Beyond Illness and Treatment

Abstract

Peer support workers or peer experts are a new workforce in the mental health services of Hong Kong. As two of the few peer support workers in mental health services, we share our experience in working in a regional hospital. We share the amazing benefit of this new workforce to service users and service providers as well as the obstacles in the further development of this service. We hope our experience can help to examine the implementation of peer support services in Hong Kong. As this service is still in its preliminary stage in Hong Kong, we are looking forward to establish a win-win situation for both our peers and the service providers for the enhancement of mental health services in Hong Kong.

Alternate abstract:

East Asian Arch Psychiatry 2014;24:125-7

THEME PAPER

Beyond Illness and Treatment

疾病和治疗以外的经验之谈

TCS Chang, JSY Liu

张志成、廖淑仪

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Ms Tobata C. S. Chang, Peer Support Worker, Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China.

Ms Jennifer S. Y. Liu, Peer Support Worker, Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China.

Address for correspondence: Ms Nancy Pang, Peer Support Service, Department of Psychiatry, Kowloon Hospital, 147A, Argyle Street, Kowloon, Hong Kong SAR, China.

Tel: [phone]; Fax: [phone]; Email: [email protected]

Submitted: 4 March 2014; Accepted: 13 June 2014

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pdfFull Paper in PDF

Abstract

Peer support workers or peer experts are a new workforce in the mental health services of Hong Kong. As two of the few peer support workers in mental health services, we share our experience in working in a regional hospital. We share the amazing benefit of this new workforce to service users and service providers as well as the obstacles in the further development of this service. We hope our experience can help to examine the implementation of peer support services in Hong Kong. As this service is still in its preliminary stage in Hong Kong, we are looking forward to establish a win-win situation for both our peers and the service providers for the enhancement of mental health services in Hong Kong.

Key words: Mental health services; Peer group

摘要

朋辈支援工作者或朋辈支援专家成为近年香港精神健康服务的新力军；作为这个为数不多团队 的一份子，本文分享其中两名精神健康服务朋辈支援工作者在某地区医院的经验，包括他们的 工作对服务使用者和提供者所带来令人鼓舞的效益，以及当进一步发展服务时所遇到的困难。 他们希望相关经验有助进一步发展香港的朋辈支援服务。在香港，这项服务仍处起步阶段，期 待达致服务使用者和提供者的双赢局面，提高香港精神健康服务的质素。

关键词：精神健康服务、朋辈

Introduction

We are Tobata and Jennifer, 2 peer support workers (PSWs) from Kowloon Hospital of Hong Kong. We have been working here since 2012. Tobata works in the rehabilitation team while Jennifer mainly helps in the Early Assessment Service for Young People with Psychosis (EASY) team. We prefer calling ourselves PSW instead of peer expert as we can call ourselves experts in our lived experience as persons with mental health difficulties; however, we are still green to be a worker in peer support service. We hope we can put less stress on ourselves and feel equal with our peers in this way. We would like to introduce ourselves briefly before we share our wonderful experience as PSWs.

Tobata has been suffering from bipolar affective disorder for over 30 years with repeated admissions to mental hospitals in the past years. She has been a member of the Kapok Clubhouse in Kowloon Hospital for 6 years and joined the 3-week basic clubhouse training with staff in Australia before she was recruited as a PSW.

Jennifer is a young lady who was diagnosed with psychosis while she was preparing to study in university 5 years ago. She joined the SHINE (晴天力量) group, a peer volunteer group of the hospital, before she started working as a PSW.

Both of us are service receivers and hope that one day we can have a chance to contribute back to the society, especially to those who have mental health problems. In the Kapok Clubhouse and the SHINE group, we gained knowledge about recovery and peer support; thus, we applied for the PSW position when the opportunity arose in 2012. We hope to use our lived experience to help other service users. Also, having a meaningful job should be a good way of helping ourselves to reintegrate into the society.

