Mental Health, Everywhere – The World According to Dr. El

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Mental health in long-term care is receiving much more attention today than it used to be. After being a nursing home psychologist for 25 years, it’s quite exciting to watch.

I have the April print edition of McKnight’s Long-Term Care News and found articles on the impact of nursing stress on the quality of care, the association between nursing attrition and the emotional toll of work, and the importance of mental health support for staff.

Last week, McKnight’s Senior editor Kimberly Marselas wrote about CMS’s increased focus on mental health issues, and Chris Wright of iCare: Seizing the Behavioral Health Opportunities of Skilled Nurses.

I hope this focus shifts the way psychological services are used and reimbursed.

While there is value in providing individual services to residents with identified mental illnesses, psychologists can and should do so much more.

The mental health challenges in nursing homes would be better served if psychologists were involved in programming, such as the STAR-VA model for dementia-related behaviors, or the Eldercare method developed by senior housing consultant Kelly O’Shea Carney , Ph.D. ., ABPP to address the behavioral health needs of long-term care residents.

She and Margaret Norris, Ph.D., wrote “Transforming Long-Term Care: Expanded Roles for Mental Health Professionals,” which “shows how mental health practitioners can use their full range of skills to create systems that are more supportive. and engaging for residents, while also giving staff more opportunities for professional growth and significance.”

As I’ve written in the past, psychologists can play an important role in many currently problematic areas, such as:

  • Staff trainingincluding education about the basics of mental health and psychiatric illness, how to work with families, stress management techniques, and other issues commonly encountered by staff in the nursing home environment.
  • Team buildingthat focuses on addressing the specific needs of units and departments, such as conflict resolution, communication skills, etc.
  • Moral stimulationusing the training of psychologists and awareness of the emotional climate of the facility to devise interventions that can enhance the culture of the facility, such as improving staff common areas or collaborating with the recreation department on activities that benefit the community inspire.
  • Improved onboardingoften touching on but vital topics, such as coping with the loss of residents or dealing with difficult families.
  • Behavior roundsto assist staff with interventions to reduce problematic behavior in residents or families.
  • Open office hourswhere residents, employees and family members can stop by for a short chat to address concerns and get directions for further services if needed.
  • System interventions where psychologists work with facility leaders to streamline systems and resolve issues, often interdepartmental, such as communication issues or disputes.
  • Group sessions for residents that cover topics such as how to make the most of rehabilitation or psychoeducation about diseases such as diabetes, and that promote connections and reduce isolation.
  • Group Sessions for Familiesto reduce their anxiety, increase their ability to manage the health issues of their loved ones, improve their understanding of how to work with the team, and reduce the amount of time staff spend dealing with family issues.
  • Family psychotherapy sessionsas it can be very painful to admit a loved one to a nursing home.
  • End-of-life supportbecause we should be experts at recognizing when residents approach death and helping them, and their families and team members, cope with the process and their grief.
  • Individual psychotherapy for residents because yes, that’s important too.

A few years ago, I got a referral to a very anxious 90-year-old rehabilitation doctor. She was very reluctant to talk to me at first, but eventually she became a fan of psychotherapy.

The morning before she was due to go home, she called me to her place in the day-care center and said, “I wish I had talked to you when I was a young woman. The work you do is so important, just as important as the cardiologist or the surgeon.”

“I know,” I replied.

Long-term care is like this woman, who could have benefited from psychological help decades ago.

I’m glad that greater awareness of mental health has entered the LTC zeitgeist, and I’d like to think that columns like mine contributed to this recognition.

The work continues, but I just wanted to let you know in advance that this is my penultimate “World According to Dr. El” column. More on that next time.

Eleanor Feldman Barbera, Ph.D., author of: The smart resident guideis a Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She is also a bronze medalist for best blog in the American Society of Business Publication Editors’ national competition and a gold medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at:

The opinions expressed in McKnight’s Long-Term Care News guest submissions are by the author and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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