1. Principal Investigator Hector W.H. Tsang, PhD, OTR Department of Rehabilitation Sciences, The Hong Kong Polytechnic University 6 Nov 2009

2.  Hong Kong Government ◦ White paper on Rehabilitation (Hong Kong Government, 1995) ◦ Hong Kong Rehabilitation Program Plan 1998-99 to 2002-03: Towards a New Rehabilitation Era (Health and Welfare Bureau, 1999) ◦ Did not address special needs of people with schizophrenia and their caregivers

3.  No existing validated questionnaire  Research addressing their needs limited (Tsang, Pearson & Yuen, 2002; Yip, 2004)

4.  Identify needs from various perspectives  Make suggestions to the Government for policy development

6. Phase One  To identify issues via focus group interview Phase Two  To develop and validate questionnaires for measuring perceived and normative rehabilitation needs for people with schizophrenia and their caregivers

7. Phase Three  To explore and compare perceived and normative rehabilitation needs via a quantitative survey

8.  Perceived needs ◦ “ what people think their need are or feel their needs to be ”.  Normative needs ◦ “ the existence of some standards or criterion established by custom, authority, or general consensus against which the quantity or quality of a situation or conditions is measured ”

9.  Three sample recruited (n=43) ◦ People with Schizophrenia (n= 14)  Aged >15 and with onset of illness at least 1 year ◦ Caregivers of people with schizophrenia (n=13)  Acted as main carer and taking care of client at least 1 year ◦ Mental health professionals (n=16)  At least 1 year experience working for people with schizophrenia  Six focus groups conducted

10. Focus groups Schizophrenia (n=14) Caregivers (n=13) Professionals (n=16) Age 39.6 ± 10.849.8 ± 9.8N/A Sex Male Female 7 (50%) 2 (15.4%) 11 (84.6%) 8(50%) Educational level Primary Secondary Tertiary 3 (21.4%) 11 (78.6%) 0 (0%) 1 (7.7%) 6 (46.2%) 0(0%) 16 (100%) Duration of illness (Year) 17.9 ± 11.3N/A Years of taking care of people with schizophrenia (Year) N/A7.9 ± 5.7N/A Experience in working in the field of mental health (Year) N/A 6.5 ± 5

11.  76 items (19 categories) were generated CategoriesNo of items Vocational13 Symptoms4 Knowledge on mental illness2 Self care3 Medical service9 Social3 Intimacy2 Family relationship6 Parenting1

12. CategoriesNo of items Leisure3 Participation in Treatment3 Housing4 Finance4 Education2 Discrimination5 Social Welfare and Security3 Budgeting2 Stress management4 Harm to self or others3 Total: 19Total: 76

13.  50 items (11 categories) were generated CategoriesNo of items Workplace/Employment3 Housing2 Community support and Welfare system 5 Medical services4 Financial needs3 Social life4 Family8

14. CategoriesNo of items Knowledge on mental illness3 Discrimination3 Stress management8 Self-care4 Leisure3 Total50

15.  To develop and validate questionnaires for measuring perceived and normative rehabilitation needs for ◦ people with schizophrenia ◦ their caregivers

16. Perceived Needs  Perceived Rehabilitation Needs Questionnaire for people with schizophrenia (PRNQ-S)(PRNQ-S)  Perceived Rehabilitation Needs Questionnaire for caregivers of people with schizophrenia (PRNQ—C)  Perceived Rehabilitation Needs Questionnaire for caregivers towards people with schizophrenia (PRNQ—CS) Normative Needs  Normative Rehabilitation Needs Questionnaire for people with schizophrenia (NRNQ—S)  Normative Rehabilitation Needs Questionnaire for caregivers of people with schizophrenia (NRNQ—C)

17. PRNQ—S (n=49)PRNQ—CS (n=32)NRNQ—S (n=48) MSDICCαMSDICCαMSDα NeedsVocational3.710.810.730.903.611.130.740.964.030.480.89 Symptoms3.461.250.690.914.350.730.900.844.270.660.89 Knowledge on illness3.861.030.450.684.170.830.730.614.090.760.92 Self care3.531.020.870.823.921.020.910.883.910.750.90 Medical service3.791.110.650.894.390.550.690.854.290.390.80 Social3.531.120.830.904.080.870.780.913.860.690.90 Intimacy3.721.300.810.953.771.170.890.883.70.740.85 Family relationship3.640.810.720.853.870.770.720.803.870.520.78 Parenting2.21.350.74/1.841.300.55/3.830.83/ Leisure3.531.120.770.84 3.821.11 0.630.943.680.630.86 Participation in treatment3.721.300.680.754.170.840.78 4.40.610.84 Housing2.861.320.750.893.341.320.860.903.880.570.80 Finance3.541.120.750.803.521.210.860.893.710.760.86 Education3.731.310.710.953.581.200.600.783.570.810.88 Discrimination3.241.330.770.93.710.990.82 4.350.610.91 Social welfare and security3.571.200.810.754.280.880.760.814.020.640.81 Budgeting3.551.460.820.843.551.250.870.844.040.870.76 Stress management3.611.270.870.934.360.680.800.834.190.570.87 Harmful to self or public2.241.240.770.762.931.090.840.714.40.670.85 Psychometrical Properties of PRNQ—S, PRNQ—CS, and NRNQ—S