Tobata’s Story as a Peer Support Worker

As a member of the Kapok Clubhouse for so many years, I understand the importance and usefulness of peer support. I worked in the rehabilitation ward when I first joined the service. I felt very tired at first because I had not worked for many years. I needed time to cope with the environment which was, in fact, familiar but my role was now different. My memory was poor and I had to work very hard to remember the names of my friends in the ward. I had worked with some of the staff in the rehabilitation team in the clubhouse before becoming a PSW and, therefore, I had no difficulties in working with them. They also invited me to their social gatherings after work.

I share my own lived recovery experience with the other service users in the ward and help them to accept their illness and plan their life after discharge.¹ They are willing to share with me about the effect of drugs on them and their illness symptoms. They appreciate that I have better understanding and empathy than the professionals and feel secure after I have shared my experiences. They gain hope and feel confident to face their future after listening to my story.

I also like to share my recovery journey with the professional trainee. The sharing helps me to enhance my confidence to speak up in front of others and have positive thinking about my illness. In the past, I lost control over my own life and, thus, others had to make important decisions about my life. I now accept my traumatic past and have a meaningful life. The trainees thank me for sharing my ups and downs with them. My experience alerts them to some things about the clients other than illness and treatment. They describe my sharing as a good lesson that they could never learn from their lecturer.

I even work with the other peer volunteers in SHINE group for mental health promotion in public schools so that youngsters in the community have better understanding of mental health. I accept my own illness and am willing to let them know that we are people with mental health problems. By working together with them, they understand that we are just like normal people.

I sometimes feel unhappy while working in the ward. Some of the clients who do not accept their mental illness reject me after learning about my background. As an expert user, I understand that we are sleepy in the morning due to the nighttime medication. However, as a staff I have to wake them early in the morning for a round of medication. I share my difficulties with my supervisors and they understand my feeling and discuss with me. Now I use other ways and my own experience to encourage my friends to get up in the morning.

My father did not support me to work as a PSW. He was worried that I would be admitted to the hospital again if I developed work stress. In the past, I could not dare to tell my colleagues in the workplace about my mental illness. I had experience of being rejected by them and would become upset. But working as a peer worker is another story. I got the job because I have experience living with my mental illness. It is my asset and not my weakness or a taboo. This paid job not only allows me to have a stable income but wins the respect and recognition from others, especially the peers. This is an effective and persuasive way to give hope to other service users.

I had a relapse and suffered from low mood a few months ago, but my supervisors and colleagues understood and supported me. I worked together with my doctor and supervisors throughout this relapse and no admission to hospital was needed. Now I have better control of my illness and my assets were enhanced after this relapse. I treat this job as my lifelong career.

Jennifer’s Story as a Peer Support Worker

As a PSW, I work mainly for the EASY team and sometimes in the Kapok Clubhouse. I help to conduct peer support group in EASY team outpatient session. I share the difficulties and concerns in the recovery journey with the clients or carers. I also help members of the Clubhouse to develop their strength and have a meaningful life.

I remember my first day of duty as a PSW; everything and all people in the hospital were new but familiar to me. My most impressive memory is my return to my last discharged ward. My primary care nurse was very happy to learn that I was now a PSW. My old friends in the ward gazed at me in admiration and hope. I could really help my peers to boost their morale.

The work of peer support fills my life with a new identity and role. It serves as a crucial function in my recovery journey.² I lost my role as a student when I was diagnosed with early psychosis. I felt that I was worthless at that time. The work of peer support helps me in rebuilding my social role and identity. It gives me a sense of acceptance and recognition despite my illness and helps in re-establishing my self-confidence. It is what medication cannot do in a client’s journey of recovery. I find the job very rewarding for myself. Every single step of my work contributes significantly towards my own recovery.

Besides, the work of peer support has broadened my personal exposure, leading me to have a better understanding of my shortcomings in social skills. I did not have much working experience as I was still a student when I was diagnosed with psychosis. In the past, all I needed to do was to pass the examination and I did not care much about people surrounding me. But after I started working in the hospital, I realised the importance of interpersonal relationship. With time, my interpersonal skills are improving under the coaching of my supervisors. So being a PSW provides me with a good opportunity for facilitating my personal growth.

However, not everything runs smoothly in my path of work. During the first few months of being a PSW, I felt confused and frustrated in the new and unfamiliar role. It was hard to grasp the concepts and develop the skills for engaging the peers. Moreover, the recovery concept was new to the hospital staff.³ They had hesitation in involving me in their work. It really took some time for me to get integrated into the health care team.

