Improving Hong Kong’s pandemic response and mental healthcare will take independent reviews – and action
Hong Kong Free Press
Last month, the Hong Kong government lifted our Covid-19 state of emergency. A few weeks earlier, the World Health Organization had declared the pandemic over as Covid becomes endemic. These developments allow the government to focus on urgent tasks of economic development and reengaging globally.
Now is also the time to reconsider a publicly available, independent review of how the government managed Covid.
In late January, Chief Executive John Lee said he opposed an “independent investigation” into the government’s management of Covid, saying his government carried out continuous reviews to improve its response to the pandemic.
Lee pointed to several changes the government had made as a result of these continuous internal reviews: setting up a new command structure; introducing a new understanding of assessing risk; introducing “safety coefficients” for emergency response measures; “strengthening the medical response system and institutional control measures”; and introducing a government-wide mobilisation mechanism.
He also implied that a lesson learned was that “the government should formulate a policy to protect high-risk groups, especially the elderly and the young.” Do we not have such a policy? That is a serious problem. The chief executive also said that the Labour and Welfare Bureau and the Hospital Authority would continue to “review their experience.”
We need much more than this and we need the results to be made public to build community support.
Authorities need to clarify what some of these changes mean in practice. First, how has the government “strengthened the medical response system and institutional control measures”? To what extent are the changes they have made sufficient to prepare us for the next pandemic? On what assumptions are they based?
Second, “formulating a policy to protect high-risk groups” should be based on diagnostics of which part of Hong Kong’s approach failed in responding to the Omicron-led fifth-wave of infections that resulted in some 13,000 Covid deaths, while Singapore recorded a fraction of Covid-related deaths.
Experts and politicians have called for an independent review. They do not mean a commission of inquiry, which is a legal proceeding. Neither do I. Rather they mean an independent investigation that goes beyond internal, sometimes silo-bound, government reviews.
Lee has so far ruled this out. Leading microbiologist Yuen Kwok-yung said we should review our systems for virus tracking, isolation and testing, and the large-scale outbreaks of Covid in elderly care homes. If the government has already reviewed these policies, officials should publish the results.
Lawmaker and convenor of government advisory body the Executive Council Regina Ip initially supported an independent review – again, not a commission of inquiry – composed of Legislative Council (LegCo) members and medical experts, but added that when she was speaking in February, still technically during the pandemic, was not the time to hold such an investigation. Perhaps we should reconsider the issue now that the government has lowered the emergency response level and the WHO has declared the pandemic over.
The purpose of such a review is not to assign blame, but to better prepare for the next pandemic. Experience tells us that such reviews, for example after the outbreak of SARS in 2003, in which 299 people died, helped prepare us for Covid in 2020. Hong Kong benefitted hugely from these reviews.
However, independent reviews by themselves are insufficient. Authorities and the community need to prioritize implementing the recommendations that follow from the reviews. We did this following SARS.
The community is now considering its policies on the management of mental health in the wake of the alleged murders of two women in the Plaza Hollywood mall by a man believed to be suffering from a serious mental disorder earlier this month.
In 2017, authorities carried out an independent review of our mental health policies. The review panel, chaired by then-secretary for food and health Ko Wing-man, included LegCo members, mental health professionals inside and outside government, academics, representatives of NGOs and others.
Government departments represented on the panel included the Hospital Authority, health, housing, education, social welfare, police, equal opportunities and NGOs such as the Council on Social Services and the Elderly Commission. Authorities set up specialist subpanels on various aspects of policy, chaired, for example, by private medical practitioners.
Which is to say, the review was cross departmental, cross sectoral – including government and civil society, public and private – focused on collaboration, and produced publicly available diagnostics and many recommendations. Still, our reviews may have blind spots, such as a failure to serve the mental health of members of ethnic minority groups in our community.
The review made at least 39 separate recommendations, some with specific targets. For example, the review called for improving the ratio of case managers to patients with severe mental illness from 1:50 to 1:40 within three to five years, that is by 2020 or 2022. The report recommended the roll out of public-private partnerships for common mental disorders by 2018.
As the mental health review shows, prioritising the implementation of review recommendations is important. Reviewing by itself is insufficient. Annual Policy Addresses delivered by our chief executives since 2017 indicate that mental health has not been a priority for our government.
In 2017, the government said that it would “improve the manpower ratio for psychiatric services under the Case Management Programme and explore how to manage stable psychiatric patients through public-private partnership.” These were recommendations of the review report.
What progress has been made on these issues? In 2018 government focused on those who had recovered from mental illnesses; in 2019, the Policy Address said nothing; in 2020, the government offered more money to “beat drugs”; and in 2021 the Policy Address again ignored the issue. In 2022, finally, paragraph 86 of the Policy Address mentioned mental health, proposing improved community-level psychiatric services and a few other measures, including a new hotline.
In the wake of the Plaza Hollywood stabbings, the chief executive pledged to strengthen four areas of work: more police patrols; the government and Hospital Authority would review and improve the treatment, rehabilitation services and processes for psychiatric patients and recovered patients; the government would convene a mental health advisory committee; and social welfare to strengthen community support services.
Lee said that health minister Lo Chung-mau would “review the entire process of psychiatric services to see if there were any [needed] improvements.”
We already have the 2017 review. The government and community response to the problems that now affect at least 290,000 people we now understand to be completely inadequate. Many of the 2017 recommendations were not implemented.
At its June 10 meeting, the government’s Advisory Committee on Mental Health recommended action in 10 areas, many of which were the same as those suggested in 2017. On critical issues such as manpower, the Committee had little to say. That is, we need the reviews, their reports should be made public, and government should prioritise their implementation.
This is where the LegCo can play a role; the legislature is an underutilised community resource in our current political system.
LegCo participation in and/or hosting reviews of critical policy problems focuses more sustained public attention on the issue. Public attention is critical for prioritising issues such as mental health and improving our pandemic response.
Holding an independent publicly available review into the management of Covid in elderly care homes, for example, could focus on how to improve cross-departmental collaboration and cross-sectoral – government-civil society and public-private – cooperation. LegCo could demand that government prioritise training and recruiting more mental health professionals, a need identified long ago.
Our public problems are complex and need to focus beyond the silos of government.
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