the power of relationships - valleyhealthlink.com · yalom’s therapeutic factors yalom (1995)...
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The Power Of Relationships A portrait of the The Winchester Medical Center
Adult/Senior Outpatient Program
Brenda J. Johnston, DNP, PMHNP-BC, PMHCNS-BC
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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
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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.)
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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)
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What Came First ?
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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.)
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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).
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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
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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)
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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)
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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)
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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)
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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))
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”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)
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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
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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).
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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).
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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)
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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.
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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)
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11 Therapeutic Factors
Universality
feeling of having problems similar to others,
not alone
Altruism
helping and supporting
others
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, observations and concerns
Interpersonal learning
finding out about themselves & others from the group
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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
origin issues
identifying & changing the
dysfunctional patterns or roles
one played in primary family
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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
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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.
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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
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Types of Group Therapy
Cognitive Behavioral Therapy,
Interpersonal Process Groups,
Psychoeducation
Psychotherapy
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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.
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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
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Outcomes
Decreased hospitalizations
Improved physical health
Increased physical activity
Establishing a routine
Improved health behaviors
Decreased reliance on medications
Improved communication
Improved coping skills
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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.
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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
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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.
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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.