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Mental health issues such as depression and anxiety are NOT a normal part of aging and are hard to discuss, diagnose, and treat. The good news is that there are innovative programs, tools, and resources that can help.
This webinar is hosted by Christopher G. Kelly, MEd, Director of Learning and Development at Griswold Home Care. He shares recent research and best practice solutions for understanding, recognizing, and treating mental health issues in older adults.
The webinar workshop features three steps:
Step 1: Learn about the most common mental health conditions faced by older adults and their family caregivers
Step 2: Hear real stories and practical tips
Step 3: Access a Mental Health and Aging Toolkit that offers innovative tools, guidelines, and resources for diagnosing and treating mental health conditions in older adults
Older adults experiencing depression or anxiety, family caregivers, professional caregivers, healthcare providers, and those generally interested in learning more about mental health and aging are encouraged to view this webinar.
For the Mental Health & Aging Toolkit from this presentation, please view the bottom of our Mental Health & Aging blog post.
Derek: Good afternoon, everybody. Welcome to today’s Solution Series webinar, titled “Mental Health and Aging: An Overview of Barriers and Solutions.” The Griswold Homecare Solution Series Webinar Program is a monthly workshop designed to empower and provide practical solutions to the fingertips of caregivers, families and healthcare professionals.
Another component of this Solution Series is hearing from you. Throughout the webinar, you’ll have an opportunity to share your thoughts, experiences and insight, which can further promote today’s topic. In fact, we’ve already had a number of questions and comments on today’s topic, before the webinar started. So, we hope that’s a great sign of the engagement that will happen over the next 60 minutes.
First, a few housekeeping items. All attendees’ lines are muted. The audience will have several opportunities to ask questions throughout the webinar, and we will also have a formal question-and-answer session at the end of the webinar.
The powerful component of this workshop are a lot of the presented tools, which address the topic of mental health, and we’ve gone out and scoured the world to bring them to you today.
The presentation, recording and all the tools that will be demoed today will be emailed to all registrants, with a complete transcript of today’s webinar, within a few days after the webinar.
First, about today’s topic, since 1990, October has included both Mental Illness Awareness Week and National Depression Screening Day. Both are designed to open the eyes of the topic.
About one in five adults suffer from diagnosable mental illness each year, and, when scanning the elderly population, awareness is often not recognized or mistaken for symptoms of other chronic conditions, which leads us to today’s objectives for the webinar.
Many times when we do hear about mental health in the news or in the press, it’s when unfortunate or tragic events happen. The topic of mental health is not a topic without stigma and is often a topic that is challenging to openly discuss, especially in the aging population.
So, to address these points, today’s webinar will focus on two objectives, to increase the awareness of mental health issues in older adults and to connect you with tools that help diagnose, screen and have treatment for mental health issues.
Joining us for our webinar, today, is our host, Chris Kelly. Chris is the Director of Learning and Development at Griswold Homecare. Chris is the architect of the Solution Series Workshop, in addition to leading all training and education programs for Griswold Homecare.
In a previous life, Chris was VP of Health Education, also a Director of Education at the Alzheimer’s Association and manage multiple functions within assisted living facilities. Welcome to the webinar, Chris.
Chris: Great. Thank you Derek. Good afternoon, everyone. I can’t say how excited I am to be part of this webinar, and Derek shared how important this topic is. Just over the last 25 years, working in healthcare, just the number of people who are out there, older adults with mental illness, those who are undiagnosed that need to be diagnosed and treated, and those who are diagnosed and are looking for information and solutions . . . So, it’s an honor to be with you for the next hour.
We always like to start our webinars by recognizing our audience and we’re excited. We have all segments of the professional and lay community.
We want to thank healthcare providers, all the doctors, nurses, social workers, recreation directors, franchisees, office staff, for all the great work that you’re doing to support people with mental illness, especially older adults.
We want to thank professional caregivers who are really on the front lines, and, from my experience, usually the first to notice changes, because you’re spending so much time with clients.
