A Constructivist Grounded Theory Study on Mental Health Recovery from a Lived Experience Perspective in Singapore.

More contemporary personal recovery conceptualisation of mental health recovery emphasize the need to consider the perspectives of people who experience mental ill-health. Most lived experience research has been done in Western cultures with relatively few studies in Asian ones, creating a gap that needs to be addressed due to differences in cultural worldviews. This study explores the notion of recovery from the lens of people experiencing mental health challenges in Singapore. We adopted a constructivist grounded theory perspective to evaluate qualitative data from 21 participants. The core category which best represented what recovery meant was "reconciling and living with experiences of mental ill-health". Our findings suggest that a variety of societal aspects greatly influence perceptions of mental health recovery in Singapore, as participants often shared their desire to live a meaningful life within society but could only do so if they found a way to manage their symptoms more effectively.

Mental health professionals' perspectives regarding how recovery is conceptualized in Singapore: a constructivist grounded theory study.

BACKGROUND: Mental health recovery has shifted from clinical conceptualizations to more personal ones. However, much of the lived experience literature has focused on people living with mental health conditions, and less attention has been placed on various mental health professionals, especially in Asian countries, where the personal recovery literature base is in its nascent stage. AIM: We sought to contribute to a growing body of work by exploring recovery from the lens of different mental health professionals in Singapore. METHODS: Mental health professionals in Singapore were invited to participate in an online interview through social media. The recordings were transcribed verbatim and analyzed using a constructive grounded theory approach. RESULTS: Nineteen participants were interviewed. A single core category, "living in society once more", and three categories, "An ongoing process", "Regaining ability to function in society", and "A normality report card" were identified from our data. CONCLUSIONS: Recovery within the Singapore mental health professional perspective focuses on helping individuals return to society and function productively while considering existing societal norms such as the highly competitive and pragmatic culture in Singapore. Future research can explore in greater depth the impact of these factors on the recovery process.

Nursing Students' Perceptions Toward Recovery in Mental Health: A Descriptive Qualitative Study.

BACKGROUND: Recovery in mental health remains inconclusive where the two most prevailing definitions "clinical" and "personal" remain. In nursing schools, students are predominantly taught straightforward concepts of clinical recovery, which result in only a perfunctory and rudimentary understanding of recovery among the undergraduates. AIMS: To explore the perceptions of nursing undergraduates on recovery for people experiencing mental health conditions. METHOD: A descriptive qualitative study was conducted on 14 nursing undergraduates from Years 1 to 4 of the study. Participants were recruited through convenience sampling, and the required sample size was determined by data saturation. Semistructured questions were used during the individual face-to-face interviews from October and December 2019. Recordings were transcribed verbatim; the transcripts were then subjected to thematic analysis. RESULTS: Three themes were identified to support the research questions: (1) semantics of major terms used in mental health care-where participants provided the description of terminologies used; (2) the meaning of recovery-where participants explained their views on "recovery"; and (3) sources of conceptualization-where participants explained their conceptual understanding on mental health conditions and recovery. CONCLUSION: The findings suggest that the need for a more holistic approach encompassing personal recovery should be included in the nursing curriculum. This is necessary to promote enabling support in the recovery of people experiencing mental health conditions beyond medical interventions.

Asian perspectives on personal recovery in mental health: a scoping review.

BACKGROUND: Personal recovery is a relatively novel concept in many Asian countries, and recovery-oriented interventions are usually adapted from western conceptualizations of recovery. AIM: To understand what personal recovery in mental health means to people in Asia, what meanings they give to their conditions, and what factors they perceive as hindering or facilitating their recovery. METHOD: The review focused on peer-reviewed papers published in English between the years 2000 and 2020. Arksey and O'Malley 5-stage method was used to guide the review. RESULTS: Thirty studies were included. Personal recovery in Asia meant a return to a pre-illness state and involved a transformative process. Mental illness was explained as being biomedically oriented, although religious/culturally bound explanations were also present in some studies. Social support, religion, meaningful activities, supportive professionals, and personalized coping strategies were viewed as supporting recovery. Religious stigma, discrimination, gendered norms, and negative societal perceptions of mental illness hindered recovery. CONCLUSIONS: The concept of personal recovery in Asia is extremely diverse. Studies exploring personal recovery among people experiencing mental illness in Asia remains in its early stages and more research is needed to better understand how it is conceptualized. Such knowledge could benefit frontline implementation of recovery-oriented services.

Implementation of peer-support services in Asia: A scoping review.

