Category Archives for Mental Health

The Best of…Call the Samaritans for a Shoulder to Lean On

Published on December 24, 2001, Pawtucket Times

             Chestnuts roasting on the fire.  Green wreaths with red ribbons. Soothing Christmas music coming from speakers in shopping malls.  Houses decorated with long strands of brightly colored lights.  Decorated evergreen trees.

            Got the Christmas spirit?  Many do, but many don’t, especially if they are seniors.

           With Christmas tomorrow, not everyone is feeling the holiday spirit.  The  holidays may be a very difficult time for seniors, particularly the elderly who have lost spouses and friends, have painful chronic illnesses or feel isolated or powerless, says Cynthia Barry, M.S.W, executive director of the Mental Health Association of Rhode Island.  At this time “some may feel depressed and even suicidal.”

            Even drinking during the holidays can put seniors at a higher risk of experiencing depression and thinking about suicide, Barry adds.

            Even drinking during the holidays can put seniors at a higher risk of experiencing depression and thinking about suicide, Barry adds.

            But the stigma of mental illness will keep older persons from seeking out needed treatment for their depression or suicidal thoughts, Barry says.  Those who feel that they have a problem with depression should visit their local mental health care, neighborhood health canter, the family physician or even private practitioners re commended by their health plan, she says.

            Carolyn Pellegrino, deputy director of Self Help, Inc., a nonprofit community action agency in the East Bay that provides senior case management to all upper East Bay communities and both Pawtucket and Central Falls, , notes that 60 percent of her older clients usually involve  persons who just worry to those experiencing severe clinical depression.

           “There’s a lot of depression out there,” Pellegrino says, adding that today’s seniors, who grew up in a different era, were told not to dal with their feelings of depression, “just get on with your life.”

          Although depression, like heart diseased, is an illness, seniors will get treated for their heart disease, but not their depression, Pellegrino says.  Oftentimes, a combination of medication and therapy can do wonders about a person’s depression, she states.

          A newly released Public Service Announcement (PSA) tells seniors to seek out another resource to fight the holiday blues.  Last week, WHJJ and B101 played a PSA featuring well-know songwriter Bill Withers who, after singing a few lines of his popular song, “Lean on Me,” urges his radio listeners “feeling low with nowhere to turn to contact The Samaritans.”

        Directed to the lonely, the depressed and suicidal, the PSA is intended to raise the awareness of the existence of The Samaritans of Rhode Island, a nonprofit program dedicated to reducing the  occurrence of suicide by reaching out to the despairing and lonely.

          Denise Panichas, serving as The Samaritans’ interim executive director states the communication-based program, established in Providence in 1979, teaches volunteers to effectively listen to people who are in crisis.  Conversations are free, confidential, most important anonymous.

         A rigorous training program teachers volunteers to feel and think without expressing personal judgements or opinions, Panichas says, noting that the listening technique, called “befriending,” calls for 90 percent listening and 10 percent talking.

          Last year, more than 20,o00 Rhode Islanders called The Samaritans, Panichas said.  The Samaritans, Panichas said.  “It doesn’t matter what the problem is, be it depression, suicidal thoughts, seeking resources for mental health services in the community or being  lonely and just needing to talk,” she said.

          Panichas notes that The Samaritans also offers other needed resources to caregivers and older Rhode Islanders. “We do community education programs and also have our peer-to-peer Safe Place Support Group for those left behind by suicide.

          For seniors who are looking for something to do with their time, the art of “befriending” is something that anybody can do.  Becoming a compassionate listener to someone in need.

         Herb Weiss is a Pawtucket-freelance writer who covers health care, aging and medical issues.  He can be reached at hweissri@aol.com.

Mental Health’s Forgotten Constituency

Published in Aging Today in March/April 1996

The principal authors of a new report on mental health nursing homes charge that cutbacks in Medicare and the block granting of Medicaid will have a disproportionately large impact on the funding of mental health treatments. The report, “Achieving Mental Health of Nursing Home Residents: Overcoming Barriers to Mental Health Care,” which this writer helped prepare, calls mentally ill residents long-term care’s “forgotten constituency.”

