Mental Illness - Planning for Aging and Future Long-Term Care

Mental illness is difficult to deal with. It's a lifelong companion, something that forces the person with the mental illness and those around them to adjust their lives indefinitely, always allowing for the toll the illness has on the person. 

Mental health is essential to overall well-being, influencing our emotional, psychological, and social functioning. However, just like physical health, mental health can be disrupted by various illnesses. These conditions can manifest in various symptoms and severities, impacting daily life and requiring different treatment approaches.

Common Mood Disorders

• Anxiety Disorders: Characterized by excessive worry, fear, and physical symptoms like rapid heart rate or shortness of breath, anxiety disorders are the most prevalent mental illnesses in the United States. The National Institute of Mental Health (NIMH) estimates that 40 million American adults experience some form of anxiety disorder each year. Generalized anxiety disorder, social anxiety disorder, and panic disorder are some of the common types of anxiety disorders.
• Depression:  A debilitating condition marked by persistent sadness, loss of interest in activities once enjoyed, and changes in appetite or sleep patterns, depression affects millions globally. According to the World Health Organization (WHO), depression is the leading cause of disability worldwide.
• Bipolar Disorder: Characterized by fluctuating moods between extreme highs (mania) and lows (depression), bipolar disorder can significantly disrupt relationships and work. The National Alliance on Mental Illness (NAMI) reports that bipolar disorder affects roughly 2.8 million adults in the U.S. each year.

Beyond Mood Disorders

While mood disorders are prevalent, other mental illnesses require attention. Here are a few examples:

• Schizophrenia: This severe mental illness can cause hallucinations, delusions, and disorganized thinking, making it difficult to maintain relationships and navigate daily life. Unfortunately, the cause of schizophrenia is unknown, but it's thought to affect about 1% of the population worldwide.
• Eating Disorders: These conditions involve unhealthy eating habits and distorted body image. Common types of eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorders. Eating disorders can have serious medical consequences and often require a combination of therapy and nutritional counseling.
• Obsessive-Compulsive Disorder (OCD):  Characterized by recurrent intrusive thoughts and repetitive behaviors aimed at reducing anxiety, OCD can be highly debilitating. The NIMH reports that OCD affects approximately 2.2 million adults in the United States each year].

Mental Health Challenges and Aging

While mental health challenges can affect people of all ages, the landscape often shifts as we enter our later years. Existing mental illnesses can become more complex with aging, and new conditions can emerge, posing significant challenges to overall well-being and potentially necessitating long-term care.

Here's a closer look at how some common mental illnesses can be exacerbated by aging:

• Depression:  Seniors are particularly vulnerable to depression due to factors like social isolation, loss of loved ones, or chronic health conditions. In older adults, depression can present differently than in younger individuals, with symptoms such as fatigue, loss of appetite, and sleep disturbances being more pronounced. Untreated depression in seniors can significantly decrease quality of life, potentially leading to difficulty managing daily tasks or self-care activities.
• Anxiety Disorders:  Anxiety disorders can worsen with age, particularly if accompanied by physical limitations or chronic pain. Seniors with anxiety might experience heightened worry about finances, health concerns, or losing independence. These anxieties can interfere with daily activities and social interactions, ultimately impacting well-being.
• Dementia: This progressive cognitive decline can affect memory, thinking, and reasoning abilities. While not a mental illness itself, dementia can often be accompanied by symptoms like depression, anxiety, or paranoia. These additional challenges can make it difficult for seniors with dementia to manage daily living independently, potentially requiring long-term care in assisted living facilities or nursing homes.

Long-Term Care Considerations

In some cases, the complexities of managing mental health conditions alongside physical limitations or cognitive decline necessitate long-term care. Some conditions can be managed with in-home caregivers; however, long-term care facilities offering specialized care and support for seniors with mental health challenges can provide a safe and supportive environment where they can receive the treatment and assistance they need to live a fulfilling life.

Health insurance, including Medicare, will only pay for short-term skilled care, so care services would be paid from income and savings unless the care recipient has Long-Term Care Insurance or qualifies for Medicaid because of low income and assets.

Unfortunately, some people with mental health conditions will not be eligible to purchase Long-Term Care Insurance. However, common depression and anxiety, if well controlled, would not be a barrier to obtaining coverage if you have no other significant health issues.

• What Is Underwriting In Long-Term Care Insurance?

Understanding and Treatment of Mental Health Issues

Despite an increased conversation around mental illness in recent years, there are still a lot of people who don't fully understand what a mental illness is. These people can suffer from undue feelings of shame, guilt, and regret and be thrown into deep psychic conflict regarding the nature of their condition, which they may not even fully understand.

