Pathway to Psychiatric Care for Older Persons in Hong Kong

Abstract

Background: Early intervention effectively improves quality of life, clinical outcomes, and social functioning of older persons with mental disorders. It is therefore important to identify the obstacles that delay their acquisition of psychiatric care. Objectives: This is the first territory-wide study to examine the pathway to care taken by the local older adults with mental health problems, and elucidate the factors that delay or speed up help-seeking behaviours. Methods: A total of 128 participants who presented for the first time to psychiatric service units in 5 clusters of the Hospital Authority during the study period were recruited. Their pathway to care was evaluated using WHO Encounter Form. In addition, they were assessed using Health of the Nation Outcome Scale, Cumulative Illness Rating Scale, and Social Support Rating Scale. Their socio-demographic data and psychiatric diagnosis were also recorded. Results: On average, participants consulted 1.3 ± 0.5 professional carers before reaching specialist psychiatric service. Hospital doctors (44.0%) and general practitioners (29.5%) were the major carers involved. The median duration between onset of symptoms and contact with first carer was 6.0 weeks whereas that between onset and consulting mental health professionals was 44.0 weeks. A number of sociodemographic, clinical, and pathway factors were associated with prolonged delays to mental health services. Conclusions: The present study identified 2 major pathways to mental health care in Hong Kong, and factors influencing duration taken to reach psychiatric services. Understanding these factors assists us to develop a combination of strategies including public awareness programmes and training courses for healthcare professionals that may shorten the delay in receiving psychiatric assessment and care.