Journal of Family Social Work

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A Critical Review of Family Caregiving of Mental

Health Consumers in Hong Kong

Dr.Kam-shingYIPPhD

To cite this article: Dr.Kam-shingYIPPhD (2004) A Critical Review of Family Caregiving of Mental
Health Consumers in Hong Kong, Journal of Family Social Work, 7:3, 71-89, DOI: 10.1300/
J039v07n03_05

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 A Critical Review of Family Caregiving
of Mental Health Consumers in Hong Kong
Kam-shingYIP, PhD

ABSTRACT. This paper is a critical review on the family caregiving of

mental health consumers in Hong Kong. The writer has a brief review on re-
lated studies of family caregiving of mental health consumers. In comparing
with those in the U.K. and the U.S.A., family caregivers of mental health con-
sumers in Hong Kong are lonely, stigmatized and unsupported by mental
health services and members in the community. [Article copies available for
a fee from The Haworth Document Delivery Service: 1-800- HAWORTH. E-mail
address: <[email protected]> Website: <http://www.Haworth
Press.com> © 2003 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Family caregiving, mental health consumers, Hong Kong,

family burden, Chinese, familism

INTRODUCTION

In the U.S.A., 65% of mental health consumers with schizophrenia1

who discharged from mental hospitals returned to their own families
(Goldman, 1982; Lefley, 1987). The studies by the National Alliance
for the Mentally Ill (NAMI) (Skinner, Steinwards, & Kaspers, 1992) in
the U.S.A. and Seeman (1988) in Canada showed that around one- to
two-thirds of mental health consumers with schizophrenia lived with

Dr. Kam-shingYIP is Associate Professor, Department of Applied Social Studies,

Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (E-mail:
[email protected]).
Journal of Family Social Work, Vol. 7(3) 2003
http://www.haworthpress.com/web/JFSW
© 2003 by The Haworth Press, Inc. All rights reserved.
Digital Object Identifier: 10.1300/J039v07n03_05 71
72 JOURNAL OF FAMILY SOCIAL WORK

their family members. Within the deinstitutionalization and community

care movements in mental health services, the importance of family
caregiving was undeniable (Thronicroft & Bebbington, 1989; Archer &
Gruenberg, 1982; Wing, 1981; Bachrach, 1976, 1978; Hafner & Heider,
1989; Bennett, 1979). Many mental health consumers were discharged
back to the community. However, only few families accepted their rela-
tives back from mental hospitals (Grob, 1994; Lefley, 1996). Without
family care, community integration of mental health consumers may
only be a myth rather than a reality. In this paper, the writer tries to de-
scribe the family caregiving of mental illness in Hong Kong.

BURDENS OF FAMILY CAREGIVERS

Lefley (1996) suggested three types of burdens and stresses. The first
are objective burdens. They refer to the demands of coping with mental
illness that include:

1. the mentally ill person’s economic dependency and inability to ful-

fill expected role functions;
2. disruption of household routines;
3. caregivers’ investments of time and energy in help-seeking and
negotiating the mental health system;
4. confusing and often humiliating interaction with service providers;
5. financial costs of illness;
6. deprivation of needs of other family members;
7. curtailment of social activities;
8. impaired relations with the outside world; and
9. inability to find appropriate alternatives to hospitalization or facili-
ties for residential placement outside of home. (Lefley, 1996:69)

All these external demands in coping are echoed by related studies

(Estroff et al., 1994; Bornstein & O’Neil, 1992; Dickens et al., 1993;
Morman, 1992; Saylor, 1994; Judge, 1994; Nicholson & Blanch, 1994;
Hatfield & Lefley, 2000). Bornstein and O’Neil (1994) found out that
mental health consumers focused on gratification or frustration provided
to them by their parents, with no recognition of their parents’ situation.
The second are subjective burdens that include:

1. feeling of dual loss: loss of person who was and of the person who
might have been;
 Kam-shingYIP 73

2. feelings of stigmatized and inability to make or fulfill personal plans;

3. empathetic suffering for the pain of a loved one;
4. worries of aged parents about the future of a disabled child; and
5. feelings of isolation, burnout, and helplessness. (Lefley, 1996:69)

All these are also mentioned in many related studies (Johnson, 1994;
Winefield & Harvey, 1994; Lefley, 1992; Lefley, 1999; Lefley, 2000a,
2000b; Cook, 1988; Greenberg et al., 1993). For instance, Johnson
(1994) found that family burdens appeared to be related to the level of
dysfunction of the mentally ill relative.
The third are burdens in management of problem behaviors that contain:

