The Power Of Relationships A portrait of the The Winchester Medical - PowerPoint PPT Presentation

The Power Of Relationships A portrait of the The Winchester Medical Center Adult/Senior Outpatient Program Brenda J. Johnston, DNP, PMHNP-BC, PMHCNS-BC

Objectives:  Discuss the value of “purpose” and the influence of interpersonal relationships on health and wellbeing  Examine the impact of social isolation on the development of common mental illnesses in elderly populations  Recognize the benefits of group therapy  Describe the services provided at the Senior Outpatient Program (SOP)  Select appropriate referrals for the SOP

Mental Illness and the Elderly  According to the World Health Organization (WHO)  More than 20% of adults older than 60 suffer from some type of mental or neurological disorder  6.6% of all disability cases in older adults are due to mental health and neurological disorders.  The most common neuropsychiatric disorders in older adults are depression, anxiety and dementia. (“WHO | Mental health and older adults,” n.d.)

No Health without Mental Health  Elderly persons with mental health problems have a higher incidence of:  Chronic illnesses  Chronic pain  Substance abuse  Neurocognitive decline (American Psychological Association, 2017)

What Came First ?

Anxiety and Depression  Anxiety disorders affect 3.8% of the elderly population.  Depression is the most common mental health problem in older adults. According to WHO, it occurs in 7% of adults older than 60 years. Symptoms of depression in older adults include:  Fatigue  Sadness  Irritability  Social withdrawal  Weight loss and loss of appetite  Loss of self-worth  Fixation on death (“WHO | Mental health and older adults,” n.d.)

Depression is a major risk factor for suicide.  In 2006, 14.22 of every 100,000 people age 65 and over died by suicide, higher than the rate of 11.16 per 100,000 in the general population.  Non-Hispanic white men age 85 and over are at the greatest risk for suicide, with a rate of 49.8 suicide deaths per 100,000 (CDC, 2006).

Neurocognitive Disorders  About 47.5 million people around the world have dementia, and it is estimated that number will reach 75.6 million by 2030. Symptoms of dementia include:  Memory loss  Depression  Irritability  Difficulty finding the right words  Inability to perform tasks and activities that require planning and organization etc. (“WHO | Mental health and older adults,” n.d

Accessing Mental Health Care Services  Mental health problems in elderly individuals are frequently under-identified by health care providers  Elderly people are often reluctant to seek mental health care  Stigma surrounding mental illness  Often present with symptoms that seem unrelated to a mental health problem  Access to services  The expense of mental health care (Townsend & Morgan, 2017)

Signs that Indicate a Need for Help May Include:  Depression  Social withdrawal  Severe anxiety  Suicidal thoughts  Sleep and appetite changes  Loss of interest in appearance  Hallucinations  Confusion  Cognitive impairment due to depressive symptoms (Townsend & Morgan, 2017)

Risk factors for mental health problems include:  Physical health influences mental health and vice versa  Chronic pain  Diabetes  Heart and vascular disease  Strokes  Urinary and bowel incontinence  Polypharmacy (Townsend & Morgan, 2017)

Risk factors for mental health problems (Cont)  Experiencing events such as bereavement  Loneliness  Financial instability  Lack of physical activity  Emotional distress  Neglect  Loss of independence  A lack of purpose (Townsend & Morgan, 2017)

What is more Deadly than Smoking, Alcoholism and Obesity?  Social Isolation contributes to increased risk of chronic diseases and can predict an earlier death  Loneliness increases the risk for the development of psychiatric illnesses such as anxiety, depression and neurocognitive decline. ( Holt-Lundstad, Smith, & Layton, n.d., 2010, Holwerda et al., 2014))

”The Atrophy of Social Life” Why are we so Isolated?  In 1930 two % of the population lived alone. By 2000 ten % of the population lived alone.  Mega-houses with spacious fenced in back yards  Air-conditioners, refrigeration, televisions and technology  Mobility and less job security  Senior living communities (Eitzen, 2004)

