Prof. P.M. Yap Memorial Lecture

Professor David Castle
MBChB, MSc, CGUT, MD, DLSHTM, FRCPsych, FRANZCP

David is Professor of Psychiatry & Consultant Psychiatrist at St. Vincent’s Hospital Melbourne and The University of Melbourne, Australia. He is also Honorary Professor, Department of Psychiatry, The University of Cape Town; Clinical Professor, School of Psychiatry and Neurosciences, University of Western Australia and Adjunct Professor, Faculty of Health, Arts and Design, Swinburne University. He has wide clinical and research interests, encompassing schizophrenia and related disorders, bipolar disorder, OCD spectrum disorders and disorders of body image. He has a longstanding interest in the impact of licit and illicit substances on the brain and body, and is actively engaged in programmes addressing the physical health of the mentally ill and the mental health of the physically ill. He has published widely in the scientific literature and is a frequent speaker at scientific meetings. His broader interests include music, literature, theatre and art.

Keynote Speech

Mental Health and Well-being of Helping Professionals

Professor Dinesh Bhugra, CBE

Across the world there is significant evidence that medical students, doctors as well as other health professionals have higher than expected rates of mental ill-health and psychiatric disorders including substance abuse disorders with consequent impact on personal and occupational functioning. In a global survey of medical students in 12 countries rates of burnout have been found to be incredibly high. Rates of psychiatric disorders also are higher. There are many reasons for this. Changing practice of medicine becoming more technical, impact of learning by simulation and tension between being professional and expected to be empathic, financial difficulties, cultural pressures have all been recognised as contributing factors. Often healthcare professionals work in high-pressure environment – with long clinical weeks and significant stressors. Wellbeing of healthcare professionals should be of great importance as they can then look after their patients in a better way. Often access to help and services is problematic due to stigma, non-recognition of stress and seeking help elsewhere. It is critical that employers, policymakers and governments ensure that access to mental health services is appropriate and readily available in a non-stigmatising and non-critical function. It is essential that evidence-based interventions including individual counselling, are available. Other inclusive activities within organizational frameworks to better improve the mental health and wellbeing of healthcare staff should be readily accessible.

Dr. Gerald Choa Memorial Lecture

Improving the Long-term Outcome of Psychotic Disorders through Early Intervention

Professor Eric YH Chen

Despite advances in pharmacological and psychosocial interventions, the long-term outcomes of psychotic disorders remain challenging. Treatment-delay has been associated with compromised long-term outcome. In the last two decades, early intervention has become a key strategy in developing services that aim at early detection and phase-specific intervention to enhance the outcome of emergent psychotic disorders. Phase-specific intervention deploys specialised teams to address the specific clinical need of patients in the first few years (the critical period) in the course of the disorder. We review the long-term outcomes of early intervention for psychotic disorders in Hong Kong, addressing the intervention effect not only for the initial years when phase-specific interventions are offered but also for subsequent years after the termination of the early intervention service. The results from Hong Kong found that the improved outcomes gained through specialised intervention in the critical period are long-lasting. We shall also discuss further ways to improve the clinical outcome through maintenance treatment as well as enhancement of cognitive function.

Plenary Session (I): Early Intervention and Genetics

Use of e-technology in Mental Health Promotion, Prevention and Early Intervention – Opportunities and Challenges

Professor Sally Chan

The use of e-technologies, such as Internet, Mobile Technologies, and Apps, in support of health and health-related fields is rapidly rising in popularity. There is a collective recognition of the value and contribution of e-technologies in advancing health. Australia is at the forefront of transforming healthcare delivery, eHealth has been adopted in mental health services.