WHAT IS KNOWN ON THE SUBJECT: Peer-support services was started in the 1970s psychiatric survivor movement in the United States of America (USA) due to the lack of transitional support for deinstitutionalized psychiatric patients. Delivered by peer-support workers (PSWs) with lived experiences of mental health conditions, peer-support workers use their experiential knowledge to help others with similar conditions. The paradigm shifts in mental health recovery has led to an increase in interest on peer-support services among the Asia countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The diversity political and cultural differences in Asia makes it a unique for people to understand the mental health ecosystem that exist within. This review is timely as it provides the insights into the current state of peer-support services for mental health consumers in Asia and the future research on them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: First, this review provided a broad overview on the current types of peer-support services and their implementation in Asia. Second, emphasized the importance and value of peer-support services for individuals with mental health conditions in their journey towards recovery. Third, important to build a more positive image for peer-support workers by assigning more clarity to their roles and systematizing training to hone their skills in providing peer support. ABSTRACT: Introduction The increasing recognition and need for recovery-oriented services led to the heightened interests of peer-support services globally, including Asia. However, little is known about the peer-support services in Asia as compared to the West, where peer-support services primarily originated from and are well established. Aim To examine available evidence on the implementation of peer-support services for such consumers in Asia. Method This scoping review was based on the Arksey & O'Malley's framework. A comprehensive search was performed across seven electronic databases. The grey literature was also searched through Open Grey and ProQuest Dissertation and Theses, alongside hand searching of the reference of the studies. Articles searched was from January 2000 to December 2021. Results Three main themes were identified to provide an overview on peer-support services for mental health consumers in Asia: the delivery of such services in Asia; Asian consumers' perceptions of them; and factors affecting their implementation. Discussion Given their relative novelty in Asia, findings from this review represent useful insights for organizations and policy administrators when formulating such services. Implications for Practice Future research should also focus on evaluating the effectiveness of such services in Asia and comparing their outcomes with other regions.

Lived experiences of mental health conditions in Singapore: A constructivist grounded theory study.

BACKGROUND: Since the 1990s, the mental healthcare field has begun shifting to conceptualisations of personal mental health recovery, emphasising the heterogeneous nature of how people develop and overcome the difficulties associated with mental ill health. Despite three decades of research on the topic, most recovery-oriented studies have been conducted in predominantly Western cultures, lacking the necessary nuances when applied in Asian settings. AIMS: We sought to contribute to a growing body of research to fill this gap by exploring the experiences of people who experience mental ill-health in Singapore. METHOD: We adopted a constructivist grounded theory approach and interviewed 21 people who had been diagnosed as experiencing a mental health condition. RESULTS: The core category emerging from interview participant perspectives was a 'roller coaster ride of confusion'. This overarching category was made up of the following four sub-categories - 'not understanding what was happening', 'losing control over self', 'unpacking the root of challenges' and 'trying to make sense of the situation'. CONCLUSIONS: Taken together, the journey of a person experiencing mental health recovery in Singapore is filled with obstacles and uncertainty due to various social and cultural influences such as family pressures, the competitiveness of society and the high-pressure nature of Singapore's educational system. Future research needs to better understand if these are generalisable experiences, and interventions to mitigate their impact need to be explored. Given the strong societal influences, change will take time. Still, this study gives a voice to the lived experiences of people who face mental health challenges in Singapore in the hope that their insights may assist future generations in developing a more mentally healthy society.

The impact of peer support work on the mental health of peer support specialists.

BACKGROUND: Peers support specialists have positive impacts on the mental health of their service users. However, less is known about how their mental health changes as a result of their activities. METHODS: We followed 10 peer support specialists over their first year of employment and interviewed them thrice. We used grounded theory to analyse the way in which the health of participants changed. RESULTS: Self-reported mental health of our participants did not change over the course of the study. However, the role did help participants grow and learn about their condition and their strengths. While sharing their past experiences could be taxing, they learned how to harness their recovery journey without risking relapse. CONCLUSION: Entering the role of a peer support specialist does not appear to negatively impact mental health, but might enhance insight and resilience. However, this appears to occur in individuals who already possess an inclination toward introspection.

Medical students' perception towards mental health recovery: a descriptive qualitative study.

