Mind and Body: When All You Have Is a Hammer, Everything Looks Like a Nail

When I worked in the psychiatric hospital, the focus of treatment was on the mental health of the patients.  Physical complaints were usually thought of as an expression of mental illness and not reflective of an actual medical problem.  We once sent a patient down to the tiny sub-basement medical clinic after she injured her left hand.  The report came back with a thorough examination of her right hand, which was missing fingers after a self-inflicted gunshot wound ten years prior.  Her left hand was still throbbing.

In nursing homes, I find the opposite situation.  The focus is on medical care, and mental health concerns are “in the sub-basement,” so to speak.  This is despite the intensely stressful experience of nursing home admission, as I’ve written about before: The Stress of Nursing Home Admission.

In her April 30, 2011 New York Times article, Jane Gross, founder of the NYT blog New Old Age, discusses the lack of mental health care in nursing homes.  In Doctor Focuses on the Minds of Elderly, she reports on the work of psychiatrist Dr. Mark E. Agronin, my guest blogger last month.  My favorite quote of the article, which is well worth the read:

Why, Mrs. Sachs asked, “do they send buses of psychologists to a high school every time there’s a tragedy,” but here, where death is constant, “there’s only a brief memorial service and cookies?”

5 thoughts on “Mind and Body: When All You Have Is a Hammer, Everything Looks Like a Nail”

  1. You speak my mind. That's also my favorite quote of the article.

    The emphasis on mental health at psychiatric hospitals can sometimes result in sub-optimal care. I wish we could all treat each individual with respect; from a holistic, biopsychosocial perspective. Human beings aren't robots. They can't be "fixed" by "drug cocktail" (psychiatric or general medical) and surgical procedures alone.

  2. Dr. El,

    I would like your opinion on the new nursing home assessment (since October 2010 in New York), do you believe the interview conducted on resident mood is adequate in screening for depression? The interview is usually conducted by a nurse or a social worker. For your readers who may not know, the person is asked if they experience little interest in pleasure in doing things, if they feel down, have trouble sleeping, feel tired, feel bad about themselves, have difficulty concentrating, thoughts of being better off dead or hurting themselves etc.

    I do believe it is a significant improvement and leads to more referrals for residents to be screened by a psychologist, however, I still feel psychological screening should be conducted by a psychologist on all residents.

  3. I'm very glad you wrote on this, and sad to say that I think in many long-term care facilities, there's not even a memorial service or a plate of cookies. Maybe someday mental health will be on par with physical (and spiritual) health!

  4. Great to hear such support for treating the whole person, physical, spiritual, and emotional. Thanks for your comments.

    Regarding the new screening tool for resident depression, Sue, I agree it's a significant improvement. Just as I don't need to know the medical diagnosis to recognize when a resident is having physical symptoms and refer them to the medical staff, the MDS 3.0 screener now has the opportunity to hear from the residents themselves if they are feeling depressed or anxious and refer them to the psychologist for further evaluation.

    I believe that some day that there will be psychological evaluations upon admission, especially since reducing depression can improve compliance with rehab, meds, and other care, not only reducing overall costs in other areas, but creating a more healing environment in general and increasing the likelihood of satisfied residents and families who refer others to the nursing home.


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