Development of OT Mental Health Service for Adult Psychiatric Patients in Public Hospitals in Hong Kong

Challenges and Opportunities

香港公立醫院成人精神科服務的發展機遇與挑戰

Maurice Wan•Occupational Therapist & Department Manager

United Christian Hospital, Hospital Authority, Hong Kong•Former Convenor and present member of the Specialty Group in Mental Health, Coordinating

Committee in Occupational Therapy (OTCOC), Hospital Authority (HA)•OTCOC Representative, Working Group on Mental Health Promotion, HA

21 March 2015

2015 International OT Conference

Acknowledgement

• Hospital Authority of Hong Kong• Mental Health Specialty Group, HA• Recovery-oriented practice Working Group,

Mental Health Specialty Group, HA• Castle Peak Hospital• Kwai Chung Hospital• Kowloon Hospital• United Christian Hospital

Outline of Presentation• Mental Health Reform

– Overseas– Hong Kong situation

• OT mental health services in public hospitals • Development of OT Mental Health Service for Adult

Psychiatric Patients in Public Hospitals– Major service initiatives developed– Paradigm shift to Recovery-Oriented Practice

• Opportunities• Challenges• Conclusion

Public Hospitals Services in Hong Kong

• Hospital Authority (HA) is a statutory body established in Dec 1990 and responsible to manage all public hospitals in Hong Kong

• Health including mental health services are organized on cluster basis (7 clusters) according to population distribution

• There are 2 mental health hospitals in Hong Kong –the Castle Peak Hospital (opened in 1961) and Kwai Chung Hospital (opened in 1982)

• Mental health services are available in general hospitals in each cluster

Health Facts of Hong Kong 2014 EditionPopulation and Vital Statistics for 2013 •Land Area (Sq. km) 1 104.5 •Mid-year Population ('000) 7 187.5 •Population Density (Persons per sq. km) 6 650 •Mid-year Population by Age Group ('000) Ø Below 15 years 797.1 Ø 15 - 64 years 5 368.9 Ø 65 years and above 1 021.5

Registered Healthcare Professionals (End 2013) Type of Professional Total Healthcare professionals to population* • Doctors 13 203 1 : 547 • Nurses 45 846 1 : 157 • Occupational therapists 1 580 1 : 4 569

Health Facilities (End 2013) •Number of Public Hospitals under Hospital Authority* 42 •Number of Hospital Beds in Hospitals in Hospital Authority 27 400 * Hospital Authority (HA) a statutory body being responsible to manage all public hospitals in HK.

Services are organized on cluster basis (7 clusters) according to population distribution

Mental Health Services in HA

• No Mental Health Policy in Hong Kong• Prevalence of mental disorders in Hong Kong

– No data – 3- year territory-wide Hong Kong Mental Morbidity Survey (HKMMS) was

conducted and funded by Hong Kong Government in 2010– CUHK, HKU, CPH, KCH & KH– Aim to survey 5700 Chinese, aged 16 to 75– Survey was completed in 2013 and report was submitted

• Interim report released on May 2012– 2500 were interviewed– 14.5 % having significant levels of neurotic symptoms, and half of them require

treatment– 4.2% suffer from depression– 6.5% suffer anxiety disorder– 2.4% have more than one disorder

Mental Health Services under Hospital Authority (HA)Vital Statistics 2012-13

Mental Health Facilities •Number of Psychiatric Hospitals under Hospital Authority 2•Number of Psychiatric Beds in Hospital Authority 3607 •Number of Psychiatric Day Hospital Places 889

Service Statistics•Psychiatric Inpatient Discharges & Death 31674•Specialist Out-patient Attendance 775109 •Psychiatric Day Hospital Attendance 219069

Manpower (Mar 12)•Number of Psychiatrist 334•Number of Registered + Community Nurses (Psychiatric) 2161•Number of Clinical Psychologist 54 •Number of OT working in HA 613•Number of OT (Psychiatric) 189

241 (Dec 14)

OT Service in Mental Health, HA• Since 1950s• Chronic/ long-stay

patients• Intervention focus

– Workshop and activities-based

– Work and life skills training

• Perceived as occupying patients

OT Coverage in Mental Health, HA

Patient Types•Child & Adolescent•Adult•Elderly

Service Types•Inpatient•Outpatient•Day hospital patient•Community Psychiatric Service•Outreach services

Scope of OT Services in Mental Health, HA

• Mental state observation & stabilization• Functional skills assessment and training like daily

living skills, cognitive function, etc. • Life coping skills training such as communication

skills, social skills, stress management, problem-solving , social cognition, etc

• Vocational counseling/ assessment / Training / resettlement/ supported employment

• Leisure exploration and management• Home assessment / management / resettlement• Community living skills assessment and training

Key Drivers ?

