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Cover -- Title Page -- Copyright Page -- Table of Contents -- List of figures -- List of tables -- Notes on contributors -- Preface -- SECTION 1 Russia and Central Asia -- Overview -- 1 State of mental health care in the Republic of Kazakhstan -- 2 Psychiatry in the Kyrgyz Republic: In between the Soviet past and a vague future -- 3 Russian Federation -- 4 State of mental health care in the Republic of Uzbekistan -- SECTION 2 Indian subcontinent -- Overview: Diversity in unity and adversity -- 5 The Bangladesh perspective -- 6 Mental health report for Bhutan -- 7 Mental health in India I: Epidemiology, services and health systems -- 8 Mental health in India II: Training and explanatory models -- 9 Mental health in Nepal -- 10 Mental health in Pakistan -- 11 Mental health services in Sri Lanka -- SECTION 3 Greater China -- Overview -- 12 Mental health in mainland China -- 13 The care of the mentally ill in Taiwan -- 14 Mental health services in Hong Kong -- SECTION 4 Far East -- Overview -- 15 History and perspective on psychiatry in Japan -- 16 South Korea -- 17 North Korea -- SECTION 5 South East Asia: Malaysia, the Philippines and Singapore -- Overview -- 18 Indonesia -- 19 Malaysia -- 20 The Philippines -- 21 Republic of Singapore -- SECTION 6 Thailand and nearby countries -- Overview -- 22 Mental health system in the Kingdom of Cambodia -- 23 Mental health in the Lao People's Democratic Republic: Some secured changes -- 24 Myanmar -- 25 Psychiatry in Thailand -- 26 Psychiatry in Vietnam -- Index.

Background: User participation is advocated on the basis that consumers know their own needs better than anyone else. Photovoice is a participatory research method that empowers the grass-root population to give voice on concerned issues for eliciting social change. Aim: This study explores the experience and impact of user participation in mental health services (MHS) in Hong Kong through photovoice. It also examines the effects of this method in studying user participation. Method: In this qualitative inquiry, authors, two peer researchers and three participants were involved in the various stages of research design, data collection and data analysis. Participants took photos showing their perception and experiences of being involved in different MHS systems. They shared their narratives through these images and reflected on the participatory experience of photovoice. Results: User participation was experienced as a gradual process of assuming control that involved personal responsibility, connection with peers, collaboration with staff, redefinition of boundaries and social inclusion. Meaningful participation gave rise to a sense of contribution, interpersonal connection and self-worth and transformed one's identity. Participants enjoyed the mutual interaction and derived benefit from the photovoice process. Issues such as consent and confidentiality arose in implementation. Conclusion: Participation entails partnership among service users, providers and peers. Photovoice opens up new space for unfolding expert knowledge. Further application of this participatory approach with the local community is suggested in order to develop person-centered care.

Although migration itself may not compromise the mental health of immigrants, the acculturative process can involve highly stressful factors that are specific to immigrant and minority status. Using structural equation modeling, this study examined the relations between acculturation orientations, perceived discrimination, acculturative stress, and psychological distress among 229 Pakistani and 218 Nepalese migrants living in Hong Kong. Although the initial hypothesized model was not confirmed, a modified model with good fit indices showed that acculturation orientation mediated the relationships of perceived discrimination and acculturative stress with psychological distress. Of all the factors in the model, acculturative stress had the strongest association with psychological distress.

Background: New Zealand has recently experienced a massive and rapid influx of Asian migrants. The Asian population has doubled in 10 years and is now the third-largest ethnic group. Materials: Databases reviewed include Medline, NZ government reports and NZ media releases. Discussion: Despite the significant growth in the Asian population, most of whom are in a vulnerable age group for mental morbidity and are exposed to adverse experiences, accurate and systematically obtained information on the mental health of Asians is lacking. Conclusion: This paper argues for a need to conduct a well-designed epidemiological study on the mental health needs of Asians in New Zealand. Recommendations on how to pursue this epidemiological study are provided.

