Psychiatrist warns lone patients face higher relapse risk
On.cc · 1 SOURCESabout 1 hour ago3 MIN
Summary
Recent violent incidents in Hong Kong involving people suspected of having mental health conditions have heightened public concern and renewed scrutiny of how the system identifies potentially dangerous cases. Psychiatrist Mak Wing-kit said patients who live alone face a higher risk of relapse, while the existing conditional discharge mechanism cannot address every at-risk case
Key Points
- Members of the public interviewed said repeated assault cases in Hong Kong had made them fear random violence and question whether government support for psychiatric rehabilitation is adequate
- Mak Wing-kit said compulsory psychiatric admission under Hong Kong's Mental Health Ordinance, Cap. 136, operates through the so-called Form 1, 2 and 3 process
- Under that mechanism, a patient can first be detained for seven days, then for a further 21 days if a specialist finds no improvement
- Mak said compulsory admission requires both a confirmed mental disorder and evidence the patient poses a risk of self-harm or harm to others
- He said conditional discharge applies to some previously detained patients with violent or harmful tendencies, but not ordinary community cases never subject to compulsory admission
- Mak said conditional discharge can require punctual follow-up appointments, medication compliance, and monitoring or examinations, and authorities may readmit a patient without restarting the Form 1, 2 and 3 process if conditions are breached
- He added that the mechanism is limited because it is designed only for risks of harming others and does not apply to self-harm or suicide risk
- On relapse warning signs, Mak said some psychiatric patients are especially sensitive to sound. In schizophrenia, that may range from ordinary irritability over noise to distorted thinking in which a patient believes the noise is deliberate harassment. He said early warning signs often include sharply worsening sleep, difficulty falling asleep, frequent waking, severe irritability, mood instability, social withdrawal, and suddenly stopping medication after deciding they are no longer ill
- Mak also said relapse risk often rises when a family caregiver who had been supervising the patient leaves because of admission to a care home, illness, hospitalisation or migration, and the patient suddenly begins living alone. In those circumstances, medication adherence may fall without reminders, while loneliness in the community can deepen isolation and aggravate extreme thoughts or delusions
- He said family monitoring is crucial in spotting early relapse, and support from community psychiatric nurses or case managers is also important. At the same time, he stressed that violence or harm to others occurs only in a very small number of severely ill patients, often involving missed follow-up, failure to take medication, or other risk factors including substance abuse
Why It Matters
The discussion points to a practical gap between hospital-based legal powers and the monitoring of higher-risk people already living in the community, especially those who become isolated. Mak also urged the public not to stigmatise psychiatric patients, saying most do not pose a greater risk of harming others and need timely treatment and support