Through an online video, the WHPCD 2022 theme Healing Hearts & Communities Webinar discussed issues such as grief support services, community care and compassionate communities, while looking forward to building a warm social support system through mutual sharing and exchanges.
The WHPCD 2022 - Healing Hearts and Communities Webinar held an online seminar and exchanged discussions among hospice professionals on October 4 and 6. Four experts and scholars were invited: Prof. Amy Chow, director of Hong Kong Jockey Club End-of-Life Community Care Project; Miss Bonnie Tompkins, principal of Pallium Canada Compassionate Communities; Dr. Ying-Wei Wang, Director of the Center for Palliative Care at Hualien Tzu Chi Hospital; and Dr. Chun-Kai Fang, Director of Hospice and Palliative Care Center of Tamsui MacKay Memorial Hospital (note: Dr. Wang and Dr. Fang are also directors of the Hospice Foundation of Taiwan). In their discussions, they focused on issues such as grief support, community care, and compassionate communities, and shared with participants about their extensive experience and insights of clinical services over a period of many years.
Hospice Opens Door to Grief Issues; Natural Disasters Open Door to Healing
Having devoted himself to psychiatry and palliative care for many years, Dr. Chun-Kai Fang has analyzed the developmental context and advantages of grief services in Taiwan under the title Diversified Grief Support Services in Taiwan.
Dr. Fang explains that the discussion on grief issues in Taiwan actually developed relatively late. As early as the 1980s, Western countries had already begun to discuss grief issues from the psychological aspect, while it was due to the necessity of hospice and palliative care that Taiwan eventually started to systematically attach importance to grief.
"In 1990, hospice and palliative care began to grow in Taiwan. At that time, four social workers devoted themselves to providing palliative care, Kai-Min Li, Fang-Hao Lin, Yu-Shi Zhang, and Shu-Lun Ge. They even took it upon themselves to translate the book Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner by J. William Worden (a member of the American Psychological Association),” says Dr. Fang with admiration since this was the first book on grief published in Taiwan. Even today, it is still being revised and released.
The grief consolation care in the hospice circle has gradually extended to a systematic educational training, and under the popularization of the concept of obtaining a peaceful life and death, the follow-up services for the bereaved family have been expanded considerably. As for the development of the medical community's emphasis on grief support, Dr. Fang, who is a psychiatrist himself, has fresh memory of it. The opportunity came from a heartbreaking natural disaster--the 921 Earthquake, which occurred on September 21, 1999. At that time, many patients with posttraumatic stress disorder (PTSD) suddenly emerged, and psychiatrists and clinical psychologists became involved in the treatment. Dr. Fang admits that the treatment provided was always focused on PTSD at that time, and not on grief. “To take it seriously, psychopathologically, grief looked like PTSD, but who is not sad that was left behind in the earthquake?” reflects Dr. Fang.
Opportunities to Meet Together as Relevant Services Appear in Response
Upon increased reflection, the connection between PTSD and grief became obvious, and the medical community began to pay close attention due to the shocking incidents in 2002, which included the 331 earthquakes and aftershocks that took place in Hualien, and the high suicide mortality rate in Taiwan (which exceeded the high suicide rate country as defined by the World Health Organization). For this reason, National Taipei University’s Nursing and Health Sciences Department established the Institute of Life and Death Education and Counseling, which has become a higher education unit specializing in the study and discussion of grief issues. It has also attracted many psychiatrists to come to study more about the subject. Dr. Fang Chun-kai was one of its students in its second year.
With the broad understanding of grief issues, relevant services have gradually formed. For example, the Taiwan Suicide Prevention Center was launched in 2005. When the severe Typhoon Morakot struck Taiwan in 2008, this governmental department immediately established a disaster relief mechanism and also commissioned psychological service-related societies, associations, and foundations to be stationed in the disaster area in order to carry out psychological reconstruction work. In 2013, the Ministry of Health and Welfare established the Department of Mental and Oral Health, and the department related to psychology was officially established.
"In addition, after 2010, the number of psychiatric practitioners surged. They usually cooperated with counseling psychologists and clinical psychologists. The accessibility of the medical system thereby allowed more people to receive the help they needed," says Dr. Fang with a smile, who notes that in Taiwan there is also a simple channel for obtaining multiple services for grief support, that is, health insurance. He continues, "When people have needs and don't know who to turn to for help, they can always go directly to the hospital to register and receive the help needed."
Grief comfort starts with the hospice, but strictly speaking, the areas for other departments and palliative care to really ignite the spark of grief support are the acute care and intensive care units. Dr. Fang is optimistic about this idea because it has taken to the society’s attention and prompted Taiwan's grief support to the development of pluralism, not only with starting local research, but also with developing evaluation tools for Taiwan's localization. At the same time, a group of experts and scholars began to review the overlooked and neglected needs, such as childhood cancer.