Development of OT Mental Health Servicefor Adult Psychiatric Patients

in Public Hospitals in Hong Kong

Worldwide Mental Health Reform (UK, Australia, USA)

• Deinstitutionalization, Less hospitalization & reduction of psychiatric beds

• Mainstreaming of mental health service • Ambulatory care & Community-based rehab and home

care• Mental health promotion, prevention and early

intervention• Focus on high prevalence common mental disorders• Integration of mental health in primary care services• Patient empowerment, users/ carer/ family participation• Community partnership/ networking• Evidence-based practice

Deinstitutionalization ProgramsKwai Chung Hospital (KCH) Experience

葵涌醫院非院化的經驗

Assertive Community Bridging Project (1999 to 2005)

• Reintegrate long-stay patients into the community

• Intensive case management model• Psychosocial rehabilitation psycho-education

programs (PREP) run by multi-disciplines• Successfully discharge patients back to their

home or half-way house

EXtended-care patients Intensive Treatment, Early diversion & Rehabilitation Stepping-stone (EXITERS)

(2003 Onwards)

• provides a step-wise therapeutic environment to facilitate integration into the community

• initial training is being carried out by medium stay wards• suitable clients will then be transferred to EXITERS hostel,

which provide a home-like setting to facilitate intensive rehabilitation

• multi-disciplinary assessment • individualized care plan with active input from the client and

review regularly• rehabilitation activities provided are coordinated• care plan is handed over to carers of the discharge

destination to ensure continuity of care.

EXtended-care patients Intensive Treatment, Early diversion & Rehabilitation Stepping-stone (EXITERS)

(2003 Onwards)

• training provided by multi-disciplinary team include– Health Education – Skill training, including social skill, budgeting skill, self-care skill,

domestic skill, etc. – Community orientation – Relative support group - counseling and training – Information / liaison centre for Community support resource network – Recreational activities and leisure habits training – Model Home training – Occupational training, including work assessment, working training,

job acquisition, skill training, on-site practice, etc. – Visits to community rehabilitation facilities, e.g. halfway houses, long-

stay care home, sheltered workshops

Gateway to Rehabilitation Project (2004 to 2006)

• For those very chronic patients who refuse rehab and chose to stay in the hospital

• Intensive case management model• Successfully discharge patients

Long-Stay Care-Home (LSCH) Waitlistees Rehabilitation Project

(2005 to 2006)

• New LSCH established by NGO and next to KCH

• To better prepare suitable patients to adjust to their new life in LSCH

Intervention for Frequent Readmitters Project (2008 to 2012)

• Young adults with schizophrenia or substance abuse or self-harm behaviors

• Assertive Community Treatment (ACT) model• Multi-disciplinary approach with case

managers• Provide round-the-clock, territorial wide,

trans-disciplinary support on health and social care

• Reduction of psychiatric beds from 1622 to 1000 in 8 years from 1999 to 2007

• OT played a very important role in rehabilitating and discharging the chronic and long-stay patients in the deinstitutionalization process

Further momentum to take the change forward ?

Recovery Movement in Mental Health復元為本之精神建康服務

• Emerged in the 1980’s

• Inspired by the lived experience of many mental health service users– Get better– Cope well with symptoms – Re-establish identity– Resume work and other life roles

• Supported by further longitudinal research – Evidence of a more positive course for the majority of

people with severe mental illness

Recovery-Oriented Practice in Mental Health復元為本之精神建康服務

De-inst

itutio

naliza

tion

De-stigmatization

Hospital Authority of Hong Kong Mental Health Service Plan for Adults 2010 - 2015 醫院管理局精神健康服務計劃 2010-2015

• Framework to guide the development and provision of adult mental health services

• Recommendations from – the Food and Health Bureau (F&HB) on mental health

services, – HA’s central co-ordinating committee in Psychiatry – the Hong Kong College of Psychiatry

Hospital Authority of Hong Kong Mental Health Service Plan for Adults 2010 - 2015

The vision of the future is of a person-centred service based on effective treatmentand the recovery of the individual.

