A Community Mental Health Approach in Identifying People at Risk of Poor Mental Health: A Case Study in Hong Kong
Affiliation(s)
1 Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China. 2 Caritas Hong Kong, Hong Kong, China.
1 Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China. 2 Caritas Hong Kong, Hong Kong, China.
ABSTRACT
People with mental health needs are often reluctant to seek help due to inaccessibility to service and also stigmatization, especially in Chinese societies. However, professional effort to identify the high-risk people is inadequate. In this paper the authors described a five-year community-based outreaching project, which aimed at identifying the high-risk groups in seven deprived and low-income communities territory wide and linking them up with mental health and social services. We assessed the project outcome by analysing the data (total number = 2181 participants) gathered on-site using the 20-item Centre for Epidemiological Studies Depression Scale (CES-D). The results of our analysis have shown that the project had successfully identified the high-risk groups (20.6%), with the following profile: the unemployed, housewife, the widowed and divorced and people with low education. They were referred to different services. The results of the post-intervention have indicated improved mental well-being of the participants who had received the services referred (n = 43). Our positive experience has confirmed the need of social workers to take an active role to reach out the unreachable, rather than be passive waiting them to come in.
People with mental health needs are often reluctant to seek help due to inaccessibility to service and also stigmatization, especially in Chinese societies. However, professional effort to identify the high-risk people is inadequate. In this paper the authors described a five-year community-based outreaching project, which aimed at identifying the high-risk groups in seven deprived and low-income communities territory wide and linking them up with mental health and social services. We assessed the project outcome by analysing the data (total number = 2181 participants) gathered on-site using the 20-item Centre for Epidemiological Studies Depression Scale (CES-D). The results of our analysis have shown that the project had successfully identified the high-risk groups (20.6%), with the following profile: the unemployed, housewife, the widowed and divorced and people with low education. They were referred to different services. The results of the post-intervention have indicated improved mental well-being of the participants who had received the services referred (n = 43). Our positive experience has confirmed the need of social workers to take an active role to reach out the unreachable, rather than be passive waiting them to come in.
Cite this paper
Ma, J. , Wong, C. and Tse, S. (2015) A Community Mental Health Approach in Identifying People at Risk of Poor Mental Health: A Case Study in Hong Kong. Advances in Applied Sociology, 5, 243-257. doi: 10.4236/aasoci.2015.59023.
Ma, J. , Wong, C. and Tse, S. (2015) A Community Mental Health Approach in Identifying People at Risk of Poor Mental Health: A Case Study in Hong Kong. Advances in Applied Sociology, 5, 243-257. doi: 10.4236/aasoci.2015.59023.
References
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http://dx.doi.org/10.1001/archpsyc.1991.01810290082015 [2] Caplan, G. (1964). Principles of Preventive Psychiatry. New York: Basic books. [3] Cattell, V. (2001). Poor People, Poor Place and Poor Health: The Mediating Role of Social Network and Social Capital. Social Science and Medicine, 52, 1501-16.
http://dx.doi.org/10.1016/S0277-9536(00)00259-8 [4] Census and Statistics Department (2011). Labour Force, Unemployment and Underemployment.
http://www.censtatd.gov.hk/hong_kong_statistics/statistical_tables/index.jsp?subjectID=2&tableID=006 [5] Chan, R. W. S. (2012). Positive Mental Health. Hong Kong Journal of Mental Health, 38, 3-4. [6] Chen, S. X., & Mak, W. W. S. (2008). Seeking Professional Help: Etiology Beliefs about Mental Illness across Cultures. Journal of Counselling Psychology, 55, 442-450.
http://dx.doi.org/10.1037/a0012898 [7] Cheung, C., & Bagley, C. (1998). Validating an American Scale in Hong Kong: The Centre for Epidemiological Studies Depression Scale (CES-D). Journal of Psychology, 132, 169-186.
http://dx.doi.org/10.1080/00223989809599157 [8] Chi, I., Yip, P. S., Chiu, H. F., Chou, K. L., Kwan, C. W., Conwell, Y., & Caine, E. (2005). Prevalence of Depression and Its Correlates in Hong Kong’s Chinese Older Adults. American Journal of Geriatric Psychiatry, 13, 409-416.