Fundamentally, eHealth represents a shift in focus away from medical care models where, instead of patients coming to tertiary facilities to receive specialist outpatient services, they can receive patient-centred care by using e-technologies at home. While many general principles of eHealth apply in various context in terms of diagnosis, treatment, management and prevention, there are subtle nuances specific to different populations of patients and situations that require attention to ensure success. Culture, gender, socioeconomic factors and other social determinants of health exert additional influence on the various ways e-technologies are leveraged for the delivery of mental health care. Further, eHealth sometimes is promoted before adequate evidence has been generated through research in terms of their effectiveness. As a result, the health system views these interventions with healthy skepiticism and is cautious in integrating these approaches into routine health service delivery.

In this presentation, Professor Chan will share her work on using e-technology in promoting mental health and psychosocial well-being for carers and people with various health conditions in diverse contexts. She will discuss the opportunities and challenges of technology-driven approach to support carers and patients. The presentation intends to stimulate regional and global collaboration to advance eMental Health through research, capacity building and health system integration.

Genetic Analysis of Transdiagnostic Dimensional Phenotypes across Three Common Mental Disorders

Professor Li Tao

Importance: Redefining psychiatric disorders based on objective biomarkers could further our understanding of the pathogenesis of psychiatric disorders and facilitate the realization of precision medicine in psychiatry.

Objective: To identify the potential core genes/pathways conferring risk to the common factor (CF) for schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD); and to re-delineate three disorders based on the tissue-specific expression profiles of a core gene.

Design, setting and participants: A top-down, cross-disorder approach by (1) using the summary statistics of GWAS from large population-based consortia to build a genomic structural equation model (SEM) for SCZ, BD and MDD, (2) mapping a potential causal core gene for the CF, (3) predicting the transcriptional output of the identified causal gene in our sample and (4) re-clustering patients by expression pattern of the causal gene in the brain and characterizing their demographic features, cognitive functions and neuroimaging traits.

Main Outcome(s), Measure(s) and Results: A common factor emerged from a well-fitting genomic SEM of SCZ, MDD and BD. One genomic region in chromosome 6 was implicated in the genetic make-up of the common factor, with fine-mapping analysis marking ZNF391 as a potential causal core gene. Gene expression inference analysis identified eight brain regions to have different expression levels of ZNF391 between patients and controls, with three biotypes arising from clustering patients based on their expression pattern of ZNF391 in the brain. The three biotypes performed significantly differently in working memory and demonstrated different gray matter volumes in right inferior frontal orbital gyrus (RIFOG) in the same order as working memory.

Conclusions and Relevance: The general predisposition to several psychiatric disorders may be influenced by variations of ZNF391, through its effects on right inferior frontal orbital gyrus and working memory. This illustrates the potential of a trans-diagnostic, top-down approach in understanding the commonality of psychiatric disorders.

Early Intervention for Students with Mental Illness in Taiwan

Professor Yang Yen-kuang

The early onset of mental disorders could be difficulty to be detected. It was reported that the diagnosis and intervention for those individuals with mental illness could be delayed for years. Most of the early onset of mental illness were noted in school age. Although the mental health promotion was very emphasized in elementary and middle school in Taiwan, the inter-cooperation between school and hospital is not very well. In this report, there are two early intervention models in Taiwan will be introduced. Firstly, a child and adolescent psychiatric outreach team included psychiatrist, clinical psychologist and other mental health professionals provided liaison services with school teachers and outreach services in Taiwan will be introduced. The main outcome is to shorten the duration of untreated period with mental illness. Secondly, a special screen program for new-coming students was conducted for many years in a university. The main findings showed that university students’ sleep quality is poor, prevalence of internet addiction is higher, the more social support the more health wellness, attention deficit problem and bullying experience being existed. Based on the above findings the related intervention and health promotion programs in the university will be presented.

Prof. P.M. Yap Memorial Lecture

Achievements and Challenges for Comprehensive Care of People with Schizophrenia

Professor David J. Castle

Schizophrenia is a complex disorder associated with a number of sets of symptoms and comorbidities. Whilst some advances have been made in treatment, many patients with schizophrenia remain with residual symptoms and associated disabilities. In particular, negative and cognitive symptoms, which account for much of the disability associated with the disorder, are less amenable to treatment with antipsychotic agents, than are positive symptoms.