We want to thank family caregivers for your dedication and support, and also recognize that you can also struggle with mental health challenges and depression.
Then, lastly, and most importantly, we want to recognize the courage and the fight that our clients put forth every day, living with mental illness, particularly again, older adults. So, we want to thank all of you and, again, hope this webinar is helpful.
Very quickly, we want to talk about what we think is a unique proprietary methodology for developing our webinars. We start by looking through 20 to 30 peer-reviewed articles. So, [Lit Review] is our first layer.
We try to identify key themes that we think are relevant. We then validate those themes through review of social media, Facebook, Twitter, discussion boards, advocacy groups, to make sure our theme is relevant and accurate.
We then reach out to the advocacy communities to make sure that we’re on the right track. Then, our final step is really today, where we have our Solution Series Webinar. As Derek mentioned, there will be opportunities, throughout the webinar, for you to help to teach us what you’re dealing with, and, that way, we can learn from each other.
On that note, we have an activity that we call “Brain Writing.” You’ll notice on your screen, to the right, there is a toolbar. You’ll see an orange box with a white arrow. When you click on that icon, your toolbar will come out and you’ll see a chat, a field where you can chat, and, what we ask, instead of waiting at the end for questions, we want this to be highly interactive.
If anything comes to mind, in terms of challenges that you’ve experienced, the tools that you’ve used that we haven’t discussed, our recommendations, questions, don’t wait till the end. We’ll go through all those comments as we go.
So, again, the idea here is we want to make sure that we’re learning from you throughout the hour, instead of just towards the period in the end when we’re fielding questions.
So, let’s start out with, really, the landscape, when we talk about “mental health and aging.” The Center for Disease Control has put out a great publication called “The State of Mental Health and Aging in America,” and let’s walk through some of the statistics that are very telling.
First of all, 20% of people, aged 55 years or older, have some diagnosed mental health issues. Based on our research, the three most common mental health conditions were mood disorders, depression, obviously being the most common and will focus on that today, anxiety and, then, what they term as “severe cognitive impairment.”
So, that could be from any form of dementia, head trauma. Those are the three most common mental health conditions, based on this study. Of those mental health conditions, depression, not surprisingly, is the most common condition among older adults.
You’ll notice throughout the presentation we’ve provided thumbnails for tools, and we’re going to walk through some of these with you. The first is the actual State of Mental Health and Aging in America publication by the CDC. It has an amazing number of facts in there, but we’d like to go through some really interesting maps and graphics.
Given that this is a national webinar, this publication took their findings and presented them in a visual way, where, depending on the state that you’re from, you can actually look at this graphic and, in this case, the topic is “The Level of Social and Emotional Support.”
Based on one of the largest surveys to date, the CDC found that the percentage of adults age 50 or over who reported that they rarely or never reach the social support that they needed, and the largest number here was 11.19% to 17.74%. So, that’s social and emotional support.
The next layer of the research was looking at an older adult’s life satisfaction. So, what was the percentage of adults, age 50 or older, who responded that they were dissatisfied or very dissatisfied with their lives? Again, look across the map. If you’re a client, healthcare provider, caregiver, this provides some context related to the demographic in your area.
The next section, very important, focuses on what the CDC calls “Frequent Mental Distress,” so any challenge from a mental-illness standpoint that is causing distress and impacting quality of life.
Here you’re seeing the percentage of adults, age 50 or older, who, in the past 30 days, experience what they term “Frequent Mental Distress,” which, obviously, is very difficult to live with, from a quality of life standpoint.
The next topic we’ll talk about is “Lifetime Diagnosis of Depression.” This is the last one we’ll talk about, but, again, will share all these tools after the webinar and you can benefit from the rest, which talks about anxiety, but, in this case, we’re looking at the percentage of adults, age 50 or older, with a lifetime diagnosis of depression.
Again, this report goes into anxiety, bipolar disorder, but it’s a great, great publication, both for clients and for healthcare providers.
We also have a great webpage from the CDC. The webpages entitled “Mental Health and Aging,” and you have a link to this report and, then, another report related to the fact that depression is not a normal part of aging.