http://dx.doi.org/10.1097/00019442-200505000-00010 [9] Chung, K. F., & Wong, M. C. (2004). Experience of Stigma among Chinese Mental Health Patients in Hong Kong. Psychiatric Bulletin, 28, 451-454.
http://dx.doi.org/10.1192/pb.28.12.451 [10] Hanh, T. N. (2007). The Art of Power. New York: Harper Collins Publisher. [11] Hartfield, B., Sharma, I., & Ryan, T. (2007). Changing the Focus of Mental Health Team: A Study of One English Locality. Journal of Integrated Care, 15, 17-28.
http://dx.doi.org/10.1108/14769018200700018 [12] HKSAR Government (2011). LCQ11: Mental Health Services.
http://www.info.gov.hk/gia/general/201105/18/P201105180167.htm [13] Hospital Authority (2011). Hospital Authority Mental Health Service Plan for Adults 2010-2015. Hong Kong: Hospital Authority. [14] Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R. et al. (2003). The Epidemiology of Major Depressive Disorder: Results from the National Comorbility Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095-3105.
http://dx.doi.org/10.1001/jama.289.23.3095 [15] Kung, W. M. (2000). The Intertwined Relationships between Depression and Marital Distress: Elements of Marital Therapy Conducive to Effective Treatment Outcome. Journal of Marital & Family Therapy, 26, 51-64.
http://dx.doi.org/10.1111/j.1752-0606.2000.tb00276.x [16] Lau, Y. K., Ma, J. L. C., & Wong, K. Y. (2006). Unemployment and Psychological Well-Being and Implications for Social Policy and Social Welfare Services: The Case of Hong Kong. Paper Presented in the 3rd Social Inclination and Social Indicators Conference, 1-2 September 2006, Institute of Sociology, Academic Sinica, Taipei. (in Chinese) [17] Lau, Y. K., Ma, J. L. C., Wan, P. S., & Lai, L. Y. (2012). Work-Family Balance or Work-Family Conflicts: A Study of the Hong Kong Employees. Occasional Paper No. 224. Hong Kong: Hong Kong Institute of Asian-Pacific Study, The Chinese University of Hong Kong. (in Chinese) [18] Layard, R., Bell, S., Clark, D. M., Knapp, M., Meacher, M., & Priebe, S. (2006). The Depression Report: A New Deal for Depression and Anxiety Disorders. London: London School of Economics.
http://cep.lse.ac.hk [19] Lee, S., Lee, M. T. Y., Chiu, M. Y. L., & Kleinman, A. (2005). Experience of Social Stigma by People with Schizophrenia in Hong Kong. British Journal of Psychiatry, 186, 153-157.
http://dx.doi.org/10.1192/bjp.186.2.153 [20] Legislative Council, Hong Kong SAR Government (2011). Updated Background Brief Prepared by the Legislative Council Secretariat for the Joint Meeting on 24 May 2011: Mental Health Services Provided by the Hospital Authority.
www.legco.gov.hk/yr11-12/english/panels/hs/papers/hs_l.htm [21] Leung, E. Y., & Cheung, H. K. (2004). The Defeat Depression Project: A Multilevel Mental Health Education Programme for Chinese-Speaking Communities in Hong Kong SAR. In S. Saxena, & P. J. Garrison (Eds.), Mental Health Promotion Case Studies from Countries (pp. 21-24). Geneva: World Health Organization. [22] Leung, S. S. K., Martinson, I. M., & Arthur, D. (2005). Postpartum Depression and Related Psychosocial Variables in Hong Kong Chinese Women: Findings from a Prospective Study. Research in Nursing & Health, 28, 27-38.
http://dx.doi.org/10.1002/nur.20053 [23] Li, S. P., Chan, C. W. H., & Lee, D. T. F. (2002). Helpfulness of Nursing Actions to Suddenly Bereaved Family Members in an Accident and Emergency Setting in Hong Kong. Journal of Advanced Nursing, 40, 170-180.
http://dx.doi.org/10.1046/j.1365-2648.2002.02359.x [24] Nayar, K. R., Kyobutungi, C., & Razum, O. (2004). Self-Help: What Future Role in Health Care for Low and Middle-Income Countries. International Journal of Equity in Health, 3, 1-10.
