the hkcss convention 2017 cum 70 anniversary101.78.134.197/uploadfilemgnt/0_20171123163845.pdfimpact...

The HKCSS Convention 2017 cum 70th Anniversary

Leadership and Innovation

Ms. Sania Yau, CEO

New Life Psychiatric Rehabilitation Association 1 November 2017

1 All rights reserved

Mental Health Information in HK

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Type of mental disorders No of people %

Schizophrenia spectrum disorders 44,850 23%

Affective disorders 44,850 23%

Neurotic, stress related & somatoform disorders

39,000

20%

Autism/ ADHD 13,650 7%

Dementia 11,700 6%

Others 40,950 21%

Total 195,000 100%

Diagnosis of people who received psychiatric services from Hospital Authority in 2012-2013

HA (2013) http://www.eoc.org.hk/eoc/upload/20135131237421769472.ppt

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Average annual increase in new case: 4.86%

Impact of Mental Illness in Hong Kong

• Prevalence of Common Mental Disorders- 13.3%, ~1 in 7 (Lam et al., 2015)

• Prevalence of Severe Mental Illness 0.3 % (Chen, 1980s)

• Most prevalent age group: 25-35 years old (Young adults) (Lam et al., 2015)


Source: Lam, L. C. W., Wong, C. S. M., Wang, M. J., Chan, W. C., Chen, E. Y. H., Ng, R. M. K., ... & Lam, M. (2015). Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Social psychiatry and psychiatric epidemiology, 50(9), 1379-1388.

Mental health is largely neglected

• Little to no time and resources is left for prevention of mental illness and promotion of mental health in the community

• No Health without Mental Health - Mental health is “not just the absence of mental disorder”, but “a state of well-being in which individual realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. WHO (2001)


• Stigma (public and self)

•Unemployment rate for people with mental illness is >35%

(General Household Survey, Special Topics Report No.48)

Public stigma and Self stigma


Mental Illness

Physical

Mental Systems

Individuals

Medical

Psycho-social

Elderly

System challenges

System Transformation For the well-being of PIR, Carers and Community


• Non-governmental organization since 1965

• Providing recovery and wellness-oriented services for people in recovery of mental illness, their families and the public

• Serving 15,000 PIR & their families annually

• > 1,000 staff members

• 70+ service units/projects, 22 social enterprises


Vision, Mission and Value since 2011

Vision

We strive to promote mental wellness for people in recovery of mental illness and for their families and the general public with the ultimate goal of equal opportunities, social inclusion, acceptance and full participation for all in the community.

Mission

We dedicated to pioneering and delivering people-focused, recovery-oriented, and evidence-based community mental health services with care and respect, innovation and continuous drive for excellence and professionalism.

Core Value

Care for People Excel for Quality


Recovery 1.0 System transformation initiated by service provider

60s

Medical model

80s Rehabilitation model

Since 2008

Recovery – oriented services and supports


Definition of Recovery (WHO, 2012)

From the perspective of the individual with mental illness, recovery means gaining and retaining hope, understanding of ones abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life and a positive sense of self.

Recovery is not synonymous with cure.

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Definition of Recovery (WHO, 2012)

• Recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery - hope, healing, empowerment and connection, and external conditions that facilitate recovery - implementation of human rights, a positive culture of healing, and recovery-oriented services.

復元 (Recovery) VS 康復 (Rehabilitation)

復元康復重點過程 (Recovery “in”) – personal recovery 結果 (Recovery “from”) – clinical recovery

目的 •獲得新的經驗和身份

•接納並重新認識自己

•克服逆境

(例如: 克服病徵對生活的影響)

•回復原本狀態

•消除病徵

特點 •著重於滿足的全人生活

•個人化的目標及過程：認識和建立自己獨有的能力和興趣

•康復者主導

•著重康復者、家人和職員之間的合作

•著重於維持或提升日常生活技能

•符合社會定義：能自我照顧、

經濟獨立、定時服藥

•專業人士主導

版權所有不得翻印 13

Core Elements

Recovery

Self-direction & choice

Responsibility

Individualized

User participation

Peer support

Family participation

Respect & Anti-stigma

Strength-based

Hope

Non-linearity

Holistic Universal Category

Individual Category

Support Category


System transformation - Process

(1) Concepts and Values

(2) Experience

from overseas

(3) Training and participation of staff, PIR and family (4) Pilot programs

and research

(5) Findings & Modifications

(6) Evidence-based implementation


Service model building

Equipping for change

Evidence-based practice and dissemination

Establish overseas partnership, consult experience of oversea recovery movement

Localize recovery concept to better suit the needs of Chinese community

Invite PIRs, carers and staff to participate in the process and training

Systematic research and pilot projects

Organize research finding, evaluate and enhance existing service

System transformation - Strategy


System transformation – Stakeholders involvement

Recovery PIRs

Carers

Staff

General Public

Mental Health Sector & Government

Establish partnership


http://copelandcenter.com/

Concerns of Staff

• How attitude change translate to behavioral change in practice?

