Severely mentally ill residents: Staff training, teamwork needed
As I discussed in Severely mentally ill residents: A ‘perfect storm’ creates a SNF wave, long-term care has a growing population of severely mentally ill (SMI) residents, with the number of residents diagnosed with schizophrenia or bipolar disorder approaching 20% in some states as of 2017.1
In addition, 46.3% of LTC residents were diagnosed with depression in 2015 and 2016.2 Some were undoubtedly individuals with severe, chronic depression.
People with SMI generally enter nursing facilities for rehabilitation following a fall or some other health crisis. Discharge choices can be limited due to coexisting medical and mental health problems, leading them to become long-term residents despite their relatively young age (an average age of 62 versus 77 in the general nursing home population3).
A review of research on individuals with mental health problems, Physical illness in patients with severe mental disorders, finds that people with SMI have a greater likelihood of physical illness than those without SMI. The authors of the study note that “important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision…contribute to these poor physical health outcomes.”
Their research suggests multiple points at which long-term care providers can intervene to assist SMI residents.
Nurses and physicians can be taught to recognize health problems typical of the SMI population so that they’ll be alert to the increased risk of illnesses such as diabetes, metabolic syndrome, obesity-related cancers, cardiovascular diseases, osteoporosis, hepatitis B/C, tuberculosis, impaired lung function, poor dental status and other concerns.
Staff members who are comfortable physically assessing older residents might need additional training to be at ease evaluating SMI individuals, who may be more physically imposing because of their relative youth, come across as unfamiliar or frightening in their presentation or be themselves uncomfortable with medical tests or interventions.