The good news is mental illness' effects can be mitigated. There is hope in the form of wellness, therapies, and medications, all of which serve to lessen the effects that a mental illness has on the person suffering from it. It cannot be understated how much a proper plan of care can be when living with a mental illness. The best thing about creating a care plan is that it doesn't require a degree in MCHD-clinical mental health counseling to create a care plan.

The first step to understanding and accepting your or a loved one's condition is understanding mental illness. Research mental illnesses, some common ones, and their symptoms. The first step to coping with mental illness is knowing that you're not alone and that help is available.

Most of all, the biggest thing for anyone living with a mental illness to realize is that they are worthy of getting help and that doing so does not make them weak.

See the Doctor

Let's say you have a sore arm. You don't know why it's sore; it just is. You expect it to go away after a while, but it doesn't. Some days, it hurts so bad you can't get out of bed, clean yourself, or go to work or school.

Would you stay in pain and bear it, or would you go to a doctor to see what can be done about it? 

The first practical step with any physical anomaly that negatively affects our lives is to see a doctor. The same is true of mental illness. When your brain is constantly causing you grief, when thoughts are uncontrollable, ideas persistent, and your lives are consistently negatively affected by your mood, attitudes, perceptions, or sensory experiences - the first practical step should always be to see the doctor.

Your family doctor is a foundation of resources. They may not be able to diagnose more severe mental health issues, but they will be able to narrow down the possibilities of your condition based on your symptoms and then send you to specialists who can diagnose you or at least investigate further. Which leads us to our next point:

See a Specialist

Perhaps you or a loved one needs to see a therapist. Psychologists, psychiatrists, and other specialists often serve as the primary diagnosticians for detecting initial changes in mental health. A psychiatrist is a medical doctor who specializes in mental health, including substance use disorders and is qualified to assess both the mental and physical aspects of psychological problems. Psychiatrists can prescribe medications and offer treatments like Cognitive Behavioral Therapy (CBT). In contrast, psychologists focus on psychotherapy and treating emotional and mental suffering in patients with behavioral intervention, but they do not prescribe medications.

A therapist is a general term encompassing professionals trained to provide various psychological counseling and support. Therapists can include psychologists, licensed clinical social workers (LCSWs), marriage and family therapists (MFTs), licensed professional counselors (LPCs), and more. They typically hold at least a master's degree in psychology, counseling, social work, or a related field and are licensed by their state to provide therapy and counseling.

Therapists differ from psychologists and psychiatrists in several ways:

1. Psychologists generally hold a doctoral degree (PhD or PsyD) in psychology and are trained to perform psychological testing, conduct in-depth therapy sessions, and treat complex mental disorders. They focus heavily on psychotherapy and treating emotional and mental suffering through behavioral intervention but usually do not prescribe medication unless they are specially certified.
2. Psychiatrists are medical doctors (MD or D.O.) who specialize in mental health, including diagnosing mental illness, managing treatment, and prescribing medications. Psychiatrists are uniquely positioned to assess both the mental and physical aspects of psychological disorders.

Therapists can treat a wide range of mental health issues, including but not limited to:

• Anxiety disorders, such as generalized anxiety disorder or panic attacks.
• Mood disorders, such as depression or bipolar disorder.
• Addiction and substance abuse issues.
• Family and relationship issues, including marital problems and parenting challenges.
• Life transitions and stress, such as coping with grief, moving to a new area, job loss, or divorce.
• Behavioral disorders, such as obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).

The type of therapy offered can vary based on the therapist's training and specialization, such as cognitive-behavioral therapy (CBT), psychodynamic therapy, or solution-focused therapy. The goal of therapy is to help individuals understand their feelings, improve their mental functioning, and develop healthier, more effective patterns of behavior.

How Can a Therapist Help?

Your family doctor might suggest seeing a therapist for mental health concerns in several circumstances, especially when you need support, guidance, or intervention related to emotional, psychological, or behavioral issues. Here are some common scenarios when consulting a therapist could be beneficial:

1. Managing Stress and Anxiety: If you're experiencing stress or anxiety that affects your daily functioning or quality of life, a therapist can help you develop coping strategies to manage these feelings effectively.
2. Dealing with Depression: For feelings of persistent sadness, hopelessness, or depression that don't necessarily require medication but do impact your well-being, therapy can provide relief and tools for recovery.
3. Navigating Life Transitions: Major life changes, such as a divorce, loss of a loved one, job loss, or a major move, can be overwhelming. A therapist can help you process these changes, manage the associated stress, and adapt to your new circumstances.
4. Improving Relationships: Whether it's issues with a spouse, family, friends, or coworkers, therapy can help you understand relationship dynamics and develop healthier communication and conflict-resolution skills.
5. Addressing Trauma: If you have experienced traumatic events, whether recently or in the past, a therapist trained in trauma can offer therapies such as EMDR (Eye Movement Desensitization and Reprocessing) or trauma-focused CBT to help you heal.
6. Behavioral Changes: If you're struggling with behaviors that are harmful or disruptive, such as addictive behaviors, eating disorders, or compulsive habits, therapy can help you understand the root causes and develop strategies to change these behaviors.
7. Self-Improvement and Personal Growth: Even if you don't have a specific mental health issue, therapy can be beneficial for personal development, helping you to better understand yourself, set personal goals, and improve your overall emotional and psychological well-being.