• How to sustain a recovery-oriented culture across all service units?

• How to address concerns and doubts of staff?

– Issue of accountability in self-direction

– Issues of continued education, supervision, and support

Concerns for Staff

• How to sustain a recovery-oriented culture across all service units? – Survey showed knowledge and attitude difference among

different level and background of staff

• How attitude change translates to behavioral change in practice?

• How to address concerns and doubts of staff? – Issues of accountability in self-direction, continued

education, supervision, and support

• Address the concerns of staff via focus group • Consolidation of recovery-oriented practice for all units

– In-depth discussion of principles and daily application among staff, PIRs, and family

Capacity building to equip for change – value and work attitude

Frontline

New

Quarterly half-day recovery workshop

Existing

Downstream training

Daily supervision

Professional Staff

New

Half-yearly one-day recovery workshop

Existing

Seed training and boost –up Specific strategies and topics

(Story telling, WRAP®, PCP, M.I. Peer support service and

advocacy, manual downstream etc.)

Supervisory Staff

Retreat and Reflection


• Staff recruitment Recruit potential

staff with recovery orientation

Recovery Glossary Facilitate common

understanding of recovery terminology

Recovery tools for staff

All rights reserved

Internal Promotion

• Share updated recovery-related information & newly developed tools to staff


Recovery Digest Intranet

Recovery-oriented Services and Support

Recovery-oriented Practice

Daily operation

Case management Program

activities and groups


Person-Centered Care Planning (PCCP)

• “…involving a collaborative process between the person and his or her supporters (including the clinical practitioner) that results in the development and implementation of an action plan to assist the person in achieving his or her unique, personal goals along the journey of recovery” (Tondora et al., 2012)


Strength-based Peer Support

Programs and Groups

Hope Self-direction & Choice


Families

• Psychoeducation and anti-stigma course

• Recovery 101 Family resource kit

• Overseas exchange for family

• Family resource website

• Family orientation package

Family recovery resource kit

All rights reserved

Mental Health Promotion and Prevention

Social inclusion

Anti-stigma

Well-being

Expressive art & Recovery

Recovery stories through Media


Anti-stigma & Anti-self-stigma Work


Dissemination - Local and Overseas

2011

2012

Chinese Recovery Website

• A sharing platform for international and local parties

Recovery Symposium 2014

2016


Dissemination – Research and Publications 1. Rediscovering Recovery: Recovery Orientation among Chinese Mental Health Consumers and

Family Caregivers. 2. Put up your new Glasses – Stigma reduction towards mental health problems among young

generation 3. Recovery knowledge and recovery-oriented services in Hong Kong 4. Experience of system transformation – Lessons from the New Life Psychiatric Rehabilitation

Association 5. Organizational Assessment of mental health recovery in Hong Kong 6. Promoting recovery among people with severe mental illness in the community in Hong Kong: A

program evaluation 7. Promoting recovery among family members of mental health service users in Hong Kong: A small

step towards a big change 8. Evaluation of staff training workshops on the recovery model in Hong Kong 9. Organization Assessment on Element of a Recovery Facilitating System 10. Applying a Mental Illness Self- Management Program—Effectiveness of Wellness Recovery Action

Planning® (WRAP®) in Hong Kong 11. Cognitive-behavioral approach self-stigma reduction program for persons in recovery 12. Public stigma reduction programs for students 13. Evaluation of Individual Rehabilitation Planning(IRP) and Person-Centerd Planning (PCP) among

persons in recovery (PIR) of mental illness


What is next? – Recovery 2.0 “helps organization do what it is already doing in a better way ..

requires a paradigm shift by redefining the way business is done”

• Strategic implementation of change

• Integrating recovery components in service delivery

• Fundamental changes in culture and ways of doing are difficult without embracing the values of learning through lived experiences and shared humanity

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(References: Frost, L., Heinz, T., Bach, D.H. (2011). Promoting Recovery-Oriented Mental Health Services through a Peer Specialist Employer Learning Community. Society for Participatory Medicine.)

Lived Experiences as the basis of co-production

• The experiences of living with life struggles and emotional distresses involved, and finding the ways of recovery.

• The experiences of using services and being affected by its measures and policies.