1. assaultive behaviors;
2. mood swings;
3. unpredictability;
4. socially offensive or embarrassing situations;
5. negative symptoms of motivation, apathy, anhedonia; and
6. conflicts over use of money. (Lefley, 1996:69)

All these problem behaviors are also described by other related studies (San &
Lavitt, 1986; Gubman & Tessler, 1987; Straznickas, McNiel, & Binder, 1993;
Backlar, 1994; Deveson, 1991; Lefley, 1987; Lee et al., 2000; Bayer, 1996).
Regarding the parents as caregivers, Gammache (1989) showed that
there were two major dimensions of burden: care and control of mental
health consumers. Cook, Lefley, Pickett, and Cohler (1994) showed
that family burden was related to the developmental stage of the mental
illness in conjunction with the age-defined life course of the parents. Pa-
rental caregivers felt stressful and frustrated in facing their aging in car-
ing for their ill relatives (Hatfield & Lefley, 2000; Lefley & Hatfield,
1999).
For those spouses as caregivers, they suffered the transformation of
the beloved person with feelings of loss and grievance (Judge, 1994). Be-
havioral problems and functional deficits of mental health consumers
were difficult to handle and explain to their children (Noh & Avison,
1988). Mental health consumers were viewed by their spouses as children
in need of supervision (Faddern et al., 1987).
When siblings became the major caregivers, older sibling rivalries
and jealousies might reemerge (Lefley, 1996:89). However, sibling
caregivers were major sources of social support for mental health con-
74 JOURNAL OF FAMILY SOCIAL WORK

sumers after the death of their parents (Hatfield & Lefley, 1993; Judge,
1994; Moorman, 1992; Saylor, 1994).
Facing all these burdens, family caregivers had various coping strategies
(Tessler, Killian, & Gubman, 1987; Spaniol & Zipple, 1994). Tessler,
Killian, and Gubman (1987) identified eight stages of coping by family
caregivers. They are:

• initial awareness of a problem with recognition of symptoms;

• denial of mental illness;
• labeling of the patient as mentally ill;
• faith in mental health professionals, with expectation of quick cure;
• recurrent crises–episodes of disturbed, aggressive behavior or sui-
cidal attempts;
• recognition of chronicity;
• loss of faith in mental health professionals;
• belief in the family’s expertise;
• worry about the future. (Tessler, Kilian, & Gubman, 1987)

Factors influencing the coping of family caregivers are social support and
network available, opportunities and their willingness to join various types
of family support groups (McFarlane, 1994; Solomon & Draine, 1994;
Johnson, 1994).
In fact, stress and coping of family caregivers are influenced by the
mental health system as well as social and cultural contexts (Lefley, 2001;
Lefley, 1998; Manderscheid & Barrett, 1987; Manderscheid & Sonnenschein,
1992; Milstein et al., 1994; Giel et al., 1983). For example, Asian and
African Americans tend to have higher tolerance of acceptance in family
caregiving of mental health consumers (Manderscheid & Barret, 1987). In-
appropriate professional intervention, attitude, and insufficient services tend
to increase the stress of family caregivers. These include:

1. reluctant, ambiguous and contradictory communication from pro-

fessionals;
2. failure of the provider system to offer training or involvement in
treatment planning to caregivers;
3. increasing financial drain, with inability of families to predict
cost-benefit of investments in treatment;
4. difficulty in finding legitimate alternatives to hospitalization or ad-
equate services in the community support system; and
5. stressors in dealing with the legal and criminal justice systems.
(Lefley, 1996:78)
 Kam-shingYIP 75

Skinner, Steinwachs and Kasper (1992) showed that half (45%) of fam-
ily caregivers reported that their ill relatives had no productive activity,
such as employment, volunteer work, school, or day treatment pro-
grams (Skinner, Steinwachs, & Kasper, 1992). In fact, many clinicians
tend to label overloading family caregivers as origins of mental illness
(McElroy & McElroy, 1994, Cook, 1988).
All these dynamics in family caregivers are represented in Figure 1.

