Samson Tse

Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems

An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis‐uses (“abuses”) of the concept of recovery: recovery is the latest model; recovery does not apply to “my” patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically‐validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.

Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: Trait differences for gaming addiction and social networking addiction

This study investigated the associations between personality traits, based on the Big Five model, and addictive behaviors to different online activities among adolescents. A sample of 920 participants was recruited from four secondary schools in different districts using random cluster sampling. A structured questionnaire, including demographic information, internet usage pattern, the Internet Addiction Test, the Game Addiction Scale, the Bergen Facebook Addiction Scale - Revised, and the Big Five Inventory, was administered to each participant. The results demonstrated a significant difference in personality traits for addictive behaviors related to different online activities. Specifically, higher neuroticism (β=0.15, p<0.001) and less conscientiousness (β=0.12, p<0.001) displayed significant associations with internet addiction in general; less conscientiousness (β=0.09, p<0.01) and low openness (β=0.06, p<0.05) were significantly associated with gaming addiction; and neuroticism (β=0.15, p<0.001) and extraversion (β=0.10, p<0.01) were significantly associated with social networking addiction. Our findings may provide a better understanding of the etiopathology of internet-related addictive behaviors and have implications for psychoeducation and psychotherapy programs.

Can Consumer-Led Mental Health Services be Equally Effective? An Integrative Review of CLMH Services in High-Income Countries

This study examined the evidence from controlled studies for the effectiveness of consumer-led mental health services. Following an extensive search of material published in English from 1980, predefined inclusion criteria were systematically applied to research articles that compared a consumer-led mental health service to a traditional mental health service. A total of 29 eligible studies were appraised; all of them were conducted in high-income countries. Overall consumer-led services reported equally positive outcomes for their clients as traditional services, particularly for practical outcomes such as employment or living arrangements, and in reducing hospitalizations and thus the cost of services. Involving consumers in service delivery appears to provide employment opportunities and be beneficial overall for the consumer-staff members and the service. Despite growing evidence of effectiveness, barriers such as underfunding continue to limit the use and evaluation of consumer-led services. Future studies need to adopt more uniform definitions and prioritize the inclusion of recovery oriented outcome measures.

Key Indicators of the Transition from Social to Problem Gambling

At the International Gambling Conference: Policy, Practice and Research in 2004 (Clarke, eCommunity-International Journal of Mental Health and Addiction, 3:29–40, 2005), a paper was presented which proposed key indicators of the transition from social to problem gambling and to recovery, based on a review of literature on factors leading to substance abuse. They included availability of gambling activities, lack of social and cultural empowerment, low socioeconomic status, and personal loss of control. Subsequently, a multidisciplinary team collected data on why people gamble. Four New Zealand ethnic groups (Päkehä/New Zealand European, Mäori, Pacific peoples and Asians) in South Auckland were targeted for both phases of the study. Phase 1 involved qualitative analysis of data from individual interviews and focus groups. Phase 2 surveyed 345 adults using a questionnaire developed from the first phase. From both phases, key indicators for problem gambling were similar to the indicators for substance abuse. Public health interventions such as reducing access to electronic gaming machines and empowerment of cultural groups, and a longitudinal study of the development of gambling in the community are suggested.

Assessing social support among South Asians: The multidimensional scale of perceived social support

The psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) of the Urdu (MSPSS-U) and Nepali (MSPSS-N) versions were investigated among Pakistani (n=148) and Nepalese (n=153) respondents living in Hong Kong. The factor analysis of the MSPSS-N conducted in this study confirmed the three factors of the original MSPSS, namely, Family, Friend, and Significant Others, while only two factors were extracted from the MSPSS-U (i.e., the Family and Friends subscales). With regard to construct validity, both the MSPSS-U and MSPSS-N were inversely correlated with depression, anxiety and stress as assessed by the Depression Anxiety Stress Scale (DASS-21). The internal reliability and construct validity of the MSPSS-U and MSPSS-N were also established and provided support for the validity of both versions as tools for measuring perceived social support among South Asian migrants.