So, again, throughout the presentation, it’s impossible in an hour to cover everything. We’re going to give you some great tools that you can look back on and learn from.
Let’s talk about the impacts of untreated mental illness. I think there’s a tendency to think about mental health conditions in a silo and as separate from medical conditions, and, from our research and the CDC’s research, we’ve learned that untreated mental health conditions in older adults have been connected to and related to the following chronic conditions.
The number one condition tied to depression is heart disease, which is obviously very debilitating. Diabetes was number two. Stroke, number three. And, when you think about those three conditions on top of depression, it makes sense that you would have increased healthcare costs, increased inability to function and complete activities of daily living, and, then, also an increase in physical or mental disability.
One of the topics that is tossed around a lot in research is, “Which comes first? Is it that a person has heart disease, and, because they have heart disease and symptoms and impact, they develop depression? Or, in some cases, does the person have depression?” When they have depression, that actually causes medical issues.
This whole bridge between the medical and the mental illness is being tossed around a lot, in research. There’s no answer, but it is very interesting dialogue to think about, almost the chicken before the egg theory. You know, is a depression first or is depression more of a complication from these conditions?
A second set of impacts related to untreated depression and mental illness, more doctor and ER visits, increased use of medicine – and, I just want to clarify, that’s not just medicine for depression, that’s increased use of medicine across all the different health conditions that we just went through.
Higher outpatient charges, longer hospital stays, it’s actually more difficult for people to rehabilitate and get back to the home and get back to the level of functioning where they were when they have depression.
Increased readmission rates and this was the most important statistic that really jumped out at me. Across all age groups, the age group 65 and over is the highest risk for suicide, as compared to these other age groups.
Again, I think that we tend to look at depression as something that’s normal. When you see that kind of statistic, that shows you that not only isn’t it normal but it’s something that we need to have top of mind.
Let’s bring some of this to light through the words and the eyes of an older adult living with depression. Just again, we scour articles and we’ve given you the links here to the article, and I’ll read it to you.
“Well, I feel as though most people that are depressed really feel unloved. That’s the main thing, or they feel unwanted or they feel as though they are useless, like I’m no more use to you anymore, so just let me go.”
This is just really, really powerful language, “unloved, unwanted, useless.”
For the clients out there who are living with depression, if these are thoughts that come to you, definitely talk to someone. Let people know that you’re having those thoughts.
For family caregivers, professional caregivers, if you hear these thoughts, you definitely want to call that out in see if there’s an opportunity for diagnosis and treatment.
A second set of core barriers, from the client perspective . . . We talk about “awareness, beliefs and stoicism.” So, based on our research, the most common barriers for older adults were, number one, they were not aware of the symptoms of mental illness, particularly depression. So, that speaks to lack of education and the lack of access to information.
Second and third points here are really, really important, that when you think about older adult generation, there is a general stoic attitude towards emotional and physical pain.
I can’t tell you the number of stories I’ve heard from nurses that I’ve worked with in the hospital setting who say . . . and I can say this because I’m 47, that you’ll have a 47-year-old patient on a gurney, for 15 minutes, 20 minutes, and they’ll complain and say they’re in pain and can they get a bed, and you’ll have a 95-year-old, frail, older adult who will lay there for hours and not say a single word.
So, it speaks to that generation when they have physical or emotional pain, basically kept it to themselves, reluctant to complain, very skeptical about the need for treatment, and they have this idea that if they just push through, they can handle things on their own.
I think that is something very unique to that generation that presents a huge barrier for healthcare providers who are trying to detect depression.
We have two great schools that will walk through here. The first one is from a great organization, an advocates organization called “Mental Health America.” They do a great job of taking the area of depression in older adults and breaking it out by prevalence, co-occurring or comorbid illnesses, which we’ve walked through.
Really interesting data around widowhood, that one-third of widows or widowers meet the criteria for depression in the first month after the death of their spouse. Think about the number of times in a facility someone has lost a spouse or even the home environment.
