In Hong Kong, around 40,000 people live with schizophrenia. Many move through a system designed to stabilise symptoms—reduce hallucinations, manage medication, shorten hospital stays. But once the symptoms are controlled, a more difficult question lingers: what kind of life are people returning to?
For Professor Sylvia KWOK from the Department of Social and Behavioural Sciences (SS) at City University of Hong Kong (CityUHK), that question exposes a deeper structural issue. “Our present psychiatric service has an existential vacuum,” she says. “For a holistic recovery, they need to build up their hope, their identity, and they also need to have life goals.”
Yet the system, she notes, continues to define success narrowly. “In the past, they only used bed occupancy or reduction of symptoms.”
Over the past decade, Kwok has been working inside Hong Kong’s halfway houses to examine a different approach—one that shifts the focus from illness to human potential. What has emerged is not just a therapeutic model, but a rethinking of how mental health systems can be governed.
At the core of her critique is the dominance of what Kwok calls a deficit model. “Usually they focus on what is wrong,” she explains. “They just focus on the patient having things like hallucinations, social withdrawal, cognitive deficits, and they just focus on how to decrease these symptoms.” This way of thinking shapes everything from frontline care to policy priorities, basically narrowing the system’s responsibility to stabilising illness before discharge.
Her alternative begins with a simple but powerful shift in perspective. “My focus is to shift to a strength-based model—what the patient has—and to build up the person’s internal resources,” she says. “Everyone has their unique character strengths … their capacity for gratitude, for forgiveness … their capacity for resilience.” In this model, recovery is not defined solely by what disappears, but by what is cultivated.
This philosophy comes to life inside halfway houses, where residents spend one to two years rebuilding routines and preparing for community living. Each resident follows a rehabilitation plan co-designed with social workers, continues medical treatment, and often works during the daytime.
By introducing strength-based positive psychotherapy alongside meaning-centred therapy, Kwok has helped transform these settings into what she describes as “a micro community for them to build their social capital”. Here, residents do more than comply with treatment. They learn to live with others, practise empathy, and gradually rebuild confidence and agency in a shared environment.
“In the past, there was mainly medical treatment, but limited psychological treatment, so patients usually felt uninspired and the relapse rate was high,” she says.
These spaces also serve another purpose. With stable housing and consistent medication in place, halfway houses allow Kwok’s team to observe more clearly the effects of psychological and social interventions.
Over 10 years, the programme has expanded to all halfway houses in Hong Kong, reaching more than 300 people. The outcomes, she notes, are encouraging, with improvements in recovery and well-being that persist even months after the programme ends.
A defining feature is the programme’s focus on meaning-making. Schizophrenia, Kwok explains, often disrupts a person’s sense of self. “Usually there is a shattering of the self,” she says. Rebuilding that sense of self requires individuals to reframe their previous experiences and unlock their potentials.
Through guided exercises, participants are encouraged to accept difficult experiences and recognise their capacity for change. Over time, this process reshapes how they see their condition. Symptoms may persist, but they no longer define the person. “They can find meaning in their struggle and gradually transform negative life experiences into positive energy or a coherent narrative of growth,” Kwok explains.
These individual transformations point to a broader question about governance. What should mental health systems be accountable for? If success is measured only by symptom reduction, then recovery remains incomplete. Kwok argues that systems must expand their metrics and add measures such as well-being and quality of life alongside the usual clinical indicators.
She also sees a clear role for scaling effective practices. Strength-based programmes, she suggests, should be embedded into daily routines in halfway houses and extended to Integrated Community Centres for Mental Wellness.
At the same time, professionals need to be trained in these approaches, and public perceptions must shift. “In Hong Kong, they usually have a stereotype,” she notes, alluding to the persistence of social stigma.
Employment is another area where change is needed. “Nowadays the government also has sheltered workshops,” Kwok says, “but they only do very tedious work like packaging.” She argues that this overlooks people’s potential, pointing out that some may be good at things like drawing, writing, acting or playing sports, and a more effective system would focus on “different career placement … so that they can utilise their strengths”.
Ultimately, Kwok’s work calls for a fundamental shift in how people with mental health conditions are understood, and recommends that, “We shift them from the patient identity to a citizen identity.”
It is a subtle change in language, but a profound change in thinking. While one frames individuals in terms of deficits and dependency; the other recognises capacity, agency and belonging. “This is where we need to go—from a deficit model to a strength-based model,” says Kwok.
