Promotion and Implementation of Recovery-Oriented Practice in a Mental Hospital in Hong Kong

Equal Opportunity Commission (2013). A Roberts, G., & Wolfson, P. (2004). The rediscovery submission by EOC on mental health policy and of recovery: open to all. Advances in Psychiatric service programmes. Retrieved from www.eoc. Treatment 10, 37-49. org.hk/eoc/.../201322112161018177.pdf Promotion and Implementation of Recovery-oriented Practice Royal College of Psychiatrists. (2004). in a Mental Hospital in Hong Kong Mak, W., Lam, B., & Yan, S. (2010). Recovery Rehabilitation and recovery now (Council Report knowledge and recovery-oriented services in CR 121). London: Royal College of Psychiatrists. Hong Kong. Psychiatric Services, 61 , 1164. Bonnie W M Siu Rex W K Sung Slade, M. (2009). 100 ways to support recovery: a Castle Peak Hospital May, R. (2004). Making sense of psychotic guide for mental health professionals. London: experience and working towards recovery. Rethink. In J.F.M. Gleeson & P.D. McGorry (Eds.), Abstract Psychological interventions in early psychosis (pp. Slade, M., Amering, M., & Oades, L. (2008). 246-260). Chichester, UK: John Wiley & Sons . Recovery: an international perspective. Objectives: As an essential direction of mental health service reform, Epidemiologia e Psichiatria Sociale 17(2), 128- recovery-oriented practice has recently been widely incorporated into the Mead, S., & Copeland, M. E. (2005). What 37. guiding principles for the transformation of mental health systems in many recovery means to us: consumers’ perspectives. countries. In L. Davidson, C. Harding & L. Spaniol (Eds.) World Health Organization. (1980). International Methods: A Committee on Recovery-oriented Practice was set up to steer Recovery from mental illness: research evidence classification of impairment, disabilities and the promotion and implementation of recovery policy in the Castle Peak and implications for practice (pp. 69-81). Boston, handicaps: a manual of classification relating to Hospital, a major mental hospital in Hong Kong. MA: Centre for Psychiatric Rehabilitation, Boston the consequences of disease. Geneva: WHO. University. Results: Recovery-oriented Practice was promoted and staff training and World Health Organisation. (2011). World Mental patient education on the concept and principles of recovery were launched, Ng, R.M., Pearson, V., Chen, E.E., & Law, C.W. Health Altas 2011. and at least 300 staff members had participated in the training. Baseline (2010). What does recovery from schizophrenia data were collected on the attitude and acceptance of staff and patient mean? Perceptions of medical students and trainee Wykes, T., & Holloway, F. (2000). Community on mental health recovery. Pilot recovery programs were adopted in the psychiatrists. International Journal of Social rehabilitation: past failures and future prospects. rehabilitation unit and gradually extended to other units. Psychiatry, 57, 248 – 262. International Review of Psychiatry, 12, 197-205. Conclusion: The report demonstrated that Recovery-oriented Practice could be successfully implemented in mental health services for Chinese populations.

Keywords: Chinese, Recovery, Mental Hospital

Introduction and patient’s self-management of his or her mental illness are the central elements Recovery-oriented practice is not in the implementation of recovery practice new in the field of mental health. Mental in mental health service. As an essential health recovery has emerged in the direction of mental health care reform literature in the past two decades and and a move towards continuous service has been implemented in non-Chinese quality improvement, the concept of populations in different countries. Peer recovery-oriented care has already been support, positive role model, partnership, incorporated into the service standards and empowerment, strength-based approach, guiding principles of the mental health patient’s participation in the treatment plan systems in many countries.

Correspondence concerning this article should be addressed to Bonnie W M Siu, Castle Peak Hospital, 15 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong. Email: [email protected]

12 Hong Kong Journal of Mental Health Hong Kong Journal of Mental Health 13 Promotion and Implementation of Recovery-oriented Practice Bonnie W M Siu and Rex W K Sung in a Mental Hospital in Hong Kong

