did not want their neighbours to know they were mentally ill. “We have two staff passes and one is without the words ‘Castle Peak Hospital’,” Mui says. She explains they used this staff pass to pretend to be social workers when carrying out home visits. This helped to prevent neighbours from finding out there were people with mental illness living on their estate.
Mui says stigma creates great pressure from relatives, employers and the public. She says patients develop a strong defence mechanism and convince themselves they are not sick. They become reluctant to take medication and refuse to visit doctors.