PSYCHOSOCIAL OT SERVICEIN HONG KONG
4th Exchange Meeting with East Asian Countries
5 September 2019
Ms. Stella Cheng
Chairperson
Hong Kong Occupational Therapy Association

Some Background on HKOTA

Background• Established in 1978, 41 years in 2019
• The only Occupational Therapy Association in HK• Joined World Federation of OT in 1984

• Number of Members: nearly 1100
• Type of membership• Full Member• Associate member• Student member• Details please refer to HKOTA Web Site http://hkota.org.hk

Mission of HKOTA
1. To promote and safeguard the interests of members of
the Association
2. To maintain professional standards of Occupational
Therapy in Hong Kong
3. To promote a better understanding of Occupational
Therapy in Hong Kong

4. To hold meetings for discussion and the interchange ofprofessional ideas
5. To establish and maintain contact with members of theprofession
6. To establish and maintain inter-professional liaisons

Structure of HKOTA
General Meeting:
All Full Members

HKOTA Executive
Committee

Continue Education
Sub-committee

Special Interest Groups

External
Representatives

Executive Committee of HKOTA 18-20
Chairperson

Ms. Stella CHENG

Continuing Education
Secretaries

Vice Chairperson

Mr. Maurice WAN

Dr. Andy Cheng

Ms. Konica KWOK

Ms. Sanne Fong

Publication
Secretaries

Honorary Secretary

Ms. Janette TAM

Ms. Sabrina LI

Ms. Glenda NG

Ms. Clara CHAN

Publicity Secretary

Honorary Treasurer

Mr. Yat HO

Ms. Loretta LIU

Mr. David LAU

Ms. Vivian CHUNGIT Officers

Membership &Public Relation
Secretaries

Mr. Nico CHING
Ms. Wincy Ng

Ms. Rebecca CHAN
Mr. Simon WONG

Chief Editor, HKJOT

supported by 2 part-time administrative workers

Dr. Kenneth FONG

Registered OT in HK
2500

2258
1908

2000
1608
1500

1255
1056

1000
674

774

500
0

More than 3 fold rise in 23 years
1996

2019

Psychosocial OT service in Hong Kong

Psychosocial OT service in HK 1950-1980• OT service started in 1950s, provided by expatriate OTs,
mainly from UK, supported by local assistants with craft
and technical skills• Long stay patients and mainly for diversional therapy,
activities for deinstitutionalization

Psychosocial OT service in HK 1980-2000• Local OT graduates• More comprehensive service in mental hospitals and day
hospitals• Focus more on rehabilitation and community reintegration• Started service in non-government organizations

Psychosocial OT service in HK since 2000
• Transformation of OT service since 2000: recovery oriented, evidenced
based, evidence driven• Introduction of Advanced Practitioner of OT in mental health service inthe Hospital Authority in 2008
‒ OT become the first contact for patients with Common Mental Disorders Clinic‒ OT work in Integrated Mental Health Clinic in primary healthcare service• Introduction of Personalized Care Programme for patients with Severe
Mental Illness in 2009
‒ More than 100 OTs employed as Case Managers in district based service

Psychosocial OT service in HK since 2000
Introduction of International
Clubhouse‒Accredited since 2001

‒World’s 11th Training Base
ClubhousePsychosocial OT service in HK since 2000
Introduction of Transforming Relapse and Instilling Prosperity(TRIP) program for patients in mental health hospitals in
Hospital Authority in 2007
‒Activity based, psychoeducational groups, individual homework‒with Multicenter Double Blind Randomized Control Trial done
‒Significant effect on relapse prevention & effective for 1 year
‒Very positive client feedback

Psychosocial OT service in HK since 2000
Introduction of 5 Ways to Wellbeing Programme‒Based on evidence base for improving well-being of the UK Foresight
Project Report 2008
‒5 sessions of psychoeducation and activities‒Very positive client’s feedback

Psychosocial OT service in HK since 2000
Introduction of Abridged Illness Management and Recovery
Programme in 2010+‒Based on Illness Management and Recovery Program (Mueser et al.,
2002; 2006)‒Abridged for Hong Kong use, cut down to 10 sessions‒Multi-center Randomized Control Trial done showing significant result inmajor outcomesPsychosocial OT’s Work Settings

Hospital Authority (Government Funded)• 2 major mental hospitals opened in 1960 & 1980
• 8 district hospitals with psychiatric in-patient beds
• 8 day hospitals in hospitals or specialist clinics• 7 GOPDs with Integrated Mental Health Clinics• A few Common Mental Disorder Clinics• OT service provided to Child, Adult & Elderly• Over 3600 in patients, blanket referral• 220,000 registered psychiatric patients in 2018
• Over 200,000 Day Hospital attendances in 2018
• 28000 diagnosed dementia patients in Hospital Authority

Non-Government Organization• Started in 1954, more than 10 NGOs now• Community Support Service‒ Integrated Community Centre for Mental Wellness‒ District Elderly Community Centres for Mild NCD• Vocational Rehabilitation‒ Sheltered Workshop‒ Supported Employment‒ Integrated Vocational Rehabilitation Services Centre‒ On the Job Training Programme• Residential Care
‒ Halfway House (HWH)‒ Long Stay Care Home (LSCH)‒ Supported Hostel

Other settings• Schools• Private Clinics• Vocational Training Center• Social Welfare Department

Psychosocial OT Clients & Service

Child & Adolescence
Conditions

Interventions• Autism Spectrum Disorder• Early Assessment for Young
People with Early Psychosis• Attention Deficit
Hyperactivity Disorder• Developmental Assessment &Training• Specific Learning Disorder• Social Skills training• Early Psychosis• Sensory Integration andsensory processing• Substance Abuse• Emotional and Impulse Control• Anxiety• Learning strategies and handwriting• Depression• School Support & Parent’s
training

AdultConditions• Common mental disorder:
anxiety, depression, mood
disturbance, sleep
disturbance, SubstanceAbuse• Severe mental illness, e.g.
Schizophrenia, Bipolar
Affective Disorder,
Psychotic Depression,
Substance Abuse

