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: [email protected]
Two Cases for Reflection

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.
Paradigm Shift Vs Paradigm
Fixation
Abnormality Vs Normality
 Adult Vs Adolescent
 Institutionalization Vs Community Integration
 Impairment Vs Strengths Development
 Biochemical Vs Interpersonal
 Emergency Vs Recoverability
(Implications to Intervention, Services and Policy)

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
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
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
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
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
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
Impairment Control Vs Strengths
Development
Impairment Control
 Disease & treatment
 Disorder and control
 Inadequacy & training
 Disability &
rehabilitation
 Problem & solution
Strengths Development
 Potential &
manifestation
 Pattern & consolidation
 Merit & appreciation
 Ability & actualization
 Difficulties, challenges
& coping
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
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
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.
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
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
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The Mental Health of Adolescents in Hong Kong: A Shifting of