The Grand Challenge:
Mental Health and Social Policy, Fit for the 21st Century
Mental illness is one of the two dominant contributors (the other one is cardiovascular disease) to the global economic burden of non-communicable diseases (Bloom et al., 2011). The high personal, social and economic costs of mental illness (including addiction disorders) and healthcare and rehabilitation provision are the major reasons for the importance of this public policy initiative.
The global cost of mental health conditions in 2010 was estimated at US$2.5 trillion, with the cost projected to surge to US$6.0 trillion by 2030 as populations increase and age over the next two decades (Bloom et al., 2011; Equal Opportunities Commission, Frebruary 2013) i .
Mental health and social policy in Hong Kong is fragmented and it needs clear vision, clear goals and viable funding. The most comprehensive document on mental healthcare and service provision is the Mental Health Service Plan for Adults. This states that “[t]he vision of the future is of a person-centred service based on effective treatment and the recovery of the individual” (p. 5) (Hospital Authority, 2011).
Despite being a major cosmopolitan city the Hong Kong, a coherent and mental health and social policy have not yet been developed over the years. It is difficult to provide comprehensive services when the extent of the problem remains unknown. It is expected that the latest statistics for the prevalence of mental health problems in Hong Kong will be available in 2014/ 15 ii.
Mental health and social policy focuses on conceptualisation, prevalence and cost of mental health issues in society; it examines the services, programmes, workforce training and social policies to support people with mental health problems (Bhugra, Tse, Ng, & Takei, 2014, Dec; Collins, Insel, Chockalingam, Daar, & Maddox, 2013).Mental health and social policy formulation is a complex undertaking because so many different interests, professions and service providers are involved.
- We seek to promote civic engagement, in particular we are concerned about engaging the views, experiences and needs of service users and their caregivers, and that they should be fully and equally represented. In the past the tendency had been to ignore their views, needs and experiences. We embrace the ethos ‘nothing about us without us’iii which signals our commitment in this respect.
- Multi-disciplinary engagement is vital for the success of this project as polices in this area must cover medical, social and occupational recovery and rehabilitation.
- Special attention will be given to comparing and learning from Western and Asian cultures, beliefs and value systems as they relate to effective mental health and social policy implementation and strategies.
The Mental Health and Social Policy research group seeks to:
- Build framework(s) to describe and examine policy-related activities and to better understand where things are
- Inform knowledge, experience, mental health and social policy in Hong Kong, the region and beyond
- Develop awareness among policy makers and key stakeholders through thorough research and good sciences
- Prepare proposals to go to government bodies to advance the development of relevant policy as well as healthcare and social support to address mental health issues
- Professor Samson Tse (Director), Department of Social Work and Social Administration, HKU
- Dr. Ka-Fai Chung, Associate Professor, Department of Psychiatry, HKU
- Mr. Dick, Service User of mental health services
- Dr. Janice Mary Johnston, Associate Professor, School of Public Health, HKU
- Ms. Kan, Service User of mental health services
- Dr. Siu-Man Ng, Associate Professor, Department of Social Work and Social Administration, HKU
- Dr. Mao-Sheng Ran, Associate Professor, Department of Social Work and Social Administration, HKU
- Dr. Paul Wong, Assistant Professor, Department of Social Work and Social Administration, HKU
- Professor Dinesh Bhugra, Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, King’s College London, UK; is also the newly elected-president of the World Psychiatric Association
- Professor Larry Davidson, Professor of Psychiatry and Director, Programme for Recovery and Community Health, School of Medicine and Institution for Social and Policy Studies, Yale University, USA
- Ms. Mary O’Hagan, former Commissioner of Mental Health Commission, New Zealand; is a private consultant for mental health services in New Zealand and internationally
- Dr. Martin Webber, Reader in Social Work, Director, International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, Heslington, York, UK
i Using bipolar disorder (BD) as an example the average age for BD onset is the early 20s, and the condition thus takes a heavy toll on sufferers’ academic and vocational achievements and, importantly, their normal developmental trajectory (Tse, Chan, Ng, & Yatham, 2014). BD affects 2% of the adult population in the US, and subclinical conditions affect another 2.4%. The annual cost of BD in that country has been estimated at US$45.2 billion, 70% of that is attributed to lost productivity (Ferrari et al., 2012; Wyatt & Henter, 1995). Figures on the annual costs and lost productivity of BD are unavailable in Hong Kong.
BD is a mood disorder with two extreme phases: the manic phase, characterised by a sustained high mood and impaired judgment (e.g., over-spending, hyper-sexuality), and the depressive phase, which is often accompanied by suicidal ideation or attempts.
ii The first, and currently only, such survey was conducted in 1984 in Shatin, one of the new towns developed in the New Territories in the 1970s and 80s (Chen et al., 1993). The Hong Kong Mental Morbidity Survey (HKMMS), the first territory-wide door-to-door survey on the community prevalence of mental disorders, was commissioned by the Food and Health Bureau of the Government of the Hong Kong Special Administrative Region in 2010. The results will be released in 2014/15. These results will not only provide comprehensive mental health information about Hong Kong citizens but also empirical data to inform the discourse and formulation of mental health policy in Hong Kong thus making our policy initiative for service planning and development viable and timely.
iii Abstracted from http://en.wikipedia.org/wiki/Nothing_About_Us_Without_Us accessed 7th August 2014: “Nothing About Us Without Us!” (Latin: “Nihil de nobis, sine nobis”) is a slogan used to communicate the idea that no policy should be decided by any representative without the full and direct participation of members the group(s) affected by that policy. This involves national, ethnic, disability-based, or other groups that are often thought to be marginalized from political, social, and economic opportunities.
Bhugra, D., Tse, S., Ng, M. K. R., & Takei, N. (Eds.). (2014, Dec). Routledge handbook of psychiatry for Asia. London, UK: Routledge.
Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., . . . Weinstein, C. (2011). The global economic burden of noncommunicable diseases. Geneva: World Economic Forum.
Chen, C.-N., Wong, J., Lee, N., Chan-Ho, M.-W., Lau, J. T.-F., & Fung, M. (1993). The Shatin community mental health survey in Hong Kong: II. Major findings. Archives of General Psychiatry, 50(2), 125-133.
Collins, P. Y., Insel, T. R., Chockalingam, A., Daar, A., & Maddox, Y. T. (2013). Grand challenges in global mental health: integration in research, policy, and practice. PLoS medicine, 10(4), e1001434.
Equal Opportunities Commission. (Frebruary 2013). Mental health policy and service programmes (Legislative Council paper no. CB(2)679/12-13(03). Hong Kong Equal Opportunities Commission
Ferrari, A. J., Saha, S., McGrath, J. J., Norman, R., Baxter, A. J., Vos, T., & Whiteford, H. A. (2012). Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study. Population health metrics, 10(16), 1-7.
Hospital Authority. (2011). Hong Kong mental health service plan for adults 2010-2015. Hong Kong: Author.
Tse, S., Chan, S., Ng, K. L., & Yatham, L. M. (2014). Meta-analysis of predictors of employment outcomes among people with bipolar disorders. Bipolar Disorders, 16(3), 217-229.
Wyatt, R., & Henter, I. (1995). An economic evaluation of manic-depressive illness-1991. Social psychiatry and psychiatric epidemiology, 30(5), 213-219.