Interventions• Early Identification of mental
illness• TRIP, AIMR, 5 Ways to Wellbeing• Preparation for discharge• Personalized Care Programme• Life Skills Assessment & Training• Vocational Rehabilitation• Crisis Intervention• Community Integration• Family’s training

Psycho-geriatrics
Conditions• Neurocognitive disorderfrom Mild to Severe• Behavioural andPsychological Symptomsof Dementia (BPSD)• Depression• Psychosis

Interventions• Early identification ofneurocognitive disorder orother mental problems• Cognitive assessment &stimulation• Life skills assessment &Training• Management of BPSD
• Environmental Modification• Family’s Training• Support to elderly homes

Our learnings in the past 40 years• Learn from global development• Build on available evidence• Drive change by local evidence• Willingness to share among OTs and act on our weakness
Recovery survey of patients of 20 settings in 7 clusters
Chinese Recovery Self Assessment
Total score: 3.174 (2011)
Total score: 3.877 (2013)(p=0.001)
Improvement in all 5 factors and in all settings

Acknowledgement• Occupational Therapist from the Hong Kong Hospital Authority:• Ms. June Chao, Mr. Raymond Wong, Ms. Odelia Yeung• Occupational Therapist Faculties from Department of
Rehabilitation Sciences, the Hong Kong Polytechnic University• Ms. Chloe Mo, Clinical Associate• Dr. Sunny Chan, Assistant Professor

Introduction to PAOT
( O N B E H AL F O F T H E 2 01 8 - 2 02 0 PAOT B OA R D )AN TH O N Y S . G R EC I A , P H D. , M A , OT R , OTR P
P R ES I D E N T

PAOT Vision Statement“PAOT, Inc. is highly recognized at the national andinternational levels as a provider of services toclients and other stakeholders in the areas ofhealth, wellness, productivity and quality of life.”

The PAOT leads and strengthens the unified vision for
Filipino OTs and stakeholders

UNIFYING VISION:
ONE occupational
therapist per 20,000
Filipinos OR 0.50 OT per
10,000 by the year 2025

Promote OTpractice

Filipino
HEALTHCARELOGOThe visual identity of Philippine Academy of Occupational
Therapy, Inc. (PAOT) was developed with the following
guiding principles: Modernization
 Legacy
 Pride Story Nationalism

Relevant Statistics

Region of PracticeNational Capital Region
CAR
Region 1
Region 2● Total number of registered OTs in
the Professional Regulation
Region 3
Commission in 2018: 4000
Region 4-A
Region 4-B● 2018 Regular member = 700
Region 5● 2018 Regular Members with
Region 6
Specified Regional Data = 330
Region 7
Region 8
Region 9* members may choose more than one region of practiceRegion 10* data is based on the PAOT membership in 2018; n = 330 (330 specified their region of practice)Region 11
Region 12
Region 13

153
6
13
4
32
70
1
6
12
57
1
0
8
16
94
4

Area of practice and Setting

2019 UPDATE: PHIL. OT LAW
1.

Signing of the the Philippine Occupational Therapy Law or Republic Act 11241 by
Pres. Duterte (March 11, 2019)2.

More open to various referral sources (not only coming to physicians)

3.

More Autonomy: Separates the OT board of examiners from the PT board
examiners and leadership of physiatrist (rehabilitation doctor)

4.

Requires membership of OT professional to PAOTOCCUPATIONAL THERAPY AND MENTALHEALTH PRACTICE IN THE PHILIPPINES

Prepared by:●Anthony S. Grecia, Ph.D., OTR, OTRP
●Jeffrey Paulino, Membership Committee Head
●PAOT August Interns

12THERE IS AN INCREASED NEEDFOR MENTAL HEALTH SERVICES
Depressive, anxiety disorders
and suicide cases have been
growing the Philippines
2.9 per 100,000 (2012 suicide
rate)

13

MAJOR PHILIPPINE MILESTONE ON
MENTAL HEALTH-2017 SIGNING OF THE
PHILIPPINE MENTALHEALTH LAW OR
REPUBLIC ACT 11036-2018-IMPLEMENTATI0N
OF THE LAW
14

PHIL. MENTAL HEALTH LAW OBJECTIVES
1. Strengthen effective leadership and governance for mental
health by, among others, formulating, developing, andimplementing national policies, strategies, programs, andregulations relating to mental health
2. Develop and establish a comprehensive, integrated effective
and efficient national mental health care system responsive
to the psychiatric, neurologic, and psychosocial needs of theFilipino people;
15

PHIL. MENTAL HEALTH LAW OBJECTIVES
2. Protect the rights and freedoms of persons with psychiatric,
neurologic, and psychosocial needs of the Filipino people;
3. Strengthen information systems, evidence and research formental health;
4. Integrated mental health care in the basic health services;and
5. Integrate strategies promoting mental health in educational
institutions, the workplace, and in communities.
16

CURRENT IMPLICATIONSOT• OTs will be referred to as Mental Health Service Provider• OTs are accountable to provide services that are evidencebased, client-centered, age-appropriate, least restrictive, andServices culturally responsive.
• Mental health services at the community level
Delivery • Community-based Mental Health Care Facilities

17

HUMANRESOURCES:
Generally, there islack of mental
health facilities
and mental
health workers
18

OT HUMAN RESOURCE
1. In general, there is a great deficit of OTs in the country
2. The current PAOT goal is to have 0.5 OT per 10,000
Filipinos (or 1 per 20000) by 2025
3. In our roster of members, only 54 OTs indicated engaging
in Mental Health Practice

19

Philippine OT Mental
Health Practice Settings
20

National Center
for Mental Health(NCMH)- OT
Chronic Care
Focus
21

National Center for Mental Health(NCMH)- OT Chronic Care Focus-Serves 4200 in-patients-Manages 56,000 out-patients per year
-provides Inter-department/ agency
rehabilitation programs

22National Center for Mental Health(NCMH)- OT Chronic Care Focus● Habit-training and improvement of level of
independence in ADLs and IADLs● Social skills, communication skills, and literacy training● Leisure exploration and participation● Pre-vocational and vocational exploration and training● Livelihood programs23