• Persons use lived experiences to plan, deliver and evaluate services with service providers.

Shared humanity – sharing of lived experiences


Cultural shift to recovery oriented practices

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Transformation of recovery oriented practice

Peer-led orientation: Co-production in different dimensions

Systemic Development for Peer Support - Challenges

Organization

Level

Service

Unit

Individual


Formalizing peer support in workforce in New Life -- Peer Support Worker Project

Peer Support Worker

• Individuals with lived experiences who identify themselves as such, and use their lived experiences to support their peers in the service system.

• We recognized the importance of lived experience and the benefits of peer support by offering employment opportunities.


Development of Peer Support Initiatives

MINDSET Peer Support Worker Project

• 3-year Project (Oct 2012 – Sept 2015)

• Pioneered by 4 mental health agencies and collaborated with 2 universities on research

• Sponsored by MINDSET, the Jardine Matheson Group


Training, Practicum and Employment

• 3 batches of training with 60 trainees

• 48 training hours and 52 practice hours

• Employment for 16 FTE PSW

Development of Peer Support Initiatives

Outcomes

• By end of project, 60 PSWs completed 3 batches of training and 35 were hired in 4 NGOs in Hong Kong

• Peer Support Worker Association established in 2015

• A 3-year Longitudinal Research Report (2017)

• Successfully lobbied the HK government to fund a 2-year project to create 32 posts of PSW in 2016. The new service will be regularized in 2018 and expanded to 40 posts.

• 17 (full or part-time) PSWs hired in New Life, including peer nannies, PSW with ASD etc..


Peer Support Development in New Life

Peer participation in different levels in the

Association:

• Service level - WRAP®, PCP, Recovery College,

sharing of lived experiences, new staff

orientation, staff / outside training, case / team

meetings

• Peer-led groups - self help groups, Hearing Voices Group, Forum Theatre

• Sub-committees and task groups of the Association


Promote Hope, empowerment, connectedness


Peer-led activities


System Advocacy


http://www.am730.com.hk/uploads/articles/258151/142774115478318photo.jpg

Co-producing Impactful Initiatives


• Honest.Open. Proud

HOP WRAP

Hearing Voices

Movement

Recovery College

Two continua model of mental health

(Keyes, 2003) From Recovery to Well-being since 2015


Corey Keys, 2003


Stepped Care Model


• A holistic health campaign promoting well-being to the general public through mindfulness-based programs & activities

330 website & app

• Provide free guided mindfulness exercises in

just 10 minutes per session

• Enable users to practise

mindfulness anytime, anywhere

• Website: http://newlife330.hk, App: newlife.330

facebook: newlife330hk

330 workshops

• Incorporate mindfulness with various interest classes such as yoga, sound, zentangle, etc

Customized solutions for corporations & schools

• 330 workshops, mindfulness training/ experiential workshops, 330 space design and eGPS, etc.

http://newlife330.hk/






http://newlife330.hk


330 App

Android/iOS: newlife330

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0 W

ork

sho

ps

身心

靈

工作

坊

Mindfulness-based primary school program


• WRAP® stands for Wellness Recovery Action

Plan™

• WRAP® is a self-management and recovery wellness tool developed in 1980s in the USA

• We started WRAP® since 2010 • The authorized organization in Hong Kong to

provide certified WRAP® Facilitators Training • We translated the WRAP® Facilitator Training

Manual into Chinese and attained the copyright to produce the Chinese version of the manual

• Awarded the WRAP® Center of Excellence in 2016


Development of WRAP® in New Life

Development of WRAP® in New Life


a. Mental health service settings: - In-patient wards of hospitals,

ICCMWs, half-way houses, sheltered workshops and long stay care homes

- Mental health professionals b. Non-mental health service settings:

- Secondary and tertiary students, teachers, single mothers, family carers, older people

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Emotion GPS (eGPS)

Emotion GPS (eGPS)

Service Characteristics

• Collaborates with Department of Psychology of The Chinese University of Hong Kong (CUHK)

• Reference to “The Improving Access to Psychological Therapies (IAPT)” & “The National Institute of Health and Clinical Excellence (NICE) Guidelines”

• Task shift - a team of Psychological Well-being Officers provide assessment and early psychological intervention under close supervision

• Increase accessibility and shorten waiting time

• Target: individuals aged 18 or above with mild to moderate emotional distress

Our service

• One-to-one guided self-help

• Psychoeducation groups


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Chinese Workbooks developed by New Life


Bridging system challenges - Well-being for people with mental illness

getting old and physically ill

Prevalence of medical comorbidity in people with SMI

Estimated prevalence, % (Relative Risk)