FAMILY CAREGIVING OF MENTAL HEALTH CONSUMERS

IN HONG KONG

The Societal and Cultural Context of Family Caregiving in Hong Kong

Hong Kong became a British colony in 1841 and was returned to

China’s sovereignty in 1997. It is densely populated with 6.6 million
people, mostly Chinese in ethnicity, within an area of less than several
thousand square kilometers (Yip, 2000; Jones, 1990). Traditional Chi-
nese culture still influences the family caregiving of mental health con-
sumers in Hong Kong. In Chinese society, a special kind of strong
familism has been formed, stressing the undeniable predominance of
the family over its members in almost all domains of life (Yang, 1995:22;
Yeh, 1990). Chinese people place extreme importance on harmony
FIGURE 1. A Multidimensional View on Family Caregiving of Mental Health
Consumers

The Importance of Family Caregiving

− Deinstitutionalization and community care
− Normlization and community integration

The Burdens and Dynamics of Family Caregiving Sociocultural Contexts of Family Caregiving
− Objective burdens: resources input and loss − Societal attitude and support
− Subjective burden: feelings and burnout − Cultural attitude and support
− Burdens in handling problem behaviors − Professional intervention and attitude
− Burdens in family roles and life cycle − Government policy and service

Coping of Family Caregivers

− From ignorance and denial to recognition and acceptance
− From helplessness and crises to family expertise in handling situations
− From hopelessness and anger to realistic demand and expectation
− From loneliness and frustration to seeking help and support network
76 JOURNAL OF FAMILY SOCIAL WORK

within and solidarity of the family, the succession of their family line,
family reputation, and wealth. Familism causes the Chinese to subordi-
nate their personal goals, interests, and welfare for the sake of their fam-
ilies (Yang, 1995; Yeh, 1990). That means traditional Chinese culture,
especially familism, facilitates or hinders family caregiving of mental
health consumers. For those family members who are willing to sacri-
fice themselves to persuade family solidarity and honor, they tend to en-
dure and tolerate caring for mental health consumers. However, if
family members regard the stigma of mental illness as a shame for the
family, they may ignore or isolate themselves from their relatives with
mental illness. Or they may have a dilemma or conflict. On the one
hand, they feel responsible for caring for their relatives with mental ill-
ness. On the other hand, they may feel shameful in admitting their rela-
tives’ mental illness.

The Problem of Mental Health Services in Hong Kong

In Hong Kong, a severe incident of psychiatric violence, which hap-

pened in 1982, stirred up the hidden fears of residents towards mental
health consumers (Yip, 2002; Mak et al., 1996). Residents protested
strongly against the establishment of halfway houses, day care centers,
and long-stay care homes for rehabilitation of mental health consumers
in their neighborhoods (Yip, 1998). To protect mental health consumers
from public stigmatization, mental health services in Hong Kong are
highly institutionalized (Yip, 1995; Yip, 2000b). There are huge mental
hospitals (each houses 2000 patients); halfway houses (with a capacity
of 40), long-stay care homes (with a capacity of 200), sheltered work-
shops (with a capacity of 150), and psychiatric rehabilitation complexes
(with a capacity from 500 to 800) (Yip, 2000c). Public stigmatization
and institutionalized mental health services may increase their sense of
helplessness and frustration in caring for their relatives with mental ill-
ness. Furthermore, institutionalized mental health services may have in-
stitutionalized effects on mental health consumers (Yip, 1995; Barton,
1959; Goffman, 1961). Many mental health consumers after long-term
institutionalization become inert, passive, and withdrawn. As a result,
family caregivers may feel difficulty in handling negative symptoms of
these mental health consumers.

Prevalence of Mental Illness and General Profile

of Mental Health Consumers

In Hong Kong, it is estimated that for every thousand adults, there are
two to three persons with serious mental illnesses such as affective dis-
 Kam-shinYIP 77

orders and schizophrenia. It is estimated that there are 882,039 mental

health consumers. Among them, 63,424 persons require psychiatric
treatment and rehabilitation (Hong Kong Government, 1991, 1996).
Most mental health consumers2 in Hong Kong are outpatients in gov-
ernmental psychiatric outpatient clinics. Thus, the profile of mental
health consumers in these outpatient clinics may reflect the general situ-
ation of mental health consumers in Hong Kong. Yip, Law, and Lee
(2000) had conducted a study in two psychiatric outpatient clinics. They
had interviewed 457 mental health consumers. More than half of them
(61.5%) were single. Most of them (80.5%) lived with their family
members, and their average age of onset was about 18 years old. Their
average duration of mental illness was about five years. All these data
showed that most mental health consumers in Hong Kong had been sick
for more than four years, and many of them had been sick for ten or more
years. They were chronic, unemployed, and passive. They lived with and
depended on their family members (Yip, 1992, 1998a; Goffman, 1961;
Barton, 1959).