OT in Acute Care Focus:
Philippine General Hospital (PGH)
OT Section, Department of Psychiatry● Provides In-patient and out-patient services● More of a Practice placement centermost OT services areprovided by OT interns (4th/5th year OT students)● In-patient: ADL and IADL training● Out-patient: Pre-vocational and vocational skills training,and come Counseling24

OT in Outpatient Care:

Philippine Mental Health Association (PMHA)
Children and Youth
CenterUse of purposeful and occupation-based
activities

development of the emotional, sensoryperceptual, social, cognitive, physicaland motor skills

Adult Work Center
Composed of psychosocial, vocational,
and family programs

Community integration (gardening)25

OT in Outpatient Care:

Philippine Mental Health Association (PMHA)

ADULT WORK CENTER focuses onusing:● IADL interventions● Pre-vocational and vocational
skills training, work hardening,
and life skills training● Sheltered employment for mental
health consumers● Psychosocial therapeutic group
activities
26

Occupational Therapy in Drug Rehabilitation● Roles of Occupational Therapists○○○○

Use of occupations and activities to promote participation in various areas of occupation
Interprofessional collaboration
Utilization of research to strengthen practice
Facilitation of supports and reduction of barriers to participation using knowledge on environmental
modification● These identified roles are in disjunct with the perceived OT roles by health authorities in thePhilippines● There is a need for these roles to be recognized by all stakeholders to be able to maximize thecontribution of OTs in this domain
Sy, M. P., Ohshima, N., & Roraldo, M. P. N. R. (2018). The Role of Filipino Occupational Therapists in Substance Addiction andRehabilitation: A Q-Methodology. Occupational Therapy in Mental Health, 1–22. doi:10.1080/0164212x.2018.1446206

27

OT & Counseling for the Youth28

Integration of Occupational Therapy and Counselingfor Developmental Disabilties: Private Therapy
Centers in the community● A number children with developmental disabilities develop
mental health concerns as they approach adolescenceand adulthood● OT integrates occupation-based acitivites with counselingand coaching principles to promote  schoolparticipation/social participation; adult education;
vocational/community integration
29

Integration of Occupational Therapy and Counselingfor Developmental Disabilties: Private Therapy
Centers in the community● Counseling utilizes client-centered and cognitive
behavioral therapy approaches (CBT)● PAOT has strongly advocated Cognitive Behavioral
Therapy and conducts training and certification courses of
CBT focusing on Anger, Anxiety, & Depression
30

For more information, discussion andsharing about mental health and female
OT practice options, We encourage you
to participate and submit abstracts tothe 7th Asia Pacific Occupational
Therapy Congress in Manila!

Let’s celebrate diversity
in OT practice and Let’scelebrate Life.

31

32

Activities
ON BEHALF OF THE BOARD OF DIRECTORS AND OFFICERS OF PAOT,

Lim Hua Beng
On Behalf of The
Singapore Association of Occupational Therapists• Occupational Therapy Developments• Supporting women Occupational Therapists to remain in practice• Mental Health Occupational Therapy in Singapore• Occupational Therapy Post-Graduate Education

Healthcare 4.0: Industry Undergoing Transformation in Singapore
Emphasis on
Community Care

Preventive Carebefore Healthcare

Leverage on
Technology

ShrinkingManpower• Care delivery incommunity andhomes• One-Rehab
Framework• Primary Care
• Preventive Careas part ofroutine Care
• Pre-habilitation• Generalist
specialist• National
Electronic
Health Record• Rehabilitation
Technology• Transdisciplinary
Practice• Upskilling
Therapy
Assistants• Top of License
Practice

Singapore Association of Occupational Therapists• Largest growth in Nursing and Allied Health• Occupational Therapy:• 12.6% growth since 2016

Singapore Association of Occupational Therapists

2016

Age

%

20 - 2943.8

30 – 39

2018

2016

2018

2016

2018

2016

2018

Gender%Nationality%

Settings

%

39

Male

17.5

16.9 Singapore/ Resident

78.2

81.3 Acute Hospitals

43.3

38.6

39.8

41

Female82.5

83.1 Non-citizen

21.8

18.7 Community Hospitals

13.3

12.2

40 – 49

13.0

15Community Agencies

20.5

24.0

50 – 59

2.7

4

Private Practices

13.9

12.1

> 60

0.7

1

Academic Institution

1.4

0.9

RegistrationType%

OT Qualifications

Full

84.2

89.5 Singapore

57.6

59.7 Government/ Agencies

1.2

1.1

Conditional

15.7

10.4 Australia

11.2

11.8 Others

6.4

11.1*

Restricted

0.1

0.1

United Kingdom

5.3

5.5

Others23.4

231067 Registered Occupational Therapists on 31 December 2016
1201 Registered Occupational Therapists on 31 December 2018
Singapore Association of Occupational Therapists%*30 (2.5%) not employed, 103 (8.6%)
exited Singapore

12.6% growth since 2016

Singapore Association of Occupational Therapists(Singapore Department of Statistics& MSF, 2018)• 4 months paid maternity leave• 2 weeks paternity leave• 6 days child care leave for eachparent• Infant and Childcare subsidies• Large hospitals houses infant andchild-care centres• 173,907 child care places with
129,674 enrolled (25.4% vacancy)(Early Childhood Development Agency, 2019)(Prime Minister’s Office, 2013, p. 24)
Singapore Association of Occupational Therapists

Registration
Board

Flexible
Employment
Part-Time

Minimum Practice
Policy• 18.7% (2018)• 16.5% (2017)• 14.1% (2016)

Employment
Benefits for Flexi
Employment
Pro-rated Annual
LeaveChild-Care Benefits& Lactation Rooms

200 Hours
Practice/Year

Singapore Association of Occupational Therapists

Job Sharing

Private PracticeAllows autonomy

Provident Fund

* Inclusive those on graduate studies and in-between employment

• Estimated 20% in Mental Health• 7% in Adult Psychiatry• 5% in Psycho-Geriatrics• 8% in Child & Adolescent Mental
Health• Informed by National Mental
Health Blueprint (2007)• One of the 5 key professionals• Occupational Therapist• Nurse• Social Work• Psychiatrist• Clinical Psychologist

