CityUHK Professor Rethinks Schizophrenia

Professor Sylvia Kwok from City University of Hong Kong is rethinking care for the approximately 40,000 people in Hong Kong living with schizophrenia. She argues the current system, focused on symptom reduction, leaves an existential vacuum after medical stabilization.

Kwok critiques what she calls a deficit model of care. This approach focuses on what is wrong, such as hallucinations or social withdrawal, and aims only to decrease these symptoms. She says this narrows the system's responsibility to stabilizing illness before discharge.

A Strength-Based Alternative

Her work promotes a shift to a strength-based model. This focuses on what the patient has, aiming to build a person's internal resources like gratitude, forgiveness, and resilience. Recovery is defined not just by the absence of symptoms, but by what is cultivated.

Over the past decade, Kwok has introduced strength-based positive psychotherapy and meaning-centred therapy in Hong Kong's halfway houses. These settings have become micro communities for building social capital. Residents learn to live with others, practise empathy, and rebuild confidence.

Kwok notes that in the past, care involved mainly medical treatment with limited psychological support. Patients often felt uninspired and relapse rates were high. With stable housing and medication in place, halfway houses now allow clearer observation of psychological and social interventions.

The program has expanded to all halfway houses in Hong Kong, reaching more than 300 people. Outcomes show improvements in recovery and well-being that persist months after the program ends.

Rebuilding Identity and Purpose

A key feature is the focus on meaning-making. Schizophrenia often shatters a person's sense of self. Rebuilding requires individuals to reframe past experiences and unlock their potential.

Through guided exercises, participants learn to accept difficult experiences and recognise their capacity for change. Symptoms may persist, but they no longer define the person. They can find meaning in their struggle and transform negative experiences into a coherent narrative of growth.

This points to a broader question about system governance. Kwok argues mental health systems must expand their success metrics. They should add measures of well-being and quality of life alongside clinical indicators.

Systemic Changes Needed

Kwok sees a need to scale effective practices. Strength-based programs should be embedded into daily routines in halfway houses and extended to Integrated Community Centres for Mental Wellness. Professionals need training in these approaches, and public perceptions must shift to counter social stigma.

Employment is another area for change. Kwok notes the government provides sheltered workshops, but they often offer only tedious work like packaging. This overlooks potential talents in drawing, writing, acting, or sports. A more effective system would focus on different career placement so people can utilise their strengths.

Ultimately, Kwok's work calls for a fundamental shift in understanding. She recommends moving people from a patient identity to a citizen identity. This frames individuals not by deficits and dependency, but by capacity, agency, and belonging. It is a move from a deficit model to a strength-based model.