World Federation of Occupational Therapists Bulletin

ISSN: 1447-3828 (Print) 2056-6077 (Online) Journal homepage: http://www.tandfonline.com/loi/yotb20

My recovery journey – service users experience of

occupational therapy Recovery Oriented Practice
in Hong Kong

Ida Wai Mei Chan

To cite this article: Ida Wai Mei Chan (2014) My recovery journey – service users experience
of occupational therapy Recovery Oriented Practice in Hong Kong, World Federation of
Occupational Therapists Bulletin, 70:1, 36-38

To link to this article: http://dx.doi.org/10.1179/otb.2014.70.1.010

Published online: 19 Dec 2015.

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 My recovery journey – service users experience of
occupational therapy Recovery Oriented Practice
in Hong Kong
Abstract: Using the story of a person’s journey through recovery, the concept of the
Recovery model in psychiatric service is revealed. The medical model mainly focuses on
clinical recovery that is the elimination or control of symptoms and restoration of function,
whereas the Recovery model is concerned with personal recovery, which is the holistic processes
of coping with challenges imposed by mental disorders (Johnson 2008). The Recovery model
emerged from the consumer/survivor movement in the 1970s, transited in 80s–90s and came
to fruition in the millenniums across the world. The introduction of the model to Asia led to a
reform in the mental health services of Hong Kong. This article described a real case to demon-
strate how an occupational therapist facilitates a person with Bipolar Affective Disorder to
take her recovery journey.
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Recovery model, Recovery Oriented Practice, mental health, Hong Kong.

Ida Wai Mei Chan
(Hong Kong) Key words:

including TRIP programme (Lee and Chan, in press), Illness

Introduction
The conventional view based on medical model has directed
government policy in mental health service development
of Hong Kong (HK) over the last century until 2010. With the
launch of Hospital Authority Mental Health Service Plan for
Adults 2010–15, the mode of service has shifted to focus on
recovery which promotes individualized care and engagement
of service users to build up their resilience and confidence,
develop healthy lifestyle and social capital, so as to pursue
independent living in community (Davidson et al).
Development of Recovery Orientated
Practice of OT in HK
In 2010, a Task Group on Recovery Orientated Practice (ROP)
under Mental Health Service Steering Committee, Occupational
Therapy Central Organizing Committee was set up to guide the
development of ROP and the followings had been achieved:
1. Recovery Self-Assessment (RSA) had been adopted as a
measurement tool to benchmark OT services across
Hospital Authority.
2. Training had been organized to promote ROP to local
therapists, such as Advanced Specialty Programme on
ROP and Illness Management by Professor Kim Musser
in 2011 and experience sharing session on local ROP in
2012. Besides, an e-courseware will be ready by 2014.
Management and Recovery Programme (IMR) ( XX
360), 5 Ways to Wellbeing (X X ) and the
In-patient Enhancement Programme, My Recovery My
Action (X X ).
4. Research activities were still in progress, such as a vali-
dation study on the Chinese RSA-User Version and the
effectiveness of IMR-HK Version.
The following is an illustration of a person with Bipolar
Affective Disorder and how an occupational therapist
incorporated the recovery components to facilitate her
recovery journey by developing a good balance between
clinical and personal recovery and eventually achieving a
satisfying lifestyle.
Experience sharing by case study –
“From Discovery to Recovery”
Story of Hung Yee (X X )
“The Unbearable Swingness of Being”
Hung Yee was the only child of a well off family. She got her
Masters degree at a young age, owned her business and had
a powerful job, yet emotional ups and downs were happen-
ing around her life.
“Mood swings had always been an old friend, or haunting
ghost, since I was little.”