http://www.equityhealthj.com/content/3/1/1
http://dx.doi.org/10.1186/1475-9276-3-1 [25] Ma, J. L., Wong, T. K., Lau, Y., & Pun, S. (2007). Family Health of Hong Kong Chinese Families and the Link to Individual Well Being. Occasional Paper No. 188, Hong Kong: Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong. (in Chinese) [26] Ma, J. L. C., Wong, T. K. Y., Lau, Y. K., & Lai, L. Y. (2011). Parenting Stress and Perceived Family Functioning of Chinese Parents in Hong Kong: Its Implications for Social Work Practice. Asian Social Work and Policy Review, 5, 160-180.
http://dx.doi.org/10.1111/j.1753-1411.2011.00056.x [27] Paul, K. I., & Moser, K. (2009). Unemployment Impairs Mental Health: Meta-Analyses. Journal of Vocational Behaviour, 74, 264-282.
http://dx.doi.org/10.1016/j.jvb.2009.01.001 [28] Radloff, L. S. (1977). The CES-D Scale: A Self-Reported Depres-sion Scale for Research in the General Population. Applied Psychological Measurement, 1, 385-401.
http://dx.doi.org/10.1177/014662167700100306 [29] Scheyett, A. (2005). The Mark of Madness: Stigma, Serious Mental Illnesses and Social Work. Social Work in Mental Health, 3, 79-97.
http://dx.doi.org/10.1300/J200v03n04_05 [30] Sousa, L., Ribeiro, C., & Rodrigues, S. (2006). Intervention with Multi-Problem Poor Clients: Towards a Strengths-Focused Perspective. Journal of Social Work Practice, 20, 189-204.
http://dx.doi.org/10.1080/02650530600776913 [31] Siu, S. W., Wan, P. S., & Wong, T. K. Y. (2011). Facing and Responding to Economic Crisis: Highlight of 2009 Survey in Hong Kong and Taiwan. Paper Presented at the 2011 Taiwan-Hong Kong Sociology and Social Image Conference, 11-12 March 2011, Institute of Sociology, Academic Sinica, Taipei, Taiwan and Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong. (in Chinese) [32] Tseng, W. S., Lin, T. Y., & Yeh, E. K. (1995). Chinese Societies and Mental Health. In W. S. Tseng, T. Y. Lin, & E. K. Yeh (Eds.), Chinese Societies and Mental Health (pp. 3-18). Hong Kong: Oxford University Press. [33] USA Public Health Service, Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. Bethesda, MD: National Institute of Mental Health. [34] Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve Month Use of Mental Health Services in the United States. Archives of General Psychiatry, 62, 629-640.
http://dx.doi.org/10.1001/archpsyc.62.6.629 [35] Wong, S. Y. S., Lau, C. H. J., Wong, E. M. C., Chung, V. C. H., Lo, S., Goggins, W., & Griffiths, S. M. (2009). Geographical and Household Variation in Health-Related Quality of Life in Hong Kong. Health and Place, 16, 315-320.
http://dx.doi.org/10.1016/j.healthplace.2009.10.015 [36] Yang, L. H. (2007). Application of Mental Illness Stigma Theory to Chinese Societies: Synthesis and New Directions. Singapore Medical Journal, 48, 977-985. [37] Ye, S., Leung, T. T. F., & Mok, B. H. (2011). Measuring Mutual Help Willingness and Criteria among Hong Kong People: Confirmatory Factor Analyses. Social Indicators Research, 103, 119-130.
http://dx.doi.org/10.1007/s11205-010-9700-x
[1] Bruce, M. L., Takeuchi, D. T., & Leaf, P. J. (1991). Poverty and Psychiatric Status. Longitudinal Evidence from the New Haven Epidemiologic Catchment Area Study. Archives of General Psychiatry, 48, 470-474.
http://dx.doi.org/10.1001/archpsyc.1991.01810290082015 [2] Caplan, G. (1964). Principles of Preventive Psychiatry. New York: Basic books. [3] Cattell, V. (2001). Poor People, Poor Place and Poor Health: The Mediating Role of Social Network and Social Capital. Social Science and Medicine, 52, 1501-16.
http://dx.doi.org/10.1016/S0277-9536(00)00259-8 [4] Census and Statistics Department (2011). Labour Force, Unemployment and Underemployment.