18. PRNQ—S (n=49)PRNQ—CS (n=32)NRNQ—S (n=48) MSDICCαMSDICCαMSDα ServicesVocational rehabilitation2.961.090.790.813.601.090.690.863.90.640.9 Community rehabilitation3.551.470.92/3.881.210.90/4.380.57/ Family intervention2.941.530.790.823.391.200.800.853.890.70.81 Residential placement1.721.100.620.942.611.130.720.844.060.660.86 Psychotherapy2.691.310.72/4.380.870.61/4.060.63/ Psychiatric medication3.531.160.810.753.530.710.740.154.430.60.89 Self management program2.571.420.86/4.130.910.84/4.170.69/ Social activity2.931.100.790.823.420.830.790.753.760.630.90 Social welfare3.571.200.810.753.551.090.910.654.090.640.88 Emergency service2.501.380.750.643.311.370.730.864.020.71 Others3.171.120.720.842.700.780.820.723.070.550.69 Psychometrical Properties of PRNQ—S, PRNQ—CS, and NRNQ—S

19. PRNQ—C (n=32)NRNQ—C (n=48) MSDICCαMSDα NeedsWorkplace/Employment 3.111.130.640.623.990.540.75 Housing 3.21.30.710.693.880.710.77 Community support and welfare system 4.070.710.580.833.890.490.77 Medical services 4.100.850.750.804.010.620.86 Financial needs 3.661.180.780.803.660.600.75 Social life 3.201.100.860.913.600.590.86 Family 3.730.880.870.884.010.590.88 Knowledge on illness 4.260.710.890.834.090.580.79 Discrimination 3.160.860.800.613.970.610.87 Stress management 4.080.770.850.894.080.510.94 Self care 3.850.910.830.783.840.580.80 Leisure 2.911.050.860.943.440.580.83 Psychometrical Properties of PRNQ—C and NRNQ—C

20. PRNQ—C (n=32)NRNQ—C (n=48) MSDICCαMSDα ServicesFamily intervention 3.661.230.71/3.920.74/ Psychotherapy 3.631.290.76/3.920.77/ Self management program 3.661.210.80/3.830.75/ Social activity 3.561.030.720.793.810.580.66 Social welfare 3.021.450.980.723.930.690.89 Emergency services 3.251.210.760.813.990.670.90 Others 2.620.810.820.573.300.650.71 Psychometrical Properties of PRNQ—C and NRNQ—C

21.  To identify perceived and normative rehabilitation needs for people with schizophrenia and their caregivers via a quantitative survey  To compare the needs and the supplies of the present mental health service delivery  To propose directions for future mental health policy and rehabilitation services development

22. Participants Schizophrenia (n=194) Caregivers (n=83) Professionals (n=112) Age 18-25 26-35 36-45 46-55 56 or above 10 (5.15%) 47 (24.23%) 58(51.79%) 56 (28.87%) 23 (20.54%) 3(3.6%) 9(10.8%) 13(15.7%) 21(25.3%) 37(44.6%) 12 (10.71%) 63 (56.25%) 28 (25.00%) 8 (7.14%) 1 (0.89%) Sex Male Female Missing 104 (53.61%) 90 (46.39%) 32(38.6%) 51(61.4%) 32 (28.57%) 72 (64.29%) 8 (7.14%) Educational level Illiterate Primary Secondary Tertiary or above 3 (1.55%) 48 (24.74%) 130 (67.01%) 13 (6.70) 6(7.2%) 30(36.1%) 41(49.4%) 6(7.2%) N/A

23. Participants Schizophrenia (n=194) Caregivers (n=83) Professionals (n=112) Duration of receiving mental health services 2 years or below 2-5 years 5-10 years 10 years or above 14 (7.25%) 35 (18.13%) 48 (24.87%) 96 (49.74%) N/A Year of taking care of people with schizophrenia 2 years or below 2-5 years 5-10 years 10 years or above N/A13(15.7%) 19(22.9%) 14(16.9%) 37(44.6%) N/A Experience in working in the field of mental health 2 years or below 2-5 years 5-10 years 10-15 years 16 years or above Missing N/A 19 (16.96%) 35 (31.25%) 33 (29.46%) 19 (16.96%) 5 (4.46%) 1 (0.89%)

