Combining technical and expert-by-experience knowledge in the quest for personal recovery from bipolar disorder: a qualitative study.

BACKGROUND: Knowledge construction is a form of communication in which people can work individually or collaboratively. Peer support services have been adopted by the public psychiatric and social welfare service as a regular form of intervention since 2015 in Hong Kong. Peer-based services can help people with bipolar disorder (BD) deal with the implications of the diagnosis, the way in which individuals with BD receive treatment, and the lifestyle changes that take place as a result of the diagnosis. Through a qualitative paradigm, this study aims to examine how individuals with BD use technical and expert-by-experience knowledge. METHODS: A total of 32 clients of mental health services were recruited from hospitals, Integrated Community Centers for Mental Wellness, and non-governmental organizations. They participated in semi-structured individual interviews. All interviews were recorded, transcribed verbatim, and analyzed using thematic analysis with the aid of NVivo. The findings were verified by peer researchers. RESULTS: Three main themes are presented in this article, including how clients made sense of the knowledge provided by mental health professionals and peer support workers (PSWs), critical perspectives about peer support services, and the way in which the services are more than knowledge transfer alone. Participants generally indicated that knowledge sharing revolved around three experiences: mood changes, medications, and sense of hope. Nevertheless, an empathic understanding of the clients' experience was more important than the sharing of knowledge. Some clients perceived medication as the chief means to recovery, so PSWs were not useful for them. However, PSW role models had an effect beyond mere knowledge transmission, as they could promote clients' pursuit of functional recovery goals. CONCLUSIONS: The present study has improved our understanding of knowledge sharing between clients with BD and health professionals or PSWs, which should take place in an empathic and hope-instilling manner. It has also emphasized the value of the presence of a role model who can speak convincingly with clients to facilitate recovery. The present findings can be used to improve the care of people with BD by generating important guidance with regard to enhancing the knowledge exchange between clients and health practitioners.

Patient involvement in mental health care: culture, communication and caution.

BACKGROUND: Patient or service user involvement in mental health services (MHS) is a hallmark of the recovery approach. OBJECTIVE: In this viewpoint article, we review Tambuyzer et al. paper 'Patient involvement in mental health care: One size does not fit all' in order to express our opinion of their work. We also suggest specific actions that may enhance the implementation of patient involvement in MHS. DISCUSSION: We make three main points about Tambuyzer et al. model. First, the cultural dimension of patient involvement seems underemphasized in the model. Second, the model might be improved if the increasing role of communications technology in patient involvement is taken into consideration. Third, it is important to acknowledge that the process of patient involvement is not linear, and participation is not a homogeneous experience. CONCLUSIONS: We suggest that the model be expanded and that further work be carried out on the implementation of patient involvement in MHS.

Training of mental health peer support workers in a non-western high-income city: preliminary evaluation and experience.

BACKGROUND AND AIMS: Peer support workers are an emerging workforce within the mental health system in Hong Kong. The purposes of this paper were to describe the development of a peer support training programme and to evaluate its outcome from the perspectives of both trainees and the users of services that they provided. METHOD: The curriculum consisted of six weeks of coursework on the recovery approach and a 24-week paid internship at the Warmline telephone service. We gathered feedback from 22 Warmline users. Eighteen trainees were also assessed using the three recovery-related psychosocial measures and qualitative methods. RESULTS: The Warmline service provided by peer support trainees lessened the isolation of service users and raised their hopes. Compared to the baseline, the peer support trainees scored marginally higher on the psychosocial measures at the end of the training. At post-training evaluation, peer support trainees said that they had gained in knowledge, were more hopeful about their own recovery, and had developed mutually supportive relationships among themselves and with their supervisors. CONCLUSION: The programme shows potential benefits for both Warmline service users and trainees. Future studies should compare different training methods and examine the implementation of peer support services in a non-western cultural context.

Can recovery-oriented mental health services be created in Hong Kong? Struggles and strategies.

Recovery has been adopted as either the national policy or guiding principle for reforming mental health services in many countries. Development and implementation of the concept of recovery is still in its infancy in most Asian countries, and Hong Kong is no exception. The present authors propose three strategies to guide the transformation of Hong Kong mental health services toward becoming more recovery-oriented.

Recovery in Hong Kong: service user participation in mental health services.

This article provides an overview of mental health services (MHS) and the application of the recovery concept in Hong Kong, focusing on user participation. It presents stakeholders' views of the recovery movement in a round-table discussion format, demonstrating agreement that user participation merits more public and official attention. Some of the present difficulties with the movement are also reviewed. Social identity theory (SIT) is then analysed as a potentially useful framework for theorizing how service users' identities change as they become service providers. The paper then provides an overview of the current financial and political position of MHS, and identifies signs that the recovery approach is becoming accepted. It also addresses the cultural meanings of the concept, and sets out examples of its implementation in the health and social welfare sectors. Lastly, it summarizes the challenges facing service providers and users and concludes that as the recovery movement is still in its infancy in Hong Kong, more coordinated efforts are needed to establish the organizational support and policy framework, so that sustainable and evidence-based service provision can be achieved.

Chromatin immunoprecipitation from human embryonic stem cells.

The functional and structural complexity of the myriad of cells in metazoan organisms arises from a small number of stem cells. Stem cells are characterized by two fundamental properties: self-renewal and multipotency that allows a stem cell to differentiate into virtually any cell type. The progression stem cell to differentiated cell is characterized by loss of multipotency, structural and morphological changes and the hierarchic activity of transcription factors and signaling molecules, whose activities establish and maintain cell-type specific gene expression patterns. At the molecular level, cell differentiation involves dynamic changes of the structure and composition of chromatin and the detection of those dynamic changes can provide valuable insights into the functional features of stem cells and the cell differentiation process. Chromatin is a highly compacted DNA-protein complex that forms when cells package chromosomal DNA with proteins, mainly histones (4). Stemcellness and cell differentiation has been correlated with the presence of specific arrays of regulatory proteins such as epigenetic factors, histone variants, and transcription factors. Chromatin immunoprecipitation (ChIP) provides a valuable method to monitor the presence of RNA, proteins, and protein modifications in chromatin. The comparison of chromatin from different cell types can elucidate dynamic changes in protein-chromatin associations that occur during cell differentiation. Chromatin immunoprecipitation involves the purification of in vivo cross-linked chromatin. The isolated chromatin is reduced to smaller fragments by enzymatic digestion or mechanical force. Chromatin fragments are precipitated using specific antibodies to target proteins or protein and DNA modifications. The precipitated DNA or RNA is purified and used as a template for PCR or DNA microarray based assays. Prerequisites for a successful ChIP are high quality antibodies to the desired antigen and the availability of chromatin from control cells that do not express the target molecule. ChIP can correlate the presence of proteins, protein and RNA modifications, and RNA with specific target DNA, and depending on the choice of outread tool, detects the association of target molecules at specific target genes or in the context of an entire genome. The comparison of the distribution of proteins in the chromatin of differentiating cells can elucidate the dynamic changes of chromatin composition that coincide with the progression of cells along a cell lineage.