In the traditional mental health service mental disability to live a meaningful life in the NIMHE guiding statement on recovery, 2005; human rights and patient’s involvements in delivery, the medical model is widely adopted community of his or her choice while striving Recovery competencies for New Zealand the Chinese society, the adoption of recovery- with an emphasis on application of biological, to achieve his or her full potential”. In 2010, Mental Health Workers, 2001; Strategic oriented practice could be considered as one of psychological, and social treatments. Before the South London and Maudsley National plan 2009-2012, 2009; Towards Recovery the directions for service development in Hong recovery becomes a trend of mental health Health Service Foundation Trust and the & well-being, 2009). Recent systematic Kong after cultural considerations. This paper service in overseas countries, many healthcare South West London and St. George’s National reviews support the view that community described the development, promotion, and professionals believed that recovery-oriented care Health Service Mental Health Trust have and hospital based facilities for individuals implementation of recovery-oriented practice devalues the role of professional intervention, jointly issued a position statement suggesting with severe mental illnesses should deliver in the Castle Peak Hospital in Hong Kong. and is against the medical model (Davidson that recovery focused services are a central “Recovery-oriented” services (Repper & et al., 2006). After years of debates and component to make mental health services fit Carter, 2011; Rogers et al., 2009; Taylor Promotion and Implementation of explorations, researchers subsequently tend to for the twenty-first century and that recovery is et al., 2009). The involvement of patients Recovery-oriented Practice agree that the recovery-oriented service model “about individualized approaches and having in organizations’ planning of services and is complementary to the medical model. They a satisfying and fulfilling life, as defined by their clinical governance processes has been The experiences from overseas countries opined that if holistic mental health services are each person”. These governmental statements highlighted (Taylor et al., 2009). In addition on the implementation of recovery-oriented to be delivered to patients, both the elements of both emphasized that recovery is a journey and to collaboration in their care, patients’ practice are valuable as the blueprint for the recovery such as self-management and patient’s an ongoing process, and that individualized participation in developing, running and adoption of mental health recovery in the participation, and the effective bio-psycho-social approach and patient’s choice are important in reviewing services has been shown to lead to Chinese populations in Hong Kong. On the treatments are of equal importance. the delivery of recovery-oriented services. positive outcomes for both the services and the other hand, staff training on the concept, patients who take on these roles. In addition, principles, and elements of recovery and Traditional healthcare service delivery Second, researchers have rather diversified there is also evidence supporting that the the opinions from staff and patients on the in the Chinese populations is often based views on the definition of recovery. Deegan implementation of recovery-oriented services meaning and importance of recovery are the on “paternalism” or “maternalism”, and the (1996) stated that “instead of focusing could increase the satisfaction of patients areas needed to be addressed. healthcare professionals tend to “prescribe” primarily on symptom relief, as the medical towards the services delivered to them (Ahuja the treatment and management plans to the model dictates, recovery casts a much wider & William, 2005; Linhorst & Eckert, 2002). Clinical Attachment in UK and USA patients. Patients are largely passive and spotlight on restoration of self-esteem and not very much involved in the decision- identity and on attaining meaningful roles in Recovery-oriented Practice in Chinese After recovery-oriented practice is adopted making process of his or her own care and society”. This definition by Deegan does not Populations as the key service development direction, four rehabilitation plans. Thus service reforms imply full recovery, i.e. a state in which full staff members (1 psychiatrist, 2 psychiatric towards a recovery-oriented approach need functioning is restored and no medications are The National Consensus Statement nurses, and 1 occupational therapist) from exploration in the Chinese populations. needed. Instead, recovery is suggested as “a on Mental Health Recovery of the United Castle Peak Hospital had a clinical attachment journey or process, not a destination or cure”. States described that the essential elements at the Institute of Psychiatry of the King’s The Definition of Recovery Anthony (1993) has developed a widely used of Recovery include “self-direction”, College in Maudsley of London in 2010, and definition of recovery as “a way of living a “individualized and person-centred”, 3 other staff members (1 psychiatrist and 2 The concept of recovery had appeared in satisfying, hopeful and contributing life even “empowerment”, “holistic”, “non-linear”, psychiatric nurses) had a clinical attachment patient’s self-help literature since the 1930s with the limitations caused by illness. Recovery “strength-based”, “peer support”, “respect”, in the Twin Valley Behavioural Healthcare and it gradually emerged as a prominent involves the development of a new meaning “responsibility”, and “hope”. Mental health in Ohio of USA in 2011. During the clinical concept in the mental health literature in and purpose in one’s life as one grows beyond services that are recovery-oriented should be attachment, they learnt how recovery-oriented the late 1980s (Ralph, 2000). There are two the catastrophic effects of mental illness”. derived based on the elements of recovery. practices were implemented in different broad definitions of recovery: 1) Official Despite that recovery-oriented services are clinical settings and on patients at different governmental or organizational definition; 2) Recovery has become an influential implemented in the mental health settings stages of their mental illness. Researcher or user-based definition. First, some mental health movement around the world. of a number of overseas countries for long, governments have developed their definition of United States of America (USA), Canada, recovery-oriented practice is not commonly Setting up of Recovery Steering Committee recovery. According to the National Consensus United Kingdom (UK), Ireland, Australia and adopted in the mental healthcare system in the Statement on Mental Health Recovery (2004), New Zealand have all adopted the concept Chinese populations (Tse et al., 2011). Having learnt from overseas mental a report published by the Department of Health of recovery-oriented care as their national health units, a Committee on Recovery- and Human Services of the United States, policies, or use it to guide care principles in In view of the global trend of the oriented Service was set up in Castle Peak “Mental health recovery is a journey of healing their mental health systems (National action implementation of recovery-oriented mental Hospital in order to steer the promotion and and transformation enabling a person with a plan on mental health 2006-2011, 2006; health service and the increased emphasis of implementation of mental health recovery. The