I still remember an occasion when I introduced myself while working in the EASY clinic. A client’s mum commented, “I wondered if you were also a patient when I first saw you. Your posture looks rigid and abnormal.” I would say it was quite embarrassing to hear that although I understand that she was worried about her son. But I received an impressive comment from another mum a year later, “From your improvement, I feel less distressed about my son’s mental situation.” This should be a good example of role modelling and hope.

I enjoy sharing the working experience as PSW with other peers working in other organisations. Their enthusiasm in their work is always a good example for me. Although I never ask myself to treat this job as a lifelong career, I am confident that I would be well-equipped to further pursue my own ambition in the future. Having to withdraw reluctantly from a degree programme 5 years ago was one of the greatest regrets in my life. Therefore, I would like to continue my studies and be a degree holder in the future. I also hope I can contribute more to the various aspects of peer support services with my further development.

Conclusion

The establishment of PSW workforce can be described as modelling recovery within services, and offering a lived example of the possibility of progress and growth. It helps to promote a recovery culture in the department. Peer support workers can also serve as a bridge between service users and service providers by narrowing the gap and breaking down barriers between them so that the goal of service improvement can be reached.

In the future, we hope that there will be a standardised policy on PSWs at the administrative level of the Hospital Authority (e.g. standardised pay scale, rank, training). There should also be more chance for mutual experience exchange among PSWs regardless of whether they are working in Hospital Authority or non-governmental organisations,² so that they may learn and get inspired from each other’s experience. Peer support workers in the Hong Kong psychiatric sector may also form their own coalition to fight for their rights, and more recognition and acceptance from the society. Peer support workers should also learn to develop their own unique style based on their interest and strength. They should be a unique specialty in the health care team. Finally, there should be development and provision of formal and recognised training so that there can be certified peer counsellors and the role of PSWs is better recognised and clearly defined.

To conclude, peer support is still in its preliminary stage in Hong Kong. But it has the potential to create a win-win situation¹ for both service users and service providers which, we think, is worth having for further development of the Hong Kong psychiatric field.

Acknowledgements

The authors would like to thank Dr Roger M. K. Ng, the Chief-of-Service of Department of Psychiatry, Kowloon Hospital and Ms Y. W. Pang, the former ward manager of the rehabilitation team, Department of Psychiatry, Kowloon Hospital for their support in the establishment and implementation of peer support services. We would also like to say thank you to all hospital staff of the Department who participate in the training and supervision of the peer support workers.

References

1. Tse S, Tsoi EW, Wong S, Kan A, Kwok CF. Training of mental health peer support workers in a non-western high-income city: preliminary evaluation and experience. Int J Soc Psychiatry 2014;60:211-8.

2. Tse S, Cheung E, Kan A, Ng R, Yau S. Recovery in Hong Kong: service user participation in mental health services. Int Rev Psychiatry 2012;24:40-7.

3. Ng RM, Pearson V, Pang YW, Wong NS, Wong NC, Chan FM. The uncut jade: differing views of the potential of expert users on staff training and rehabilitation programmes for service users in Hong Kong. Int J Soc Psychiatry 2013;59:176-87.

Introduction

We are Tobata and Jennifer, 2 peer support workers (PSWs) from Kowloon Hospital of Hong Kong. We have been working here since 2012. Tobata works in the rehabilitation team while Jennifer mainly helps in the Early Assessment Service for Young People with Psychosis (EASY) team. We prefer calling ourselves PSW instead of peer expert as we can call ourselves experts in our lived experience as persons with mental health difficulties; however, we are still green to be a worker in peer support service. We hope we can put less stress on ourselves and feel equal with our peers in this way. We would like to introduce ourselves briefly before we share our wonderful experience as PSWs.

Tobata has been suffering from bipolar affective disorder for over 30 years with repeated admissions to mental hospitals in the past years. She has been a member of the Kapok Clubhouse in Kowloon Hospital for 6 years and joined the 3-week basic clubhouse training with staff in Australia before she was recruited as a PSW.