Singapore Association of Occupational Therapists

• Integrated Mental Health Care
MentalHealthPromotion

Integrated
MentalHealth Care

Manpower
Development

Research &Evaluation

Singapore Association of Occupational Therapists• Response, Early Intervention andAssessment in Community Mental
Health (REACH) (Children &Adolescents Mental Health)• Early Psychosis Intervention Program(EPIP)• Community Mental Health Team
(CMHT)• Job Club
• Community PsychoGeriatric Program(CPGP)

• Psychosocial Trauma Team• Mood Management Post-Stroke• COPD Support Team• Occupational Therapy Led Return to Work Coordinator in all public
hospitals

Singapore Association of Occupational Therapists

• Mental Health Graduate Scholarships (National Mental HealthBlueprint Health Manpower Development Scholarships)• Shortage of Occupational Therapy applicants• Challenge to attract new practitioners to mental health practice• Shortage in every practice domain• Growth slowest compared to other practice areas

Singapore Association of Occupational Therapists

Heathcare: One-Rehab Framework

Singapore Association of Occupational Therapists

Social Services:
3rd Enabling Masterplan

Singapore Association of Occupational Therapists• Developed collaboratively with key Allied Health Professionals• OT key roles:• Triaging needs• Determining and extending sessions• Primary care provider• Community Reintegration• Frame Basic Standards for OT students and new graduates (C-Reg) andnew full reg OT:• Entrustable Professional Activity (EPA) System

Singapore Association of Occupational Therapists

PT EPAsOT EPAs

Assess movement and functionof an individual

Assess occupational performance ofan individual

Plan therapy to optimize
movement and function

Plan therapy to maximize
occupational participation

Implement therapy to optimize
an individual’s movement andfunction

Implement therapy to maximize an
individual’s participation inmeaningful occupation(s)Level ofSupervision during
Conditional Reg

Level ofSupervision uponFull-Reg

Level 3
(remotesupervision)Level 4
(Unsupervised
Practice)Plan for Transition of Care
Plan for Transition of Care (Transfer /(Transfer / Discharge) to
Discharge) to support occupational
optimize movement and function transition
Conduct education for Patient/Client/Caregiver/Family
Singapore Association of Occupational Therapists(Ministry of Health Singapore, 2019)• Assessing and determining intensity of rehab care
• Authority to refer• Authority to discharge or extend rehab sessions• Work with patients to determine functional goals• Track outcomes• Pilot of first contact clinician for hand therapy

Singapore Association of Occupational Therapists

Singapore Association of Occupational Therapists• Assistive Technology and Powered Mobility• Early detection and intervention• OT Consultancy in Pre-school, School• Early Intervention Programme• Facilitating Transition• Transition in different stages of schooling• Schooling to Work and Employment Support• Leisure Participation• Care-giver support and training• Universal design of home and community President of SAOT Introducing Theme of OT Day 2020:“Integrating Care with Impact & Unity

Singapore Association of Occupational Therapists• Masters and PhD Scholarship in
selected universities in Australia,
Canada, UK, USA and Europe• Future Fit: Local Graduate
Programmes ensuring capability:• One-Rehab Framework• National Mental Health Blueprint• Enabling Masterplan 3 and beyond
Team of Occupational Therapists performing
Cognitive Screening in partnership with
Community Centre
Singapore Association of Occupational Therapists• Skillsfuture Singapore Framework• Skillsfuture Singapore (SSG) Funding• Professional Conversion Programme• 4 years to Accelerated 3 Year Bachelors
Degree for career change• Work and Learn Post-Graduate Course• Stackable Modules• Stackable Qualifications• 90% SSG Funding

257 participants in 13 courses/seminars delivered by 14 Health & Social Sciences faculty and 28 Overseas
and Local Health & Social Care thought leaders over 25.5 days
Singapore Association of Occupational Therapists• Achieved through theaccumulation of “stackable” post
graduate modules.
• Aligned with the specific needs ofthe health and social care industry(EPA, One-Rehab, EMP3)• Inter-professional• 10 students per module to launch

Singapore Association of Occupational Therapists• Elder Health & Rehabilitation (launched)• Mental Health• Child Health & Wellbeing• Primary & Community Care
• ? Hand Rehabilitation

Opportunities• SG Gov focus:• Health and social care
• Skillsfuture education• Inclusive society• Key OT leaders in government
advisory committees, policy
positions, heads of social
service agencies
Singapore Association of Occupational Therapists

Challenges• Leadership renewal• > 100% increase in student intake(60 to 130)
• Rapid pace of development
leading to unequal improvements
in practice domains• Ensuring supervision/mentoringand practice quality across sectors
and domains

Singapore Association of Occupational Therapists(Not same as all active members)GeneralAg
ild i ng- ICF
rern- e la
ad te
ole d
sc
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iti T e tio
ve chn
Re n oM ha b logyenita l itat
lH
i
ea on
lth
OT
W
or
kre CBR
la
te
d
OT
Dr
ivi
ng
ch

ge
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OT ra
Th l
OT e o
Pr ry
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tic
e

Et
hi
c-

Continuing Education
Online Education

14

12
10

8
6

4
2

0

Health condition
Intervention
KAOT(2018)X2=8.12, p=0.04

Union Activity / M utual Advocacy••

Su p p o rtin g OT & PTs lab or u n io n
Safety of yo u n g h ealth w orkers fro m
co n flict, u n fair d ism issal, h arassm en t an dviolen ce

Complying M edical Law

Violence / Assault
OUT

OKASEAN Exchange Meeting- by Taiwan Occupational Therapy
Association
Delegate: Sarah Chan, Ph.D.
September 5 20191

History of Taiwan OT

 Rooted from mental health OT
Taiwan Occupational Therapy
Association was established

1970

1982

Formal occupational
therapy education

1986

Constituted the law for
the occupational therapy

1997

1999

Established the
Met the membership
requirements of the Occupational Therapists
Union of R.O.C.
WFOT

2History of Taiwan OT (cont’d) occupational therapy in Taiwan was started

from the psychiatry sanatorium
government began theallowance to community
rehabilitation projects
1989

1974
Taiwan Occupational
Therapists started
practicing in various
institutions

law amendment
until
2008

1994
The law of the mental healthinstitution setting: management
and incentives

3

Taiwan's current mental health services
 Mental health institutions

Among general medical institutions in Taiwan by 2018
 504 psychiatric outpatient clinics
 132 daycare units The number of beds in acute and chronic units isapproximately 21,200 in total

 accounting for 12.6% of the total numberof hospital beds in Taiwan.