14 Hong Kong Journal of Mental Health Hong Kong Journal of Mental Health 15 Promotion and Implementation of Recovery-oriented Practice Bonnie W M Siu and Rex W K Sung in a Mental Hospital in Hong Kong

Committee consisted of representatives from attitude of Chinese mental health professionals them. The Committee had just finished another is assigned two peer-mentors for emotional, different departments including the General towards recovery. A convenient sample of study on the information and participation social, and practical assistance for settling into Adult Psychiatry, Child and Adolescent 206 Chinese mental health professionals of needs of inpatients and the results would be the new environment; 3) “Activity Plan” - Psychiatry, Old Age Psychiatry, Forensic different disciplines including psychiatrists, available shortly. monthly outing activity is planned, organized, Psychiatry, Occupational Therapy and Clinical psychiatric nurses, occupational therapists, and evaluated by patients and staff members Psychology, Nursing Services Division, and clinical psychologists and social workers in Staff and Patient Training on Recovery act as a “coach” only. With the experience of Medical Social Services Unit. The Committee Castle Peak Hospital were asked to fill in the the running of the pilot recovery programs in had also invited a peer specialist to join as one Recovery Attitudes Questionnaire-16 (RAQ- In order to implement recovery-oriented the rehabilitation team, recovery programs of the Committee members. In order to have a 16) (Borkin, 2000). In general, they had high practice, staff education and training is were gradually extended to different wards clear direction for the promotion and adoption acceptance of recovery. Almost all of the essential. Workshops were held and more than and units, modified according to the nature and of mental health recovery, the Committee participants strongly agreed or agreed that a 300 staff members of different disciplines setting of the individual wards and units. had compiled a Policy of Recovery-oriented good understanding of one’s mental illness were trained on the concept, definition and practice. In the Policy paper, there is a helps in recovery (96.6%) and that the recovery principles of recovery. Seminars were held by Discussion mission statement, a working definition of process requires hope (95.6%). About 70% the Committee members to share with staff on recovery, and 10 guiding principles for the strongly agreed or agreed that all people with what they had learnt from recovery clinical Recovery-oriented practice has been implementation of recovery. The working serious mental illnesses can strive for recovery. attachment in UK and USA. E-learning was implemented in different overseas countries definition and the 10 principles were adopted The study revealed that Chinese mental health launched to staff at all levels to further educate for many years. In the Chinese populations, after reviewing the principles of recovery professionals had positive attitude and high staff on the concept and principles of mental recovery is a relatively novel concept. In order from different countries and organizations in acceptance of recovery and their mental health recovery. A newsletter was published in to explore whether recovery-oriented practice order to guide the development of recovery- readiness for the implementation of recovery different languages and delivered to all staff for is applicable for the Chinese populations, oriented practice in Castle Peak Hospital. was supported. the promotion of recovery-oriented practice. opinions from patients, carers and mental The working definition from the organization Patient education on recovery is equally health professionals needed to be sought. and service provider’s perspectives was In another study, members of the important for the implementation of recovery, Moreover, we could not “copy” the recovery “Empowering people with mental illness to Committee developed a questionnaire for as Chinese mental patients are relatively models from overseas countries to the Chinese develop effective self-management for their measuring the perceived importance of passive, less vocal in expressing their needs, populations without cultural modifications and wellness and meaningful life with community the elements of mental health recovery by and less participative in their management local adaptations. Chinese mental patients are participation”. The 10 principles were: 1) psychiatric inpatients in Hong Kong. In plan. The principles of recovery were relatively passive and do not frequently speak Personal responsibility and self-management; the development of the questionnaire, the incorporated into the core training module for up their needs, and Chinese mental health 2) Strength-based approach; 3) Peer support; Committee had translated recovery as “康復進 patients of the rehabilitation team. Moreover, professionals may not be very familiarized 4) Hope, satisfying and meaningful life; 5) 程” in Chinese, after collecting opinions from posters and a VCD were made, and booklets with the concept and practice of recovery. Empowerment and choice; 6) Partnership; 7) patients in patient focus groups. This Chinese were published to facilitate the education of Therefore, education on recovery needed Sense of identity; 8) Individualized approach; translation emphasizes that recovery is a patients on mental health recovery. to be conducted for patients and healthcare 9) Holistic approach; and 10) Community journey and an ongoing, improving process. professionals before recovery-oriented practice integration. The Committee had decided to A sample of 101 psychiatric inpatients then Pilot and Implementation of Recovery is to be implemented successfully. Strategies promote and implement recovery-oriented completed the questionnaire and their perceived programs and directions needed to be established for the practice in Castle Peak Hospital basing on importance of the 24 elements of recovery in implementation of recovery-oriented service. the 10 guiding principles in 3 years’ time the questionnaire was explored. The majority A series of recovery programs were Baseline data collection is important in the (3 principles in the 1st and 2nd year and 4 of them suffered from schizophrenia (75.2%) piloted in the Extended-Care Patients Intensive initial period of the adoption of recovery- principles in the 3rd year). and they perceived most of the elements of Treatment, Early Diversion and Rehabilitation oriented practice. Ongoing evaluations of recovery as important. “Having meaning in Stepping Stone (EXITERS) hostel of the the outcomes and effectiveness of recovery- Baseline Research and Data Collection life” was rated by 91.1% of the participants rehabilitation team of Castle Peak Hospital. oriented services are essential for the as an important element of recovery, followed Examples of recovery programs included: 1) implementation process. The Committee on Baseline data were important for the by “Hope” (86.1%) and “General health and “EXITERS Farm” - the EXITERS Farm is Recovery-oriented Service of Castle Peak implementation of a new service model. The wellness” (85.1%). These studies supported run by patients, they decide what, when, how Hospital strives to promote the principles Committee therefore had conducted 2 studies that Chinese mental health professionals and who to plant. They cook and share farm and implementation of recovery-oriented at Castle Peak Hospital (Siu et al., 2011; Siu accepted recovery and that Chinese mentally ill products among themselves; 2) “Peer Mentor practice for the psychiatric services in order et al., 2012). The first study explored the patients opined that recovery was important to Service” - each newly transferred-in patient to provide quality treatment with emphasis on

