[Mental Health]Doctors need to stalk and treat mental illness.

Article Yao Chaowen “Ming Pao”

The recent homicide at the Plaza Hollywood in Diamond Hill, Hong Kong and the recent massacres of caregivers have aroused public concern about mental health services. Some people have questioned why mentally ill patients should not be forced to receive treatment.

Can such murders be avoided?

(Hong Kong News) Chen Youkai, a member of the Mental Health Advisory Committee and a chair professor of the Department of Psychiatry at the University of Hong Kong, said: “The most important thing is communication. If you don’t know what he (mentally ill) thinks in his heart, you will not know what happened.” Identifying the patient’s mental problems through dialogue, early diagnosis and treatment can be prevented. He asserted that the killing news has no significant relationship with the imitation effect except that it will cause negative emotions or intentional imitation.

Mental illness eats away at the mind and heart

When the abnormal behavior of a small number of mentally ill patients is difficult to detect, citizens question “why should they be released (back to community life)”? Some councilors once again mentioned the implementation of the community treatment order, which means that mentally ill patients who meet specified conditions are required to receive a specified course of treatment while living in the community, and those who do not comply may be recalled to the hospital for treatment.

The meeting was held in Professor Chen Youkai’s office in Huangpu. There were two calligraphy paintings on the wall. One was written with the words “breathing when you see the words”, which made people look at it involuntarily. Chen Youkai said that breathing can relax people, and the calligraphy and painting reminded him that being able to breathe is actually a happy thing.

“Many people have a hard time exhaling and breathing”, and some mental illness symptoms may affect the patient’s breathing. Therefore, he called for more attention to mental health.

Chen Youkai understands that due to recent tragedies, citizens have scruples about the mentally ill and will “avoid because of fear, or increase the distance (with the mentally ill)”.

In the past, some patients were worried about losing their jobs and friends after being diagnosed with mental illness, so they dishonestly told their true illness and did not receive appropriate treatment early, which “in the end increased the risk.” Chen Youkai couldn’t help feeling, “Mental illness eats away at people’s thoughts and hearts.”

Mandatory treatment fears hospital paralysis

The suspect in the Plaza Hollywood murder is reported to be suffering from delusional schizophrenia, a type of psychosis. Patients will experience severe symptoms such as hallucinations, auditory hallucinations, and delusions. Chen Youkai pointed out that such hallucinations “are the patient’s subjective memory” and can only be discovered by the patient’s initiative to speak out. From the appearance, one can only see “he (the patient) is motionless, thinks slowly, speaks slowly, and looks depressed.”

However, he believes that if patients are forced to receive treatment, it is necessary to weigh the patient’s personal and freedom of choice, and also consider the capacity of the facility. If “all patients enter the hospital, our (hospital) will be immediately paralyzed.” Even with the mandatory admission of existing patients, there will continue to be new severely mentally ill patients, and others besides the mentally ill will commit similar hurtful acts. He reiterated that “only a small number of psychopaths are at risk of this[extreme behavior]when they are under the influence of psychosis for a small number of times”.

He understands that the incident may alarm the public,

But frankly, “paradoxically,

We should face it (mental illness can affect a person’s behavior so much),

Create an inclusive environment.”

When the patient’s condition is mild,

Encourage them to “tell what’s on their minds” and treat them early,

In order to reduce the risk of similar incidents in the long run.

Psychotherapy is one of the methods of treating mental illness, which emphasizes communication with patients.

Chen Youkai will pay attention to how to make patients feel at ease when communicating with patients. For example, the speed of speech should not be too fast, and the conversation table should not be too wide. When he extracts medical records, he will listen carefully to the patient’s words before starting to write slowly, so that the patient can feel sincere concern and feel that “he is a person, not just a patient”, so that he can let go of his guard and talk about his troubles.

Reassure patients and prevent them from speaking out about their troubles

Chen Youkai said frankly that it is not always possible to communicate effectively with patients. He remembers a patient with schizophrenia who refused treatment because of his hallucinations, “telling him that he is fine and telling him not to take medicine”.

He felt very sorry for not being able to help the patient who was deeply troubled by mental illness, and it was unforgettable. Faced with different mental illness patients, it is inevitable to receive too many negative emotions. Chen Youkai said that in addition to being a doctor, he is also an ordinary person and has empathy. Only in this way can he understand the emotional problems of the patients, but he also “cannot overdo it and withdraw in time.” At this time, he will look back at history, use “time and space to expand his thinking, and see the difficulties faced by different times” and not allow himself to indulge in the idea of ​​”I am miserable”.

With limited consultation time, Chen Youkai also feels powerless, describing the treatment of mental illness as “long, complicated, and stalking”, but it is difficult to achieve significant results with just a few consultations. Therefore, family members who have been with patients for a long time need to communicate more with patients to make them feel supported.