From: the Laws & Regulations Database of The R.O.C., Ministry of Health and Welfare website

4

Taiwan‘s current mental health services (cont’d) Community-based rehab
Service types

Number of institutions(available beds)

home care services

108

Psychosocial rehabilitation centers

68 (3208 beds)

Half-way houses

149 (6299 beds)

psychiatric nursing homes

44 (4100 beds)
5

From the Laws & Regulations Database of The R.O.C., Ministry of Health and Welfare website

Psychosocial rehabilitation
workshops: drop-in centers

https://www.youtube.com/watch?v=2P-SCRa2Wr4
https://www.youtube.com/watch?v=SUzj-96TyZU

6Half-way houses
https://www.youtube.com/watch?v=RRAPg6hlvE&feature=youtu.be

Materials adopted and adapted from youtube: https://www.youtube.com/watch?v=rbQ91UnfT_Y&t=

7

Regulations on manpower allocation
 general hospital setting (acute, chronic, & day care) One OT staff every 35 beds is required Mental health institutions/teaching hospitals : In acute and chronic wards, one OT staff per 100/80 beds

is required

 day care unit : one OT staff per 75/60 beds is required
from the Laws & Regulations Database of The R.O.C., Ministry of Health and Welfare website

8Gender Equity Acts
 Act of Gender Equity in Employment (2002)
 revisions until 2016
 Prohibit gender discrimination
 Sexual Harassment Prevention

 Various support (Menstrual leave, Maternity leave,

Parental leave…)

from the Laws & Regulations Database of The R.O.C. website

9Gender Equity Acts
 Female labor workforce
 50.19% (2002)

51.14% (2008)

 Parental leave applications
 310K (2002)

480K (2008)

from the Statistics Database of Ministry of Labor Force website

10Pre-Maternity Leave pregnancy

pregnancy
Restingfamilycare leave

delivery

Paternity
Leave

Adjust work loading

Breastfeeding Room
Adjust work
loading
Parental leavepay

Resting
Guarantee theright to work

Parental leave
rightdeliveryMaternity
Benefitbreast-feeding

family care leave

Materials adopted and adapted from the Ministry of Labor Forceraise children

11

12

THE CHALLENGES OF
PSYCHOSOCIAL OCCUPATIONAL
THERAPY IN JAPANThe Occupational
Therapy Supporting
People to Live
Comfortably in Their
Local Community

SIGNIFICANT PSYCHOSOCIAL PROBLEMS IN
JAPANThe increase in dementia patients
Disaster mental health
The excess of suicide
The increase in people with neurodevelopmental disordersAddiction as a social problem
Social adaptation of the people with mental disorders who bleak the law
Difficulties in transitioning to community life for long-term hospitalized
patients

THE INCREASE IN DEMENTIA PATIENTSCurrent dementia rates

12

Increased dementia rates

10

The number of dementia patients is
estimated to reach approx. 7 million
in 2025.
The number of early-onset dementia
patients was estimated to reach 37,750
people in a study by MHLW in 2009.

8
6
4
2
0
2012

2015

2020

2025

2030

2040

2050

2060

Preventive measuresRehabilitative Intervention
Continued employment support(for early-onset dementia patients )Alzheimer Café

http://www.jaot.or.jp/ot_job/to_live/to_live_006.html

DISASTER MENTAL HEALTH
Japan disaster rehabilitation assistance team: JRAT(2015)
Disaster psychiatric assistance team: DPAT (2013)
Disaster Medical Assistance Team:DMAT(2005)

http://www.dpat.jp/images/dpat_documents/1.pdf

https://www.jrat.jp/images/PDF/rp_haken.pdf

THE EXCESS OF SUICIDE
20,840 suicides in 2018
The number of suicides was reached
to over 3 million in the period from1998 to 2012.
• The cause and/or motive of suicides
 Male: Economical problem, Daily life problem
 Female: Health problem
In those all circumstances, it is suggested thatthey have contracted depression.

Medical Management of depression
Preventive measures

https://www.who.int/mental_health/suicide-prevention/country-profiles/JPN.pdf

THE INCREASE OF NEURODEVELOPMENTALDISORDERSThe number of children and students
who have neurodevelopmental disorders(ASD, ADHD, or others) has reached to41,986 according to a study by MEXT in
2015. It has increased 6.1 times ascompared to the study in 2006.
The number of patients have reached
to 195,000 according to a study by
MHLW in 2014.
Involvement in places of education
Support to the preschool children
Support to the children after school
Continued employment support to theadultshttp://www.jaot.or.jp/ot_support/qa/qa_017.html
http://www.jaot.or.jp/ot_job/sugoudeADDICTION (DEPENDENCE) AS A SOCIAL
PROBLEMAlcohol dependenceDrug dependenceGambling addiction
Alcoholism Rehabilitation Program; ARP
Matrix modelSerigaya Methamphetamine Relapse Prevention Program; SMARPP

SOCIAL ADAPTATION OF THE PEOPLE WITH
MENTAL DISORDERS WHO BLEAK THE LAW
In the number of arrests who has mental disorders by crime name in 2017,
theft was the highest order followed by assault and battery. Their ratio in
total of criminal offense was 1.5% according to the white paper on crime in
2018.
Act on Medical Care and Treatment for Persons Who Have Caused Serious
Cases Under the Condition of Insanity(2003)
Occupational therapy in prison

DIFFICULTIES IN TRANSITIONING TO COMMUNITY
LIFE FOR LONG-TERM HOSPITALIZED PATIENTSThe number of the long-period
inpatients was reached to 0.313 million
in 2014.
• Their average hospitalization period was 281
days.
• Especially, cancelation of social hospitalization to
the schizophrenia patients is one of serious issue
to be work on.