http://www.censtatd.gov.hk/hong_kong_statistics/statistical_tables/index.jsp?subjectID=2&tableID=006 [5] Chan, R. W. S. (2012). Positive Mental Health. Hong Kong Journal of Mental Health, 38, 3-4. [6] Chen, S. X., & Mak, W. W. S. (2008). Seeking Professional Help: Etiology Beliefs about Mental Illness across Cultures. Journal of Counselling Psychology, 55, 442-450.
http://dx.doi.org/10.1037/a0012898 [7] Cheung, C., & Bagley, C. (1998). Validating an American Scale in Hong Kong: The Centre for Epidemiological Studies Depression Scale (CES-D). Journal of Psychology, 132, 169-186.
http://dx.doi.org/10.1080/00223989809599157 [8] Chi, I., Yip, P. S., Chiu, H. F., Chou, K. L., Kwan, C. W., Conwell, Y., & Caine, E. (2005). Prevalence of Depression and Its Correlates in Hong Kong’s Chinese Older Adults. American Journal of Geriatric Psychiatry, 13, 409-416.
http://dx.doi.org/10.1097/00019442-200505000-00010 [9] Chung, K. F., & Wong, M. C. (2004). Experience of Stigma among Chinese Mental Health Patients in Hong Kong. Psychiatric Bulletin, 28, 451-454.
http://dx.doi.org/10.1192/pb.28.12.451 [10] Hanh, T. N. (2007). The Art of Power. New York: Harper Collins Publisher. [11] Hartfield, B., Sharma, I., & Ryan, T. (2007). Changing the Focus of Mental Health Team: A Study of One English Locality. Journal of Integrated Care, 15, 17-28.
http://dx.doi.org/10.1108/14769018200700018 [12] HKSAR Government (2011). LCQ11: Mental Health Services.
http://www.info.gov.hk/gia/general/201105/18/P201105180167.htm [13] Hospital Authority (2011). Hospital Authority Mental Health Service Plan for Adults 2010-2015. Hong Kong: Hospital Authority. [14] Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R. et al. (2003). The Epidemiology of Major Depressive Disorder: Results from the National Comorbility Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095-3105.
http://dx.doi.org/10.1001/jama.289.23.3095 [15] Kung, W. M. (2000). The Intertwined Relationships between Depression and Marital Distress: Elements of Marital Therapy Conducive to Effective Treatment Outcome. Journal of Marital & Family Therapy, 26, 51-64.
http://dx.doi.org/10.1111/j.1752-0606.2000.tb00276.x [16] Lau, Y. K., Ma, J. L. C., & Wong, K. Y. (2006). Unemployment and Psychological Well-Being and Implications for Social Policy and Social Welfare Services: The Case of Hong Kong. Paper Presented in the 3rd Social Inclination and Social Indicators Conference, 1-2 September 2006, Institute of Sociology, Academic Sinica, Taipei. (in Chinese) [17] Lau, Y. K., Ma, J. L. C., Wan, P. S., & Lai, L. Y. (2012). Work-Family Balance or Work-Family Conflicts: A Study of the Hong Kong Employees. Occasional Paper No. 224. Hong Kong: Hong Kong Institute of Asian-Pacific Study, The Chinese University of Hong Kong. (in Chinese) [18] Layard, R., Bell, S., Clark, D. M., Knapp, M., Meacher, M., & Priebe, S. (2006). The Depression Report: A New Deal for Depression and Anxiety Disorders. London: London School of Economics.
http://cep.lse.ac.hk [19] Lee, S., Lee, M. T. Y., Chiu, M. Y. L., & Kleinman, A. (2005). Experience of Social Stigma by People with Schizophrenia in Hong Kong. British Journal of Psychiatry, 186, 153-157.
http://dx.doi.org/10.1192/bjp.186.2.153 [20] Legislative Council, Hong Kong SAR Government (2011). Updated Background Brief Prepared by the Legislative Council Secretariat for the Joint Meeting on 24 May 2011: Mental Health Services Provided by the Hospital Authority.
www.legco.gov.hk/yr11-12/english/panels/hs/papers/hs_l.htm [21] Leung, E. Y., & Cheung, H. K. (2004). The Defeat Depression Project: A Multilevel Mental Health Education Programme for Chinese-Speaking Communities in Hong Kong SAR. In S. Saxena, & P. J. Garrison (Eds.), Mental Health Promotion Case Studies from Countries (pp. 21-24). Geneva: World Health Organization. [22] Leung, S. S. K., Martinson, I. M., & Arthur, D. (2005). Postpartum Depression and Related Psychosocial Variables in Hong Kong Chinese Women: Findings from a Prospective Study. Research in Nursing & Health, 28, 27-38.