There is thus an imperative for the field to explore novel modes of treatment, both biological and psychosocial, for people with schizophrenia. This talk will explore a number of such approaches and place them in the context of the holistic care of people with schizophrenia.

Learning objectives:
1) To provide a context about how medications can be part of recovery-oriented treatment in people with schizophrenia
2) To supply an overview of the utility and shortcomings of the dopamine hypothesis of schizophrenia
3) To highlight some recent advances in pharmacological and other biological treatments for schizophrenia
4) To address briefly some advances in psychological and broader psychosocial aspects of the care of people with schizophrenia
5) To explain how supported decision making can be employed in the clinical context, with people with schizophrenia

Plenary Session (IIA): Community Care

The Work of Advisory Committee on Mental Health

Mr. Chris Fung

The Advisory Committee on Mental Health (ACMH) is a standing committee to advise the Government on mental health policies, including the establishment of more integral and comprehensive approaches to tackle multi-tactual mental health issues in Hong Kong. The ACMH has been established for two years. What has it done? What is its future plan? And how can it cooperate with various sectors in Hong Kong?

Community Care on Integrated Community Centre for Mental Wellness - Past, Present, Future

Ms. Deborah Wan, BBS, JP

The evolution of community care for the recovery of persons with mental health needs – the Integrated Community Care for Mental Wellness (ICCMW) from its existence in 2009 as a pilot project to the setting up of 24 ICCMW in various districts in Hong Kong in 2010. Its service has been reviewed in 2015 and several improvement measures were implemented. I have the privilege of piloting this service and witnessed its existence and thereafter 10 years, this community service is under the review of the current Rehabilitation Programme Plan. My presentation is on the macro-perspective of ICCMW, based on my observation on conducted visits to 4 ICCMWs operated by 4 non-government organisations, lastly is my recommendation for its future and the way forward.

Personalised Care Programme for SMI – Medical-Social Collaborations

Dr. Yeung Wai-song

In line with the global trend of moving towards the community care for patients with mental illness, the Hospital Authority (HA) has enhanced its community-based psychiatric services in recent years. Lately, the HA has reviewed its service provision on community psychiatric services (CPS) and has developed a new service model which comprises three tiers, namely the Intensive Care Team (ICT) (社區專案組), the Personalised Care Programme (PCP) (個案復康支援計劃), and Standard Community Psychiatric Services (Standard CPS) (精神科社康服務). The new service model covers a wide range of support for psychiatric patients in need of community care.
The main focus of the CPS is to provide personalised care for psychiatric patients and their carers using a case management approach with a view to facilitating their community re-integration and enhancing recovery.

Plenary Session (IIB): Support for Carers

Hardship Endurance in Organizing Caregivers of New Taipei City

Ms. Huang Li-ling

New Taipei City Association of Families and Persons with Mental Illness (NTC-AMI) was founded on July 3rd 1994 in New Taipei City, Taiwan. It is a nonprofit, self-help organization of families and persons with mental illness which aimed to link up with other similar organizations in Taiwan and advocate the inclusion of those who suffered from chronic psychiatric illness into existing Welfare Law for Handicapped Person (now named People with Disabilities Rights Protection Act). In the past years, various activities and services have been promoted and implemented for families and persons with mental illness. It includes community rehabilitation services, supportive employment programs, independent self-help service user groups, education programs (Familylink Mental Health Education), resources centers, fiduciary services, hotline and advocacy for rights etc.

