Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore.

WHAT IS KNOWN ABOUT THE SUBJECT: Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities. As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones. When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector. Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden. Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions. Lastly, public awareness campaigns should honour caregivers by highlighting their strength, resilience, and dedication. The state can provide financial assistance in the form of tax relief for their income per annum or caregiver allowance to alleviate the financial stress that caregivers are facing. ABSTRACT: Introduction The progressive deinstitutionalisation of mental healthcare has increasingly shifted care responsibilities from healthcare professionals to family caregivers for individuals with severe mental illness. Caregivers must balance many obligations, which often compromise their overall health and well-being, while helping their loved ones integrate into the community. Aim To identify and understand caregivers' needs and challenges as they help individuals with severe and enduring mental health challenges integrate into the community. Methods This study used a descriptive qualitative approach to explore the experiences and challenges of caregivers for individuals with severe and enduring mental health challenges when integrating back into the community. A semi-structured guide was used during the video-conferencing interviews conducted between December 2021 and November 2022. This study was reported according to the 32-item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings Fourteen caregivers were individually interviewed by the primary author. Most caregivers were female, with an average of 15 years of experience caring for their loved ones. Using Braun and Clark's six-phase thematic framework, we inductively generate the themes and subthemes from the data. The two themes were (i) challenges (whose subthemes included personal challenges in caregiving, the lack of awareness, and stigma and employment) and (ii) support (whose subthemes included the importance of socialisation for individuals with mental health conditions, existing avenues of support and potential areas for support). Discussion Our findings informed the contemporary needs of caregivers caring for individuals with severe and enduring mental health challenges integrating into the community. Like the global challenges for people with mental health issues, psychosocial support and other supplementary support are still common themes in mental health settings. The findings further specifically highlighted the importance of accessible points of contact as resources and employment-enabling and sustaining initiatives to help manage caregivers' emotional and system challenges, which addresses the gaps identified in the findings. Caregivers' peer-support groups, life skills training and public mental health awareness are also necessitated by the caregivers' voices. Implications for Practice Priority areas include having a centralised point of contact within the community for caregivers. Government or not-for-profit organisations can take the lead by initiating employment-enabling initiatives for individuals with severe and enduring mental health challenges and their caregivers.

Exploring long-term volunteerism in a community family service centre in Singapore: A Focused Ethnographic Study.

Volunteerism contributes significantly to the social development of a country. Although the rate of volunteerism has steadily increased over the years, the numbers of regular volunteers remains small. While the existing literature has elucidated individuals' motivations for volunteerism, research is lacking on their motivations and challenges in sustaining long-term volunteerism. A focused ethnographic approach was adopted in this study to explore 20 participants' motivations and challenges towards long-term volunteerism. Purposive sampling was used to recruit participants in one single-family service centre in Singapore from October to December 2018. Data were collected through covert observations and semi-structured interviews. Field notes, observational data and findings from the interviews were triangulated and analysed through thematic analysis. In this study, a central exhaustive description of the volunteers 'providing help while receiving good deeds' is established. This was supported with three main themes revolving around the volunteers: fulfilling life goals, deriving meaning from experiences and striking a balance in the life. These themes characterised the motivations and challenges faced by them amidst their voluntary works. They reported that the satisfaction and fulfilment through volunteering had brought personal growth, well-being and happiness to them. The sense of purpose through volunteering further enhanced their experiences. Finally, some volunteers reported that volunteering enabled them to strike a balance in their own life by engaging it as a form of solace. The findings suggest that sustained volunteerism is a multidimensional construct involving the interplay of different factors in the individual's life. By understanding motivations underlying long-term volunteerism, voluntary organisations can create volunteering opportunities that dovetail with volunteers' personal goals, thus boosting their satisfaction and incentivising their sustained engagement. Additionally, the organisations can hold regular bonding activities to promote rapport among their volunteers, beneficiaries and staff, thus encouraging the volunteers to persevere on their volunteering journey.

Primary percutaneous coronary intervention for acute myocardial infarction secondary to acute left main coronary occlusion in an institution without on-site cardiothoracic surgical support.

AIMS: There is no consensus on the optimal management of acute myocardial infarction due to acute left main coronary occlusion (LMCO). We evaluated the feasibility of primary percutaneous coronary intervention (PCI) for acute LMCO in an institution without on-site cardiothoracic surgical (CTS) support. METHODS AND RESULTS: We retrospectively identified 20 patients, median age 67 years (range 38 to 81). Sixteen patients presented with cardiogenic shock. All patients required intra-aortic balloon pump counterpulsation and inotropic support. Sixteen patients underwent stenting and four had balloon angioplasty only. Thrombolysis In Myocardial Infarction 3 flow was restored in 13 patients. Post-PCI, six patients were transferred to a tertiary institution for further care: three underwent extracorporeal membrane oxygenation (ECMO), one underwent both ECMO and coronary artery bypass grafting (CABG), one died before ECMO initiation and one stabilised without further intervention. Thirteen patients died in-hospital. There was one subsequent death out of the seven hospital survivors, with median follow-up 390 days (range 60 to 660 days). There was a trend towards survival with a shorter door-to-balloon time (p = 0.07). CONCLUSIONS: Primary PCI may be a feasible initial revascularisation strategy for acute LMCO in centres without on-site CTS support.

Acute neurological events in a patient with secondary polycythaemia and arteriovenous malformations.

General internists and adult cardiologist are seeing adult congenital heart disease more frequently in their clinical practices. We report the case of a polycythaemic patient with the cerebral and pulmonary arteriovenous malformations (AVMs) who presents with a transient ischaemic attack (TIA). Treatment strategies such as antiplatelet drugs and vensection may at best be ineffective and at worst detrimental to the patient.

Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study.

BACKGROUND: The prognostic importance of various hemodynamic responses to adenosine infusion in patients undergoing adenosine stress myocardial perfusion stress (MPS) has not been defined. METHODS AND RESULTS: We identified 3444 unique patients (53.5% women, mean age 74.0+/-8.4 years) who underwent adenosine (with no additional exercise) stress myocardial perfusion single photon emission computed tomography (MPS) and were followed up for 2.0+/-0.8 years. Multivariable Cox proportional hazards analysis was used to assess the prognostic value of hemodynamic variables in predicting cardiac death (CD). Two hundred twenty-four CDs (6.5%) occurred during follow-up. By multivariable analysis, higher rest heart rate (HR) and to a lesser extent lower peak HR were markers of CD. When added to the multivariable model in place of peak and rest HR, the peak/rest HR ratio was an independent predictor of CD. Peak/rest HR ratio additionally risk-stratified patients within each MPS category. A significant interaction was found between gender and peak systolic blood pressure (SBP), in which there was an increased risk associated with a low peak SBP (<90 mm Hg at end of adenosine infusion) in men but not in women. CONCLUSIONS: Patients undergoing adenosine stress MPS with high rest HR and low peak/rest HR ratio have increased risk of CD, as do male patients with a low peak SBP. Assessment of the hemodynamic response to adenosine adds incremental prognostic value to MPS results and enhances identification of patients at risk for CD.