A New Service Direction

Early intervention and assertive treatment,particularly for those at risk of relapse and hospitalization.

Emphasis on the provision of appropriate support to patients, carers andfamilies in a timely and accessible manner

Patients with severe or complex mental health needs will be provided with co-ordinated multidisciplinary specialist care intensively in appropriate hospital settings

Patients with less severe or less complex needs, including common mental disorders, will receive specialist supported care in the community, including primary care settings.

HA Mental Health Service Plan for Adults 2010 - 2015

Custodial inpatient settingCustodial inpatient setting

Long duration of inpatient stayLong duration of inpatient stay

Episodic care focusing on crisisinterventionEpisodic care focusing on crisisintervention

Most staff of different disciplines provide care in hospital

Most staff of different disciplines provide care in hospital

Piece-meal community services, with weak linkages with community/ primary care

Piece-meal community services, with weak linkages with community/ primary care

Service delivery with a provider-focusService delivery with a provider-focus

Therapeutic and personalized careTherapeutic and personalized care

Focus on recovery and social inclusion. Inpatient care only when indicatedFocus on recovery and social inclusion. Inpatient care only when indicated

Proactive individualized care in appropriate settings, specific to patientneeds

Proactive individualized care in appropriate settings, specific to patientneeds

Mental health specialist care teamsworking in hospital and communityacross boundaries

Mental health specialist care teamsworking in hospital and communityacross boundaries

Comprehensive, broad-based,integrated community mental health services, with close collaboration with other care providers e.g. primary care clinicians, NGOs and governmentdepartments (e.g. housing, police)

Comprehensive, broad-based,integrated community mental health services, with close collaboration with other care providers e.g. primary care clinicians, NGOs and governmentdepartments (e.g. housing, police)

Patient-centred service delivery withengagement of the usersPatient-centred service delivery withengagement of the users

New

Care

Model

Hospital Authority of Hong Kong Mental Health Service Plan for Adults 2010 - 2015

1. To develop a quality, outcomes-driven mental health service2. To work for the early identification and management,

including self-management, of mental illness3. To manage common mental disorders in primary care

settings, where possible4. To further develop and expand community mental health

teams5. To refocus in-patient and out-patient hospital services as

new therapeutic environments6. To seek greater collaboration with disability support and

rehabilitation providers outside the HA

Key Recommendations

Major Service Initiatives Developed since 2010

2010年後主要服務的發展

Triage Clinic (2009-10)分流診所

• At psychiatric SOPCs in five clusters to provide timely assessment and consultation for patients with common mental disorders and other relatively mild conditions who were triaged as routine cases

• OT Clinic was also established to provide first line intervention program on early symptom management (E-Map)– Structured Psycho-education– Cognitive Behavioural Therapy and Intervention– Occupational Lifestyle Redesign

• Shorten waiting time of routine cases, with the median waiting time for first appointment of these cases reduced from 17 weeks in 2008-09 to 8 weeks in 2009-10

OT Clinic Early Symptom Management Program (E-Map)

OT Clinic: Early Symptom Management

Program

Doctor: on SOPD waiting listTriage by nurse

Patient with a referral at SOPD (Psychiatry)

Category IIIpatients

Category I/II

patients

Dischargefrom HA system

Family Medicine /General Out-patient Clinic

Common Mental Disorders Clinic (CMDC) 2010精神健康診所

• at the psychiatric SOPCs to further enhance the support for persons with common mental disorders.

• provide patients waiting for appointment at psychiatric SOPCs with assessment and services.