Modifiable risk factors Schizophrenia Bipolar disorder

Obesity 45-55 (1.5-2) 21-49 (1-2)

Smoking 50-80 (2-3) 54-68 (2-3)

Diabetes 10-15 (2) 8-17(1.5-2)

Hypertension 19-58 (2-3) 35-61(2-3)

Dyslipidemia 25-69 (<5) 23-38(<3)

Metabolic syndrome 37-63 (2-3) 30-49(1.5-2)

De Hert M., Schreurs, V., Vancampfort, D., Winkel, R. V. (2009)

• Only1% of persons with serious mental illness, compared with 10% from the general population sample,

met the criteria for all 5 of selected health indictors: non-smoker, exercise, good dentition, absence of

obesity, and absence of serious medical co-occurring illness (Dickerson, et al. 2006).

Factors contributing to morbidity & mortality in people with SMI

(National Association of State Mental Health Program Directors Medical Director Council, 2006)

Psychotropic medications

• contribute to symptoms of medical illness, e.g. weight gain, reduction in pain

sensitivity, metabolic syndrome, diabetes…

Impacts of symptoms

• e g. impaired reality testing, disorganized thought processes, decreased motivation, learnt helplessness…

Higher rate of modifiable risk factors

• e.g. smoking, alcohol consumption, poor nutrition, obesity, lack of exercise,

Vulnerability

• higher rate of homelessness, victimization, unemployment, poverty, social isolation

Lack of access to health care

• lack of coordination between mental health and general health care providers

Physical Health of Community Dwelling Persons-in Recovery in Hong Kong

• A survey conducted in 2014-15 by the Association

• 837 community dwelling persons in recovery (Aged 45 or

above) from 7 Integrated Community Centres for Mental

Wellness operated by New Life Psychiatric Rehabilitation

Association in Hong Kong

• Items included: demographics, psychiatric diagnosis, visual

and auditory impairments, recent fall, smoking & exercise

habit, pain, ambulation, and medical diseases

Model of Successful Aging (Crowther, et al., 2002; Rowe & Kahn, 1998)

Prevention

•Promote health & safety awareness, adoption of healthy lifestyle & early detection

Early intervention

•Empower members to manage their own chronic diseases & promote physical health

Care & support

•Provide various intervention / support to members with disabilities and enable them to live in the community

Service Models in Meeting Service Gap between Mental and Physical Health Needs

“耆樂融融330” (2015-16)

• Funded by the Hong Kong Red Swastika Society

• Conducted in 7 The Wellness Centre • Embraced 4 major components:

(1) health-related programs for soon-to-be old and aging users (such as health screening conducted by nurse, health talks and exercise group)

(2) intergenerational programs between young people and aging people with mental illness

(3) therapeutic groups focused on better adaptation to aging using bio-psychosocial-spiritual approach

(4) home based assessment and training delivered by occupational therapist to promote home safety and minimize fall incident

Aging 330 (2016-17) (focused on PIR with metabolic syndromes)

• Exercise series

• Health club (provision of disease specific information / peer

support /peer-assisted, co-delivered, and peer-led activities)

Program-based interventions • Health talk (prevention

strategies of aging-related diseases)

• Exercise series

• Self-help & routine health check activity

• Promotion of positive health behaviors in various support groups

Prevention Stage

Early Intervention Stage

Members without metabolic syndromes

Metabolic syndromes well-controlled

Program-based interventions • Self-help health check in

TWC

• Routine body check activity at TWC

Case-based intervention • Health clinic for

member’s follow-up & monitoring

Program–based interventions • Self-management

program for metabolic syndromes

Metabolic syndrome not well-controlled

Members with metabolic syndromes

Routine Health Screening and Body Check at TWC

Physical Health Care Program for Soon-to-be-old and Older Adults with Mental Illness

“Get, set, go for a healthier life” - A 3-year project funded by the Hong Kong Jockey Club Charities Trust in The Wellness Centre (2017-2020)

Objectives: • Improve access and care of physical health to people in recovery of

mental illness aged 45 and above; • Promote the coordinated and integrated mental, physical and dental

health care for people with mental illness in The Wellness Centre; • Implement the established standards of care for prevention,

screening, assessment, and treatment in The Wellness Centre; • Reduce unnecessary use of somatic emergency services and

underuse of preventive medical services.


330 – Healthy Body, Mind and Spirit


After all, we are still

learning ……

Thank You


the hkcss convention 2017 cum 70 anniversary101.78.134.197/uploadfilemgnt/0_20171123163845.pdfimpact...

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