CRITICAL REVIEW OF FAMILY CAREGIVING

OF MENTAL HEALTH CONSUMERS IN HONG KONG

Unbalanced Distribution of Resources

In Yip, Law, and Lee’s (2000) study, the rate of mental health consum-
ers participating in mental health services is shown in Table 1.
The striking fact was that mental health services in Hong Kong were
highly unbalanced in distribution of resources (see Table 2). On the one
hand, there were 16.8% of mental health consumers participating in ac-
tivities and services organized by psychiatric rehabilitation agencies.
Many of them actually participated (62.0%/16.8% = 3.5) in more than
three types of related services. On the other hand, the other 83.2% of
mental health consumers, apart from normal regular medical follow-up
from psychiatric outpatient clinics, were left alone in the community.
Most of them (80.5%) lived with their family members. That means
they were only cared for by their family caregivers during their years of
chronic mental illnesses.

Overwhelming Demand

Chan (1993) interviewed 50 mental health consumers with schizo-

phrenia and their family caregivers in Hong Kong. The findings showed
78 JOURNAL OF FAMILY SOCIAL WORK

TABLE 1. Percentage of Mental Health Consumers Participating in Mental

Health Services in Hong Kong (Yip, Law, & Lee, 2000)
Have/Have not participated in social welfare services

Have: 16.8% Have Not: 83.2%

TABLE 2. Rate of Participation in Different Types of Social Welfare Services

Different types of services % of subjects participating in this % of subjects NOT participating

service in this service
Self-Help Group 2.8% 97.2%
Halfway House 8.8% 91.2%
Supported Employment 11.5% 88.5%
Interest Group 11.3% 88.7%
Personal Counseling 11.1% 88.9%
Sheltered Workshop 11.5% 88.5%
Day Hospital 2.5% 97.5%
Church 0.9% 99.1%
Others 1.6% 97.9%
Total in Terms of Attendance (62.0%)

that about 70% of them needed to be cared by their family caregivers.

Mothers were regarded as the most important (40%) family caregivers.
Other family caregivers were fathers (9%), husbands (9%) and wives
(5.4%). Chan’s study also showed the meaning and functions of family
caregiving.
Chan’s study showed that the responsibility of family caregivers
were heavy and important. They had to care for the daily living of their
relatives with mental illness (see Table 3). They prepared food, washed
clothes, cleaned the house, and reminded their relatives to get up and eat
their meals. They had to persuade their relatives to maintain regular med-
ication (Yip, 1998b). They had to support their relatives emotionally and
psychologically (Chan, 1993). The problem was aggravated by the fact
that most mental health consumers were young adult, chronic patients
(Yip, Law, & Lee, 1999). That means their family caregivers still had to
take care of them for many years. Also, 40% of these family caregivers
were aged mothers (Chan, 1993) who were fragile and weak elderly.
 Kam-shingYIP 79

TABLE 3. Meaning and Functions of Family Caregiving by Consumers and

Their Caregivers (Chan, 1991:145)

Meaning and Function of Family Caregiving Agreed by Mental Health Agreed by Family Care-
Consumers (%) givers (%)
Taking caring of mental health consumers’ 49.1% 38.0%
daily living
Reminding mental health consumers to take 13.7% 16.0%
medication
Supporting mental health consumers psycho- 12.2% 12.2%
logically and emotionally
Offering help when needed by mental health 8.7% 4.4%
consumers
Keeping an eye on the mental health consumers 1.7% 8.8%
Giving advice on mental health consumers 1.7% 5.8%
Supervising mental health consumers in medi- 1.7% 2.9%
cal follow-up
Giving financial support to mental health con- 1.7% 2.9%
sumers
Helping mental health consumers in difficulties 3.5% 0.0%

Endless Burdens and Difficulties

Wong (2000) had interviewed 74 family caregivers of mental health

consumers with schizophrenia in Hong Kong. In this study, Wong de-
scribed the following difficulties in caregiving:

• Difficulties in managing drug compliance and follow-up;

• Difficulties in handling bizarre behaviors;
• Difficulties in dealing with excessive and uncontrollable emotion
and hallucination;
• Difficulties in handling negative symptoms; and
• Social costs associated with the care. (Wong, 2000:366)

Among all these difficulties, Wong’s study showed that the most diffi-
cult is in dealing with negative symptoms of mental health consumers.
The second most difficult was the social costs associated with the care,
and the third difficult one was in dealing with excessive and uncontrol-
lable emotions and behaviors (Wong, 2000). That means these family
caregivers were, in fact, genuine and devoted. Regardless of their heavy
daily workload and even their deteriorating health condition (nearly
half of them were risky and vulnerable mentally and physically), they
tolerated the difficulties in taking care of their mental health consum-
ers (Wong, 2000). They did not mind facing the bizarre behaviors,
80 JOURNAL OF FAMILY SOCIAL WORK

thoughts, and unreasonable demands of the mental health consumers.

