香港心理衞生期刊 三十六卷 第二期 二０一０年冬 Hong Kong Journal of Mental Health Volume 36 No. 2 Winter 2010
Message from Issue Editor
Relevancy and Challenges of Recovery Model: a Primer Review
Winnie W N Ho Beat Drugs Fund, Security Bureau Marcus Y L Chiu Hong Kong Baptist University William T L Lo Kwai Chung Hospital Michael G C Yiu United Christian Hospital |
Abstract
| The conventional notion of treat-and-recover medical model could not quite describe the recovery process of people with severe mental illness. Although full restoration of functions were rare, ample evidence showed that many people with schizophrenia do not necessarily deteriorate over time, but enter into episodes of symptomatic remission. New concepts and values of recovery emerged with emphasis on personal agency and empowerment, are accepted as the core value of the mental health policies in some developed countries at a phenomenal rate. This paper reviewed the general concept and components of recovery, and argued with illustrations in hope, self-agency, and stigma that in spite of different cultural interpretation on personhood and the illness, the recovery model put forth by SAMHSA statement contained valuable relevancy for psychiatric rehabilitation in Hong Kong and perhaps elsewhere in Asia. |
摘要
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『復元』模式的關聯與挑戰–初步文獻概覽 傳統『治療-復原』醫學模式的看法並不能準確地描繪出嚴重精神病患的康復過程。雖然只有少數人能百份百的復原其功能，但相多當的證據顯示許多的精神分裂症患者不一定隨時間變差，反而是斷斷續續的進入沒有病徴的時期。在已發展國家的中，關於『復元』的新概念和價值正在崛起，強調個人自主(personal agency) 與充權 (empowerment)，迅速地廣為精神健康政策所接受。本文評閱現有文獻中關於『復元』的概念及其組成部份，以希望(hope)、自主(self-agency)及污名(stigma)等基本範疇為例，主張縱使不同文化對個體及精神病有不同的詮釋，美國藥物濫用及精神健康行政處所提出的『復元』模式，對香港、以至亞洲的精神復健仍然有相當寶貴的關聯及含意。 |
Keywords
| recovery, Chinese, mental illness |
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District-based Personalized Care Program for Patients with Severe Mental Illnesses - a Pilot Case Management Service Model in Hong Kong
W K Lee Kwai Chung Hospital Kenny K Wong Integrated Care Programs Department, Hospital Authority |
Abstract
| Overseas literature showed that district-based community mental health teams and case management models have achieved positive outcome in healthcare service utilization, clinical, psychosocial and quality of life domains. The 2009-10 Policy Address of Hong Kong stated the pilot implementation of district-based Personalized Care Program (PCP) for patients with severe mental illnesses (SMI) in 3 districts, one of which being Kwai-Tsing (KT) district. KT District-based PCP was implemented at Kwai Chung Hospital in April 2010. There were 2 functional components in this program: personalized case management model and community partnership. The program objectives were: person-centered care, needs and risk management, active user and carer participation, gate-keeping to prevent avoidable hospitalization, better treatment adherence and reduction of disabilities, enhancement of strengths, recovery and social inclusion of patients with SMI, cultivation of mental health professional workforce, construction of district-based community partnership. In this paper, we described the program details and its outcome evaluation. |
摘要
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醫院管理局葵青區社區為本個案復康支援先導計劃 香港2009/10年度的特首施政報告落實推行地區為本的社區精神健康團隊和個案經理服務模式的先導計劃，醫院管理局葵涌醫院的葵青區個案復康支援計劃目的是透過個案經理，於葵青區為重性精神病患者，提供持續及個人化的深入支援服務，並加強與社區夥伴合作，協助患者復元和融入社會，本文章會描述計劃詳情和評估它的初步成效。 |
Keywords
District-based Personalized Care Program, case management, severe mental illnesses |
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Survey on the Employment Profile of PYNEH Psychiatric Patients
Siegfrid W K Lee W S Yeung Dorothy M Y Kwong Daisy Y M Wong Pamela Youde Nethersole Eastern Hospital |
Abstract
