Mental Health Everywhere – The World According to Dr El

Dr El

Nowadays, mental health in long-term care facilities receives much more attention than ever before. After 25 years as a nursing home psychologist, it’s pretty exciting to see.

I skimmed through the April print edition of McKnight Long Term Care News and found articles on the impact of nurse stress on quality of care, the link between nurse turnover and the emotional toll of work, and the importance of mental health support for staff.

Last week, McKnight’s Editor Kimberly Marselas wrote on the increased attention given by CMS to mental health issues, and on iCare’s Chris Wright: Seizing the Behavioral Health Opportunities of Skilled Nursing.

I hope this attention will lead to a change in the way psychology services are used and reimbursed.

While it is helpful to provide individual services to residents with identified mental health issues, there is much more that psychologists can and should do.

Mental health issues in nursing homes would be better served if psychologists were involved in programs, such as the STAR-VA model for dementia-related behaviors, or Method of care for the elderlydeveloped by senior living consultant Kelly O’Shea Carney, Ph.D., ABPP to meet the behavioral health needs of residents of long-term care facilities.

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

As I have written in the past, psychologists can be instrumental in a wide variety of currently problematic areas such as:

  • Staff trainingincluding education on the basics of mental health and psychiatric illnesses, how to work with families, stress management techniques and other issues that commonly arise for nursing home staff.
  • team buildingwhich focuses on meeting the specific needs of units and departments, such as conflict resolution, communication skills, etc.
  • Boost moraleusing the training of psychologists and awareness of the emotional climate of the establishment to design interventions that can improve the culture of the establishment, such as improving staff common areas or collaborating with the recreation department on activities that inspire the community.
  • Improved integrationaddressing often unaddressed but vitally important topics such as coping with the loss of residents or dealing with difficult families.
  • Behavioral roundsto help staff intervene to reduce problem behaviors in residents or families.
  • Business hourswhere residents, workers and family members can come and talk quickly to address concerns and get advice for other services if needed.
  • Systemic interventions where psychologists work with school leaders to streamline systems and resolve issues, often between departments, such as communication issues or turf disputes.
  • Collective sessions for residents which cover topics such as how to get the most out of rehabilitation or psychoeducation about illnesses like diabetes, and which promote connection and reduce isolation.
  • Collective sessions for familiesto reduce their anxiety, increase their ability to manage the health issues of loved ones, improve their understanding of how to relate to the team, and reduce the time staff spend on family concerns.
  • Family psychotherapy sessionsbecause admitting a loved one to a retirement home can be very painful.
  • End of life supportbecause we should be experts at recognizing when residents are close to death and helping them, their families and team members cope with the process and their grief.
  • Individual psychotherapy for residents because, yes, it is important too.

A few years ago I received a referral for a very anxious 90 year old rehab resident. At first, she was extremely reluctant to talk to me, but she eventually became a devotee of psychotherapy.

The morning before she went home, she called me to her place in the common room 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 looks like this woman, who could have benefited from psychological services decades ago.

I’m glad that more mental health awareness has entered the LTC zeitgeist and I’d like to think that articles like mine have contributed to that recognition.

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

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

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

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