Strengthen support system at hospitalfor the patients move to live in local
community.
Resources in local community; medicalcare, food, clothing, employment, shelter,friend and entertainment.

millions
4

Inpatients

Outpatients

3

2

1

0

1996

1999

2002

2005

2008

2011

2014

The number of the patients who use medical institutions(MHLW)

CONSTRUCTION OF COMMUNITY-BASEDINTEGRATED CARE SYSTEMS WITHSUPPORT FOR MENTAL DISORDERSCONSTRUCTION OF COMMUNITY-BASED INTEGRATED CARESYSTEMS WITH SUPPORT FOR MENTAL DISORDERS
To support mental disorders patients to live in their own way with piece ofmind as a member of local community, the system should be secured“medical care”, “long-term care”, “welfare services”, “shelter”, “social
involvement”, “employment” and “education” comprehensively.
The system should supports the idea of the movement from “the life
centered around hospitalized medical care” to “the life centered around
local community”.
The system should be infrastructure to support various mental disorders.
The system should be contributed to realize the “Inclusive Society” which
creates daily life and worth living for every local resident, and their local
community by all their members.

Create the Inclusive Society

CONTRIBUTIONS OF OCCUPATIONAL THERAPISTS TO THE
REGIONAL COMPREHENSIVE CARE SYSTEM INCLUDINGSUPPORT FOR THE PEOPLE WITH MENTAL DISORDERS
Medical（psychiatry / General）

Acute phase Convalescent phase Transition period Outpatient

Psychiatric Occupational Therapy
Psychiatric emergency ward
child and adolescent psychiatric disorders ward
psychiatric ward for transition of long-term patients
Ward for inpatients with mental disorders who
bleak the law
OthersProvision of“ mental function”“ADL ability”
information basedon ICF・Mental health and welfare centers
・Employment and Life Support Centersand others

Support for continued
employment,
coordination of work
place and support for thestability of employment
based on assessmentof psychiatry conditionand daily life ability

Psychiatry
day carePsychiatry
visiting services

Continued
employment

CORPORATION
Outpatient/Inpatient
Daily medial

LivingPatients

long-term care and welfare
services
Independent living training（Home care/ Nursing care）

Support for Transition of
employment andcontinued employment

Day care /Entrance
・Home care service
・Nursing care service

・Home

Public participation / Regional cooperation / Education

Various consulting
serviceCompanies, peer support, self‐government association, volunteers,
NPO and school

The Japanese Association of Occupational Therapists (partially modified)

THE NUMBER OF PSYCHIATRIC MEDICAL INSTITUTIONS AND
OCCUPATIONAL THERAPISTS DEALING WITH VARIOUS
PSYCHIATRIC DISORDERS N=452
The numberof responded
institutions

The number ofOccupational Therapists

Schizophrenia

180

901

Depression

171

850

Dementia

179

879

Child and adolescent psychiatric disorders

64

315

Neurodevelopmental disorders

111

559

Alcohol dependence

118

575

Drug dependence

62

317

Gambling addiction

45

243

PTSD

54

299

Higher brain dysfunction

51

268

Eating disorders

71

379

Epilepsy

110

526

Psychiatric emergency
Physical complications (such as disuse syndrome,
cerebrovascular disease and musculoskeletal disorders)＊

81

472

68

371

Suicide prevention

37

182

Disaster mental health

28

177

MAIN MEDICAL CONDITIONS(PSYCHIATRIC OCCUPATIONAL THERAPY)
The most The second The thirdlargest of largest of largest of
conditions conditions conditions

Total
0

（F0）Organic, including symptomatic, mental disorders

55

147

90

292

（F1）Mental and behavioral disorders due to psychoactive
substance use

1

19

26

46

（F2）Schizophrenia, schizotypal and delusional disorders

353

46

12

411

（F3）Mood [affective] disorders

8

183

151

342

（F4）Neurotic, stress-related and somatoform disorders

2

6

45

53

（F5）Behavioral syndromes associated with physiologicaldisturbances and physical factors

0

0

1

1

（F6）Disorders of adult personality and behavior

0

0

5

5

（F7）Mental retardation

0

9

52

61

（F8）Disorders of psychological development (including PDD, AS)

0

5

27

32

（F9）Behavioral and emotional disorders with onset usuallyoccurring in childhood and adolescence

0

0

2

2

n=419

* Three conditions are chosen by sequentially beginning with the largest.

100

200

300

400

RESTORATION PROCESS AND PURPOSE OF
OCCUPATIONAL THERAPY N=341
Transitional

Convalescent

PurposeAcute phase① Improvement of metabolic function

82

15

8

② Improvement of circadian rhythm

226

127

58

③ Prevention of mentally disuse atrophy

171

108

71

④ Steadiness of mind through occupational

307

239

113

⑤ Recovery of remaining capability and self-eﬃcacy through occupational

206

281

138

⑥ Acqirement of the ADL/IADL abilties including continued employment

70

185

157

⑦ Improvement and acquirement of social skills

69

205

193

including visualized structuralization and environment

9

43

45

⑨ Support to understand features of own disorders

97

162

152

5

17

96

⑪ Advise and direction on how to interact with helpers and their family

21

22

98

⑫ Supprt to develop and perticipate in self-help group

3

4

37

⑬ Supprt for contued employment and stability of the jpb

1

0

51

⑭ Support for work balance and leisure activities

26

41

115

⑮ Others

15

6

14

period to thephasecommunity⑧ Acqirement of activation method for the compensation ability,⑩ Support to visit and experience the facilities of support for job seekers

OUTREACH SERVICE FOR THE PATIENTSDISCHARGED FROM THEIR HOSPITALIZED
Main visiting place
TREATMENT
n=87 Multiple answers■ The larges answer was their home, 85 responded (98%). Then, it was grouphomes (57 respondents), continued employment facilities (16 respondents),
training facilities for daily life (9 respondents), employment offices (7respondents) and patient’s workplaces.

Skills and roll of Occupational Therapy for the patients subjected to outreach service

The number of responses

Evaluation and intervention of mental function

68

Evaluation and intervention of physical function

25

Evaluation and intervention of activities, such as ADL and IADL

69

Evaluation and intervention of study and continued employment

5

Evaluation and intervention of leisure and participation in community

36

Evaluation and intervention of physical environment, such as assistive technology andliving environment

14

Evaluation and intervention of personal environment, such as family and friends

28

Evaluation and intervention of social environment, such as institutions and services

15

EMPLOYMENT SERVICES BY OCCUPATIONAL
THERAPISTSIn the business handling transitions to the continued
employment, the institutions which allocate occupational
therapists had more than doubled new employments employedcontinually comparing with the institutions who do not allocate
occupational therapists (MHLW 2017).
In Japan, although there are 3,471 institutions which handlingtransition support, only few institutions allocate occupational
therapists in their office (JAOT 2017).