24. Most important needs PRNQ-S (Schizophrenia) Medical Services (M=4.02,SD=0.76) Knowledge on Mental Illness (M=3.95,SD=1.05) Stress Management (M=3.87,SD=1.02) PRNQ-CS (Carers) Medical Services (M=4.48,SD=0.53) Symptoms (M=4.39,SD=0.65) Stress Management (M=4.39,SD=0.81) NRNQ-S (Professionals) Discrimination (M=4.5,SD=0.57) Participation in Treatment (M=4.49,SD=0.54) Harmful to Self or Public (M=4.39,SD=0.69)

25. Most important services PRNQ-SSocial Welfare and security (M=3.61,SD=1.17) Psychiatric Medication (M=3.58,SD=0.99) Community Outreaching Services (M=3.48,SD=1.40) PRNQ-CSPsychotherapy (M=4.20,SD=1.10) Self Management Program (M=4.19,SD=0.98) Community Outreaching Services (M=4.04,SD=1.17 NRNQ-SCommunity Outreaching Services (M=4.51,SD=0.59) Psychiatric Medication (M=4.35,SD=0.64) Self Management Program (M=4.23,SD=0.69)

26. Most important needs PRNQ-CKnowledge on Mental Illness (M=4.30,SD=0.77) Stress Management (M=4.25,SD=0.76) Community Support and Welfare system (M=4.14,SD=0.75) NRNQ-CStress Management (M=4.22,S=0.57) Discrimination (M=4.19,SD=0.64) Knowledge on Mental Illness (M=4.19,SD=0.54)

27. Most important services PRNQ-CFamily Intervention (M=3.70,SD=1.23) Self Management Program (M=3.71,SD=1.19) Emergency Services (M=3.60,SD=1.27) NRNQ-CEmergency Services (M=4.11,SD=0.7) Psychotherapy (M=4.09,SD=0.75) Social Welfare (M=4.07,SD=0.70)

32. Mean

34. *P ≦ 0.05

35. Mean *P ≦ 0.05

36. Mean *P ≦ 0.05

37.  Allocate more resources in terms of funding and manpower on the provision of rehabilitation services (e.g., family intervention, psychotherapy, etc).  Strengthen social, welfare, and financial support to people with schizophrenia and their caregivers (e.g. Comprehensive Social Security Assistance, advocacy groups, etc).

38.  Empower people with schizophrenia and their caregivers and set up channels to solicit their opinions in developing mental health care policy and rehabilitation services given the fact that their opinions are significantly different from normative needs as expressed by mental health professionals in some aspects  Formulate policies and strategies to reduce social stigma on mental illness.

39.  Enhance public education on mental illness by establishing community-based resource centres, setting up hotlines, etc.  Conduct similar needs assessment in a regular way to include other conditions (e.g., bipolar disorders, substance abuse, etc.) and different age groups.

40.  Increase manpower for psychiatric rehabilitation particularly occupational therapists, psychologists, and social workers  Adopt second generation psychotropic drugs to reduce side effects and improve recovery.

41.  Adopt an ‘Integrated Community-based Care Approach’ which allows utilization of available community resources and provides early intervention, crisis support, protected housing, sheltered employment and integrated supported employment.  Develop complementary and alternative approaches to the treatment of mental illness such as cognitive remediation training and mindfulness-based interventions.

42.  Formulate specific policies on provision of psychiatric services for caregivers to reduce their burden, increase their quality of care, and improve their quality of life.  Allocate more resources and manpower on the provision of services for caregivers  Provide more support and practical advice for caregivers on psychiatric symptoms, use of medications, and management of disturbing behaviour and disabilities. 

43.  Provide adequate interventions and support to alleviate caregivers’ emotional crisis in taking care of their relatives with schizophrenia.  Publish caregiver booklet or launch formal care-support programmes, as guidelines or promotions for home-based care.  Set up more resource centres to allow easier access to caregiver supports and information services.

44.  Public Policy Research Grant, RGC  Richmond Fellowship of Hong Kong  United Christian Hospital  Department of Rehabilitation Sciences, The Hong Kong Polytechnic University

45. Thank You!

47. Back

59. Glossary for the Services provided in Hong Kong regarding Public Policy Research (PPR) by (Principal Investigator: Dr. Hector W.H. Tsang, Department of RS, The Hong Kong Polytechnic University) Back