Clint Maun, CSP
According to the World Health Organization, five of the 10 leading causes of disability are related to mental disorders. Furthermore, it is expected that in less than 20 years, depression will be the second leading cause of disability in the world. While most mental conditions are no more prevalent in older adults than in other age groups, certain disorders, such as dementia and delirium, are more common among seniors. In fact, the mental health needs of this group are significant. Recent studies state that 18 to 25 percent of older adults have mental health needs. In nursing care and personal care facilities, the number increases. In fact, research from the Mental Health and Aging Advocacy Project estimate that 50 percent of older adults in nursing homes suffer from depression.
Considering the facts
mentioned above, meeting the mental healthcare needs for seniors living in
long-term care institutions is a pressing issue. Unfortunately, when it
comes to providing proper care, a considerable amount of barriers stand in
the way. For example, in most cases only a limited amount of formal mental
health services are provided to residents, and most staff receive very little
training with respect to mental health. Adding to this is the long-held
stigma attached to emotional and/or or psychological problems. Some family
members or caregivers may minimize the presence of emotional problems out
of protectiveness for the individual-they don't want to raise the issue
because they don't want to hurt the individual. Lastly, there is the
theory that older adults do not separate mental symptoms from physical
symptoms, and because of this inseparability, they do not seek out mental
health care-rather they just pursue treatment for the physical ailments.
While all this information
appears extremely discouraging, the good news is that this situation is not
set in stone. There are a variety of initiatives in the air and in action to
help address the issue of mental health among seniors. That being said there
are a number of items your facility can scrutinize. Perhaps you can start by
asking some poignant questions-like how exactly do you measure up when it
comes to meeting residents' mental and behavioral needs? Below are some
questions to help you assess your organization's level of care. It's critical
that you ask yourself these questions now, because you can bet on these
issues arising later.
Does your facility
have geriatric psychologists or psychiatrists on staff?
Despite the high rates of depression and other mental disorders in nursing
home residents, there are several reasons why these individuals do not
receive the needed care. One reason is that patients do not present
complaints of depression or distress in straight forward ways-depression
presents itself differently, without the usual, easily recognized cluster
of symptoms. Trained psychiatrists and/or psychologists perform services
that can help stop and treat problems before they get out of control.
Diagnosing disorders, checking medication, counseling, and training staff
are just a few of the benefits they provide. Geriatric psychiatrists and
geriatric psychologists are specially trained to help older adults-having
one on staff, even if it's on a limited basis, demonstrates that your
facility acknowledges the special needs an elderly population calls for.
What kind of
contingency planning does your facility have?
Is your facility equipped to handle an emergency if a resident has
psychiatric problem? If your institution is not prepared to handle these
types of situations , at the very least, you should have a detailed plan
of where and how a resident will be transported to an emergency room at a
Additionally, staff should be trained in the kinds of voluntary and involuntary commitment that may be needed in case of a mental health emergency. They should also be aware of who and what additional resources are available when help is needed.
Do you have a mental
This type of committee focuses on problem behaviors in the residence.
It helps staff assess reasons for the behavior and develop appropriate
responses to behavior. It can also promote education among staff members.
After all, enhancing the education of healthcare professionals and front
line workers so they have a better understanding of the aging process is
paramount. Creating a behavior team at your facility will help increase
awareness and better ensure that staff will be able to recognize the early
signs of mental health problems and provide access to effective
What kind of
activities and counseling does your facility offer?
For good mental health, older adults need stimulation. Your facility should
have challenging, interesting and consistent activities for the residents.
A game of checkers in the social hall is simply not enough. Furthermore,
if your facility doesn't offer one-on-one or group counseling, it should
seriously consider doing so. Studies showing the effectiveness of
psychotherapy and counseling have revealed that counseling is equally
effective to medication to treat depression, and has more lasting effects
Do you have a
Make sure that the facility has a written policy on restraints and that
frequency is monitored. Obviously, you'll want to keep restraint use on
the low end, as they're often viewed as a failure of treatment. The state
keeps statistics on the use of restraints. Compare your facility's rate
with others-you can count on prospective clients doing the same.
While the bad news is that disorders such as dementia and depression can
and do occur in later life, the good news remains that the vast majority of
seniors can still look forward to mental health. The impact of behavioral
health on a patient's physical health should never be underestimated, and
when your facility addresses the identification and treatment of mental
problems good physical, mental and emotional well-being for senior residents
can be maintained.
Source: The Metrics of Care and Cost in Long Term Care Facility Operations Relative to Psychological Health of Residents