“We have so many patients that need care, and I don’t think many of us have been trained to work with the mental health side. I got into this field to help older people, and I don’t feel like I really get to do that right now with everything we need to get done in a shift.”
– Staff member at nursing facility
There is enormous strain on professionals in medical and senior communities to accomplish numerous tasks and be fully present for their patients during a shift. Most workers were drawn to this field to help older adults and patients live with dignity, care, and compassion. It can be disheartening for many professionals when they experience the reality of working in these settings: the amount of paperwork, logistics, and coordination required by the system take time away from direct care with patients. Furthermore, staff see that residents’ needs are not merely physical, but mental, emotional, spiritual, and social as well. Over time, staff can feel increased pressure to meet each of these needs, all while working under time, staffing, financial, and training constraints.
Accumulating stressors from the pandemic on the healthcare system have compounded the problem. A recent survey from the American Health Care Association found that 86% of nursing homes in the U.S. are experiencing moderate to severe staffing shortages, 96% of nursing homes are struggling to hire additional staff, and 78% have hired temporary agency staff to fill the gaps. Furthermore, over the past decade many medical systems have made financial cuts to departments such as social service and chaplaincy, who offer care for patients beyond their physical needs. While these services have been eliminated from the budget, the need for this care has certainly not reduced. Who, then, is left to address these needs for patients?
In addition to staffing dilemmas, providers across medical settings find themselves increasingly limited to one piece of the healthcare puzzle. Researchers have found that there is often a lack of ownership for mental health care, leading to staff not seeing it as part of their job. It often feels like it is (or should be) someone else’s responsibility to manage mental health care symptoms. As a result, patients with mental health issues have poorer outcomes from surgery and medical procedures, as well as worse experiences of care than those without a mental health diagnosis.
In a fractional medical system, it makes sense that providers feel the best thing for patients is to refer out to a specialist and distance themselves from patients who appear out of their scope. The consequences of this model, however, are that patients with mental health conditions feel as though they are falling through the cracks. Meanwhile, staff continue to feel unprepared, stuck, and out of their scope with a subset of patients in their communities. How can we begin to approach these obstacles?
The first suggestion is to provide staff with more training on mental health topics. Without quality training, staff and residents are placed in difficult and potentially harmful situations. Often conscientious staff become fearful of doing or saying the wrong thing, which in turn leads them to distance themselves from residents with mental illness. This action alone can unintentionally foster an increased sense of mistrust, isolation, or fear in their residents (which can exacerbate symptoms like anxiety, paranoia, depression, or withdrawal) and negatively impact functioning. WCPA offers training and consultation programs to senior communities, and NAMI offers mental health first aid training for the general public which has also been a promising tool for staff in medical settings (https://namimissouri.org/resources/about-mental-illness/mental-health-first-aid).
Another idea is to provide staff and leadership with ongoing consultation with local mental health clinicians. While it may seem ideal to outsource our residents’ mental health care to a psychiatrist or therapist alone, the reality is that humans are complex social beings. Therapy and psychiatry are incredibly beneficial and should be consulted whenever necessary. However, once residents return home from their appointments with these specialists, the staff in the senior community are their primary social contacts and caregivers. What staff says and does matters immensely, and these helping professionals deserve the space to discuss the challenges they experience and the opportunities to learn new ways of approaching residents with complex needs.
Healthcare professionals are the backbone of our medical and senior care systems. They deserve more opportunities to learn and be supported as they serve patients with medical and mental health needs. Patients and residents also deserve to be understood, addressed, and properly cared for by compassionate staff. If your community would like more information on training and consultation, please feel free to reach out to WCPA to discuss how we can collaborate and help support your staff.
* This article is the second in a three-part series, which covers the issue of mental health stigma in healthcare. The first article (Spring 2023) focused on individuals with mental health issues as they navigate the medical system. The final article will spotlight the experiences of family and loved ones who support an individual with physical and mental health issues.
Amy Neu, MSW, LCSW