However, he also noticed the recent tragedy of caregivers, pointing out that many caregivers of the mentally ill themselves may have been under heavy pressure, not only to take care of the patients, but also to work long hours to support the family economy. He said that when he held lectures related to mental illness, he often encountered family members of mentally ill patients who continued to ask him for more information after the lecture.

Multiple superposition of symptoms aggravates the condition

The reason why Chen Youkai has repeatedly emphasized the importance of communicating with mentally ill patients is that, in addition to the difficult observation of symptoms that belong to the patient’s subjective memory, some patients are better at hiding their emotions and it is difficult to find their problems. For example, Chen once had a doctor who suffered from masked depression and had strong suicidal tendencies, but he pretended to be nonchalant and continued to work as usual. Due to the workplace, he was afraid to ask his colleagues for help, and no one around him noticed his abnormality.

He said with a smile, “Don’t think that doctors are superhumans. The first task of a doctor is to take care of his own mental health before he can help others.”

In addition to communication, early treatment for mentally ill patients is also very important. Chen Youkai pointed out that the common point of different mental illnesses is that their symptoms can overlap multiple times, that is, if one symptom does not disappear, it will cause new symptoms.

The Hospital Authority has launched the “Spiritual Disorder” Service Project (EASY) since 2001. It plans to form a team of doctors, nurses, social workers and other multi-professionals to provide referral, assessment and treatment services for patients with schizophrenia aged 15 to 64 during the critical period (critical period) in the first 3 years of onset. Chen is responsible for the project consultant for the first 10-year follow-up study on the efficacy of early intervention services for schizophrenia in Hong Kong, and has been advocating early consultation and treatment for mental illness patients.

He said that the symptoms of schizophrenia “are generally determined in the first few years of the onset”, so patients should receive treatment at the early stage of the onset to change the long-term effects of the disease. From the start of the project to 2021, about 170 successful follow-up cases among the participants have effectively reduced their suicidal tendencies, number of hospitalizations and recurrence rates within 10 years.

Unresolved shortage of psychiatrists

This tragedy has also aroused the public’s attention to public medical services in psychiatry. Chen Youkai has been practicing medicine for 33 years. He said with a smile that it is very interesting to understand the complexities of the human brain and human psychology. At the beginning, he entered the profession due to a shortage of psychiatrists. However, the core problem of shortage of psychiatrists has never been solved.

According to the statistics of the Hospital Authority, the current psychiatric doctor-patient ratio is 1 to 761, which is not optimistic. Asked about the reason why the manpower problem has not been solved for a long time, Chen explained that with the increase in public awareness of mental illness, changes in the times and lifestyles, the number of “diseases” of mental illness has increased, and more people have sought medical treatment.

Although there is no exact figure, 20% of mental illness patients are emotional illnesses

The mood disorder that has been widely discussed in recent years is one of the “new diseases”. “Actually, this disease has always existed, but in the 1990s (the 1990s) few people sought medical treatment, and now it is common.” Although there are no exact figures, nearly 20% of the mentally ill patients in recent years are cases of mood disorders. Severe mood disorders may cause hallucinations, delusions and other symptoms of psychosis, and they may also have suicidal tendencies.

Therefore, Chen Youkai believes that the treatment of mood disorders can also refer to EASY’s approach. However, because the number of patients is “much larger (than schizophrenia), it is much more difficult to do”, and there are still invisible patients in the community who have not sought treatment. Therefore, the feasibility of treatment methods that can help patients relieve symptoms without negative labels (stigma) should be studied, such as exercise.

Mild illness can be treated with psychotherapy

He also lamented, “Psychiatric treatment is not a simple matter. It is not a matter of training for two days to quickly become a therapist.” Helping patients overcome (overcome) mental distress requires experience. Someone proposed to imitate foreign countries and train emotional counselors in a two-day course to take care of patients with mild to moderate emotional disorders. “

He said frankly that two days of training can only provide preliminary cognition, and those with mild illness can be improved only by psychotherapy. However, there are many psychotherapy methods. Cognitive behavioral therapy alone requires two years of full-time training. It is difficult to increase manpower in the short term.

In the long run, the ideal goal is to identify the severity of patients’ illnesses when they seek treatment based on the “stratified care model”, and immediately refer them to receive corresponding intervention services, so that patients with severe mental illness can receive effective treatment in a timely manner.

Ladder support mode takes time

He explained that in the existing “stepped care model”, patients must first receive assessment and education from low-level support before gradually upgrading treatment and “trying” out the most effective treatment method. “It takes a long time and countless ineffective treatments are frustrating (defeating)”.

However, in the triage support model, the personnel who first contact the patient must have professional knowledge to immediately judge the patient’s needs and refer him to receive appropriate treatment. Therefore, it is also important to study “which method is sure to be effective for which type of patients”.

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