MENTAL HEALTH RECOVERY PRACTICES IN TAIWAN POTENTIAL NEW LENS FOR COMMUNITY MENTAL HEALTH

Taipei Medical University/PingtungChristian Hospital

DuujianTsai

Research Team Members

Duujian Tsai 1,2 , Vincent Chin-Hung Chen 2,3 , Ai-Ling Huang4, Tsang-Yaw Lin5, Yu-Chia Chen6,

Chih-Yuan Lin4, Chung-Ying Chen5, Cheng-Chung Chen7

1. Taipei Medical University2. Pingtung Christian Hospital 3. Chiayi Chang Gung Memorial Hospital4. Taipei Veterans General Hospital Yuli Branch5. Tsao-Tun Psychiatric Center6. Social Empowerment Alliance7. Kaohsiung Municipal Kai-Syuan Psychiatric Hospital

Email： Duujian Tsai: duujiantsai@gmail.com

Backgtround

Issues related to mental health: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care.

Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making.

There is a need for a fundamental shift in the context of the provider–service user relationship to fully facilitate service users’ engagement in their care.

D Newman et al. 2015

Objectives

This paper reviews the development of community mental health recovery practices in Taiwan.

A collaborative and interactive paradigm featuring community engagement will be proposed to replace biomedical as well as individual-oriented models.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

3rd layer Taiwan as a Therapeutic Community

Yu-Li Township as 2nd layer TC

Hospital as 1st Layer TC

Three Layer Model of Therapeutic Community—Yuli Model

TaipeiNorth

East

Central

Penhu

South

Kaoshiung

BALANCINGthose oppositional binary extremes between institutionalization & deinstitutionalization.

New Asian Value Formation

Community Based International Parternership

Psychiatric hospital/Institute Mental health center

Department of Mental Health

Psyc H

General H

Community H

Health Center/PCU

Village Health Volunteer

Person

Province

Sub districtVillageFamily

Health ServicesLevel of Administration

Ministry of Public Health

Administration line Supervision and collaborati on line

District

Region

Self care

Primary mental health care

MH screening /monitoring

Outpatient services for common psychiatric

disorders

Specialized comprehensive psychiatric care

Mental Health Services

U-societyPromoting Asian Theories

For Developing Recovery Model Under U-society

Materials and Methods

A contrast-of-context historical approach is adapted to analyze the oral narratives and documentary archives of various recovery models in Taiwan, with comparison to approaches found in recent literature reviews of professional journals.

Following the discourses on humanistic deinstitutionalization and therapeutic communities, Taiwan has gone through five phases of establishing recovery models.

Identity narrative approach

Starting from the person

Story

Story

complete

Language Step 2(externalization)

New meanings and values

Language Step 1(internalization)

（social meanings,cultural values）

HistorySocietyInstitutionFamilyIndividual

incomplete

Therapeutic Community

Branch of Taipei Veteran General Hospital Yu-li

Yuli Veteran Hospital

In the Yuli Therapeutic model (YLTC), the extent to which patients can produce thick description in the oral history interviews, integrate experiences they have encountered, relate how they feel and what they explain at different stages in sharing their life stories is related to their residual function.

Yuli

rely heavily on the interviewer’s support

I: Are you feeling it is difficult to follow those rules?

A: For me? No, it’s not difficult. I will be fine after taking a rest.

I: Then, what do you feel when you say your consciousness is not clear?

A: When I feel (it is) unclear, I take a rest. Is that what you mean?

I: So, you want to keep mentally clear.

A: I want (it) to be clear as (in) my normal life. When I need to, I have to take a rest.

I: You feel better after taking a rest?

A: Yes.

I: How often does the psychotic episode happen? Is it bothering you frequently?

A: Just need to take a rest. At present, I don’t feel too bothered. It’s fine for me during the time period of the episode.

I: How do you cope with it when your illness occurs?

A: When I’m ill, I have to keep clean and sleep. I will eat my meal first, then take a bath, change clothes and finally go to sleep.

I: Do these activities help?

A: Take a bath, change clothes, eat a meal, take a bath…no, the order is to eat a meal, then to take a bath, and then to sleep. Eating and sleeping are important. I need both. Sometimes, I may chat and have a cigarette…

I: You just said that you suffer from schizophrenia. Can you feel it? (How) do you feel your own symptoms….

A: Yes. It is when I feel lethargic.

A drowsy feeling creeps over me. I cannot sleep… Cannot sleep….Right now I feel a bit drowsy….

I: Now?

A: enn…

I: Do you want to take a rest?

A: Yes. I have to. (A1002)

I: Do these activities help?

A: Take a bath, change clothes, eat a meal, take a bath…no, the order is to eat a meal, then to take a bath, and then to sleep. Eating and sleeping are important. I need both. Sometimes, I may chat and have a cigarette… (A1002)

patient with better residual functions

I have many ideas and tend to think too much. I just like thinking. It is my nature to indulge in flights of fancy. I so like to let imagination run wild by habit, friendships….. Unrealistic utopian fantasies are my daily favorites. I cannot resist doing it. However, I realize that I have to find a balance between fantasy and reality to be happy. I am happy only when I can reach a satisfactory point in my thinking. It is really hard for me to find a satisfactory balance in my daily life. (A1001)

I have to rely on psychiatric medicine. Without it, my mind will be filled with crazy thoughts and fantasies. Taking medicine helps me control my psychosis. Ideas then are not able to come out. No way to fantasize…. If I do not take medicine, I will start to feel crazy and have extreme fantasies. So many different issues will arise in my mind. Medication helps me control my emotions as well as my mental status. (A1001)

The narrative competence of psychiatric patients is an important foundation for shaping collective life, whether they are in deteriorating or recovery mode.