• patients may receive pharmacological treatment and allied healthservices at the CMDCs

• OT will provide psychoeducation, CBT, Coaching, Lifestyle Redesign Program

• A total of seven CMDCs (with one in each of the seven hospital clusters) have been set up and they have replaced the triage clinics previously set up in five clusters

Case Management Programme (CMP) for persons with severe mental illness (2010-11)

個案管理服務

• For patients with severe mental illness with stabilized conditions may be discharged from hospitals to continue their treatment and rehabilitation in the community, subject to risk assessment by a multi-disciplinary team

• Provide intensive, continuous and personalized support to these patients

• Achieve better treatment outcome and facilitate their recovery and re-integration into the community

Case Management Programme for persons with Severe Mental Illness (2010-11)個案管理服務

• Role of case manager (Nurse/ OT/ SW)– develop individual care plan having regard to the patient’s needs and risk

profile. – maintain contact with the patient throughout the recovery journey,– coordinate and arrange for the delivery of appropriate services to the

patient– monitor the progress of recovery and make prompt arrangements for the

patient to receive treatment when there is sign of relapse of mental illness. – work closely with various service providers for continuity of care upon

discharge, particularly the Integrated Community Centres for Mental Wellness operated by a non-governmental organization under SWD’s subvention to provide one-stop, integrated and accessible community support services to discharged mental patients

Integrated Mental Health Program (IMHP) 2011綜合精神健康服務

• Established in family medicine specialist clinics (FMSCs) and general outpatient clinics (GOPCs) of HA to foster collaboration betweenthe CMDCs and primary care services for better support to patients.

• Under the IMHP, patients with stabilized conditions from the CMDCs will be provided with maintenance treatment in the primarycare settings by FM specialists and GP working in multi-disciplinary teams

• Screen, assess and treat other patients at FMSCs and GOPCs with signs of mental health problems so as to relieve their conditions as early as possible and enhance their chance of recovery.

• To facilitate the management of mental patients in the primary care settings, psychiatrists will share the clinical practices and protocols with primary care personnel.

Integrated Mental Health Program (IMHP) 2011綜合精神健康服務

• Care model– Time-specific, encounter specific – Key workers (nurse / social worker / OT) – Risk stratification & monitoring by standardized tool– Step-wise care according to risk level:

• Low risk → key worker • Medium risk → key worker + primary care doctors • High risk → FM +/- Psychiatrist

– OT as Key worker• As a gatekeeper in initial assessment and risk stratification • Patient education & self management support • Brief psychotherapy e.g. behavioural activation, problem solving therapy • Follow up & symptom and risk monitoring • Care coordination • Relapse prevention

Enhancement of OT for Psychiatric Inpatient Service 2012強化復元為本之精神科住院服務

• Develop, plan, implement and monitor an illness management and recovery programme in acute psychiatric wards

• Facilitate early engagement of acute admitted patients, early discharge and better community re-integration

• Role of OT• Empower patients to take responsibility for their recovery and mental well-being• To enhance patients’ ability in managing mental illness, mental health & every

day living • Support patients’ recovery and better prepare for their discharge• Program provide

• Recovery and goal setting• Illness management• 5 ways to well-being• Relapse prevention

Mental Health Promotion精神健康教育推廣

• HA Working Group on Mental Health Promotion established in 2010– Multi-disciplinary approach including OT – Terms of reference

• Review current evidence on effective mental health promotion practice• Advise on mental health promotion strategies in HA• Coordinate mental health promotion activities which should be in line

with HA’s strategic directions• Act as vetting panel for funding allocation exercise for mental health

promotion programs• Evaluate the effectiveness of funded mental health promotion programs

Mental Health Promotion精神健康教育推廣

• Annual plan for mental health promotion activities with funding support

• Multi-disciplinary approach and cross-sectoral collaboration among HA, Clusters, F&H Bureau, NGOs & other community partners

• Activities include standardised psychoeducation packages, carers support kit, camp, performance, etc.