However, as their mental health consumers were young adults, they felt
frustrated and helpless in facing their relatives’ negative symptoms,
poor motivation in employment, and poor personal hygiene. They were
powerless, fragile, and deprived.

Inappropriate Professionals’ Attitudes and Interventions

Yip’s (1995) study showed that many professionals in mental health

services tended to be bureaucratic and inhumane in facing the individ-
ual needs of mental health consumers and their family caregivers. What
they were concerned with were only legal procedures, hospitalization,
and medication to control relapse and prevention of violence and ag-
gression. Wong (2000) and Chan’s (1993) studies described that family
caregivers’ needs were not understood by both policy makers and pro-
fessionals in mental health services. Furthermore, related studies on so-
cial workers in family services (Chan, 1993; Yip, 1995, 1998b) showed
social workers in family services did not have sufficient knowledge to
handle mental health consumers. Some workers still thought that odd
and bizarre behaviors and insanity manifested by mental health con-
sumers might threaten other ‘normal’ clients in family services. Similar
to some clinicians in other countries (McElroy & McElroy, 1994; Cook,
1988), many clinicians in Hong Kong tended to label overloading fam-
ily caregivers as origins of mental illness.

Underdeveloped Service and Support

Support and services for family caregivers in Hong Kong are thin and
underdeveloped. First, there is an absence of any advocacy group for
family caregivers in Hong Kong. The voices and stress of family care-
givers are rarely heard by professionals and the public (Pearson & Ning,
1997). Secondly, there is no independent self-help group for family care-
givers. All relative groups are occasionally run by professionals in mental
health services. Most of these groups are only regarded as a means to ensure
medical compliance of mental health consumers rather than enlightening
the burden and stress of family caregivers. Right now, there are only two
family resources centers in Hong Kong. They served those mental health
consumers who are discharged from two psychiatric halfway houses in a
psychiatric rehabilitation agency.
 Kam-shingYIP 81

Problems of Prolonged Burden

Within the shortage of support and service, the overloading family

caregivers in Hong Kong may be at risk for psychological and physical
breakdown. Wong’s (2000) study demonstrated that 30% of family
caregivers’ mental health was at a risk of psychological unbalance and
breakdown. Chan’s (1993) study also showed that many aged mothers
showed signs of psychological and physical burnout. Pearson and Lam
(2002) and Pearson and Ning (1997) also clearly demonstrate the des-
peration and sense of helplessness of lonely family caregivers in taking
care of mental health consumers. The situations of family caregiving in
Hong Kong are represented in Figure 2.

IMPLICATIONS TO FAMILY SOCIAL WORK

Comparing those in the U.K. and the U.S.A., the situation in Hong
Kong is different in the following ways:

1. About 16.8% of mental health consumers are still isolated in insti-

tutionalized hospitals, long-stay care homes, halfway houses, and
psychiatric rehabilitation service complexes. Most mental health
consumers (83.2%) are still left to be cared for in the community.
Apart from receiving medication from psychiatric outpatient clin-
ics, they do not have any services to support their rehabilitation
and recovery. Instead, their daily caring is still the responsibility
of their overloaded family caregivers. Many of them are fragile,
aged parents.
2. Dense population and competitive commercial life in Hong Kong
intensify public stigmatization towards mental illness. Coupled
with poor support to mental health consumers, mental relapses in
the form of psychotic violence stirred up the hidden fears of resi-
dents. A large scale of anti-halfway house movement prevails in
this decade. As a result, a rejecting community may reinforce
institutionalization of mental health services and isolating mental
health consumers from the community.
3. Unlike those in the U.K. and the U.S.A., family caregivers of men-
tal health consumers in Hong Kong are not properly supported by
family resource centres, pressure and advocacy groups, as well as
self-help groups of family caregivers. The plights and voices of them
are not heard by both professionals and policymakers.
82 JOURNAL OF FAMILY SOCIAL WORK

FIGURE 2. A Multidimensional View of Family Caregiving of Mental Health

Consumers in Hong Kong

Chinese Cultural Context:

