Academic journal article East Asian Archives of Psychiatry

What Will It Take for Recovery to Flourish in Hong Kong?

Academic journal article East Asian Archives of Psychiatry

What Will It Take for Recovery to Flourish in Hong Kong?

Article excerpt

Abstract

The notion of mental health "recovery" is beginning to stimulate important changes in the mental health care provided to persons with serious mental illnesses in Hong Kong. However, the Chinese culture poses many challenges to implementing the types of recovery-oriented practices developed over the last 2 decades in the West. This article considers some of the challenges that policy makers, system leaders, practitioners, family members, and persons with mental illnesses themselves may face in attempting to transform care in Hong Kong. In addition to shifting from an individualistic to a more collectivist culture that emphasises the importance of family involvement, the primarily linear notion of mental stability that currently guides practice may need to be reconsidered in the face of evidence which suggests that recovery is a non-linear path that involves hard work both on the part of the individual as well as the family.

Key words: Culture; Family; Mental disorders

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Introduction

"The idea of madness should by no means imply a total abolition of the mental faculties. On the contrary, the disorder usually attacks only one partial faculty...A total upheaval of the rational faculty...is quite rare" (Philippe Pinel, 1794).1

The notion of mental health "recovery", that is, recovery from and in the midst of a serious mental illness,2 is taking root in Hong Kong. In addition to prominently displayed posters and other artwork in mental health settings that introduce the concept of mental health recovery to persons with serious mental illnesses and staff alike, there are initial efforts to train and hire peer staff (staff who are themselves in recovery) and educate existing staff about the values and principles of recovery-oriented practice.3,4 There also appears to be increasing involvement both of persons with serious mental illnesses (referred to as "service users") and family members in advocacy, research, and quality improvement initiatives.5,6

It is important to note, though, that there are important differences in the cultural values and societal structures that hold sway in Hong Kong that pose new and different challenges to implementation of a recovery vision versus those typically encountered in the United States or United Kingdom. In the following sections, we would like to offer a few observations about the status and future of recovery and the development of recovery-oriented practices within the Hong Kong context, and suggest a few directions for the consideration of our valued colleagues as they go about this challenging, but extremely important, work of assisting persons with serious mental illnesses to regain dignified and meaningful lives in their local communities.

The Importance of Working with Families

One obvious difference between Hong Kong and the West is its deeply-rooted hierarchical and collectivist structure that emphasises social harmony, deference to elders and people in positions of authority (e.g. physicians), filial loyalty, and the family as the primary social unit.3,7 This set of values, beliefs, and practices contrasts with the western emphasis on individualism, autonomy, self-determination, personal choice, and the person as the primary unit of focus. As we have pointed out in previous publications,5,8 these differences call for significant changes in the ways in which mental health care is planned, delivered, and evaluated. Rather than a primary focus on the promotion of collaborative decision-making between practitioners and the person using services, Asian cultures may prefer shifting, at least at first, to collaboration between mental health practitioners and the family unit to which an individual belongs.9,10

We have some experience with such a shift in the West, particularly in ethnic minority communities,11 in which our ordinarily person-centred approach to decision-making is broadened to include family members and other influential "natural supports" (e. …

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