Therapists can provide a supportive and non-judgmental environment to explore your feelings and behaviors and develop practical solutions to enhance your mental health and overall quality of life.

Psychologists and Diagnosis 

Seeing a psychologist will allow you to find a diagnosis for your condition. While some people are of the idea that so-called "labels" are ineffective or unimportant for mental illness, understanding what your brain is going through is intensely useful. Not only does it allow you to put a definitive boundary on your condition, but it also means that you can externalize it, lessening self-blame, doubt, and shame. It also shows patients that they aren't alone and that their condition is diagnosable and, therefore - treatable.

Once you have your diagnosis, you can go back to your family doctor, who will be able to use your diagnosis and the psychologist's suggestions to establish a care plan for you.

When to See a Psychiatrist

You might consider seeing a psychiatrist for several reasons, particularly when dealing with complex mental health issues that may require medical treatment beyond counseling alone. Here are some situations where consulting a psychiatrist could be beneficial:

1. Diagnosis of a Mental Health Disorder: If you or your doctor or therapist suspect you have a mental health condition or if symptoms are interfering significantly with your daily life—such as persistent sadness, extreme mood swings, or debilitating anxiety—a psychiatrist can provide a thorough assessment and diagnosis.
2. Medication Management: Psychiatrists are medical doctors who can prescribe and manage medications for mental health disorders. If your condition might benefit from pharmacological treatment—such as antidepressants for depression, mood stabilizers for bipolar disorder, or antipsychotics for schizophrenia—a psychiatrist can help.
3. Complex Mental Health Issues: For more severe or complex mental health issues that might require a combination of therapy and medication, a psychiatrist can provide an integrated approach to treatment.
4. Treatment-Resistant Conditions: If you've tried other forms of treatment, like therapy with a psychologist or counselor, and haven't seen improvement, a psychiatrist can offer alternative options, including advanced medical treatments.
5. Psychiatric Evaluation for Other Medical Treatments: Some conditions, such as severe depression, may be treated with procedures like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS). Psychiatrists are qualified to evaluate whether you are a candidate for these treatments.
6. Co-occurring Disorders: If you have simultaneous mental health disorders and physical health issues, a psychiatrist can help manage your care, considering the interplay between these conditions, potentially in coordination with other medical specialists.

Seeing a psychiatrist is a step towards understanding and managing your mental health in a scientifically informed and medically comprehensive way.

All these mental health professionals, along with your family doctors, will develop a plan of care for you or a loved one to deal with mental health concerns.

What's in a Care Plan?

What your care plan can look like will differ from person to person and condition to condition. Not all mental illnesses are experienced the same way, and one person's needs will usually be very different from other people with the same condition.

However, they usually all involve one form of therapy or another, as well as, in some situations, some kind of prescription medication. 

Other things available on a care plan can include socialization, support groups, lifestyle changes, nutritional adjustments, and more.

However, as with most chronic conditions, care for mental illness starts at home. It's important to have a good support network around you, to be able to confide in friends and family, and to be able to be honest about your mental and emotional well-being. Additionally, your support network should be able to help you meet your care plan requirements, such as ensuring that you're taking your medication, that you're getting to your appointments, and that they're there for you to confide in.

Medications and Mental Health

Here's a breakdown of some common types of mental health medications and when they might be used:

1. Antidepressants:

• Function:  These medications help regulate brain chemicals like serotonin and norepinephrine, which are often imbalanced in depression.
• Used for:  Major depressive disorder, dysthymia (persistent mild depression), and sometimes anxiety disorders.
• Examples: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) or sertraline (Zoloft), serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor).

2. Anti-Anxiety Medications:

• Function:  These medications work in various ways to reduce symptoms of anxiety, such as calming overactive nerves or promoting relaxation.
• Used for Generalized anxiety disorder, social anxiety disorder, panic disorder, and sometimes as a short-term treatment for insomnia caused by anxiety.
• Examples: Benzodiazepines like alprazolam (Xanax) or lorazepam (Ativan) - used cautiously due to potential dependence; Buspirone (BuSpar) - non-benzodiazepine option.

3. Mood Stabilizers:

• Function:  These medications help regulate mood swings and prevent episodes of mania or depression in bipolar disorder.
• Used for:  Bipolar disorder, sometimes used for schizoaffective disorder (combination of bipolar and schizophrenia symptoms).
• Examples: Lithium, Lamotrigine (Lamictal), Valproic acid (Depakote).