The Yuli Therapeutic Community

The Earthquake Recovery Model

The Earthquake of September 21, 1999

These functions could be considered valuable forces in all cultural, natural and physical senses.

Accordingly, a remarkable self-healing power was evident in communities there.

We observed continuing life functions for survivors in one of most damaged areas, Chi-Chi Township, right at the center of the earthquake in Nantou County.

After the 921 earthquake, familiar places seemed foreign to people in Taiwan.

Phase Changing Rapidly after Eearthquake

Emergent care

Urgent allocation

Environmental health issues

Temporarily housing

Recovery phase

Health promotion

社區組織模式

Model for community Empowerment

Central government County governmentMilitary commander

Local NGOsCommunity leadersCounty health bureau

Farmer’s societies

Partnerships between Universities and community health center

Women groups

Supports from social welfare divisions

Community health Recovery& promotion center

Daily regular meetingsat county government

Family supporting centers from welfare division

Community networksfor mutual supports

Community Recovery Model for improving quality of life & public health

essential conditions to promote participation in decision making: having personal support,having access to knowledge, being involved in a dialogue and clarity about responsibilities.

JÖNSSON et al, 2015

In hospital settings as well as in indigenous communities

Dealing with substance abuse

Jia Lao Village（Therapeutic community ）

The therapeutic model used for treating substance abusers at the Tsao Tun Psychiatric Center. The Jia Lao Village

This therapeutic community was first established in 2007 with funding from the Ministry of Health and Welfare.

20

The organizational culture

The narratives of residents there are very coherent and go in depth into various life experiences.

This resident regards the JLVTC as a supportive environment to help substance abusers rebuild their social life with different skills training.

This kind of culture of mutual support is very important for the TC for substance abuse.

A complementary therapeutic model are finally proposed based upon narrative

identity findings.

III: Taiwan as TC

II: Yu-Li Town as TC

I: Hospital as TC

Hospital care

TC for substance abuers as Complementary to Yu-Li Model

TC in Jia Lao Village

TC for the Severe Mental Ill

Peer-based support like Alcoholics or Narcotics Anonymous can be helpful for people with serious mental illnesses, particularly when programs accept use of mental health medications.

Green et al. 2015

Sense of Empowerment through Oral History Practice

Take oral history project to various opinion leaders in tribal areas, students become aware of the power of reflexivity in indentifying natives' narratives.

This power led students and teachers to recognize relative narratives in multiple settings or from various persons; however, broader consensus could be reached at a higher level, with sensitivity to narrative formation or reconfiguration.

As a result, possibilities of empowerment are therefore everywhere when we realize new identity formation could be initiated.

24

金岳社區發展協會

結合歷史記憶與社會脈絡

9 ethnicgroup atverybeginning

12 afterpassing thefundamentallaw

Now thereare 14 ethnic groups

Moving toward 16Ethnic groups

the death rate of traffic incident drop from number one of death cause to number 4, the teenage pregnancy reduced from 69.2‰to 29.4‰，gouty OPD visit number drop from the number one to number seven. These are along with a cultural renaissance movement with attention to alcoholism in cultural terms: we should drink only for ceremony rather than in daily life. Only drink the wine made my our own with traditional custom and curtsey , which will never lead to be drunken

The death rate of traffic incident drop from number one of death cause to number 4, the teenage pregnancy reduced from 69.2‰to 29.4‰，gouty symptom OPD visit number drop from the number one to number seven. These are along with a cultural renaissance movement with attention to alcoholism in cultural terms: we should drink only for ceremony rather than in daily life. Only drink the wine made my our own with traditional custom and curtsey , which will never lead to be drunken.

integrate mental health promotion and recovery for people with ADHD

mobilizes family and social support networks

ADHD Family Support Group－A Hospital-based Model in Taiwan

Learning from the oral history approach

（1） Parents stated: ‘We have to help our children find a way to work towards having peaceful minds.’ ‘It may be through breathing exercises to help free them from panic.’ Parents also ‘assist and guide children to cultivate the habit of taking notes.’ Those behavior techniques help.

（2） ‘While watching the kids absorbed in things that interest them, we are very much moved by the various ways they try to overcome their inner obstacles.’

（3） ‘Everybody has to find their own way of getting through life. Happiness and self-sufficiency will follow. I will do my best to accompany my children in their process of searching.’

（4）‘A capable schoolteacher is able to identify the strengths of different children and provide appropriate guidance, encouragement and support.’ ‘The teacher gives a case responsibility and recognition of his/her achievements. These kids behave in totally different ways to achieve superb performance.”

People whose networks can be characterized as having a pro-medical culture report better recovery outcomes.

Perrya and Pescosolido 2015

service-oriented collaborative model

Recovery-Oriented Care: A Paradigm ShiftMcKenna et al, 2014

Mixed Recovery Model

Rehabilitation Shop Victory Gas Station

Community Mental Health Center

Tribal Village & Holding Center

humans are more relational, ‘gift-exchanging animals’ who are naturally disposed to cooperate for mutual benefit.

ADRIAN PABST 20 July 2012

Modern economics assumes that human beings are fundamentally self-interested.

Conclusions

A new sense of communal life can be seen as the most crucial resource for developing innovative recovery models of community mental health.

Such communal life should be capable of emancipating patients and their families from the biomedical paradigm by recognizing their own innovative competence in the process of developing therapeutic communities.

Lessons attained here will provide a new lens for further endeavors for smart technology innovations as well as international collaborations in reducing mental health gap.

Thank you for all your attentions.

three scientific challenges: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship. AMERING et al, 2014