1. Nuclear family with extended family
support network among siblings
2. Familism: Family honor, glory,
harmony

Burden of Family Caregivers:

a. Uneven utilization of services
Rejecting Community: b. Unreasonable demand
Institutionalized Mental Health
Psychiatric violence, public c. Endless burden and difficulties
Services: Large mental hospital, half-
stigmatization, anti-halfway (Caring 83.2% mental health
consumers) way houses, long-stay care homes,
house movement, and dense and service complexes
populations (Caring about 116.8% of mental
health consumers)

Problems of Prolonged Burden:

Physical and mental breakdown of caregivers;
Unable to take care of mental health consumers;
Mental relapse of mental health consumers;
Potential risks of disruptive behaviours; and
Violence to caregivers and the community.

Inappropriate Professional Attutude:

Underdeveloped Service to Support Institutionalized professionals in mental
Family Caregiving: health services;
Thin family resources centre; Lack of competence, training, and knowledge
Absence of relative self-help group;
to handle clients with mental problems in
Absence of family advocacy group;
Thin psychoeducation for families. family services or youth service; and
Stigmatization and labeling towards clients
with mental illness.

That means in Hong Kong, not only should the mental health consumer
be cared for in the process of rehabilitation and recovery. Instead, the
overloaded and stressful family caregivers should also be cared for and
supported by the government, by the professionals, by the welfare agen-
cies, as well as by the members of the community. Without their sup-
 Kam-shinYIP 83

port, family caregivers are at a risk of burnout, leaving the mental health
consumers uncared for in the community. To ease the plight of family
caregivers, family social work services should be rendered to family
caregivers in Hong Kong in the following ways.

Advocating the Rights of Mental Health Consumers

and Family Caregivers

Pressure groups and consumer groups should be established for both

mental health consumers and their family caregivers by social workers
in Hong Kong. The rights of mental health consumers and their family
caregivers in having a normal and decent community life should be ad-
vocated. The government in Hong Kong should be pushed by all these
groups to allocate more resources and services for mental health con-
sumers, especially those who are solely dependent on their family care-
givers in daily living. Funding should be given to render family resources
and support centres, home help teams, or outreaching psychiatric support
teams to ease the burden of family caregivers in taking care of mental
health consumers in Hong Kong.

Nurturing and Supporting Familism in Chinese Culture

Familism in traditional Chinese culture should be supported and nur-

tured so that mental health consumers in Hong Kong can be rehabili-
tated within a normal family setting. However, the shame of having a
relative with mental illness should be lessened by proper public mental
health education so that public stigmatization and labeling towards
mental illness can be alleviated. Social workers and health profession-
als in Hong Kong should help mental health consumers and their family
caregivers to establish supportive social networks. These networks can
be formed by social workers by integrating volunteers, supportive neigh-
bors, and friends, as well as professionals, together in helping mental
health consumers to search for employment, encourage them to have so-
cial and recreational activities, to remind them to have proper medication,
and solve their problems in daily life.

Training Social Workers to Support Family Caregiving

Social workers in Hong Kong should receive sufficient training to sup-

port family caregiving for mental health consumers. They should under-
stand the importance, the dilemmas, and the needs of family caregiving for
84 JOURNAL OF FAMILY SOCIAL WORK

mental health consumers. They should learn how to conduct psycho-

educational programmes, counseling, self-help groups, and advocacy
groups for family caregivers in Hong Kong. They should reflect their
own attitudes in encountering family caregivers of mental health con-
sumers. Instead of labeling family caregivers as causes of mental illness,
they should support and empower them to have a better rehabilitation envi-
ronment for their relatives with mental illness.

CONCLUSION

As a conclusion, this paper is a critical review on the family caregiving

of mental health consumers in Hong Kong. Related studies showed that
family caregivers in Hong Kong are overloaded with endless burdens in
taking care of their relatives with mental illness. Social workers should
advocate for better services and support for family caregivers in caring
for mental health consumers. In addition, more research and studies
should be conducted to explore suitable intervention models in lightening
the burdens of family caregiving of mental health consumers in Hong
Kong.

NOTES
1. In this paper, to avoid labeling persons with psychiatric disabilities, the term
‘mental health consumers’ is used to replace the labels of ‘mental patients’ and ‘mental
outpatients.’
2. In Hong Kong, there is no large scale epidemiological study of mental illness.
The only available one was a small-scale study done by C. N. Chen (Chen et al., 1993)
in the Shatin area, which is only one district in Hong Kong. The data given by the gov-
ernment are only a rough estimation based on this study and international statistics.

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