VISUALIZATION OF THE MENTALLYDISORDERS PATIENTS’ VOICETo Create theInclusive
SocietySEND THE RECOVERED PEOPLE’S MESSAGE ON
INTERNET AND TV
JPOP-VOICE（JPOP®;Japan Public Outreach Program 2009～）
Baribara（Barrierfree Variety Show, Nippon Hoso Kyokai ; Nippon Hoso
Kyokai (Japan Broadcasting Corporation) 2014～）
Bethel-net, Bethel Movie (Bethel house)ACTIVITIES OF PEER SUPPORT STAFF
iJaMP(established in 2015)• An institution to develop peer support specialist of mentally disorder. The representative is aperson with mental disabilities.

Hokkaido Peer Support Association (established in 2014)• An institution working to develop and spread peer support. Hokkaido Peer Support
Association is an institution The representative is a person with mental disabilities.

The number of offices which using peer support staff was 130, and thenumber of the peer support was 337 people.
(in a study by Ministry of Health, Labor and Welfare in 2010)

CURRENT STATUS AND ISSUES OF
PSYCHOSOCIAL OCCUPATIONAL
THERAPY IN JAPANBased on the survey by theJapanese Association of
Occupational Therapists(JAOT)PRESENT SERVICES WHICH OCCUPATIONTHERAPISTS ARE ENGAGED IN
Medical service• Occupational Therapy to the inpatients from acute phase of the illness to the convalesce• Occupational Therapy to the outpatients at day hospital• Occupational Therapy in outreach serviceWelfare services• Employment transitioning support• Return to work(re-work) program• Training for self-reliant life
• Support for neurodevelopmental disorders

Medical welfare service in judicial area
• Occupational Therapy for inpatients with mental disorders who bleak the law• Occupational Therapy in prison

CHANGES IN THE WAY OF APPROACH NOWADAYSCognitive behavioral approach• Social Skills Training; SST• Cognitive behavioral therapy; CBT• Mindfulness Based Occupational Therapy; MBOT

Training program for neuro-cognition and social-cognition• Neuropsychological educational approach to cognitive remediation; NEAR
• Social cognition and interaction training; SCIT

Approach based on recovery concepts and evidence• Assertive Community Treatment; ACT• Individual Placement and Support; IPS• Illness Management and Recovery; IMR• Wellness Self-Management; WSM

Approach developed and led by the patients• Wellness recovery action plan; WRAP
• Self-directed research

CHANGES IN THE WAY OF APPROACH NOWADAYSMainly in medical service, cognitive behavioral approach and introductionof training for neuro-cognition and social cognition are advanced. On theother hand, support activities based on parson centered approach are
spread by introducing recovery concepts mainly in the welfare services forpeople with mental disabilities.
In Japan, theory construction and study on the effects of occupational
therapy are future subjects.
By introducing recovery concepts, approach from clients’ viewpoints
became more important. User involvement research will be also important in
the future.

THE FUTURE AGENDA
Promotion for the prevention and development of rehabilitation for the dementia.
Construction of disaster support system and improvement of occupational therapy
technique to the PTSD and so on.
Involvement of suicide prevention, improvement of occupational therapy techniquefor depression.
Construction of continuous support system for the people with neurodevelopmental
disorders.
Improvement of support technique for not only substance-related disorders but also
addictive disorders of gambling and so on.
Improvement of support technique and construction of support system for people
with mental disorders who break the law.
As contributions to the community-based integrated care system, firmly involvementin the transition to live in local community for the long-period inpatients,
independence training to continue daily life in the community, allocation of theoccupational therapist and improvement of the support technique toward continued
employment support facilities.

THE FUTURE AGENDA
Additionally,
Promotion of occupational therapy services and researches in collaboration withpeople with mental disabilities.
Improvement of occupational therapy technique in emergency psychiatry, theprevention and early intervention in psychiatry.
Construction of occupational therapy theory and verification of effectiveness.

A workplace friendly to female occupational
therapists, and the support of Japanese
Association of Occupational Therapists
女性作業療法士が働きやすい職場と日本作業療法士協会の支援

Japanese Association of Occupational Therapists

Exective Director UDA Kaoru

Changes in the number of JAOT members

Total

Number of
female members

Number of
male members

Voluntary withdrawals
and reasons characterics of women

Family caregiving

Retirement

Leave of absence
Resignation due tomarriage

Pregnancy, childbirth,child-careDue to reasonscharacteristics ofwomen
Number of voluntarywith drawals

Current status offemale members in JAOT
●Number of female Directors : 4people(Male Directors : 18people)●Number of Delegates: 29people(13.9%)●Percentage of womenas department members
and committee members: 26.0 %Changes in Japanese female labour force participation rateby age group (the M-curve)

１９７５
１９８５
１９９５
２０１２

Gender Equality Bureau Cabinet Office

2012 Comparison with ratio of female OT

Total

With aspouseRatio of JAOTby age group
Ratio of women in JAOT
(including those on
leave of absence)(age)The gap between statistics and reality
In statistics,
employment rate of Japanese female andthe ratio of female OT remain high.
Whereas in reality we hear that,“It’s so hard to achieve a good balance
between work and family life.”“I can’t get the help or understanding
I need from the workplace or my family.”
Ratio of female members participatingin JAOT activities is low.

Initiatives launched to facilitate female
members’ involvement in JAOT activities
2013 The 2nd 5-year strategic action goal was set as“facilitating female members’ involvement in JAOT activities”
As 65% of JAOT members are female,
we need to improve work environment to further
facilitate their involvement in JAOT activities.
●Even in the case of life events such as pregnancy,
childbirth, childcare etc., members should be able tokeep working as OT and participate in JAOT activities.
●More female members’ involvement in the
management of JAOT as delegates or directors isneeded.