16 Hong Kong Journal of Mental Health Hong Kong Journal of Mental Health 17 Promotion and Implementation of Recovery-oriented Practice Bonnie W M Siu and Rex W K Sung in a Mental Hospital in Hong Kong recovery and with respect to human right. A 人員接受了培訓。另外，委員會進行了 Davidson, L., O’Connell, M., Tondora, J., Styron, Rogers, E.S., Kash-MacDonald, M., & Brucker, policy was published for the promotion and 二項學術研究，以探討專業人員及病人 T., & Kangas, K. (2006). The Top Ten Concerns D. (2009). Systematic Review of Peer Delivered implementation of recovery. Baseline data 對「康復進程」的態度及接受度。以復 About Recovery Encountered in Mental Health Services Literature 1989 – 2009. Boston: Boston were collected and staff and patient education 康組作為試點，委員會在醫院內推行了 System Transformation. Psychiatric Services, 57, University, Sargent College, Center for Psychiatric programs were launched. Recovery programs 一系列有關「康復進程」的活動，以使 640-645. Rehabilitation. Retrieved from http://www.bu.edu/ were piloted in the rehabilitation unit and then 其逐步推行至醫院內其它服務單位。 drrk/research-syntheses/psychiatric-disabilities/peer- extended to other units gradually. Deegan, P.E. (1996). Recovery as a journey of the delivered-services/ heart. Psychiatric Rehabilitation Journal, 19, 91-97. 總結：「康復進程」的服務模式在中國人 Siu, B.W.M., Yeung, Y.M., Poon, M.Y., & Sun, L.N.N. Conclusion 精神科服務體系中是可行的。 Ireland Mental Health Commission. (2009). Strategic (2011). Attitude towards Recovery in Chinese Mental Plan 2009 – 2012. Ireland: Ireland Mental Health Health Professionals. Hong Kong Journal of Mental After a few years of work on the promotion *「康復進程」乃青山醫院精神科專業人員 Commission. Health, 37(2), 35-42. and implementation of recovery-oriented 透過病人及職員的聚焦小組對“Recovery” practice in Castle Peak Hospital, we believe 的中文詮譯。強調「康復進程」是一個個人 Linhorst, D.M., & Eckert, A. (2002). Involving Siu, B.W.M., Ng B.F.L., Li, V.CK, Yeung, Y.M., Lee, that “recovery is possible” in the Chinese 化的過程，精神病患者在過程中不但學會好 people with severe mental illness in evaluation and M.K.L., & Leung A.Y.H. (2012). Mental Health populations. 好管理自己的精神健康，同時也是一個追求 performance improvement. Evaluation & the Health Recovery for Psychiatric In-patient Services - 進步的過程，無論疾病所造成的限制是否存 Professions, 25, 284-301. Perceived Importance of the Elements of Recovery. The East Asian Archives of Psychiatry, 22, 39-48. Acknowledgements 在，都可以超越疾病，過著滿足、有希望、又有貢獻的生活。 Mental Health Commission of Canada. (2009). Toward Recovery & Well-Being: A Framework for A Mental South London and Maudsley NHS Foundation Trust We would like to thank all the members of Health Strategy For Canada. Canada: Mental Health and South West London and St George’s Mental the Committee on Recovery-oriented Service References Commission of Canada. Health NHS Trust. (2010). Recovery is for All. Hope, in