4. Antipsychotics:

• Function:  These medications primarily target dopamine receptors in the brain, helping to manage symptoms like hallucinations and delusions in schizophrenia and other psychotic disorders.
• Used for: Schizophrenia, schizoaffective disorder, and sometimes for severe bipolar disorder or psychosis caused by other conditions.
• Examples: Risperidone (Risperdal), Olanzapine (Zyprexa), Aripiprazole (Abilify).

5. Stimulants:

• Function:  These medications increase alertness and focus, helping to improve concentration and reduce hyperactivity in individuals with ADHD.
• Used for:  Attention deficit hyperactivity disorder (ADHD).
• Examples: Methylphenidate (Ritalin), Dextroamphetamine-amphetamine (Adderall).

This is not an exhaustive list, and many other medications are used for various mental health conditions. A mental health professional will determine the most appropriate medication(s) based on a patient's specific diagnosis, symptoms, and medical history.

For someone on prescription medication for depression or other mental health issues, it is crucial to stay on the medication unless instructed by your doctor to stop or taper off the drug. 

Some medications will make you ineligible for Long-Term Care Insurance, while many simple anxiety and depression medications will have little impact on your ability to get an LTC policy.

Managing Existing Mental Health Conditions in Long-Term Care

For seniors with pre-existing mental health conditions, transitioning to long-term care can be daunting. However, these facilities can provide a supportive environment where ongoing treatment and management of mental health are prioritized. Here's how long-term care facilities address existing mental health concerns:

• Continuity of Care:  Ideally, communication with a resident's previous healthcare providers establishes a baseline understanding of their mental health history and treatment plan. This allows long-term care staff to continue medication regimens and therapy approaches seamlessly.
• Specialized Care Teams:  Many long-term care facilities have staff trained in mental health, including psychiatrists, therapists, and nurses. These professionals can monitor residents' mental well-being, adjust medications as needed, and provide individual or group therapy sessions.
• Supportive Environment:  Long-term care facilities can create a structured and predictable environment that reduces stress and anxiety for residents. Additionally, social activities and group sessions can combat loneliness and isolation, common triggers for mental health issues in older adults.

The Intertwined Threads: Mental Health and Cognitive Decline

The relationship between mental health and cognitive decline, particularly dementia, is complex and multifaceted. Here's how pre-existing mental health issues can influence dementia and vice versa:

• Mental Health as a Risk Factor:  Studies suggest that certain mental health conditions, like depression or anxiety, might increase the risk of developing dementia later in life. Chronic stress associated with these conditions can potentially damage brain cells and contribute to cognitive decline.
• Mental Health Symptoms of Dementia:  Dementia itself can manifest symptoms that mimic or exacerbate pre-existing mental health conditions. For example, depression and anxiety are common in individuals with dementia, further complicating the clinical picture.
• Medication Interactions:  Medications used to treat mental health conditions may interact with medications used for dementia, requiring careful monitoring and potential adjustments by healthcare professionals.

A Holistic Approach is Key

Effectively managing both mental health conditions and cognitive decline necessitates a holistic approach. Long-term care facilities play a crucial role in:

• Early Detection:  Monitoring residents for signs of depression, anxiety, or other mental health concerns alongside cognitive changes.
• Integrated Treatment:  Combining medication management, therapy, and lifestyle modifications to address both mental health needs and cognitive decline.
• Family Involvement:  Collaborating with families and loved ones to ensure continuity of care and provide emotional support.

By recognizing the interconnectedness of mental health and cognitive decline, long-term care facilities can create a supportive environment that promotes overall well-being for their residents, allowing them to live a life with dignity and quality, even with these challenges.

Use the LTC NEWS Caregiver Directory to find professional caregivers and quality long-term care facilities. This tool is the largest database of caregivers, senior communities, and long-term care facilities in the nation, and it is free to use.

• Find Quality Long-Term Care Providers Near You | LTC News

Be Proactive with Health and Planning

Being proactive with mental health is crucial for maintaining and enhancing the overall quality of life for yourself and your loved ones. Mental health influences every aspect of daily living, from managing stress and interacting with others to making decisions and coping with challenges. 

Proactive mental health care can prevent issues from escalating into more serious conditions, reduce the risk of developing associated physical health problems, and significantly improve one's ability to enjoy life and maintain relationships. 

By addressing mental health concerns early, you or a loved one are better equipped to lead fulfilling, productive lives and can avoid the long-term consequences that unchecked mental health issues might bring. This proactive approach fosters resilience, promotes well-being, and supports achieving personal and professional goals, ultimately leading to a healthier, more balanced life.