Healthcare costs . . . Some more details around the dire issue related to suicide in older adults, and, then, also, on a positive note, the positive impact that treatment can have. Then, at the very bottom, [there is] some information about the attitudes that older adults have towards depression.
Again, if you’re a healthcare provider, newer to depression, this is a great publication to read through.
Our next client barriers are access to support and services, and this makes sense when you think about this demographic and this age group. Older adults often lack access to care and support, due to medical issues, and, when we say “medical issues” think about the hearing challenges, the vision challenges, the fact that most older adults are dealing with some level of pain that can impact their motivation to look for information, and their concentration.
Decreased mobility and lack of transportation affects their ability to get to doctor’s appointments, social events, makes isolation more common, inability to get the support groups.
A term, been out for quite a while called “The Digital Divide.” Think about how easy it is for us to go on a website and find information. For those people who are over 65, there’s generally low access and comfort with some of the e-tools that we’re used to, like email and texting.
There are also a lot of online portals now, where physicians can connect with patients, and many older adults don’t have that technology and aren’t comfortable with that type of technology.
Then, finally, depression is a barrier, because, if you’re depressed, you’re not going to be as motivated to reach out to your doctor, to reach out to your family, and then that can lead to isolation.
What I’d like to do before we go to our next slide is . . . You know, we talked about the Brain Writing. For those of you who are out there in the audience, think about the barriers that we just went through, from the standpoint of clients, and, if you’re a client and family caregiver out there, what barriers did we not mention?
Are there any barriers that you would add to our list, and then any stories, any experiences that you could share, related to the topic of client barriers?
So, let’s skip now and talk about the barriers for healthcare providers. This is, again, great quote from a great advocacy organization called The National Alliance on Mental Illness. You here turned in the industry, NAMI. “Depression in elderly people often goes untreated because many people think that depression is a normal part of aging and the natural reaction to chronic illness, loss and social transition.”
So, what’s really impactful about this quote is, if your healthcare provider, consumers have this misperception. So, there are people out there, older adults, families out there that think depression is normal. So, they’re not going to come to you.
Then, it is the case that there are healthcare providers out there that, due to stigma due to their education, also believe that in the older adult population depression is something that is just going to happen and that there aren’t a lot of treatments and a lot of things that you can do about it.
So, let’s shift and talk about the healthcare provider barriers. Before we do, I think it’s really important to recognize the healthcare providers and professional caregivers and franchisees out there who are working very hard to recognize and treat depression.
And also note that in the CDC study, they noted that the prevalence of depression in older adults has started to lower and has started to go down, and that speaks of the great work that you’re doing, but our attitude is that we can always improve. Healthcare providers can always improve.
So, some of the common barriers for healthcare providers are inadequate vigilance and screening, so, either lack of access to screening tools and lack of time. How long do you have to spend in the office with an older adult? So, time constraints can play a part in that.
We talked about stigma and misperception. Poor access to older adults, not only in the office, but we mentioned the challenge with the digital divide and the challenge with mobility.
Then, the last part, I think, is really important, and I know healthcare providers work really hard to speak to this, but we’re used to . . . and when I say “we” I’m speaking to when I worked in the field as a healthcare provider.
We’re used to our language and our terms, which tends to be more technical. We use large words that a lot of older adults haven’t heard before.
One of the common barriers is we’re not taking that technical language and simplifying it and presenting it in a way that they can understand and act from, and, again, this is all . . . We’re recognizing the great work that you’re doing, but we also want to call out, based on our research, the areas where we can all improve.
We spent the greater part of the webinar, so far, talking about barriers. Let’s shift to the positive and talk about solutions and best practices that will help us to improve outcomes, and the rest of the presentation will focus primarily on depression, since it was the most common mental illness that older adults were coping with.
First, let’s focus on screening and discussing and diagnosing depression. This quote really jumped out at me, because it speaks to this generation, where they just say it like it is. “I didn’t know anything about depression.
I didn’t know I was depressed.” You can’t say it any better. It’s one line that really speaks to the challenge of lack of awareness and access to information.