• Programs implemented– Respect, acceptance and care towards the mentally ill patients– Carers of the people with SMIs– 同行共渡你我他 -携手照顧展關愛 for launching of the PCP with emphasis on

the importance of collaboration among various stakeholders in patients’recovery journey

– Promotion of Recovery-oriented practice

Recovery-oriented OT Practice in Mental Health復元為本之精神建康服務

• Recovery is rediscovering meaning and purpose after having mental illness. (Deegan, P)

• It is a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness (Anthony, B)

• A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential(SAMHSA 2011)

Domains of RecoveryPersonal Recovery• Hope• Strengths/ Resilience• Personal identitySocial Recovery• Community participation• Valued social roles• Citizenship and contributionFunctional Recovery• Assessment like work/ cognitive• Skills training• Adjustment• AdaptationClinical Recovery• Diagnosis• Treatment and medication• Symptoms/ illness management

-

Phases of Recovery

Hos

pita

l Pha

se

Com

mun

ity

Phas

e

Promoting Recovery-oriented practice in Mental Health

• Enhance patients/ users involvement in ROP– Setting of Recovery Goals – patients attending day

hospital would be encouraged to set recovery goals– Case conference – involvement of patients/ carers

would be enhanced as far as possible and feasible

Recovery goal

setting and

planning

Needs assessment

Case Conferences

Promoting Recovery-oriented practice in Mental Health

– Social and recreational activities – patients would be involved in planning and organizing an activity of their choice on monthly basis

– Community meeting – patients would be involved in organizing and chairing the meeting for feedback and discussion on daily service operations

Community MeetingUser-led activities

Recovery Programs Developed• Social Cognition Interaction

Training Program• Metacognitive Training Program • Illness Management and

Recovery Program (IMR)• Five Ways to Well-being• Peer Support (Job Buddies)

Program

Opportunities

機遇

Direction of HA Mental Health Service Plan 2010-2015

• Person-centered care and recovery-oriented practice• Early identification and intervention• Management of high prevalence common mental disorders • Integration of mental health service in primary care settings• Case management for people with SMIs• Enhancement of support for carers and family• Greater collaboration with disability support and rehabilitation providers

Implications• Increasing expectation from users/ carers/ family on mental health services• importance of OT’s role in early identification and intervention• More involvement in high prevalence common mental disorders and SMIs• Further service development like in carers/ family, etc

Recovery-oriented Practice in Mental Health• Align with the philosophy and practice of OT as an enabling

profession• In line with the Vision of OT in HA revised in the 1990s that

“ All our clients shall live a meaningful life of their choice”• Beyond psychiatry to well-being with emphasis on strength-

based and positive psychological intervention• Common language through collaboration among the multi-

disciplinary professions in ROP that further the recognition of OT’s contribution in mental health

• Room for development of occupations and other intervention strategies for realizing ROP in OT

Role Enhancement 強化專業角式– Case ManagerCase Management Program (CMP)

• CMP provides intensive, continuous and personalized support services to patients with SMI in community settings in order to achieve better treatment outcome and facilitate their recovery and re-integration into the community

• Role enhancement of OT as Case Manager– Provide needs and risk assessment– Formulate individual and recovery-oriented care plan – Coordinate and arrange for the delivery of appropriate services to patient– Monitor the progress of recovery and make prompt arrangements for the

patient to receive treatment when there is sign of relapse of mental illness– Work closely with various service providers like ICCMW for continuity of

care and to facilitate social inclusion

Role Enhancement強化專業角式– Psychosocial Interventionin CMDC

• High prevalence CMDs and long waiting time• CMDC provides timely assessment and consultation for

patients with common mental disorders and other relatively mild conditions who were triaged as routine cases (ie not urgent)

• Role enhancement of OT in psychosocial intervention– Use of occupations to include psychological therapy like CBT,

MI, SF– As an enabler to facilitate self-management– As a Life Coach for Occupational Lifestyle Redesign

Role Enhancement 強化專業角式 – Key WorkerIntegrated Mental Health Program (IMHP)

• Integrated mental health service in primary care settings with multi-disciplinary support

• IMHP provides treatment support to patients with stabilized conditions from the CMDCs and to screen, assess and treat other patients at FMSCs and GOPCs with signs of mental health problems

• Role enhancement of OT as Key Worker– As a gatekeeper in initial assessment and risk stratification – Patient education & self management support – Brief psychotherapy e.g. behavioural activation, problem solving

therapy – Follow up & symptom and risk monitoring – Care coordination – Relapse prevention

