1. The Mental Health of Adolescents in Hong Kong: A Shifting of Paradigm in Intervention, Service and Policy Professor Kam-shing YIP Professor Department of Applied Social Sciences The Hong Kong Polytechnic University E-mail: ssksyip@polyu.edu.hk

2. Two Cases for Reflection A: a male adolescent who was a victim of bullying and becomes a client with first onset of paranoid schizophrenia A: a male adolescent who was a victim of bullying and becomes a client with first onset of paranoid schizophrenia B: an female adolescent who was prolonged sexually abused by his elder brother and suffers from borderline personality disorder, substance abuse and self cuttings. B: an female adolescent who was prolonged sexually abused by his elder brother and suffers from borderline personality disorder, substance abuse and self cuttings.

3. Paradigm Shift Vs Paradigm Fixation Abnormality Vs Normality Abnormality Vs Normality Adult Vs Adolescent Adult Vs Adolescent Institutionalization Vs Community Integration Institutionalization Vs Community Integration Impairment Vs Strengths Development Impairment Vs Strengths Development Biochemical Vs Interpersonal Biochemical Vs Interpersonal Emergency Vs Recoverability Emergency Vs Recoverability (Implications to Intervention, Services and Policy)

4. Abnormality Vs Normality Abnormality Orientation - Persons with Mental Illness are Abnormal Persons - Persons with Mental Illness should be Treated Abnormally - Persons with Mental Illness should be Excluded and Isolated from Society - Persons with Mental Illness Even after Recovery can only become Persons with Low Normality Normality Orientation - Persons with Mental Illness are also normal persons - Mental health and mental illness is not mutually exclusive but co-existing to one another - Everyone to certain extent is mentally healthy and mentally unhealthy - Every person including person with mental illness should be regarded as normal persons with right, dignity and individuality

5. Shifting from Abnormality to Normality The Fallacy of abnormal persons needs abnormal treatment; and abnormal persons make an abnormal persons become normal Adolescent with mental health problems are due to oppressive and stressful abnormal environment (Normal Persons with Normal response within abnormal environment) Recovery is a regain and reaffirm of normal treatment within a normal environment with love, genuineness, care and meaningful relationship and life pattern

6. Adults Vs Adolescent Adult Oriented Intervention - Comparatively Stable Self System - Comparatively Clear Diagnosis - Formal Communication - Private Practice Oriented Clinical Practice - Individual orientated intervention Adolescent Oriented Service - Comparatively unstable self system - High co-morbidity in Diagnosis - Informal Communication - Relationship oriented practice - Family and social environment oriented intervention

7. Shifting from Adult Oriented Service to Adolescent Oriented Service Adolescents with mental problems should be recovered with service and intervention that are: 1. Facilitating normal meaningful relationship 2. Advocating and constructing supportive normal social environment 3. Preparing holistic & humanistic support for different possibility of crisis and emergencies 4. Re-affirming adolescent’s manifestation and development of potentials, ability and strengths

8. Institutionization Vs Community Integration Institutionization - Hospitalization - Servicization - Medicalization - Bureaucratization - Legalization - Chronicization - Dehumanization Community Integration - Community based intervention - Affirming normal community life pattern and activities - Persons in environmental Care - Avoidance of un-necessary and fixated medical treatment and hospitalization - Medical Treatment cowork with psychosocial support - Adolescent Participation and Decision - Humanizing crisis intervention and emergency handling

9. Shifting from Institutional Care to Community Integrated Care Adolescents with mental health problems should avoid unncessary medication, detention, hospitalization, restriction and labelling Adolescents with mental health problems should be treated and recover within - a community based and integrated service network - A normal community life (school, family, recreation, peer interaction, courtship and employment) - A normal respect, genuine concern, empathetic understanding and supportive expectation

10. Impairment Control Vs Strengths Development Impairment Control Disease & treatment Disease & treatment Disorder and control Disorder and control Inadequacy & training Inadequacy & training Disability & rehabilitation Disability & rehabilitation Problem & solution Problem & solution Strengths Development Potential & manifestation Pattern & consolidation Merit & appreciation Ability & actualization Difficulties, challenges & coping

11. Shifting from Impairment Control to Strengths Development Adolescents with mental health problems should not be regarded as diseases, disorders and impairment. Their potentials, abilities, merits, strengths can be manifested, actualized, developed and consolidated. In doing so, their basic psychosocial needs can be met with a result of recovery of mental health problems

12. Biochemical Vs Interpersonal Biochemical Interpretation - Genetic Determinants - Neuro-transmittor - Medication, EEC, Psychosurgey is the only solution Irreversible harmful effect, accumulative effect Vs immediate effect Placebo Effect Vs Real effect general effect Vs specific effect Retardation effect Vs Treatment effect Conspiracy and Hiding the Real Fact (Briggin: 1994 ) Interpersonal Articulation - parental child relationship - Family trauma, abuse and violence - Instability in attachment - Affective bond - Manipulating relationship - Exploitative interaction - Oppressive Social environment

13. Shifting from Biochemical to Interpersonal Articulation Adolescents with mental problems should not be solely regarded as biochemical and genetic problem and medication is the only solution. Adolescents’ mental problem is closely related to interpersonal oppression, manipulation and exploitation with their significant others. Building a supportive social environment and advocating adolescents’ rights, opportunities and respect in society is crucial in intervention.

14. Emergency Vs Recoverability Emergency: Psychiatric Emergency Crisis Intervention Violence Control Abuse Protection Suicide Management Recoverability Strengths oriented & Holistic Self directed & Individualized path Mutual Help Empowerment Hope & Respect Responsibility No Linear

15. Shifting from an Emergency Taxonomy to Recovery Based Adolescents with mental problems should be attended only when emergency and crisis comes. Services and Intervention should not be narrowed by emergency and crises focus. Instead, holistic, individualized, peer support, strengths and empowerment, hope and respect, holistic and responsibility based recovery should be the sole focus in adolescent mental health services and intervention