In 2018, Dr. Fang participated in a meeting with the International Work Group on Death, Dying, and Bereavement. At that meeting, he discussed with scholars from Singapore and the United States to develop the Healing CUP Model (Context-Users-Providers Model). This model emphasizes six key moments, including: initial diagnosis, relapse or disease progression, discontinuation of curative treatment, patient death, one year after death, and two years after death. It also combines medical institutions and community resources to provide users with better grief support services.
Early Preparation in Coping with the Arrival of a Super-aging Society
Dr. Fang mentions that there are many volunteer resources in Taiwan, and these can provide immediate and powerful assistance in initial grief support. Even when complex grief situations occurs or when more professional intervention is required, Taiwan also has high-quality and sufficient resources. He says, "Psychologists in Taiwan must be qualified through the national licensing system, so they can provide services of a certain quality or higher, which is something that many countries still do not have.”
When it comes to foreign trends, different countries have different directions. The United States, which has been plagued by constant natural and man-made disasters, is the most complete in terms of grief support services. Meanwhile, the United Kingdom, which has the most complete development of hospice care, focuses on prevention rather than on cure, and under the construction of compassionate cities, even before a patient dies, the family's grief support service begins in order to avoid the worsening of grief in the future.
On the occasion of WHPCD in 2017, Taiwan also officially launched the Compassionate City Movement, which was initiated by Dr. Ying-Wei Wang, who was then the Director-general of Health Promotion Administration under the Ministry of Health and Welfare. He studied under Allan Kellehear, Professor of Faculty of Health Studies at the University of Bradford in the UK and proposed the concept of Building a Compassionate City.
At that time, although the Taiwanese society as a whole was still a long way from the estimated timeline of becoming a super-aging society in 2025, it had already prepared in advance for this uneasy future. Given that the main living situation of most elderly citizens was still within the local neighborhood of the community, how the community should take care of them in accordance with their health awareness status, dementia, and other conditions has become a much-discussed topic. Therefore, the government successively promoted systems such as age-friendly cities, dementia-friendly communities, and compassionate communities.
"I was thinking at the time that both the elderly-friendly community and the dementia-friendly community are biased towards the hardware and institutional aspects; but the compassionate community is more humane and has a certain kind of warmth," says Dr. Wang. He believes that by accumulating what he has done in the past, and by incorporating the warmth of the compassionate community into it, it is possible for more elderly citizens in the community to be well taken care of without having to visit the hospital.
Experts Give Lectures in Taiwan as the Compassionate Community Takes Shape
In order to quickly establish the concept of compassionate communities in Taiwan, at the end of 2017, Dr. Wang invited Allan Kellehear, a medical and public health sociologist, to Taiwan for a six-day educational training. He joked that at first, Mr. Kellehear had no expectations for Taiwan, since "Over the years, he has been invited to share in many countries, but in many places, especially in Asian countries, the concept has never been able to fullyferment and develop. However, after those six days, he completely changed his mind about Taiwan," Dr. Wang smiles proudly.
Dr. Wang is known to say, "When you are moved, you will be impulsive, and on impulse, you will act. After the action, it will become a movement."
During those six days spent in Taiwan, Mr. Kellehear felt deeply moved by the trainees and sensed the impulse. He even saw the actions in some community care projects carried out by Taipei City Hospital and Hualien Tzu Chi Hospital.
In addition to his expectations, Mr. Kellehear pointed out the blind spots of the compassionate community in Taiwan at that time, saying that Taiwan's community and home care are medical and health services, but the compassionate community focuses on the mutual care in the community, which includes schools, workplaces, points of care, churches, and etc. The care between people is the axis of the compassionate community.
And Taiwan did not disappoint, especially in the active carrying out of related plans by the Health Promotion Administration and Taipei City Hospital. Dr. Wang says frankly that in the five years since 2017, it has still been difficult to reach the standard in terms of the results, citing, "The promotion of the entire system requires time and thrust, and we need to work harder to achieve it."
In this webinar, Dr. Wang also held a two-way discussion with Ms. Bonnie Tompkins from Canada. Dr. Wang says that Canada’s promotion of compassionate communities started early, and it can even be said that it was a structure discussed by the national movement. “In terms of compassionate communities, most people are waiting for the public sector to guide the direction, but the government contractors are not experts in this area. The experts are from the private sector. We should follow the example of Canada and let the private sector think carefully about feasible solutions and provide the government with critical reference and experience.”
From grief support to compassionate communities, whether abroad or locally in Taiwan, it has been a long and challenging road. However, in the process of discussion with each other and mutual learning, we are gradually building a system and characteristics that conform to our country. The WHPCD 2022 Webinar also fully comforted the soul and the community through the wonderful sharing of the four experts.