According to Nancy Emerson Lombardo, one the new report’s authors, mental health experts worry that the situation for mentally impaired elders may worsen if proposals are passed by the 104th Congress to drastically cut Medicare, dismantle the Medicaid program and repeal essential features of the Nursing Home Reform Act.

Big Battle

Lombardo emphasized in an interview that, given present efforts in Washington to reduce Medicare and Medicaid spending. “It will take a big battle to restore mental health funding even to the inadequate levels of a few years ago, let alone bring it up to par with payments for treatment of other medical problems.”

She said that adding to the difficulties facing mental health advocates is evidence that many managed care programs taking over Medicare benefits for elders have greatly reduced mental health services.

Evidence has mounted in recent years, some from federal investigators, that physical illnesses of people especially frail elders, cannot be treated separately from mental illness. The report quotes a 1982 Government Accounting Office report that stated, “Left undiagnosed and untreated, mentally ill residents have limited prospects for improvement, and their overall conditions m ay decline more rapidly and ultimately place greater demands on the health care system.”

Achieving Mental Health…is being published this spring by the nonprofit Hebrew Rehabilitation Center for the Aged’s (RCA) Research and Training Institute in Boston, in conjunction with the Mental Health Policy Resource Center (MHPRC) in Washington, D.C. It is based on a 1993 invitational conference that brought together more than 130 experts in mental health and aging. Besides being released as an HRCA issue brief, the 50-page paper will be simultaneously published in the Journal of Mental Health and Aging (New York: Springer Publishing Company). The findings are being presented at the American Society on Aging’s 42nd Annual Meeting in Anaheim, Calif., in March.

The report enumerates a variety of obstacles to the provision of appropriate mental health services.  These include a shortage of mental health professionals trained in geriatrics; lack of in-service training in nursing homes to teach facility staff to treat behavioral and functional consequences of mental health or dementia; and inadequate Medicare payments and reimbursement rules that do not reflect the relative costs of preferred treatments.

Model Programs Recommendation

The report also notes that, in spite of these hurdles, model mental health programs do exist in some nursing homes; they are funded by an array of federal and state agencies, nonprofit foundations and even by some of the facilities themselves, drawing upon nonfederal funds.  The issue brief recommends that such programs be identified, cost-benefits calculated and the results widely disseminated to nursing homes for replication.

However, mental health experts involved in the issue brief agree that progress is slow and good mental health care in nursing homes is still exception rather than the rule.

Key recommendations in the report include:

  • Additional funding for research, staff training, and consumer education initiatives;
  • Improved Medicare and Medicaid reimbursement to pay for psychiatrists to train nursing home staff members in mental health services;
  • Sthe “unbundling,” or separating, of mental health services from nursing home per diem rates, so that funding intended for such assistance cannot be buried in lump-sum reimbursements for care and forgotten;
  • Full implementation of all federal nursing home reform mandates passed in 1987 and 1989, such as those requiring training for nursing home staff and strictly limiting the use of psychotropic drugs and physical restraints with residents;
  • Increasing the percentage of mental health services paid for by Medicare and other federal and private insurance to match that paid for other medical services.

Further, the report recommends that reimbursement incentives to be redirected to recognize  behavioral methods and deemphasize “medication-only” treatment.

The report’s authors added that Washington has failed to recognize cost-effective but humane alternatives to wholesale budget cuts.

For example, given the current antiregulatory mood in Congress, report cards for consumers can be one solution to assist family members in choosing a nursing home that provides adequate mental health training to its staff, said another of the report’s authors, Gail K. Robinson, deputy director of the MHPRC.

She suggested, “With such ratings, consumers and their families can be more selective in choosing a nursing home that provides better quality mental health care. Moreover, facilities could use the ratings to identify their weaknesses and correct them.”

According to Lombardo, there are less costly ways to improve mental health services than obtaining psychiatric specialists care for most residents. For example, she said, “The facility’s in-service training budget could easily be used to bring in experts to teach staff how to care for residents with mental illness or behavioral problems.” This redirection of funds would allow specialists to serve as trainers and troubleshooters, rather than as  consultants for individual residents.

Lombardo also called on nursing home administrators to support simple changes in their in-service training philosophies: “Administrators must realize the actions of all staff members in their facilities affect the mental health of residents either positively or negatively. Therefore, every person should attend training on mental and behavioral issues.”