Jennifer is a young lady who was diagnosed with psychosis while she was preparing to study in university 5 years ago. She joined the SHINE (晴天力量) group, a peer volunteer group of the hospital, before she started working as a PSW.

Both of us are service receivers and hope that one day we can have a chance to contribute back to the society, especially to those who have mental health problems. In the Kapok Clubhouse and the SHINE group, we gained knowledge about recovery and peer support; thus, we applied for the PSW position when the opportunity arose in 2012. We hope to use our lived experience to help other service users. Also, having a meaningful job should be a good way of helping ourselves to reintegrate into the society.

Tobata's Story as a Peer Support Worker

As a member of the Kapok Clubhouse for so many years, I understand the importance and usefulness of peer support. I worked in the rehabilitation ward when I first joined the service. I felt very tired at first because I had not worked for many years. I needed time to cope with the environment which was, in fact, familiar but my role was now different. My memory was poor and I had to work very hard to remember the names of my friends in the ward. I had worked with some of the staff in the rehabilitation team in the clubhouse before becoming a PSW and, therefore, I had no difficulties in working with them. They also invited me to their social gatherings after work.

I share my own lived recovery experience with the other service users in the ward and help them to accept their illness and plan their life after discharge.¹ They are willing to share with me about the effect of drugs on them and their illness symptoms. They appreciate that I have better understanding and empathy than the professionals and feel secure after I have shared my experiences. They gain hope and feel confident to face their future after listening to my story.

I also like to share my recovery journey with the professional trainee. The sharing helps me to enhance my confidence to speak up in front of others and have positive thinking about my illness. In the past, I lost control over my own life and, thus, others had to make important decisions about my life. I now accept my traumatic past and have a meaningful life. The trainees thank me for sharing my ups and downs with them. My experience alerts them to some things about the clients other than illness and treatment. They describe my sharing as a good lesson that they could never learn from their lecturer.

I even work with the other peer volunteers in SHINE group for mental health promotion in public schools so that youngsters in the community have better understanding of mental health. I accept my own illness and am willing to let them know that we are people with mental health problems. By working together with them, they understand that we are just like normal people.

I sometimes feel unhappy while working in the ward. Some of the clients who do not accept their mental illness reject me after learning about my background. As an expert user, I understand that we are sleepy in the morning due to the nighttime medication. However, as a staff I have to wake them early in the morning for a round of medication. I share my difficulties with my supervisors and they understand my feeling and discuss with me. Now I use other ways and my own experience to encourage my friends to get up in the morning.

My father did not support me to work as a PSW. He was worried that I would be admitted to the hospital again if I developed work stress. In the past, I could not dare to tell my colleagues in the workplace about my mental illness. I had experience of being rejected by them and would become upset. But working as a peer worker is another story. I got the job because I have experience living with my mental illness. It is my asset and not my weakness or a taboo. This paid job not only allows me to have a stable income but wins the respect and recognition from others, especially the peers. This is an effective and persuasive way to give hope to other service users.

I had a relapse and suffered from low mood a few months ago, but my supervisors and colleagues understood and supported me. I worked together with my doctor and supervisors throughout this relapse and no admission to hospital was needed. Now I have better control of my illness and my assets were enhanced after this relapse. I treat this job as my lifelong career.

Jennifer's Story as a Peer Support Worker

As a PSW, I work mainly for the EASY team and sometimes in the Kapok Clubhouse. I help to conduct peer support group in EASY team outpatient session. I share the difficulties and concerns in the recovery journey with the clients or carers. I also help members of the Clubhouse to develop their strength and have a meaningful life.

I remember my first day of duty as a PSW; everything and all people in the hospital were new but familiar to me. My most impressive memory is my return to my last discharged ward. My primary care nurse was very happy to learn that I was now a PSW. My old friends in the ward gazed at me in admiration and hope. I could really help my peers to boost their morale.

