Academic journal article Hong Kong Journal of Psychiatry

General Hospital Psychiatry in Hong Kong

Academic journal article Hong Kong Journal of Psychiatry

General Hospital Psychiatry in Hong Kong

Article excerpt


The emphasis on the community care of psychiatric patients has led to, inter alia, the development of general hospital psychiatric units, After a review of the overseas and local histories, the particular roles of the general hospital psychiatrist are discussed and some suggestions are made for the future development of general hospital psychiatry in Hong Kong.

Keywords, psychiatry, general hospital, Hong Kong, consultation-liaison, re-integration


There is a recognized international trend towards managing mental patients in the community as far as possible. One of the results has been the development of psychiatric units in general hospitals while mental hospitals are seldom or no longer built. In Hong Kong, the policy of the Hospital Authority (a statutory quasi-governmental body established on 1 December 1990 to manage all local public hospitals) is in line with this (Hong Kong Hospital Authority, 1995).

The benefits of community-based psychiatric care are certainly multiple. General hospital psychiatric units contribute substantially to the success of community-based care. This paper aims at reviewing the development of general hospital psychiatry in Hong Kong, looking at this aspect of our practice in relation to the whole specialty and discussing some particular roles of the general hospital psychiatrist.


Three models are discernible when we consider how the general hospital patient gets psychiatric care.

They may be referred to the psychiatric clinks just like patients requiring the attention of doctors of any other specialty. A considerable proportion of these have to be seen quickly. Many psychiatric out-patient departments reserve a number of urgent new case slots for such patients.

In the second model, visiting psychiatrists go to the general hospital wards to see the patients- Being visitors, the psychiatrists have no offices of their own and often have to assess the patients under circumstances not entirely suitable.

If there is a psychiatric unit within the general hospital itself, flexibility with respect to the time and place of the consultation or assessment will be enhanced. There is also increased sophistication of the service.

In general, these models have developed in a chronological order. As we go from the first model to the third, there is progressive integration of the psychiatric and non-psychiatric aspects of patient care and the service becomes more and more client-centred. However, al three modes of service delivery still exist to different extents in various parts of the world including Hong Kong.



All over the world before the 1950s, the single word that could describe the policy of managing mentally deranged individuals was "isolation". The psychiatrically ill were rejected and the "healthy" members of the community tried all means to separate them from the rest of the population, Wealthy families built extensions of their promises to accommodate mentally disordered relatives. Society at large put the less well-off psychiatric patients into asylums.

Lieh Mak et at (1981) provided & good summary of the development in the past 4 decades or so. The segregationist approach was increasingly challenged about 10 years after the second world war. While Thomas Szasz (1961) and R D Laing (1965) are perhaps the most well-known among the theoreticians of the anti-psychiatry movement in general Maxwell Jones (1952), Russel Barton (1959), Erving Goffman (1961) and Franco Basaglia (1968) particularly opposed the method of managing mental patients prevailing then. Their efforts were greatly helped by the timely discovery of chlorpromazine and other antipsychotic drugs that offered considerable-symptomatic relief t:) psychotic individuals (Kane & Freeman, 1994). …

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