Castle Peak Hospital (Dr. CH Hung, Dr. Agency and Opportunity in Psychiatry. A position Amy Liu, Dr. Henry Cheung, Dr. CF Chan, Ms Ahuja, A.S., & Williams, R. (2005). Involving Mental Health Commission of New Zealand. (2001). statement by consultant psychiatrists. London, Jolene Mui, Ms LH Chan, Mr. Victor Lee, Ms patients and their carers in educating and training Recovery Competencies for New Zealand Mental United Kingdom: South London and Maudsley NHS Foundation Trust and South West London and St Mayie Tsang, Ms Wendy Chan, Dr. Lina Sun, practitioners. Current Opinion in Psychiatry, 18, 374- Health Workers. New Zealand: Mental Health 380. George’s Mental Health NHS Trust. Ms KW Lui, Ms YM Yeung, Ms WM Lau, Ms Commission of New Zealand. Daisy Wong) for their valuable opinion, great Anthony, W.A.(1993). Recovery from mental illness: National Institute for Mental Health in England, NHS. Taylor, et al. (2009). A systematic review of the enthusiasm, and concerted efforts in the past the guiding vision of the mental health service system (2005). NIMHE Guiding Statement on Recovery. international published literature relating to quality of few years. in the 1990s. Psychosocial Rehabilitation Journal, England: National Institute for Mental Health in institutional care for people with longer term mental 16, 11–23. England, NHS. health problems. BMC Psychiatry, 9, 55. 摘要 Borkin, J.R. (2000). Recovery Attitudes Questionnaire: Ralph, R. O. (2000). Recovery. Psychiatric Tse, S., Siu, B.W.M., Kan, A. (2011). Can Recovery- 「康復進程」在一所精神科醫院的推 development and evaluation. Psychiatric Rehabilitation Skills, 4, 480–517. Oriented Mental Health Services be Created in Hong 行 Rehabilitation Journal, 24, 95–103. Kong? Struggles and Strategies. Administration and Repper, J., & Carter, T. (2011). A review of the Policy in Mental Health and Mental Health Services Center for Mental Health Services, Substance Abuse literature on peer support in mental health Research (An international journal on mental health and Mental Health Services Administration U.S. policy by Springer). DOI 10.1007/s 10488-011-0391-7. 目的：*「康復進程」乃全球精神科服務的 services. Journal of Mental Health, 20, 392-411. Department Of Health And Human Services. (2004). 重大方向。世界各地均以此為其精神科服 National Consensus Statement on Mental Health 務改革的政策。 Recovery. United States: Center for Mental Health Services, Substance Abuse and Mental Health 方法：青山醫院成立了跨職系的委員會， Services Administration U.S. Department Of Health 為「康復進程」的推行制定了方向。 And Human Services.

結果：委員會舉辦了多項為醫院的專業 Council of Australian Governments. (2006). National 人員及病人而設有關「康復進程」的 Action Plan on Mental Health 2006 – 2011. Australia: 培訓及教育。至今共有多於三佰位專業 Council of Australian Governments.

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