Role Enhancement 強化專業角式 - a Summary• From conventional roles of providing services to target patients with severe

mental illness to include patients with common mental disorders • From providing skills training to include providing psychological therapy• From a therapist to enhanced role as Life Coach for meaningful life of

client’s choice• From providing services in mental health facilities to include primary care

settings• From role of OT to enhanced roles as Key Worker and Case Manager with

multi-skilling and trans-disciplinary approach

Implications• Increasing mental health needs call for innovative service model or service

redesign• Role enhancement or new roles of OT are needed and emerging• Facilitate professional development and career progression

Mental Health Service Review 精神健康服務檢討

Review Committee on Mental Health•Set up in May 2013•Chaired by the Secretary for Food and Health, and members with wide representation, including legislative councillors, academics, healthcare professionals, service providers, service user and caregiver, as well as representatives from the Equal Opportunities Commission and the Hong Kong Council of Social Services.•Aims

– Review existing policy on mental health and to mapping out the future direction for development of mental health services

– Strengthen the provision of mental health services according to changing needs of the community and resource availability

Mental Health Service Review精神健康服務檢討

• Tasks– examine the existing service delivery models, identify service gaps and consider

measures for improvement along the following directions –• promote public awareness and understanding of mental health• reduce the prevalence of mental illness through early identification timely

intervention• provide quality and accessible mental health services, from primary and community

care, specialist intervention and hospital care to rehabilitation and other social support services

Implications• Attention from Government on mental health service• The direction of HA mental health service plan will continue

Challenges

挑戰

Workforce Development

人力支源的發展

The Service Needs • Facilitate early inpatient discharge and early rehab• Reduce relapse and avoidable readmission• Support for ambulatory and community care/ services• Need for early identification and intervention• Need for carers/ family intervention• Promote service accessibility• Need for cultural relevant, quality, evidence-based effective

treatment program/ interventions

Need for Innovative Service Model, Service Redesign, Role Enhancement of Professionals

Allied Health (AH) Career Progression Model in HA

Objectives• Address the service needs in HA• Redesign the AH career structure• Facilitate professional development• Enhance career progression

Career Progression Model for OT in Mental Health

• To meet service needs in HA• Three tier model

– OT Practitioner (1st tier)• New recruit • Practitioner• Specialty Practitioner (Mental Health)

– Advanced Practice OT (Mental Health)– Consultant OT (Mental Health)

Career Progression Model for OTin Mental Health – Qualification, Competence & Training

Level of Practice Qualification Competence Training

Consultant OT (Mental Health)

Ø Master’s degree in MH

Ø Possesses recognized post-graduate professional qualification relevant to MH practice

Ø 10 years of experience in OT

Ø Knowledge and training in research, and EBP

Ø Provide specialized MH service at subspecialty level and across different subspecialties

Ø Provide clinical consultancy and advice

Ø Develop, monitor and evaluate service

Ø Coordinate service of the subspecialty within same cluster

Ø Provide staff training for advanced professional practice

Ø Provide supervision to OT in lower tiers

Ø Psot-graduate professional training in MH service and disease management

Ø Advanced specialty training for OT in MH service

Ø Training in research and EBP

Ø Health care management training

Ø Leadership training

Career Progression Model for OTin Mental Health – Qualification, Competence & Training

Level of Practice Qualification Competence Training

Advanced Practice OT (Mental Health)

Ø Master’s degree in MH

Ø Possesses recognized post-graduate professional qualification relevant to MH practice

Ø 5 years of experience in OT

Ø Provide specialized MH service at subspecialty level

Ø Assist in staff training for advanced professional practice

Ø Provide supervision to OT in lower tiers and to supporting staff

Ø Psot-graduate professional training in MH service and disease management

Ø Advanced specialty training for OT in MH service

Ø Training in management and EBP

Ø Supervisory training

Career Progression Model for OTin Mental Health – Qualification, Competence & Training

Level of Practice Qualification Competence TrainingSpecialty Practitioner (Mental Health)

Ø Demonstrate competence in required areas, including functional, people and team competencies

Ø Provide basic MH service for patients of different specialties and stages of care