Background: Bipolar disorder (BD) is a chronic mental disorder, and family members play a key role in taking care of the affected individuals. The recovery movement has gradually transformed mental health services, for example, through the introduction of peer support services (sharing of expert-by-experience knowledge), and it has challenged the prevailing view that people with mental illness cannot recover. Aims: Through this study, the researchers explored how family caregivers in a Chinese context conceptualise recovery, how caregivers interact with peer support workers (PSWs) and how they perceive peer support services. Methods: Fourteen family caregivers from community settings participated in individual semi-structured interviews. The data were analysed through thematic analysis. Results: Family caregivers had multifaceted definitions of recovery and had various degrees of contact with PSWs. The views and experiences shared by PSWs were hope-instilling for caregivers and changed their perception of BD and their loved ones. Some limitations of PSWs were also identified. Conclusion: Social connectedness and functional outcomes were important indicators of recovery among Chinese family caregivers. Caregivers began to understand the benefits of PSWs after experiencing their services. Peer-led services could be a helpful support for both service users and family caregivers.

Background: Youth drug use is a significant at-risk youth behaviour and remains as one of the top priorities for mental health services, researchers and policy planners. The ecological characteristics of secondary school students' behaviour in Hong Kong are understudied. Aim: To examine individual, familial, social and environmental correlates of drug use among secondary students in Hong Kong. Method: Data were extracted from a school survey with 3078 students. Among the 3078 students, 86 students reported to have used drugs in the past 6 months. A total of 86 age- and gender-matched controls with no drug-use behaviour in the past 6 months were randomly selected from the remaining students. Multiple logistic analysis was used to examine differential correlates between those who used and did not use substance in the past 6 months. Result: Positive school experience and perspective to school and parental support are protective factors of drug use. Lower self-esteem, lower self-efficacy against using drugs and higher level of permissive attitude towards drugs were associated with drug use. Students who were low in self-esteem and rather impulsive tend to use drugs. Conclusion: To prevent students from drug use, efforts in individual, family, school and community-levels should be addressed.

Background and Aims: Peer support workers are an emerging workforce within the mental health system in Hong Kong. The purposes of this paper were to describe the development of a peer support training programme and to evaluate its outcome from the perspectives of both trainees and the users of services that they provided. Method: The curriculum consisted of six weeks of coursework on the recovery approach and a 24-week paid internship at the Warmline telephone service. We gathered feedback from 22 Warmline users. Eighteen trainees were also assessed using the three recovery-related psychosocial measures and qualitative methods. Results: The Warmline service provided by peer support trainees lessened the isolation of service users and raised their hopes. Compared to the baseline, the peer support trainees scored marginally higher on the psychosocial measures at the end of the training. At post-training evaluation, peer support trainees said that they had gained in knowledge, were more hopeful about their own recovery, and had developed mutually supportive relationships among themselves and with their supervisors. Conclusion: The programme shows potential benefits for both Warmline service users and trainees. Future studies should compare different training methods and examine the implementation of peer support services in a non-western cultural context.

Background: Public expenditure on mental health education has grown exponentially in the past two decades. Does the experience of stigma among people with mental health problems improve over time? Our study aims to compare the levels of perceived stigmatization, rejection experiences and stigma–coping among mental health service users in Hong Kong between 2001 and 2017 using longitudinal and repeated cross-sectional study design. Method: The baseline survey was completed by 193 psychiatric outpatients in 2001. They were traced for re-assessment in 2017. Another sample of 193 outpatients matched in age, gender and psychiatric diagnosis was recruited in 2017 for cross-sectional comparison. Participants completed a 39-item questionnaire on stigma experiences, Beck Depression Inventory and Disability Assessment Schedule at both time points. Results: In total, 109 of 193 participants (56.5%) of the 2001 survey were re-assessed. No significant change in perceived stigmatization, rejection experiences and stigma–coping was found among the 109 participants interviewed in 2001 and 2017. For cross-sectional comparison, significant differences in two perceived stigma items were observed upon Bonferroni correction (chi-square test, p < .005) and remained significant after controlling for confounding factors by regression analysis. Improvements in perceived stigmatization were on marriage and friendship, while viewpoints on trustworthiness, dangerousness, devaluation, avoidance and personal failure remained unchanged, and there was no improvement in rejection experiences and stigma–coping. Conclusion: Positive attitude changes over time are unlikely to occur if there is no targeted intervention on stigma. Our findings highlight that evidence-based antistigma interventions are urgently needed.