How can you learn about depression? If you’re an older adult, I am so excited to share a great tool that the National Institute of Health has developed. It’s called NIH Senior Health.
It is the best website in that NIH broad group of educational designers and health literacy experts, together, and we’re showing you, here, the webpage about depression, but you basically can search any health topic related to older adults and it will come up, but, if you click on . . .
If you notice, we see it says “Resize Text.” If you’re an older adult or a family caregiver trying to help someone with depression or you think they may have depression but they have visual impairment, you can actually, on the fly, increase and decrease the text size.
For those people who have visual challenges that impact their ability to read black on white, you can actually on the fly, change the contrast, so that the back of the document becomes dark and the text becomes light. So, there are just amazing ways to actually to, on-the-fly, accommodate vision challenges.
Also, there are many videos. If you scroll down, what I like about this webpages they take a lot of time to explain about the different types of depression. All we hear is the word “depression.”
In reality, when we talk about the clinical side, there is major depressive disorder, there is [inaudible 0:22:27] disorder. You have bipolar disorder or bipolar depression. As we get down here, you can see descriptions of the different types of depression.
I think these are very important for healthcare providers to get to know, if you don’t already.
Then, obviously, a great way, given the size of the font and the ability to adjust the screen, to help older adults to get educated about depression and other mental health conditions. So, great, great resource.
The second resource comes from another great advocacy organization called “The Family Caregiver Alliance,” and, similarly, they just have a great Introduction to Depression.
What I like about their organization is they don’t at all minimize what a client is going through, but they’re here to take care of the family caregiver. So, they present this from the context of how you could help your family member, but, also, how you can look for symptoms of depression that you might have.
Here you can see “Special Caregiver Concerns” really speaks to those issues that you would be dealing with and how you can help yourself, and it is well documented that, when it comes to family caregiving, you put yourself last, and that that can affect your health and your ability to support your family member.
Next, you want to learn the symptoms of depression, and, what we’ve done here is outline the symptoms of depression, specifically, in older adults. So, obviously, depression could affect people of many different ages. Since our focus here is on mental health and aging, we wanted to make sure that you knew the nuances related to depression for older adults.
So, some issues are new memory problems, confusion, social withdrawal. People who have been active, now they don’t want to go play cards or play bridge or go see their friends.
Loss of appetite, weight loss, are very, very important. Vague complaints of pain . . . We talked about stoicism, that an older adult is not directly going to come out and tell you they feel depressed.
So, you can see things like facial expression. When someone moves, they might moan. So, when you hear those sort of subtle complaints, you want to pursue it a little bit further, to see how much pain there in and if that’s affecting their mood.
Sleeping too much or too little, being anxious and/or irritated . . . Again, these are changes. These are things that have changed. Delusions or thinking things that are not reality-based and then hallucinations, which would be seeing, hearing or feeling things that are not reality-based. So, those are, again, not all of the symptoms of depression but those that are most common in older adults.
So, [here are] a few tools. We have a great tool that the National Alliance on Mental Illness has developed called “The Depression in Older Persons Fact Sheet.” It’s got, again, great information, specific to older adults, “Why depression is going untreated and things you can do to make a difference with a person with depression.”
There’s great article published by the US Preventative Services Task Force. Their focus is on not just depression but trying to prevent mental health and medical conditions.
This is a great article that speaks to screening tools. Then, we also have . . . So, here’s the article.
It gives you the scope and purpose of the article, the methodology that they took. It talks about the prevalence and burden, and then also gives you best practices in terms of screening for depression.
Then, the last tool on this page is from the American Psychiatric Association, again, a great, great organization that provides an overview of depression. Then, a little sidebar here, you’ll notice that the value here is that you actually have a video of a person talking about depression.
For those of you who have been on our webinars for the past, six, seven months, we always have a person with the condition on the webinar with us, to share their real-world experiences.
As long as I’ve been doing this, it’s been next to impossible to have someone feel comfortable going on a national webinar, talking about depression, and that speaks to how strong the stigma is.