The conceptualisation of recovery in mental healthcare, for which two definitions ('clinical' and 'personal') prevail, remains inconclusive. In most curricula of medical education, undergraduates are taught straightforward concepts of clinical recovery, which result in their perfunctory and rudimentary understanding. A qualitative descriptive approach was adopted to explore medical undergraduates' perceptions of recovery for people with mental health conditions. Participants were recruited from a Singapore-based university through convenience sampling; the required sample size was determined by data saturation. Individual face-to-face interviews were conducted through Zoom, an online conferencing platform using semi-structured questions from March to July 2021. Recordings of the interviews were transcribed verbatim and thematically analysed. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the reporting of this study. Seventeen medical students with the majority (fifteen) of them in their fourth year of medical undergraduate education participated in this study. Four themes were identified: the relationship between mental illnesses and well-being; opinions on mental well-being; understanding of mental illnesses; and perceptions of recovery from mental illnesses. The medical undergraduates in this study predominantly conceptualised recovery based on functions, although many also agreed on respecting patients' perspectives in defining it. This aligns with contemporary approaches that emphasise more shared decision-making opportunities and empowering people with mental health conditions. Accordingly, our findings highlighted the need for foundational medical education to incorporate these constructs in their curricula and strategise to provide more meaningful discussions about them.

Machine Learning in Health Promotion and Behavioral Change: Scoping Review.

BACKGROUND: Despite health behavioral change interventions targeting modifiable lifestyle factors underlying chronic diseases, dropouts and nonadherence of individuals have remained high. The rapid development of machine learning (ML) in recent years, alongside its ability to provide readily available personalized experience for users, holds much potential for success in health promotion and behavioral change interventions. OBJECTIVE: The aim of this paper is to provide an overview of the existing research on ML applications and harness their potential in health promotion and behavioral change interventions. METHODS: A scoping review was conducted based on the 5-stage framework by Arksey and O'Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines. A total of 9 databases (the Cochrane Library, CINAHL, Embase, Ovid, ProQuest, PsycInfo, PubMed, Scopus, and Web of Science) were searched from inception to February 2021, without limits on the dates and types of publications. Studies were included in the review if they had incorporated ML in any health promotion or behavioral change interventions, had studied at least one group of participants, and had been published in English. Publication-related information (author, year, aim, and findings), area of health promotion, user data analyzed, type of ML used, challenges encountered, and future research were extracted from each study. RESULTS: A total of 29 articles were included in this review. Three themes were generated, which are as follows: (1) enablers, which is the adoption of information technology for optimizing systemic operation; (2) challenges, which comprises the various hurdles and limitations presented in the articles; and (3) future directions, which explores prospective strategies in health promotion through ML. CONCLUSIONS: The challenges pertained to not only the time- and resource-consuming nature of ML-based applications, but also the burden on users for data input and the degree of personalization. Future works may consider designs that correspondingly mitigate these challenges in areas that receive limited attention, such as smoking and mental health.

Barriers and facilitators of peer support work in a large psychiatric hospital: a thematic analysis.

BACKGROUND: Peer support workers are an important addition to the mental healthcare profession. However, much of the literature and knowledge of the peer support role is derived from western countries. This concept is relatively new in Asian countries. AIMS: The study sought to improve the understanding of the barriers and facilitators of peer support work in a large psychiatric hospital in Singapore. METHODS: This study used qualitative data from a larger mixed-methods study. Thematic analysis was conducted based on the five steps recommended by Braun and Clarke (2006): (1) familiarisation of data whereby transcripts were read and reread, (2) generating initial codes, (3) searching for themes by gathering relevant codes, (4) reviewing themes and (5) defining and naming themes. RESULTS: Four subthemes under the broader notion of facilitators (supportive figures, defined role, opportunities for personal growth and identifying personalised coping strategies) and three subthemes under the concept of barriers (unclear role, hostility from non-peer-support-specialist staff and unsupportive working environments) were identified. CONCLUSION: Our findings echoed those of previous studies conducted in western countries providing some evidences for the cross-cultural nature of these barriers and facilitators. However, the way their impact can be mitigated or enhanced is likely to be different owing to cultural barriers, such as the general consensus and acceptance of larger personal recovery ideologies. Further research is required in community settings to better understand the boundaries and limitations of our findings. This information will allow us to continue improving peer support worker integration in diverse mental healthcare settings.

The personal recovery movement in Singapore - past, present and future.

The personal recovery movement is beginning to gain traction within Singapore's mental healthcare systems. We believe it is timely to give a broad overview of how it developed and provide suggestions on how it can evolve further. From the early custodial care in the 1800s to the community-centric programmes of the 1900s and early 2000s, we now find ourselves at the forefront of yet another paradigm shift towards a more consumer-centric model of care. The following decades will allow personal recovery practitioners and researchers to innovate and identify unique but culturally appropriate care frameworks. We also discuss how the movement can continue to complement existing mental healthcare systems and efforts.