Nursing Homes Are Turning Away Patients with Mental Health Issues

Daniel D. Sewell Photo

Daniel D. Sewell, MD, Director, Senior Behavioral Health, UC San Diego Medical Center

Care For Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers and the American Association for Geriatric Psychiatry in developing this post.

Chemical restraint is a serious problem in nursing homes. History has shown that psychotropic medications tend to be overused in order to keep residents with problem behaviors such as wandering or combativeness subdued or “under control.”

In other words, there are documented instances when serious psychiatric drugs are given to people who might not have needed them.

To address this and other nursing home quality issues, the Centers for Medicare & Medicaid Services (CMS) created a Five-Star Quality Rating System. One of the rating criteria is the number of residents at the facility who are receiving antipsychotic medications: the larger the number, the lower the score the facility receives.

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Putting Profits Over Patients: Medicare Part D Changes Mean Disaster for People with Depression

Daniel D. Sewell Photo

Care For Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers and the American Association for Geriatric Psychiatry in developing this post.

Putting Profits Over Patients: Medicare Part D Changes Mean Disaster for People with Depression
Daniel D. Sewell, MD, Director, Senior Behavioral Health, UC San Diego Medical Center

In older adults, depression can have severe consequences. It’s associated with an increased risk of suicide; decreased physical, cognitive and social functioning; and greater self-neglect; all of which are associated with increased mortality. This is a vulnerable population that needs effective, affordable access to mental health care.

Unfortunately, proposed changes to the Medicare Part D drug program would put older patients living with depression at even greater risk.

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Older Adults Are Being Overlooked When it Comes to Mental Health Care

Daniel D. Sewell Photo

Care For Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers and the American Association for Geriatric Psychiatry in developing this post.

Daniel D. Sewell, MD, Director, Senior Behavioral Health, UC San Diego Medical Center

For most individuals in the U.S., accessing mental health care is a struggle, but older adults may have it worst of all. Due to stigma, misinformation, and false beliefs about aging, they frequently go without adequate care for depression and other psychiatric illnesses and psychological problems. Too often, doctors offer prescription drugs as a cure-all solution, and fail to address the overall mental health and well-being of the older patient.

The truth is, addressing mental health issues in older populations requires paying more attention, not less. In aging adults, depressive symptoms can point to a physical illness, while physical pain or other physical complaints can often be a sign of mental health issues.

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My Mental Health Care on Base: A Perfect Storm

Sarah Davies Photo

Sarah Davies, Families for Depression Awareness Volunteer

I like to think that my issues with the mental health care on our Army post are the result of a perfect storm. I live with Bipolar II, which I know how to self-regulate for the most part. There are times, however, where either I know I need to check in or my primary care manager (PCM) recommends a visit. At our current duty station, I have seen both a psychiatrist and psychologist at the recommendation of my PCM. Both visits have left me wanting better care. The psychiatrist put me on an anti-depressant, which is contra-indicated for Bipolar as it can spin me into a manic state (which it did). I stopped taking the meds and asked to be seen by a psychiatrist to figure out a self-care plan without medication. I saw him one time—during which he allowed me to speak for maybe five minutes out of an hour. He asked for my background—during which I mentioned my college education—and he went off on a tangent about a woman he dated that went to my alma mater and how attractive the women there seem to be. My lack of confidence in his ability to listen to me, his one job, kept me from returning.

I mention all of this because I believed my bad experiences were just a result of those doctors not listening to me; like I said, a perfect storm of incompetence that I was unlucky enough to be part of. When I said that to my husband, he countered my assessment. It’s just a regular storm. It’s what too many spouses and service members face when they go to mental health [services].

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