The work of peer support fills my life with a new identity and role. It serves as a crucial function in my recovery journey.² I lost my role as a student when I was diagnosed with early psychosis. I felt that I was worthless at that time. The work of peer support helps me in rebuilding my social role and identity. It gives me a sense of acceptance and recognition despite my illness and helps in re-establishing my self-confidence. It is what medication cannot do in a client's journey of recovery. I find the job very rewarding for myself. Every single step of my work contributes significantly towards my own recovery.

Besides, the work of peer support has broadened my personal exposure, leading me to have a better understanding of my shortcomings in social skills. I did not have much working experience as I was still a student when I was diagnosed with psychosis. In the past, all I needed to do was to pass the examination and I did not care much about people surrounding me. But after I started working in the hospital, I realised the importance of interpersonal relationship. With time, my interpersonal skills are improving under the coaching of my supervisors. So being a PSW provides me with a good opportunity for facilitating my personal growth.

However, not everything runs smoothly in my path of work. During the first few months of being a PSW, I felt confused and frustrated in the new and unfamiliar role. It was hard to grasp the concepts and develop the skills for engaging the peers. Moreover, the recovery concept was new to the hospital staff.³ They had hesitation in involving me in their work. It really took some time for me to get integrated into the health care team.

I still remember an occasion when I introduced myself while working in the EASY clinic. A client's mum commented, “I wondered if you were also a patient when I first saw you. Your posture looks rigid and abnormal.” I would say it was quite embarrassing to hear that although I understand that she was worried about her son. But I received an impressive comment from another mum a year later, “From your improvement, I feel less distressed about my son's mental situation.” This should be a good example of role modelling and hope.

I enjoy sharing the working experience as PSW with other peers working in other organisations. Their enthusiasm in their work is always a good example for me. Although I never ask myself to treat this job as a lifelong career, I am confident that I would be well-equipped to further pursue my own ambition in the future. Having to withdraw reluctantly from a degree programme 5 years ago was one of the greatest regrets in my life. Therefore, I would like to continue my studies and be a degree holder in the future. I also hope I can contribute more to the various aspects of peer support services with my further development.

Conclusion

The establishment of PSW workforce can be described as modelling recovery within services, and offering a lived example of the possibility of progress and growth. It helps to promote a recovery culture in the department. Peer support workers can also serve as a bridge between service users and service providers by narrowing the gap and breaking down barriers between them so that the goal of service improvement can be reached.

In the future, we hope that there will be a standardised policy on PSWs at the administrative level of the Hospital Authority (e.g. standardised pay scale, rank, training). There should also be more chance for mutual experience exchange among PSWs regardless of whether they are working in Hospital Authority or non-governmental organisations,² so that they may learn and get inspired from each other's experience. Peer support workers in the Hong Kong psychiatric sector may also form their own coalition to fight for their rights, and more recognition and acceptance from the society. Peer support workers should also learn to develop their own unique style based on their interest and strength. They should be a unique specialty in the health care team. Finally, there should be development and provision of formal and recognised training so that there can be certified peer counsellors and the role of PSWs is better recognised and clearly defined.

To conclude, peer support is still in its preliminary stage in Hong Kong. But it has the potential to create a win-win situation¹ for both service users and service providers which, we think, is worth having for further development of the Hong Kong psychiatric field.

Acknowledgements

The authors would like to thank Dr Roger M. K. Ng, the Chief-of-Service of Department of Psychiatry, Kowloon Hospital and Ms Y. W. Pang, the former ward manager of the rehabilitation team, Department of Psychiatry, Kowloon Hospital for their support in the establishment and implementation of peer support services. We would also like to say thank you to all hospital staff of the Department who participate in the training and supervision of the peer support workers.

References

Tse S, Tsoi EW, Wong S, Kan A, Kwok CF. Training of mental health peer support workers in a non-western high-income city: preliminary evaluation and experience. Int J Soc Psychiatry 2014;60:211-8.

Tse S, Cheung E, Kan A, Ng R, Yau S. Recovery in Hong Kong: service user participation in mental health services. Int Rev Psychiatry 2012;24:40-7.

Ng RM, Pearson V, Pang YW, Wong NS, Wong NC, Chan FM. The uncut jade: differing views of the potential of expert users on staff training and rehabilitation programmes for service users in Hong Kong. Int J Soc Psychiatry 2013;59:176-87.