Stand by me
Few of us can comprehend what life is like for people coping with schizophrenia and other psychiatric problems. Even immediate family members may fail to empathise, as Cheung Yuk-way can testify.
She became concerned when her daughter, Sandy Pang, started behaving oddly, talking to herself into the night and sitting out in the park in the rain. Pang was eventually diagnosed with schizophrenia, and after short stays in a mental ward spent four years in a halfway house in Wong Tai Sin run by the New Life Psychiatric Rehabilitation Association.
Cheung knew little of mental illness and, following her daughter's discharge in 2009, joined a support scheme for former patients' families to learn more about schizophrenia. But Cheung's husband showed far less compassion.
'After she was discharged, my husband would scold her for being lazy and not finding a job. But I learned that fatigue and listlessness are among the side effects of the psychotropic drugs she was taking, and urged my husband to be more understanding,' says Cheung, a cleaner.
'I also learned about the symptoms of a relapse and how to handle such a situation. Schizophrenics are prone to long and incoherent ramblings. I used to lose my temper whenever she did that. I have learned to take her out for a walk instead.'
Because her husband has yet to come to terms with their daughter's difficulties, Cheung moved out to live with Sandy to ease her transition into everyday life.
'I moved out ... [because] I was afraid that she had become accustomed to group living and would find it hard to live on her own,' she says.
Recently, organisations serving psychiatric patients have put more emphasis on the role of family in their rehabilitation. The shift comes in response to a government drive to strengthen community support following a 2010 chopping attack, when a man with a history of mental illness killed two people and seriously injured three others in Kwai Chung. The tragedy also led to the establishment of 24 government-funded centres across the city to help former psychiatric patients reintegrate into society.
Francis Yiu Man-kit - a social worker at one of the centres, the Lok Hong Integrated Community Centre for Mental Wellness in Wong Chuk Hang - says family members usually best understand the patients and the critical role their support plays in recovery.
'They must learn about the illness and what to do in case problems arise,' Yiu says. 'If patients stop taking medication, instead of scolding them and forcing them to take it, they should tell a doctor to see whether there's a need to change the prescription. In most cases, patients stop taking the medication to avoid debilitating side effects, such as a loss of appetite and insomnia.
'Family members are also under a lot of strain seeing the condition of their loved ones worsening. Racked by guilt, some parents blame their poor parenting for their children's mental illnesses. Counselling can help family members learn to let go.'
Ah Chun, 25, who was diagnosed with bipolar affective disorder in his last year of university in 2009, worries about the strain his condition puts on his father, a driver who divorced his mother when he was little.
'He thought his failed marriage triggered my depression and developed insomnia after my diagnosis,' he says.
But his father's condition improved after Yiu, who took charge of Ah Chun's rehabilitation, intervened.
'He accepted that it was not his fault and knows how to deal with me when I begin to show signs of hyperactivity,' Ah Chun says.
Eppie Wan Ho-yu - senior supervisor at Tung Wah Group of Hospitals' Wong Chuk Hang Complex, which runs the Lok Hong centre - says tragedies involving mental patients can be pre-empted by reaching out to family and neighbours.
'The establishment of the centres is a big improvement on existing support services for mental patients,' Wan says. 'Before that, we had health professionals to follow up on the recovery process. But this service is available only to people who were admitted to mental wards and are referred to us after they were discharged.'
But many mental illnesses, such as psychosis, do not warrant a hospital stay, so when these people's families seek help, Wan and her team have to turn them away
According to the Mental Health Service Plan for Adults 2010-15, released by the Hospital Authority following the Kwai Chung tragedy, 25 per cent of Hong Kong's population, or 1.7 million people, have some kind of mental disorder.
About 3 per cent of the population, or 200,000 people, suffer severe mental illness.
Citing the experience of care providers around the world, the report says mental health services that are overly hospital-based are unlikely to meet the needs of the population.
This is why, of about 40,000 diagnosed schizophrenic patients in Hong Kong, about half are expected to be managed solely within the community through mental wellness centres.
Dr Eileena Chui Mo-ching, associate consultant in psychiatry at Queen Mary Hospital, says the centres, set up in 2010, provide an avenue for residents to seek prompt help before a tragedy occurs.
'When people suspect that they or a family member has a mental ailment, they are not sure whether or where they should seek medical help,' Chui says. 'Even if the symptoms are mild, they can now go to the centres for help.'
Cheung Yuk-way understands how helpless family members can feel when there is poor community support.
When her daughter began showing signs of mental breakdown in 2003 after breaking up with her boyfriend, Cheung tried to seek help.
'I took her to see a government social worker, who said she was fine. I had to take her to Guangzhou, where a psychiatrist confirmed a diagnosis [of schizophrenia].'
Now as a saleswoman with a social enterprise run by New Life, Pang says her mother's support helped her overcome her mental illness.
'She visited me often when I was in hospital and the halfway house. She has stood by me no matter what I do. She helped me get my life back.'