3. Different recovery-oriented treatment programmes She attempted suicide when her mother passed away
had been developed or translated for local application, suddenly. She was treated in the private sector for a very

36 WFOT Bulletin Volume 70 November 2014

 short period of time and diagnosed with depression. She
was back on the right track and engaged in her busy life
again. However, it was not the end of the story.
“I want a way out” of all these mess was all I could think of
during the darkest days of my life. I only felt that I needed a way
out, and a permanent exit would be the answer to my problems.”
She tried to kill herself again and finally she came to the
attention of the public mental health service. She was admitted
to hospital and her journey of recovery formally started.
In-patient phase – “the Nuthouse is more than
just Nutella”
When Hung Yee was admitted to the psychiatric ward as
an in-patient, she are invited to join different therapeutic
group programmes organized by occupational therapists.
Usually, the group programmes covers four domains: voca-
tional, life skills, self and illness management, and leisure.
She was empowered to make her own choices of activities
daily, as we believe that service users are the experts of their
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own lives. At the same time, occupational therapists explore
their needs and suggest different treatment options for them.
Hung Yee started with some interest classes in OT sessions.
“After being more emotionally stable, the ward offered me occu-
pational therapy by attending their day-time activity. It was
like a sweetener to the relatively dry life staying in the ward…
There I got the chance to participate in different activities and learn
something interesting. The nice thing is, this service respects my
free will. Nothing is compulsory, you pick what you enjoy doing.”
After a thorough discussion and exploration with Hung
Yee, the case occupational therapist suggested she join the
Occupational Life-Style Redesign programmeme to enhance
her awareness of favorable and unfavorable factors of her
old style of living, and help her to set goals for the optimal
life-style in future.
“Having aspired to and trained to be a high power executive, it
was a drastic move to step down from such glory. Against the
background of several rounds of burn-out and near break-down,
and with the sensible advice from my OT, I slowly came to an
awakening and accepted that this might not be the best way to
lead my life in the years to follow. Her advice for me was to
take up something lighter so I did not have to drive myself crazy
to achieve, like before.”
Hung Yee was discharged home after 7 months of
in-patient treatment.
Post-discharge phase – “Co-dependence to
independence with autonomy in between”
Hung Yee joined the Recovery Support Programme service
immediately after her discharge; her case occupational
therapist extended her role as a community case manager.
A new service, Recovery Support Programmeme was devel-
oped in 2009 (Hospital Authority 2009), which incorporated
recovery model and case management model to support
WFOT Bulletin Volume 70 November 2014
the post discharge adjustment and recovery of service users
in the community. Occupational therapists act as case man-
ager in RSP to facilitate them to go through the recovery
process in the community. The hospital is a protective shelter,
whereas the real challenge is in the real life situation. Hung
Yee’s case manager made weekly home visits to her and worked
with her to cultivate different opportunities to facilitate her
generalization of all the knowledge and skills learnt from
hospital into daily practice in her own living environment.
The Recovery journey is a non-linear process. Hung Yee
was originally diagnosed as depression, yet after discharge
her behavior and overall presentation changed signifi-
cantly. She turned on a turbo, picked up big projects, spent
a lot of money in a week, and seemed fuelled with energy.
Her case manager then reviewed with her what she has
learnt in the Illness Management and Recovery Programme
in hospital. Through this process she was empowered to
manage the illness by herself, by going through her own
list of signs and symptoms and matching it with her history.
Both Hung Yee and her therapist found that it was not
likely that what she was experiencing was pure Depression.
Her diagnosis was eventually revised to Bipolar Affective
Disorder and the medications were adjusted. She was now
able to take up her own responsibility to manage her illness
as well as her life.
“This independence would not have come so gracefully had I not
received sensitive and thoughtful care through the Recovery Support
Programme. Showered with weekly home visits, my therapist
observed that I was not an authentic depression case. I was
actually BAD to be exact. I was really thankful that she was so
observant. Now I had an explanation for how I feel and what I did,
and best of all, a solution, a hope to obtain my internal peace.”
“With the change of medication came also new management
