Hopes and Wishes of Clients with Mentally Illness in Hong Kong

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.

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.

Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation

Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.