The benefits of social supports  Potentially reduced risk for cardiovascular problems, some cancers, osteoporosis, and rheumatoid arthritis  Potentially reduced risk for Alzheimer's disease  Lower blood pressure  Reduced risk for mental health issues such as depression

How do our Relationships with Others Improve Health?  Being nagged by your spouse to have better health behaviors  Having a sense that you are loved, cared for and listened to  Social relationships enhance a sense of personal control  Social ties inspires persons to want to live healthier lives  Supportive interactions with others benefit immune, endocrine, and cardiovascular functions and reduces the body’s response to stress which decrease ”wear and tear” (Eisenberger & Cole, 2012).

Do Relationships always Improve Health?  There is a dark side:  Poor marriages can lead to poor physical and mental health  High care-giving demands  Raising grandchildren  Negative social environments contribute to increase substance abuse and other unhealthy behaviors  Smaller families increases care-giver burden (Eisenberger & Cole, 2012).

Using Interpersonal Theory to Target Mental Illness  Based on the assumption that all mental health issues are connected to interpersonal struggles  Altering relationship patterns improves wellbeing and can lead to healing (MacNair-Semands, 2015)

Yalom’s Therapeutic Factors  Yalom (1995) defined therapeutic factors as "the actual mechanisms of effecting change in the patient" (p. xi).  Yalom identified 11 factors that influence the processes of change and recovery among group therapy clients.

In the Context of Therapeutic Environment  Therapeutic/Curative Factors  Instillation of hope  Universality  Imparting Information  Altruism  Substitute family  Development of socializing techniques  Imitative Behaviors  Interpersonal Learning  Group Cohesiveness  Catharsis  Existential Factors (Yalom & Leszcz, 2005)

11 Therapeutic Factors  Imparting information  Universality  teaching about problem  feeling of having and recovery problems similar to others, not alone  Developing social skills  Altruism  learning new ways to talk about feelings,  helping and supporting observations and others concerns  Instillation of hope  Interpersonal learning  encouragement that  finding out about recovery is possible themselves & others from the group  Guidance  nurturing support & assistance

11 Therapeutic Factors  Cohesion  Corrective recapitulation of family of origin issues  feeling of belonging to the group, valuing the  identifying & changing the group dysfunctional patterns or roles one played in primary family  Catharsis  release of emotional tension  Existential factors  life & death are realities  Imitative behavior  modeling another’s manners & recovery skills

Valley Health’s Senior Outpatient (SOP)Behavioral Health Program  The Winchester SOP opened on December 11, 2013  Offers an integrated psychiatric and medical approach to mental health and wellness, specifically designed for those aged 55 and up.  450 persons have received services

Winchester Medical Center SOP  Developed as a result of Valley Health’s Community Benefit Assessment  This assessment completed every 3 years, consistently identifies the top 2 needs within the Shenandoah Valley=  Mental Health and Substance Abuse.  Long waiting lists in the area and lack of services which provide specialized outpatient psychiatric treatment for older adults  Valley Health developed the Intensive Outpatient Program model to target adults 55 and over requiring intensive behavioral health support within a region in which many retired individuals reside.

SOP Services Winchester Medical Center also has two inpatient psychiatric units which serve adults  and senior adults who can receive a continuum of care after their discharge to the intensive outpatient program Services offered at the SOP  Medication management,  Group/Individual/Family Therapy-  Primarily Group Modality,  Psychiatric Nurse Practitioner, Psychiatrist oversight and direction.  Case Management 

Types of Group Therapy  Cognitive Behavioral Therapy,  Interpersonal Process Groups,  Psychoeducation  Psychotherapy

Admission Criteria  Patients aged 55 and up with a mental health diagnosis  Someone who is experiencing an acute or chronic psychiatric episode who is requiring intensive behavioral health support for at least 3-11 hours a week.  Intensive Outpatient Program (IOP) is defined as at least 9 hours of service and most individuals begin at this level.