Oct. 2015 Suggestions for facilitating female
members’ involvement in JAOT activities were madeGoal 1Create an environment where one can1) return to work smoothly even once resigned,2) join seminars even with children to care for, etc.
In a word, to be able to keep working as an OT.

Goal 2
Set the desired ratio (30% for instance)of female members as delegates (since 2019)and management members (since 2019),
and to realize it.

An introduction of initiatives launchedHomepage banners

Work as an occupational therapist

Female consultation desk

Initiatives launched in conferences ①
💕 Low-fare nurseries are installed＊Participants are increasing.
Participants with children are more
often seen on conference sites.
＊Nurseries are still few in branch-level
conferences and workshops.

Initiatives launched in conferences ②

💕 Installed the “booth for female members”:
presenting talks about“JAOT with each directors’ childcare
experiences,”“Female administrators’ way of work,”“Branch associations with more female
directors”,
while members gathering there candiscuss freely.

●It became a place where members can talkabout something they can’t in the workplace.
●Members struggling to find their own way ofwork share their experiences with each other
there.

“The window”, a featured page for female
members on JAOT official magazine
💕On JAOT official magazine, one page isdesignated to publish female members’ articles.
● Published serially since July 2013
● Topics such as“Difficulties in balancing work and childcare”,“Issues faced after reinstatement”, and“Appreciating the understanding of colleagues”
are common, while many members look forward
to the release of new issues. They feel inspiredby the positive attitude of OTs in these articles,
and learn about female OT’s wisdom.

From the columns on OT magazine
💕Often times, one female OT’s questions would
gain feedback from three OTs, consisting of●An OT in similar situation●slightly senior female OT●A very experienced female OT＊There is always an advisor who is having the same
experience.
＊The advisor herself talks about the experience also
for the first time on a magazine.
＊Commonly asked questions not only include thoseabout preganancy, childbirth and childcare, but alsofamily caregiving, being sick, and not having enoughtime to train juniors.

Findings from female OT’s comments①
Achieve a balance: The point is not to achievea balanced daily schedule, but to consider towhat extent one’s own vision of being an OT, amother, a wife, and what one really want to do
are achieved.
Understanding: What’s needed is not only
single actions such as “I can take a leave fromwork,” “my husband would help withhouseworks,” “I can go to conferences,”but also understandings in which one is“acknowledged as a human being.”

Findings from female OT’s comments ②① They want to keep working as OTs.
② They are capable of self-management.

They are aware that they are equippedwith the ability to manage their own
actions and involvement in various
occasions.

JAOT’s support from now on
It is true that more time is needed to facilitate theinvolvement of female directors etc. in JAOT activities.
Whereas,●We can see that with improvements in work
environment and regulations, it is easier for female OT towork in ways they want
●With the booth and/or consultation desk for female
members installed in conference sites, female members
are able to express themselves, and mutual
understandings among JAOT members are facilitated.
●The above mentioned initiatives could be developed intoa nationwide mechanism.

Thank you very much for listening.

OCCUPATIONAL THERAPYIN
MONGOLIA
Erdenetsetseg Myagmar

President, Mongolian OTA

Fukuoka, Japan
2019

Content
1

MONGOLIA AT A GLANCE

2

OCCUPATIONAL THERAPY IN MONGOLIA

3CHALLENGES

4SUPPORTS NEEDEDMongolia at a glance

Population
3.2M

Territory
1.6M km²

GDP$3,600Population pyramid
60+
15-59

30.5%

6.4%

63.2%
Life expectancy:

65.88

69.89
75.44

The five most common causes of morbidity
per 10,000, 2008-2017• Respiratory
diseases• Gastrointestinal
diseases• Cardiovasculardiseases• Urogenital
diseases• Trauma,
intoxication

The five most common causes of mortality
per 10,000, 2008-2017• Cardiovasculardiseases• Cancer• Trauma,
accidents,
intoxication• Gastrointestinal
diseases• Respiratory
diseases

OT in Mongolia (pre-Bachelor period)
Enrolled in Euro
Master of OT

Signed MOU
between MNUMS
and ZHAW

2004

Start of Bachelor programcurriculum development

2010

2012

2007
WFOT conducted
needs assessment

Started PT programwith Gunma
University

2014

StartedTrain-the-Trainer
program by
ZHAW

Recruited our first
OT students

MONGOLIAN NATIONAL UNIVERSITY OF MEDICAL SCIENCES(MNUMS)• School of Medical Sciences• School of Public Health

School Of Nursing• School of Dentistry

School of Pharmacy and BioMedicine

Nursing(Bachelor Degree)
Nursing (Diploma)

School of Nursing

Physical Therapy(Bachelor Degree)
Midwifery(Bachelor Degree)
Technologist of Radiology(Diploma)
Occupational Therapy(Bachelor Degree)OT in Mongolia (Bachelor program)

Second cohort
graduatedTozato Fusae
Lee BumsukShiori Katsuyama

2015

2017

2016

2018

Gunma guest
lecturers
Tozato Fusae
Lee BumsukShiori Katsuyama
Tadahiko Kamegya

First OT students
graduatedTozato Fusae
Lee Bumsuk
Kiyotaka Iwasaki

2019Occupational Therapy Lecturers

Our
Team
Layout2

Occupational Therapists with Bachelor
Degree16

Occupational Therapy Students

4+15+6+1035

Employment of Occupational therapists

OT in Neurology &TraumaPediatric OT
Rehabilitation Center for children
with disabilties
Kindergarten for children with CP
Kindergarten for children withhearing disabilities

Working in different
field
Lives abroad

62.5%

31.25%

Acute care tertiary hospitals
Sub-acute care rehabilitation centers

Geriatric & Mental
Health6.25%

0%

No work positions in these fields.

To strengthen OT service…

01 Determine situation

03

02 Develop strategic plan

04 Implement

Establish monitoring framework
and review processes

Challenges

Low number ofstudents

Lack of teachingcapacity

Absence of tools andequipments

Lack of practicalskillsWhere are we now?
Where are we going?
Option A

Option B

Option C

Further Support Options
Scholarship for Undergraduate
students

Student exchange
programs

Post Graduate
trainings

Thank you