Academic journal article East Asian Archives of Psychiatry

Quality of Life in People with Mental Illness in Non-Residential Community Mental Health Services in Hong Kong

Academic journal article East Asian Archives of Psychiatry

Quality of Life in People with Mental Illness in Non-Residential Community Mental Health Services in Hong Kong

Article excerpt


Over the past few decades, there has been a change in the focus of mental health services from eradication of the disease to the enhancement of quality of life (QOL) of individuals living in the community with mental illness. There has also been a shift in the treatment paradigm from symptom management and relapse prevention to promotion of QOL. (1) With this shift, more emphasis is now placed on QOL as an outcome measure for treatments and programmes, as well as for determining resource allocations in community psychiatric services. (2)

The concept of QOL has become increasingly popular as an assessment factor in people with chronic mental health problems. However, it still remains ambiguous and controversial. (3) In a basic sense, QOL refers to a means for quantifying one's overall standard of wellbeing. (4) It incorporates all aspects of an individual's existence, including his/her success in obtaining certain expected or desired circumstances, states, or conditions. (5) For people with chronic mental health problems, it is generally accepted that QOL is a multidimensional concept that relates to satisfaction with various aspects of life, including physical, social, and mental health functioning, as well as general health perception. (6)

Objective Versus Subjective Quality of Life

Quality of life comprises both objective and subjective elements. (7) The objective elements of QOL include aspects external to a person's experiential life, such as general health and functional and socio-economic status. These can be assessed objectively in a number of ways: (a) with biological, material, social, behavioural, and psychological indicators; (b) by objectively assessing daily activities and functioning (8); (c) by measuring health status and material resources (9); (d) with external life situations, such as social and economic indicators, behavioural competence, and role performance measures (10); and (e) with biological factors. (4) Chan and Yu (3) also added the factors of attainment of resources and opportunities as an objective QOL measure.

Although objective data can help assess the health and functional status of an individual, these are considered inaccurate reflections of an individual's wellbeing. (11) It is argued that measures of QOL assessment should include a significant subjective component as well. (12) The term 'subjective' implies that the evaluation of QOL depends on the individual who is living that life. It should be based on an individual's point of view, (13) self-rating, (12) or interview. Thus, any assessment of one's objective life condition has to take account into the individual's scale of value. Subjective QOL has become increasingly popular as an outcome measure to evaluate health services in clinical practice. (14)

In general, the subjective QOL experience for any individual is dynamic and subject to change. Thus, it may vary with time and with a number of other personal and environmental factors. (15) These factors may include: (a) age (16); (b) gender; (c) ethnicity; (d) culture (17); (e) presence of illness (18) and the type of illness; (f) financial status; and (g) societal influence. (19)

Quality of life is considered a multidimensional concept, (8) consisting of a number of different dimensions.(19) Some researchers have proposed that QOL be divided into at least 3 major dimensions: physical, psychological, and social. (19) Other researchers have proposed 5 categories for the assessment of QOL: physical health, mental health, work, social life, and home and family. (20) Within these different proposed models for assessing QOL, there are overlapping dimensions. A more widely used version of a 4-dimensional categorisation of QOL was suggested by the World Health Organization (WHO) in 1998 (21) which comprised physical health, psychological health, social relationships, and environmental dimensions.

Efforts to measure QOL were first undertaken in the US in 1997. …

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