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 local hospital.

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 health committee?

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 interventions.

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 than medication.

Do you have a restraint policy?

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.

Final Thoughts

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