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

• lder 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

• f 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

 Universality  feeling of having problems similar to others, not alone  Altruism  helping and supporting

• thers

 Instillation of hope  encouragement that recovery is possible  Guidance  nurturing support & assistance

 Imparting information

 teaching about problem and recovery

 Developing social skills

 learning new ways to talk about feelings,

• bservations and

concerns

 Interpersonal learning

 finding out about themselves & others from the group

11 Therapeutic Factors

 Cohesion  feeling of belonging to the group, valuing the group  Catharsis  release of emotional tension  Existential factors  life & death are realities  Imitative behavior  modeling another’s manners & recovery skills  Corrective recapitulation of family of

• rigin issues

 identifying & changing the dysfunctional patterns or roles

• ne played in primary family

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

• utpatient 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.

The Senior Outpatient Program

 The Senior Outpatient Program has expanded over the last year to also serve adults under the age of 55  Collaboration with the patient’s primary care physician and other healthcare providers are strongly encouraged to ensure the best continuity of care.  Typical length of treatment is 6-8 weeks

Outcomes

 Decreased hospitalizations  Improved physical health  Increased physical activity  Establishing a routine  Improved health behaviors  Decreased reliance on medications  Improved communication  Improved coping skills

Assessments and Referrals

 Our clinical staff offers free, confidential assessments to determine if behavioral health services are needed.  Referrals to our program may be made by the family physician, nurses, mental health professionals, assisted living facilities and others concerned about the welfare of their family member, friend or loved one.  Patients can also self-refer into the program.

Two locations: Winchester and Woodstock, VA

 Program operates 5 days a week  Patients receive an individualized treatment plan developed based on the needs that have been identified.  Patients set realistic goals, learn healthier coping skills and participate actively in their own recovery  Diagnostic mental health evaluations by a psychiatrist/psychiatric nurse practitioner and licensed therapist

Insurance Coverage

 Insurance Services are covered by Medicare and many commercial insurance providers.  Valley Health’s financial assistance department works with each client individually to facilitate financial viability when necessary.

References

 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2006) Web-based Injury Statistics Query and Reporting System (WISQARS) Retrieved from: http://www.cdc.gov/ncipc/wisqars.  Eisenberger, N. I., & Cole, S. W. (2012). Social neuroscience and health: neurophysiological mechanisms linking social ties with physical health. Nature Neuroscience, 15(5), 669–674. https://doi.org/10.1038/nn.3086  Eitzen, S. (2004). THE ATROPHY OF SOCIAL LIFE. Society, (September/October), 12–16.  Holt-Lundstad, J., Smith, T., & Layton, B. (n.d.). Social Relationships and Mortality Risk: A Meta-analytic Review. Retrieved October 9, 2017, from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316  MacNair-Semands, R. R. (2015). Interpersonal Group Therapy. In The SAGE Encyclopedia of Theory in Counseling and Psychotherapy (Vols. 1–2, pp. 570–572). Thousand Oaks,: SAGE Publications, Inc. https://doi.org/10.4135/9781483346502  Mental and Behavioral Health and Older Americans. (n.d.). Retrieved October 10, 2017, from http://www.apa.org/about/gr/issues/aging/mental-health.aspx  Townsend, M. C., & Morgan, K. I. (2017). Essentials of psychiatric mental health nursing: concepts of care in evidence- based practice (Seventh edition). Philadelphia, PA: F.A. Davis Company.  Umberson, D., & Montez, J. K. (2010). Social Relationships and Health: A Flashpoint for Health Policy. Journal of Health and Social Behavior, 51(Suppl), S54–S66. https://doi.org/10.1177/0022146510383501  Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed). New York: Basic Books.