Making the subjects of mental health care: a cross‐cultural comparison of mental health policy in Hong Kong, China and New South Wales, Australia

Abstract

Constituting ‘social problems’ in particular ways has a range of effects, including for how subjects are positioned within policy and discourse. Employing an approach grounded in poststructuralist and social constructionist thinking, this analysis interrogates how the subjects of mental health care were constituted and problematised in mental health policies in two distinctive contexts, unsettling the taken‐for granted assumptions which underpin these problematisations. Two policies were selected for analysis as exemplar pieces of mental health policy reform in Hong Kong and New South Wales (NSW). Subjects were constituted as ‘patientised’ individuals (in Hong Kong) encouraged to depend on professionals who help them reintegrate into the ‘normal’ community, and as ‘traumatised’ individuals (in NSW) expected to take responsibility to guide the delivery of mental health care and respected as a part of diversity in community settings. While both policies constituted subjects as ‘unwell individuals’ and enacted ‘dividing practices’, subjectivities were shaped by distinctive cultural and socio‐political contexts. This analysis shifts our attention away from a focus on the effectiveness of policy solutions to the heterogeneity and contingency of policy ‘problems’ and ‘subjects’, opening up new possibilities for ‘out‐of‐the‐box’ policy responses to mental health.

Interprofessional dynamics that promote client empowerment in mental health practice: A social work perspective

“…Community mental health systems in Sydney and Hong Kong include not only specialised mental health services, but also a range of familial, vocational and residential community services that support but are not limited to users with mental health issues. In the policy context, discourses of recovery, personalisation and holistic care have become increasingly influential in guiding the delivery of mental health services in both Hong Kong and Sydney (Cui et al, 2019b). A key difference lies in their dominant cultural orientations, as the two cities represent examples of what are often described as featuring collectivist and individualist cultures, despite their similar cosmopolitan representations as multicultural and multiracial societies.…”

‘I think we're getting a bit clinical here’: A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service

“…Such re‐orientations to the provision of mental health support would have important implications for the workforce, changing the kinds of workers we classify as health and social care providers to include those who are currently either assigned to the periphery of the health sector or siloed into other domains. Changing the way we think about health, and thus the kinds of knowledge, expertise and actions required to foster good health, can change the system (Cui, Lancaster, & Newman, 2019). We contend that until health systems are recognised as cultural systems that include, intersect and generate multiple meanings and subject positions, having far‐ranging implications beyond the ‘health’ sector, we cannot begin to understand engagement, accessibility and patient‐centred care or address the temporal and fluctuating social challenges (re)created by processes of medicalisation.…”

Mental health services in Hong Kong: development of community-based inclusive development practice faced with the cultural barriers

“…This positive non-intervention policy enabled the colonial government to target the most needy and allow the less needy to be cared for by their family members or themselves (Cheng et al, 2013). Therefore, Hong Kong's mental health service system reflects its colonial legacy with the presence of a publicly funded health system (Cui et al, 2019a(Cui et al, , 2019b) and limited government expenditure on mental health care as a percentage of gross domestic product (0.24%; Legislative Council Secretariat, 2010); this created a conflict between collectivist ideas and the modern model of mental health delivery (Chen et al, 2019).…”

“…Empowerment, social inclusion and citizenship represent the central tenets of the Western recovery movement and ensure the full participation of patients in mental health services (Fukui et al , 2010; Rowe and Pelletie, 2012); mental patients in Hong Kong are still susceptible to asymmetrical power relationships with medical professionals under a biomedical model, which differs from the psychosocial model endorsed in the West (Schoeb, 2016). Chinese patients with mental illnesses rarely express their opinions or challenge medical professionals’ opinions and prescriptions (Wong et al , 2010); instead, they depend on medical professionals to make relevant decisions pertaining to their recovery and integration (Cui et al , 2019a).…”

“…Power inequality between medical professionals and patients was revealed in the Mental Health Review Report published in 2017 by the Hong Kong Food and Health Bureau (HKFHB) by Cui et al (2019a). The Mental Health Review Report made 40 recommendations for enhancing the mental health services proposed by the Review Committee on Mental Health (Review Committee) set up in 2013 (HKFHB, 2017; Legislative Council Secretariat, 2020).…”