Meeting the mental health needs within the long-term care sector is an increasing concern. Studies reveal that 44% of those living in long term care have symptoms of depression yet only a small proportion actually receive an evaluation by a licensed mental health professional (8.4%) or psychological therapy (2.6%).1 Depression is a major cost driver for operators, as it affects staff workload, morale and burnout. Many seniors also struggle with loneliness. Both depression and loneliness result in poor health and increased mortality rates for elders, confronting providers with a serious moral, social and economic dilemma. With the growing elderly population, increasing needs and shrinking budgets, bringing in sufficient outside mental health professionals to deal with the crisis is far beyond the limitations of cost and availability.
Can trained lay people be effective support group facilitators?
I am proposing that we take a look at three fantastic under-utilized resources within our communities to address the rising costs and budget cuts: the residents themselves, volunteers and caregivers. These are rich resources that can be used in a brand new way – a way that benefits and inspires them and those they are helping. As ‘lay people’, interested high-functioning residents, volunteers and caregivers can effectively facilitate mutual support groups. Mutual support groups have a significant impact on depression. Lay people are already effectively facilitating support groups in our communities but this approach is not being utilized within long-term care. Using standardized, research-based programs, this model could be possible within the long-term care sector provided that the following elements are in place:
- The residents, volunteers, caregivers and recreation staff are given a standardized program to follow;
- The residents, volunteers and caregivers have an affinity for small groups and regular volunteer work;
- They are provided with standardized training in facilitating support groups within long-term care;
- The residents, volunteers and caregivers are under the supervision of recreation staff who can advise them and provide support as needed.
This proposed use of lay people to help tackle the growing mental health needs requires a paradigm shift within recreation departments but will provide the much needed help. Research backs the concept up. According to the Journal of Consulting and Clinical Psychology, paraprofessionals with training and the use of standardized support group programs, are as effective as mental health professionals at addressing seniors’ mental health needs, such as depression.7 In 1994 the American Psychological Society reported that self-help groups and paraprofessionals produce the same effects as treatment by professional therapists.9 The US Institute of Medicine also recognizes peer support led by trained staff and lay people can be an integral component of a mental health program for older adults and their caregivers.2
Why is peer support important?
On a practical level, the need for mental health services cannot possibly be met by existing mental health professionals. When we do the math, it just won’t happen. First of all, there are not enough professional therapists available to meet the needs. Second, there is no budget to pay for the numbers of therapists required. And third, many people will not seek or accept professional help in any case, particularly the older generation. Typical treatment continues to focus on pharmacotherapy but research suggests that the use of non-pharmacologic psychosocial interventions such as mutual support groups, in conjunction with pharmacotherapy when necessary, is a more effective approach to treating depression.8
New ways to inspire residents, caregivers and volunteers
The following is a practical approach to leveraging a recreation department through a strategic plan that inspires residents, volunteers and caregivers and gives them purpose:
- Educate the recreation program staff regarding the theory of mutual support (aka peer support/self help groups), and obtain training on facilitation of mutual support group programs See www.javagp.com.
- Leverage (increase) the potential effectiveness of this department by training others (e.g. any other interested staff, residents, long-time volunteers, caregivers etc.) to facilitate these support groups, therefore helping them, help the residents, help one another.
- Create a schedule that has daily programs focused on residents helping each other (e.g. one-to-one visits of resident visiting and supporting other residents – with the help of volunteers/caregivers – a form of mentorship). This sets in motion a powerful change mechanism called the “helper therapy principle” whereby people who help others, are themselves helped (Riessman, 1967). For information about the Java Mentorship Program email firstname.lastname@example.org.
- Train recreation staff to set other structures in place, whereby the volunteer residents, caregivers and volunteers are trained to actively participate in seeking out and supporting lonely members in their communities. With proper support and training is given they are motivated to help others while also experiencing personal benefits and self-improvement.
Recent research has indicated that recruitment and retentions of volunteers is promoted by:
- Opportunities to help others
- Opportunities to share and socialize
- The experience of self-improvement and growth10
All of these are compelling reasons to invest in training for recreation staff, residents, volunteers and caregivers in facilitating mutual support groups & providing them with the needed ongoing support. Those in our care deserve it.
1Canadian Institute for Health Information. (2010). Depression among seniors in residential care. Ottawa, Canada.
2Buckwalter, K., Martinez, O., & Stone, R. I. (2012). The mental health and substance use workforce for older adults: In whose hands? Washington, DC: Institute of Medicine of the National Academies.
3Association of Advocates for Care Reform. (1997). Alone in a crowd? Vancouver: Peanut Butter Publishing.
4McDonald, R. M., & Brown, P. J. (2008). Exploration of social support systems for older adults: A preliminary study. Contemporary Nurse, 29(2), 184-194.
5Guse, L. W., & Masesar, M. A. (1999). Quality of life and successful aging in long-term care: Perception of residents. Issues in Mental Health Nursing, 20(1), 527-539.
6Tomaka, J., & Thompson, S. (2006). The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of Aging and Health, 18(3), 359-384.
7Bright, J. I., Baker, K. D., & Neimeyer, R. A. (1999). Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions. Journal of Consulting and Clinical Psychology, 67(4), 491-501.
8Hyer, L., & Intrieri, R. C. (Eds.). (2006). Geropsychological Interventions in Long-Term Care. New York: Springer Publishing Company Inc.
9Christensen, A., & Jacobson, N. S. (1994). Who (or what) can do psychotherapy: The status and challenge of non-professional therapies. Psychological Science, 5(1), 8-14.
10Guerra, S. R. C., Demain, S. H., Figueiredo, D. M. P., & Sousa, L. X. M. D. (2012). Being a volunteer: Motivations, fears and benefits of volunteering in an intervention program for people with dementia and their families. Activities, Adaptation and Aging, 36(1).