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. Keywords: Asia, legislation, lived experience, mental health services, personal recovery

Application of a bottom-up approach to reduce healthcare disparity between the urban and rural areas

Disparity in access to healthcare between the rural and urban regions occurs world-wide, both in higher and lower income countries. In order to offset poor health outcomes, a number of approaches to structuring healthcare services can be used. Several factors have been identified to play a role; nevertheless, they contribute to the healthcare gap to various - depending on whether a higher or lower income country undergoes evaluation. Traditionally, healthcare systems worldwide adopt a top-down approach, which is initiated by large institutions providing resources required for large scale projects along with the centralisation of efforts. Therefore, although it does lead to change, the results can be short-lived. The authors discuss the bottom-up approach used in ASHWINI organisation in Gudalur, India which allowed for the development of accessible and sustainable healthcare system managed by the community. Other projects, based in part on the principles of a bottom-up approach, have been applied in other countries to reduce healthcare disparities. A bottom-up approach, designed to deliver geographically-accessible, locally managed, culturally appropriate care, can provide sustainable results, and since it is universal in nature, it can be applied in other setting with similar structures.

Strategies for culturally appropriate care: the regulatory perspective

The Care Quality Commission's latest resource outlines the ways in which they expect care to be provided to meet diverse needs. Amanda Halliwell identifies what care homes need to do.

Family Stress

Serious illness creates a need for financial and legal support for individuals and their families. Nonmedical issues are often as pressing on them as their medical concerns. Clinicians must have a basic understanding of meeting those needs of advance planning, income and family maintenance, access to insurance, and family preservation within the context of culturally appropriate care. Knowledge of community and faith-based resources to meet the nonmedical needs of the palliative care patient is an essential aspect of care. Since these are often unknown to patients and their families, the clinician must know how to guide patients through the morass of cultural and legal requirements for this purpose.

Improving Dementia Care for Gitxsan First Nations People

This project originated from nursing staff’s learning need for knowledge, approach, attitude, and skills in dementia care that was identified by the Gitxsan Health Society. In collaboration with the First Nations Health Authority, the Gitxsan Health Society sought to educate nurses on how to provide culturally appropriate care to older Gitxsan persons living with dementia, and also to increase the understanding of nurses, family caregivers, and the wider community about dementia as a chronic condition. This project involved a mixed-methods approach (multiple qualitative approaches, as well as a quantitative component). The team was guided at each stage by a Cultural Advisory Council of four Elders recognized as Knowledge Holder from the community. The project involved a strong element of reciprocal co-learning and knowledge exchange. From discussions and exchange with community members, three large interlinking themes emerged to guide the researchers: (a) loss and grief; (b) relationality; and (c) access and connection. These themes gave voice to the gaps and needs in care, but also highlighted the potential areas of strength that can be built on to improve care for the older Gitxsan person living with dementia. Family and other community members identified the need for more information regarding dementia, the need to access in-community and external supports, and the need to inform nurses about what considerations are required when caring for Gitxsan people living with dementia. A better understanding of the Gitxsan ways of knowing about dementia can help nurses incorporate more culturally safe practices into the care of persons living with dementia.