Ø Provide specialized MH service under supervision

Ø Advanced specialty training for OT in MH service

Practitioner Ø Complete 3 yrs structured training for the new recruited OT

Ø Clinical experience in at least 2 defined specialty groups

Ø Provide basic MH service

Ø Advanced clinical program in related specialty groups

Ø Fundamental Training in MH

New Recruit Ø University New graduates

Ø Part II Registration

Ø Provide basic MH service under supervision

Ø 3 yrs structured training for newly recruited OT

Advanced Specialty Training forOT in Mental Health

• Develop knowledge and skills to meet service demands of OT in Mental Health

• Structured training program including lectures, practicum and case studies

• Major specialized training conducted– Community mental health– Cognitive Behavioural Therapy – Changeways Programme – Motivational Interviewing– Solution-Focused Therapy– Life Coaching– Occupational Lifestyle Redesign– Family intervention

Implications

• Resources available for training and career progression – sustainability?

• Support from major stakeholders like management and doctors for new service model and redesign

• Struggling of professional roles or ready to take up new or enhanced role

• Proactive stance through the support from Hong Kong Occupational Therapy Association

Evidence-based Practice 實証為本• Active program evaluation and research activities are

conducted or being carried out in the OT services within HA

• Major activities are– TRIP program– Inpatient Enhancement Program– IMR program– Wellness in Psychiatric Rehab– Validation study of the RSA for Recovery Practice– Social Cognitive Interaction Training/ Metacognitive Training

Implications• Management support and coordination important

Service Collaboration 服務合作

• International Mental health reform – Involve communities, families and consumers– Community partnership and networking

• HA direction – support to patients, carers and families in a timely

and accessible manner– Greater collaboration with disability support and

rehabilitation providers outside the HA– Recovery-oriented practice in mental health

Service Collaboration 服務合作• Increasing need to work collaboratively with patients,

carers and families• Require to work interdependently among different

disciplines and networking with different service sectors under the new service model/ redesign

Implications• Affirmation of professional core competence • Initiative to engage in building new service model/ redesign• strategies in networking and community partnership• Role of Hong Kong Occupational Therapy Association

Networking with Hong Kong Mental Health Promotion Association through

HKOTA

Policy Advocacy 政策倡導

• No mental health policy in Hong Kong• Mental Health Service Review by F&H Bureau• Need to move into the policy arena through

the platform of HK Occupational Therapy Association (HKOTA)

Policy Advocacy 政策倡導Hong Kong Mental Health Committee ( HKMHC 香港精神健康議會)•Established in Oct 2011•Members consist of major stakeholders of NGOs, various users andfamily groups, and professional associations including HKOTA

Policy Advocacy 政策倡導• Mission

– Facilitate the development of long term mental health policy, workforce planning, positive mental health and social harmony(促進有關當局發展長遠而貫徹的精神健康政策，就人力及資源配合作出規劃，推廣精神健康的正向態度，促進社會和諧，建設一個融和的社會)

– Set up a “Mental Health Commission” to formulate, review and execute mental health policy so as to promote mental health of people in Hong Kong(本會建議政府設立「精神健康委員會」，負責制定、檢討及執行精神健康政策，促進香港市民的精神健康)

Policy Advocacy 政策倡導• Activities

– Education materials– Mental health promotion activities– Seminars and workshops– Proposal on Mental Health Policy for