Our missions
-Facilitating social inclusion of persons with mental illness
-Assisting families to face and combat discrimination and stigma
Our beliefs
- It is courageous for families to shoulder up the responsibility to cope with the difficulties in relation to mental illness, and therefore the society at large should be accepting and supportive.
-It is believed that each person with mental illness has potentials and opportunities to recover.
- Persons with mental illness have the right to live in the community, just like you and me.
- Diverse services to journey with persons with mental illness to live a different life.
Website：www.ntcami.org.tw

Empowering Primary Family Caregivers of People with Schizophrenia in Hong Kong

Dr. Zhou Dehui Ruth

Family caregivers provide significant support to people with schizophrenia in their journey of recovery. A number of studies report the subjective and objective burdens carried by primary family caregivers, which affect their life quality and endanger their psychological well-being. This study compares the effectiveness of three group interventions in supporting primary family caregivers of schizophrenia outpatients in Hong Kong, namely a psychoeducation group, a narrative therapy group and an integrative group that aims at synthesizing the strength of the two. Altogether 116 caregivers joined the groups, with 89 participants having completed the intervention and 85 participants having completed the pre-, post and two-month follow up assessment. A questionnaire with various standardized psychometric scales, such as Experiences of Caregiving Inventory and Inner resource scale were administrated to the participants. The statistic results suggest unique strength of each intervention. Family relationship subscales including family cohesion, expressiveness and conflict, were found to be significantly improved in both the psychoeducational group and the integrative group. Three interventions all indicated significant improvements on total positive caregiver experiences. Both the narrative group and the integrative group showed better mental health, inner resource, and hope. This study was a pioneering study that empirically compared three intervention approaches for caregivers of people with schizophrenia. The research findings are referential for mental health professionals in selecting the existing intervention approaches or designing new intervention programmes to support the caregivers of people with schizophrenia and provide insights in empowering family caregivers.

Name of Authors:

K. S. Yu¹, C. Yang², C. K. Lee^3
1Headquarter, The Mental Health Association of Hong Kong
²Jockey Club Amity Place (Tai Po), The Mental Health Association of Hong Kong
³Amity Place (Kwun Tong North), The Mental Health Association of Hong Kong

Summary:
The Collaborative Recovery Model (CRM) provides the guiding principles and 4 Life-Jet tools (Camera, Compass, Map, Album) to help persons-in-recovery bringing values and strengths into focus for life vision and goal attainment. A Group Program on CRM was designed by the Mental Health Association of Hong Kong and implemented in its Halfway Houses and Integrated Community Centres for Mental Wellness to examine the effectiveness of CRM group coaching. Pretest and posttest evaluations were collected from 33 participants by using the Stage of Recovery Instrument, Warwick-Edinburgh Mental Wellbeing Scale, World Health Organization Quality of Life-BREF(HK) and Goal Attainment Scale. Results indicated improvements on the participants’ psychological wellbeing, quality of life, personal goal attainment and stage of recovery. The CRM Group Program could be feasible and cost-effective in promoting positive peer support atmosphere as well as validating personal strengths and values for persons-in-recovery.

02 Topic: Social Network Factors for Recovery

Name of Author:
C.W. Chang
Department of Social Work, The Chinese University of Hong Kong

Summary:
Background:While social network has been recognized to be important for recovery from mental illness, few studies have investigated which aspects of social network are related to mental health recovery in Chinese context.

Objective: This study investigated the relationship between various social network factors and personal recovery among Chinese people with mental illness in Hong Kong.

Method: A total of 131 Chinese adults with mental disorders were recruited from ICCMWs. Social network variables were obtained by using a social network interview methodology. These variables included frequency of contact, instrumental support, emotional support, informational support, closeness with network members, criticalness from network members, and network size. Personal recovery was evaluated by Recovery Assessment Scale. Given that the functions of family network and peer network are different in Chinese culture, these two types of networks were examined separately.

Results: Results of the analysis on the relationship between family network and peer support indicated that high levels of family emotional support, high levels of family criticalness, and a large family network were significantly related to high levels of personal recovery. Results of the analysis on the association  between peer network variables and personal recovery revealed that closeness with peer network members was positively related personal recovery.

Conclusions: Increasing family emotional support, decreasing family criticism, assisting service users to connect to more family members, and helping service users enhance closeness with peers might be helpful in facilitating personal recovery for Chinese adults with mental illness.