Cultural Icons and Marketing of Gambling

A number of different countries and states have or are in the process of developing formal or informal guidelines to govern gambling advertising and marketing of gambling. There is a growing consensus that gambling advertising should not mislead the public, be fair, provide information on the odds of wining and there should be provisions in place to protect vulnerable groups, such as, children. In the development of these guidelines by different countries or states there has been no real consideration of the need to engage with different indigenous and ethnic populations to ensure that they are protected as vulnerable populations. Further there is a need to engage with these populations within countries and across countries to ensure that indigenous and ethnic minority cultural icons, values, religious practices and music are not used without their permission or exploited in the business of promoting and marketing different forms of gambling products. New Zealand’s experience of marketing and advertising of gambling is discussed in this paper. It is outlined the development of casinos in New Zealand and how Maori were actively encouraged to participate in the opening of these establishments and therefore, legitimate their existence as a safe place for Maori, the indigenous population of New Zealand to frequent on a regular basis. Since then other ethnic minority populations have been targeted to engage in different forms of gambling by recognising their significant cultural events, importance of family events and celebrating and promoting the success of important sport role models. Gambling advertising can be direct or subtle, however, little research has focussed on the third person effect associated with gambling advertising. New Zealand has adopted a public health approach to reduce gambling related harm. One of the key strategies introduced to reduce gambling related harm has been the development and implementation of harm minimisation regulations. Research conducted in New Zealand regarding individuals’ attitudes and behaviour to gambling, highlights that Maori have a high recall of gambling advertisements alongside other ethnic populations. The paper suggests that as part of a public health approach to reduce gambling related harm that it is now timely in New Zealand, for consideration to be given as to how much exposure, if any, New Zealanders should be subjected to gambling advertising.

Reasons for Starting and Continuing Gambling in a Mixed Ethnic Community Sample of Pathological and Non-problem Gamblers

Very few studies have investigated motivational differences between pathological gamblers (PG) and non-problem gamblers (NPG), or between men and women. Motives for starting gambling have not been distinguished from motives for continuing gambling. From a community survey questionnaire listing reasons generated from the population studied, the motives of 103 current PG met the DSM-IV-TR criteria of five or more symptoms within the 12 months to October 2004. NPG assented to less than three symptoms. Generally, PG had significantly stronger motives than NPG and preferred continuous forms of gambling. There were no overall gender differences in motives, but electronic gaming machines and bingo were the primary choices for female PG. Gambling to escape from stress and troubles increased for PG but not for NPG, while gambling for social reasons decreased for both groups. Because of disproportionate numbers of PG and NPG in the Caucasian, Maori, Pacific Island and Asian groups, ethnic differences were not examined. The findings supported some aspects of theories of gambling motivation. Lowering stress for PG, raising community awareness of the risk of gambling to socialize and undertaking longitudinal research in community samples were suggested.

Recovery in Hong Kong: Service user participation in mental health services

Abstract This article provides an overview of mental health services (MHS) and the application of the recovery concept in Hong Kong, focusing on user participation. It presents stakeholders’ views of the recovery movement in a round-table discussion format, demonstrating agreement that user participation merits more public and official attention. Some of the present difficulties with the movement are also reviewed. Social identity theory (SIT) is then analysed as a potentially useful framework for theorizing how service users’ identities change as they become service providers. The paper then provides an overview of the current financial and political position of MHS, and identifies signs that the recovery approach is becoming accepted. It also addresses the cultural meanings of the concept, and sets out examples of its implementation in the health and social welfare sectors. Lastly, it summarizes the challenges facing service providers and users and concludes that as the recovery movement is still in its infancy in Hong Kong, more coordinated efforts are needed to establish the organizational support and policy framework, so that sustainable and evidence-based service provision can be achieved.

Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues

BackgroundProblem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues.MethodsThis is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536) who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger). Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis.ResultsApproximately 3/100 (3%) answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1). Increasing age reduced likelihood of gambling concerns – logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99) p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p < 0.0001) to have concerns about their smoking, use of recreational drugs, and alcohol. Similarly there were more likely to indicate problems with depression, anxiety and anger control. No significant relationship with gambling worries was found for abuse, physical inactivity or weight concerns. Patients expressing concerns about gambling were significantly more likely to want help with smoking, other drug use, depression and anxiety.ConclusionOur questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.

Community participation and social inclusion: How practitioners can make a difference

Abstract People with mental disorders are marginalised and socially excluded from many aspects of community life. They often experience difficulty with obtaining employment, participating in community activities, affordable and sustainable housing, financial and legal issues, transportation, and limited information about, and access to, the options that are available to them. In this article, we describe a selected number of activities that promote social inclusion. Social inclusion not only offers us a framework for developing mental health policy, but serves to measure how well mental health services are achieving recovery-orientated outcomes. Examples are provided to highlight how the concept of social inclusion can be applied in the everyday practice of mental health practitioners.