We’ve had clients with MS, with Parkinson’s, clients dealing with aphasia, all willingly join and share great experiences. Because depression is so stigmatized, we actually, we’re not able to recruit a client or an older adult living with depression.
So, we’re hoping that the awareness created, the stories that we share in videos like this video, will help people to feel courageous and feel like even though the stigmas out there, they’re going to play a part in changing that. So, again, [these are] three great tools.
Let’s stop again and Brain Write. We just went through some of the common symptoms of depression in older adults. What’s missing? What symptoms, if you dealt with it or you’re a family caregiver or professional caregiver, that you’ve seen? They could be listed here or any symptoms that you’ve noticed, specific to older adults, that you’d like to share with us.
The next thing we say is, “Talk about depression.” Now, I just mentioned the long-standing stigma. I can’t tell you how many times people with depression have said to me, “Do you know how frustrating it is when people say ‘Talk about depression,’ as if it’s so easy to do?”
We’re technology, here, that it isn’t easy to do, but that there are great tools that are out there that can help clients talk about their depression, especially older adults, and also help family caregivers, particularly adult children who may notice the signs and you’re not really sure how to bring this topic up with your parent.
So, again, the NIH Senior Health website has a great adaptable webpage. They have a topic that they call “Discussing Sensitive Topics,” and one of those sensitive topics is depression.
Then, second tool that I think is tremendous, related to this topic, is from the Alliance for Aging Research, and the title says it all, “How to Talk to Your Elderly Parent about Depression,” and, again, as you walk through this tool, there are some great specific tips on “What is depression? What are the facts about depression and getting older? How do you know your older parent is suffering with depression?”
Then, this, to me, is the most important section, where it gives you specific tips about how to bring the topic up and how to have a positive discussion, without creating defensiveness, anger, frustration. So, again, [there are] so many great tools out there, and we’re excited to have the opportunity to bring them to you.
The next topic or best practice is, we want to make sure that we’re effectively screening for depression. Were really fortunate, today, to have numerous validated tools, and, when we say “validated,” we mean “proven.” You know, these were tools that were developed by researchers and over a period of years proven to be an effective screening tool for depression.
[It’s] very, very important to know that, when we talk about a screening tool, it is not diagnostic, meaning that when you screen Alzheimer’s, depression, any condition, screening tools are just to raise the flag.
They’re to give a family member, client, a healthcare provider, a sense that depression may be an issue, and in the case that it is an issue, then we do a more formal, comprehensive diagnosis, which we’ll talk about in a bit.
So, these are just two tools that we’re calling out that I feel are the most reliable. The first one is The Geriatric Depression Scale. What I like about this page is, if you’re actually a practitioner that is giving this screening tool, it gives you a lot of background information, but, if you scroll down, we’re actually going to open up one of these short forms.
So, this is the short form of the tool, in English, and I’ll go through some of these questions, and, if you’re an older adult, think about it.
Are you basically satisfied with your life, have you dropped many of your activities and interests, do you feel that your life is empty, do you often get bored, are you in good spirits most of the time?
Are you afraid that something bad is going to happen to you, do you feel happy most of the time, do you often feel helpless, do you prefer to stay at home, rather than going out and doing things, do you feel you have more problems with memory than most people?
Do you think it is wonderful to be alive, do you feel pretty worthless, the way you are now, do you feel full of energy, do you feel your situation is hopeless and do you think that most people are better off than you are? Every one of these screening questions have been studied and proven to be effective.
As you, as a practitioner, give this particular screening tool, there’s an accumulation of points, and that allows you to figure out whether you should talk to the client or family about pursuing a comprehensive diagnosis.
Again, I went through those for clients and family caregivers, because, even though they’re professional tools, we’re hoping that this can possibly serve as a screening for you, during the webinar.
A second validated tool that’s been used for years, that’s very effective, is called “The Hamilton Depression Rating Scale,” and we’ll walk through some of these questions. This one’s a little bit different, in that there’s a ranking. So, the first section is “ranking the level of depressed mood,” and they define that as “sadness, hopeless, helpless or worthless.”