Background and Aims: More mental health services are adopting the recovery paradigm. This study adds to prior research by (a) using measures of stages of recovery and elements of recovery that were designed and validated in a non-Western, Chinese culture and (b) testing which demographic factors predict advanced recovery and whether placing importance on certain elements predicts advanced recovery. Method: We examined recovery and factors associated with recovery among 75 Hong Kong adults who were diagnosed with schizophrenia and assessed to be in clinical remission. Data were collected on socio-demographic factors, recovery stages and elements associated with recovery. Logistic regression analysis was used to identify variables that could best predict stages of recovery. Receiver operating characteristic curves were used to detect the classification accuracy of the model (i.e. rates of correct classification of stages of recovery). Results: Logistic regression results indicated that stages of recovery could be distinguished with reasonable accuracy for Stage 3 ('living with disability', classification accuracy = 75.45%) and Stage 4 ('living beyond disability', classification accuracy = 75.50%). However, there was no sufficient information to predict Combined Stages 1 and 2 ('overwhelmed by disability' and 'struggling with disability'). It was found that having a meaningful role and age were the most important differentiators of recovery stage. Conclusion: Preliminary findings suggest that adopting salient life roles personally is important to recovery and that this component should be incorporated into mental health services.

Objective: This pragmatic randomized study was conducted to compare the effectiveness of telephone and face-to-face counseling in influencing problematic gambling beliefs and behaviors. Method: Ninety-two participants from diverse ethnic backgrounds who had been affected by problem gambling were provided with psychological interventions delivered either by telephone or conventional face-to-face counseling over a 3-month period. Results: A significant overall time effect between pre- and postintervention assessments was found for total hours, money and proportion of income spent, and the attitudes and beliefs scores. There was no significant difference in effect size between the two groups. Conclusion: This study provides preliminary evidence that both face-to-face and telephone counseling interventions might be equally effective in terms of short-term clinical outcomes measured postintervention.

Background: Studies have consistently reported high rates of suicidal ideation (SI) among individuals with disordered gambling. None have explored gambling-related familicidal-suicidal ideation (FSI). Aims: This study examined the (1) prevalence of SI and FSI among treatment-seeking gamblers in Hong Kong, (2) characteristic profile of factors associated with SI and FSI, and (3) factors that predict SI and FSI. Method: This is a retrospective analysis of data collected at initial clinical assessments from a specialized gambling counseling centre in Hong Kong. Participants were gamblers (N = 3,686) who sought treatment at the centre between 2003 and 2012. Information about socio-gambling demographics, physical and mental health status, current presenting problems, self-rated South Oaks Gambling Screen (SOGS, Chinese version), and occurrence of SI or FSI were examined. Descriptive analysis and ordinal regression analysis were used to investigate the characteristics of the gamblers and the association of variables. Results: In our sample, 720 (20.0%) individuals reported SI, and 22 (0.6%) individuals reported FSI at the initial assessment. Individuals with SI and FSI differed from the nonsuicidal individuals in terms of their demographics, gambling experiences and severity, mental and physical wellbeing, and types of gambling-related problems. The adjusted ordinal regression model shows that participating in table games in casinos and having familial and financial problems seem to enhance the likelihood of having SI and FSI. Conclusion: While mental health issues are significantly related to SI and FSI among gambling treatment seekers, the impacts of physical, family, and financial strains should not be underestimated.