skills. My therapist had the patience and skills to tame a wild yet
intelligent being to pick up new tricks. Thanks to the laundry list
of symptom indicators, I gradually came to grasp how to monitor
plus manage my situation with a heightened sense of reflection
and sensitivity.”
Peer volunteer phase – “If I can do it, SO CAN
YOU!”
The therapeutic relationship between Hung Yee and her
therapist has changed by the end of the RSP service. Hung
Yee has a lot of talents indeed. She has a gift in music, rich
experience in teaching and a big heart, and she is ready to
make use of her strengths and personal experience in the
journey of recovery to be a role model for her peers. She
joined the Peer Volunteer Programmeme and took up the
responsibility for organizing interest classes in the occupa-
tional therapy department.
“I am now serving the OT unit as a Peer Volunteer, teaching
English on a weekly basis. My favorite opening line is: I was
once hospitalized for 7 months. Here I am back on my own feet,
alive and kicking. If I can do it, SO CAN YOU!”
37
 Reflection by Hung Yee and her
therapist
“Personally I have used various kinds of helping profes-
sionals in the past decade or so, both in the public and
private sectors. My OT is by far the best! She treats and
respects me as a person (not a case on file!), and helps me
with a holistic approach. She coaches me to understand my
illness, and guides me to learn to reflect on any emerging
symptoms. Raising self-awareness is important for someone
like me living on my own. This empowers me to be inde-
pendent and autonomous, instilling strength and hope for
leading a peaceful yet fulfilling life.”
Hung Yee
In the past, the medical model directed the policy making,
service planning, professional training, as well as the roles
of professionals and patients. When I was an OT student,
I was trained to fit into the “Treat- and-recovery” mode
and believed that patients had to be treated and recover
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first before reclaiming an ordinary life in the community.
This mode guided my practice as an OT for a long time
until the discovery of the Recovery model (Ho et al 2010).
It overturned the role of professionals and patients; patients
were empowered to take an active role in the treatment
process; the focus of treatment emphasized their needs
and not just their problems and we saw the strengths of
the patient instead of the weaknesses. I needed to admit
that there was a struggle between using Medical model
and Recovery model in my practice. However, by going
through the recovery journey with Hung Yee, I was able
to see how there can be a good balance between these two
models. The critical point was how much you respect that
people have aspirations and talents as well as disabilities
and needs. Hung Yee’s recovery had its ups and downs. As
long as she was equipped to self-manage her illness, she
could live with the illness and lead a peaceful yet fulfilling
life on her own. There was no need to take sides with either
model, you just need to stand firm with the OT vision “All
the clients shall live the meaningful life of their choice.”
and keep a good balance.
Occupational Therapist
38 WFOT Bulletin
Conclusion
Medical model dominated the overall development of health
care services for centuries. The emergence of the recovery
model is indeed an evolution for our current practices and
health care system. It is an art and challenge for us to explore
the optimal positions among all health care providers, service
users and their carers.
References
Davidson, L., O’Connell, M., Tondora, J., Recovery in Serious Mental Illness:
Paradigm Shift or Shibboleth? Retrieved January 1, 2014 from,
Programme for Recovery and Community Health of Yale University
and the Connecticut Department of Mental Health and Addiction
Services. Website: http://www.ct.gov/dmhas/LIB/dmhas/Recovery/
paradigmshift.pdf
Ho, W.W.N., Chiu, M.Y.L., Lo, W.T.L., Yiu, M.G.C. (Winter 2010) Relevancy
and Challenges of Recovery Model: A Primer Review. Hong Kong
Journal of Mental Health, 36(2), 4-17.
Hospital Authority (2012) Hospital Authority Mental Health Service
Plan for Adults 2010-2015. Retrieved September 1, 2010 from,
Hospital Authority Website: http://www21.ha.org.hk/files/PDF/
mental%20health%20platform/MentalHealthServicePlan_Pamphlet
_ENG_Final.pdf
Hospital Authority (2009) Operational Manual for Recovery Support
Programme for Discharged Psychiatric Patients in the Community.
Johnson, A. (2008) Evaluation of a hospital’s transition to the recovery
model approach. Graduate School of Education and Psychology.
Pepperdine University. Doctor of Psychology.
Lee, S.W.K., Chan, S.H.W. (In press) Illness Management Training:
Transforming Relapse and Instilling Prosperity in an Acute Psychiatric
Ward: An user’s perspective. In S. Ingrid. (Ed). International Handbook
of Occupational Therapy Interventions. (2nd ed). NY: Springer.
Address for correspondence
Ida Wai Mei Chan
Occupational Therapy Department
Pamela Youde Nethersole Eastern Hospital
No. 3 Lok Man Road, Chai Wan, Hong Kong
Email: chanwm07@ha.ogr.hk
Volume 70 November 2014