| Employment is always a concern of psychiatric rehabilitation. The aim of this survey was designed to investigate the employment status and difficulties of psychiatric SOPD patients in the Hong Kong East Clusters. 201 SOPD patients were successfully interviewed and the employment rate was 53%. Among them, 54% found jobs by their own effort & 74.5% got a full-time job but 25% earned less than $5000. Around 40% could sustain job for more than 5 years. For those who were unemployed, 95.8% had working experiences & over 60% wished to resume worker role. The average length of unemployment was 56 months. Major difficulties encountered included low confidence, effects of illness, poor interpersonal relationship, stigma & work stress. In addition, majority of them seldom utilized community rehabilitative resources to enhance their vocational functioning. Several improvement actions were suggested to promote their employment opportunities in a coming event “Work EXPO 2009” at PYNEH. |
摘要
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香港東聯網精神科服務使用者之就業調查 是項調查旨在瞭解精神病康復者的就業情況，在201位受訪者中，超過半數受僱，當中更有四成多人能維持現職超過5年。至於受訪的待業者，他們絕大部份曾經受僱，而待業時間之中位數為56個月，他們在尋找及維持工作兩方均表示感到不同的困難。最後，他們最常使用之社區就業資源為勞工處，其他如僱員再培訓局課程及在職培訓計劃則較少參加。因此，對那些有工作能力及動機的康復者而言，提供就業機會、營造支持的態度及環境，均有助他們對工作的發揮和貢獻！另外，加強公眾教育以提昇各界人士對康復服務的認同和使用亦十分重要。 |
Keywords
| employment, psychiatric patients, survey |
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A 9-year Review of Patient Profile of the Elderly Suicide Prevention Programme of a Regional Hospital in Hong Kong
Mimi M C Wong C F Tsui S W Li C F Chan Y M Lau Castle Peak Hospital |
Abstract
| Aim: This study aims to examine the patient profile of all the patients who have attended the Fast Track Clinic under the Elderly Suicide Prevention Programme of Castle Peak Hospital from 2002 to 2010. Methods: Case notes of the 1,097 patients who presented during the study period were reviewed. Results: Among the 1,097 patients, 89% of them were diagnosed to have depressive illness. 84 of them attempted suicide upon presentation and they were more likely to have previous suicidal attempts than the non attempters. Over half of them employed a lethal, physical method. After their recruitment into the Elderly Suicide Prevention Programme, only three among the 84 (3.6%) suicide attempters eventually committed suicide under the active care of the service. Conclusions: The elderly suicide attempters employed a lethal method which reflected their high suicidal intent. The programme can be regarded as successful in reducing the reattempt rate of this high risk group. |
摘要
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香港老人精神科速治服務病人特微的九年回顧</> 老人精神科速治服務自二零零二年成立以來，為有自殺傾向的長者提供快捷和適當的診斷和治療。青山醫院乃其中提供此服務的醫院，在二零零二至二零一零年間，一共醫治了一千零九十七名長者。當中有八十九百份比的長者被診斷患有抑鬱症。八十四名長者於求診時有自殺舉動，而這些長者相比那些沒有自殺舉動的，較多有過往自殺舉動的歷史。他們都傾向選擇具有危險性的方法自殺，這可反映他們自殺的決心。在接受了青山醫院的老人精神科速治服務以後，有自殺舉動的八十四位長者當中，只有三位在治療其間死於自殺，可見服務的成效。 |
Keywords
| depression, suicide attempt, elderly, suicide prevention |
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Review of Dementia Caregiving Experience and Interventions in Chinese Communities
W C Chan Shatin Hospital |
Abstract
| As population continues to age, the number of persons with dementia has been increasing rapidly. It is a common practice in Chinese communities for family members to provide the majority of dementia care. Literature from developed countries reveals that dementia caregivers experience significant stress and burden, which adversely affects the psychological and physical health of care providers as well as care recipients. This paper aims at understanding family caregiver experience among Chinese caregivers and reviewing interventional studies conducted in Chinese communities, which are pivotal in the design of effective carer support services appropriate to local context. |
摘要
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華人社區的失智症患者照顧經驗及介入 隨著人口不斷老化，失智症患者的數目正快速增長。在華人社區，家庭成員提供大部分失智症患者照護的做法甚為普遍。已發展國家的經驗表明，失智症照顧者承受重大的壓力和負擔，這對照顧者及失智症患者的生理及心理健康都會帶來不利影響。本文旨在了解在華人社區護老者的經驗，並分析照顧者干預的研究，作為設計適合本地情況及有效的護老者支援服務的基礎。 |
Keywords
Chinese, dementia, carer stress, carer burden, carer interventions
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Internet-based Treatment of Anxiety and Depression
Professor Gavin Andrews
Professor
School of Psychiatry
The University of New South Wales, Sydney
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| Transcript of the presentation at the 19th Yap Pow-meng Memorial Lecture of the Mental Health Association of Hong Kong delivered on 24th June 2010. |
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