Hong Kong (全民精神健康政策意見書) submitted to Food & Health Bureau on May 2014

– Meeting with Secretary and Deputy Secretary of F&H Bureau, HKSAR

全民精神健康政策意見書（定稿）

2014年5月

香港精神健康議會

Policy Advocacy 政策倡導中華人民共和國 香港特別行政區 食物及衛生局 - 精神健康論壇

2013年 6月 3日 (星期一 ) 上午 10時 香港職業冶療學會意見書

1. 職業治療的目的在於幫助任何病患或殘疾的人士，包括精神病患者，重新生

活，如一般人能處理日常的生活活動，有自己的工作、學習，閒暇及朋友。

2. 在促進一個以復元為基礎的精神復康服務，幫助康復者不單止能重反社會，

並能重拾或重建個人生活角式，我們建議 l 加強輔助就業的發展。 l 推動公開就業，學效英美國家釐定政策如提供稅務優惠等，積極鼓勵顧

主聘用精神病康服者，並提供「合理工作調適」措施如彈性上班時間、

個別培訓、工序改善、以及設立《工作教練》處理康服者在工作上遇到

的壓力、人際及有關問題，好讓康服者能夠穩定工作。 l 設立「輔助居所」- Supported Housing 政策，以滿足康服者的基本住屋

需要，鼓勵獨立生活，減少在社區因居住院舍帶來的污名。 l 設立「輔助教育」- Supported Education 政策，為年 的康服者提供再

接受教育的機會及設立「合理學習調適」措施如處理壓力，改善學習能

力，提升自信等以提升康服者就業的機會。 l 設立「輔助閒暇」- Supported Leisure Participation政策，鼓勵沒有或不

能工作的康服者積極參與閒暇活動，重整生活模式或社會角式，以建立

一個健康及有意義的人生。

3. 為有效在社區治療情緒病及嚴重精神病患者，我們建議應為家庭醫生及私家精神科醫生提供足夠支援。 透過增加專職醫療人手如職業冶療師、社工及臨床心理學家等，及早提供有關心理輔導、工作輔導及訓練、生活技能訓練

等，讓病患者仍可繼續工作及上學。 4. 在預防精神病及實現以復元為基礎的精神復康服務，我們建議在每個聯網成

立一隊由不同專業組成的「精神健康促進隊」- Mental Health Promotion Team透過在社區建立跨界別、跨專業的聯繫及合作，去污名及促進精神健康。

5. 在人手供應方面，我們建議政府應有一個長遠規劃，並按實際情況，彈性提供培訓學額，以滿足需求。

6. 我們建議成立「精神健康議會」- Mental Health Commission，釐定精神健康政策，統籌整體服務發展，處理醫社合作，支源分配，人手規劃及培訓等。

Hong Kong SAR, People Republic of China Food & Health Bureau – Mental Health Forum

3 June 2013 (Monday) 10am Recommendations for Mental Health Policy in Hong Kong

Hong Kong Occupational Therapy Association

Occupational Therapy profession has been advocating the importance of

empowering our clients to live a meaningful life of their choices through returning to their valued life roles at home, work and leisure. With the paradigm shift of mental health services worldwide, such as UK, Australia and USA, and in Hong Kong from institutional to community care, the focus of treatment nowadays emphasize more on multidimensional recovery and social inclusion in addition to symptom management. We therefore need to have a service delivery framework guided by a distinct Mental Health Policy in Hong Kong. Key recommendations are:- 1. To establish an independent Mental Health Commission to formulate the mental

health policy for Hong Kong, coordinate the development of mental health services, reduce service fragmentation, resource allocation and workforce planning.

2. To promote a recovery-oriented mental health services, we have to address the needs for multidimensional recovery and social inclusion like supported employment, supported education and supported leisure participation so as to keep our clients not only in the community but in their own lives again.

3. To improve the accessibility of our clients to allied health services such as

occupational therapists, social workers and clinical psychologists in the community for focused psychological intervention strategies, vocational counseling and assessment, life skills training, lifestyle redesign and care coordination

4. To set up Mental Health Promotion Team not only to reduce stigma and

discrimination, to promote mental health literacy, but also to enhance positive mental health and wellbeing with evidence-based strategies

5. To develop Workforce Planning Strategies for mental health practitioners due to

increase demand for mental health services including inpatient care, outpatient and community mental health services.

HKOTA (June 2013)•Recommendation for Mental Health Policy submitted to F&H Bureau of Hong Kong Government•Attended Mental Health Forum

Conclusion• Development of OT mental health service for adult psychiatric patient

influenced by– Worldwide mental health reform– Recovery-Oriented Practice– HA mental health service plan

• Service beyond chronic psychiatric patients to include high prevalence CMDs

• Involve new care model/ service redesign, new or enhanced role of OT• Future opportunities from changing mental health services and increasing

demand and expectation• Challenges include workforce development, evidence-based practice,

collaboration and policy advocacy• Supporting role of HKOTA is important

All OTs will take pride to be Mental Health OT Practitioners

Thank You