From Empowerment to Recovery "Promoting Community Mental Health Issues, Achievements and Visioning i

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From Empowerment to Recovery "Promoting
Community Mental Health Issues, Achievements
and Visioning into the Future"

• Dr YEUNG Wai SongSenior Medical Officer,
• Pamela Youde Nethersole Eastern Hospital
• 17 December 2009

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Contents

• Psychiatric Service
• ISoS
• PYNEH Experience
• Empowerment
• Recovery
• Journey to the West
• (???)

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Service Roadmap

• Prevention
• Early intervention
• Diagnosis treatment
• Treatment rehabilitation
• Acute care

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Challenges

• Deinstitutionalisation
• Community Psychiatric Care
• Stigma and Discrimination
• User / Community Expectation

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International Study of Schizophrenia (ISoS, 2007)

• The course of illness and outcome from
  schizophrenia is superior in the developing world
  
• Mortality in schizophrenia is, in fact, lower in
  the developing world than in the developed world

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Dilemma

• Insights into ones illness may be rewarded with
  poor outcome ( Leff, 2006)
• Internalized stigma may reduce the persons sense
  of empowerment and eventual functioning
• Attempts to reduce internalized stigma should
  enhance the recovery process

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PYNEH experience
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Personalized care

• To shift the focus of service orientation from
  inpatient to recovery support
• Information technology system, case management
  design and structured programs at critical stage
  of illness are utilized to address needs

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Linkage at the Point of Care

• Special designs are required to overcome gaps in
  fragmented services and provide useful
  information at all points of clinical care
• Strategies to overcome barriers to post-discharge
  recovery by linking patients to community
  resources

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Linkage at the Point of Care

• Established Mental Health Station at entrance of
  Psychiatric OPD to introduce a variety of
  community resources (???????)
• Collaborate with NGOs to run rehabilitation
  programs to enhance linkage.
• Provided electronic educational and resources
  pamphlets in the departmental intranet to
  facilitate patient education and information at
  the point of care
• Collaboration with Hong Kong Family Link Mental
  Health Advocacy Association to run regular
  educational and support sessions

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Community Platform

• Representatives of doctors, nurses, allied health
  professionals and community partners from HKEC
• Co-chaired by a Psychiatrist and a Representative
  from Community Partners to ensure social needs
  are met when patients are in the community
• Community partnership model with regional NGOs
  has evolved over time to include a comprehensive
  range of elements essential for good
  communication among NGO and healthcare
  professions
• Solid foundation for collaboration and
  development of new initiatives and empowerment
  programs to meet the need of patients and family

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Current Partners in the HKE

• Baptist Oi Kwan Social Service (CMHL, CMHC, CMHH)
• Fu Hong Society (CMHL, CMHC)
• Richmond Fellowship of Hong Kong (CMHL, CMHC)
• The Society of Rehabilitation and Crime
  Prevention, Hong Kong (CMHL)
• TWGHs (CMHC)
• TWGHs Cross Centre
• Christian Family Service Centre
• Hong Kong Family Link Mental Health Advocacy
  Association
• Hong Kong Rehabilitation Power
• Barnabas Charitable Service Association
• Neighbourhood Advice-Action Council

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Empowerment of users

• Patients and families are encouraged to voice out
  their needs and to give input to existing
  services
• From 2007 onwards the team partnered with NGOs to
  run a series of patient and family empowerment
  programs

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2008

• "Beyond Bounds I with over 290 participants.
• Focus groups to obtain their views on psychiatric
  service and NGO service respectively.
• User forum ??????? in the Central Library in Jan
  2008, with open sharing, story telling by
  patients and families.
• Production of booklet with inputs from users and
  service organizers???????.

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2009

• Beyond Bounds II with over 500 participants in a
  series of public exhibitions.
• Photo Workshops in hospitals and the HKE
  Community with kick off in Central Library on
  17/6/09, to encourage and facilitate patients to
  express their thoughts and feeling to the public.
  
• Experience sharing by recovered patients touched
  the hearts of 200 guests, parents and families.

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Matching the Needs of Users

• 2009 A virtual Patient and Relative Club named
  Fans_at_beyond bounds (???????) was set up
• A database is to categorize the needs of members,
  to encourage community partners to develop
  services tailored to the needs of patients and
  families

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Vocational Rehab

• 2009 A survey on employment situation of
  psychiatric patients
• A Work Expo(???????) was organized for 3 days
  under the Community Mental Health Platform with
  Labour Department, 4 NGOs, 2 commercial firms and
  5 sponsors. There were a total of 705
  participants
• Talks, experience sharing by users, exhibitions,
  booths and mock interviews were held
• Our Employment Survey was presented and a press
  conference was held to boost public awareness

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Recovery Oriented Service

• Personalized care plan
• Sensitive to the differences in perceptions
  between users and therapist
• Substantial changes in treatment philosophies and
  practices
• Guidelines should be collaborative rather than
  autocratic.

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Users participation

• Advocate
• Priority of Needs
• Quality of Life
• Recovery
• Goals

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Empowerment Dilemma

• Trust
• Choice
• Power

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Trust (Hall et al. 2002)

• Fidelity. Pursuing the patients interests above
  the interests of other relevant parties.
• Competence. Avoiding mistakes and achieving the
  best possible outcomes, both technically and in
  areas of communication.
• Honesty. Telling the truth and avoiding
  falsehoods.
• Confidentiality. Protecting private information.
• Global trust. The holistic aspect of trust
  inherent to the relationship between people.

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Choice (Coulter, 2003)

• Professional choice - the clinician decides and
  the patient consents
• Shared decision making information is shared
  and both decide together
• Consumer choice the clinician informs and the
  patient makes the decision

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Power

• Paternalistic power over the users
• Anti-psychiatry movement
• Consumer-led services

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Empowerment (Rose 2000, Kruger 2000)

• Individual Empowerment seeks to help clients
  make changes
• Interpersonal Empowerment strengthens supportive
  social networks for oppressed clients
• Political / Government Empowerment consists of
  collective actions to influence government
  decision.

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Recovery advocates

• Include users and caregivers at every level of
  the system from policy to individual service
  planning
• Relationship is the most potent therapeutic
  factor contributing to recovery
• Different views about the types of activities or
  relationships that contribute to empowerment
• Feedback about their service needs and
  preferences, and the extent to which these needs
  and preferences are met

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Remission and Recovery (Liberman 2008)

• Remission of symptoms
• Engaging in productive activity, like work or
  school
• Independent management of day-to-day needs
• Cordial family relations
• Recreational activities
• Satisfying peer relationship

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Journal to the West (???)

• The skeleton of the story is Xuánzàng's quest to
  bring back Buddhist scriptures from Vulture Peak
  in India
• but the flesh is provided by the conflict between
  Xuánzàng's disciples and the various evils that
  beset him on the way

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Companions

• Sun Wukong (???) is the most intelligent and
  violent of the disciples, he is constantly
  reproved for his violence by Xuánzàng.
• Zhu Bajie ( ???) is characterized by his
  insatiable appetites and is constantly looking
  for a way out of his duties.
• Sha Wujing (???) is a quiet but generally
  dependable character.

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Therapists role

• Facilitative rather than directive,
• Hope inspiring rather than pessimistic
• Autonomy enhancing rather than paternalistic
• Help each individual reach their full potential

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Thank you