http://dx.doi.org/10.1002/nur.20053 [23] Li, S. P., Chan, C. W. H., & Lee, D. T. F. (2002). Helpfulness of Nursing Actions to Suddenly Bereaved Family Members in an Accident and Emergency Setting in Hong Kong. Journal of Advanced Nursing, 40, 170-180.
http://dx.doi.org/10.1046/j.1365-2648.2002.02359.x [24] Nayar, K. R., Kyobutungi, C., & Razum, O. (2004). Self-Help: What Future Role in Health Care for Low and Middle-Income Countries. International Journal of Equity in Health, 3, 1-10.
http://www.equityhealthj.com/content/3/1/1
http://dx.doi.org/10.1186/1475-9276-3-1 [25] Ma, J. L., Wong, T. K., Lau, Y., & Pun, S. (2007). Family Health of Hong Kong Chinese Families and the Link to Individual Well Being. Occasional Paper No. 188, Hong Kong: Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong. (in Chinese) [26] Ma, J. L. C., Wong, T. K. Y., Lau, Y. K., & Lai, L. Y. (2011). Parenting Stress and Perceived Family Functioning of Chinese Parents in Hong Kong: Its Implications for Social Work Practice. Asian Social Work and Policy Review, 5, 160-180.
http://dx.doi.org/10.1111/j.1753-1411.2011.00056.x [27] Paul, K. I., & Moser, K. (2009). Unemployment Impairs Mental Health: Meta-Analyses. Journal of Vocational Behaviour, 74, 264-282.
http://dx.doi.org/10.1016/j.jvb.2009.01.001 [28] Radloff, L. S. (1977). The CES-D Scale: A Self-Reported Depres-sion Scale for Research in the General Population. Applied Psychological Measurement, 1, 385-401.
http://dx.doi.org/10.1177/014662167700100306 [29] Scheyett, A. (2005). The Mark of Madness: Stigma, Serious Mental Illnesses and Social Work. Social Work in Mental Health, 3, 79-97.
http://dx.doi.org/10.1300/J200v03n04_05 [30] Sousa, L., Ribeiro, C., & Rodrigues, S. (2006). Intervention with Multi-Problem Poor Clients: Towards a Strengths-Focused Perspective. Journal of Social Work Practice, 20, 189-204.
http://dx.doi.org/10.1080/02650530600776913 [31] Siu, S. W., Wan, P. S., & Wong, T. K. Y. (2011). Facing and Responding to Economic Crisis: Highlight of 2009 Survey in Hong Kong and Taiwan. Paper Presented at the 2011 Taiwan-Hong Kong Sociology and Social Image Conference, 11-12 March 2011, Institute of Sociology, Academic Sinica, Taipei, Taiwan and Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong. (in Chinese) [32] Tseng, W. S., Lin, T. Y., & Yeh, E. K. (1995). Chinese Societies and Mental Health. In W. S. Tseng, T. Y. Lin, & E. K. Yeh (Eds.), Chinese Societies and Mental Health (pp. 3-18). Hong Kong: Oxford University Press. [33] USA Public Health Service, Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. Bethesda, MD: National Institute of Mental Health. [34] Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve Month Use of Mental Health Services in the United States. Archives of General Psychiatry, 62, 629-640.
http://dx.doi.org/10.1001/archpsyc.62.6.629 [35] Wong, S. Y. S., Lau, C. H. J., Wong, E. M. C., Chung, V. C. H., Lo, S., Goggins, W., & Griffiths, S. M. (2009). Geographical and Household Variation in Health-Related Quality of Life in Hong Kong. Health and Place, 16, 315-320.
http://dx.doi.org/10.1016/j.healthplace.2009.10.015 [36] Yang, L. H. (2007). Application of Mental Illness Stigma Theory to Chinese Societies: Synthesis and New Directions. Singapore Medical Journal, 48, 977-985. [37] Ye, S., Leung, T. T. F., & Mok, B. H. (2011). Measuring Mutual Help Willingness and Criteria among Hong Kong People: Confirmatory Factor Analyses. Social Indicators Research, 103, 119-130.
http://dx.doi.org/10.1007/s11205-010-9700-x