If a person doesn’t have depressed mood, based on their opinion of themselves, it would be absent, zero, and it goes up to a level of four, where the person virtually only reports these feelings, meaning that it’s very severe.
The other sections are “feelings of guilt,” which can be common with depression, “feelings of suicide,” which, if you remember, we talked about, is so prevalent with this age group, and, probably the most critical topic we can talk about in this hour, “early insomnia,” “middle insomnia,” so different levels of insomnia.
“Level of work and activities.” So, it’s not uncommon for people, 65 and over, to be working. If you’re not working, it’s just your level of activity.
“Psychomotor issues,” or your ability to move or speak . . . “Level of agitation,” “level of anxiety,” and, here, they’re calling that two things. One is “psychosocial anxiety,” [meaning] “how is anxiety affecting you emotionally?”
“Somatic anxiety” means “how does anxiety actually affect how you feel physically, how does it affect your body?” So, again, there are many different . . . I think we go up to 25 points, here. [It’s] a great, great screening tool, both the Geriatric Depression Scale and the Hamilton Rating Depression Scale.
So, for practitioners that are on the webinar, we call that “truthful’s” here. If you’re interested in Brain Writing, it would be great to add any other tools that you’ve used, aside from these tools, and particularly those that have been helpful as you were screening for depression.
The next best practice is to get an early, accurate diagnosis. So, the initial step is screening, which we talked about. If you are screened and there is a chance the healthcare provider feels that you may have depression or any other mental illness, we want to make sure that you’re having a comprehensive assessment. That typically includes a physical exam, and that’s really to rule out any medical causes that could be mimicking depression or other mental illnesses.
A review of your current and past medications, and that is really because there are many medications that can cause side effects that could mimic depression, and it also helps them to understand what you haven’t tried, and that way they can make a better plan for new medications that you might try.
A clinical interview, which we’ve all probably been through, where they’re going to go through a history, family history, work history. [It’s] really important if you’re comfortable as a client that they also speak with family members or close friends, and I always think that what that does is it gives them an outside perspective.
There are times where you might be depressed but not have insight into it. That way, you can benefit from hearing from the family, as well as close friends, and the healthcare provider could benefit as well.
Blood test in lab studies are typically ordered. Then, depending on the physician, insurance, a variety of different imaging studies you probably heard of, CAT scans, PET scans. There are specific imaging studies that are ordered for depression and mental illness.
We’re going to highlight a great tool from The Agency for Healthcare Research and Quality. For healthcare providers and professional caregivers that are out there, the US Department of Health and Human Services and the AHRQ actually have this National Guideline Clearinghouse, and what they do is they post the most recent accurate clinical practice guidelines for all conditions.
Once a week, I’ll go here and I’ll search for a condition. Here, it was “Diagnosis and Treatment of Depression in Older Adults,” and these are very recent guidelines from 2012. So, what I like about the guidelines [is] the way their structured.
They go through the clinical specialty. They go through who should be using the guidelines. I would argue that everyone should know them, but this is who should actually be using them in practice.
Then, under “Intervention and Practices Considered” is a great, great outline that covers best practices in screening and diagnosis and also best practices in treatment management and the evaluation of depression. So, if you’re working directly as a practitioner and you have not had access,
I would definitely recommend that you . . . you know, when we send the presentation out, that you definitely check the guidelines out, and we’re actually going to go through some of the most effective treatment approaches.
This quote presents what I think is great news, and this came from NAMI. “Once diagnosed, 80% of clinically depressed individuals can be effectively treated by medication, psychotherapy and electroconvulsive therapy or what is called ECT or any combination of the three.
When you look at these full clinical practice guidelines, you saw a huge list of treatment approaches. Based on our research and NAMI’s Research, the three most effective approaches are medicine, psychotherapy and ECT, and we’ll talk about these in some detail.
The second important point came from the task force on community preventive services. For older adults, the top recommend the treatment is home or clinic-based depression care management. So, the term “depression care management” may be new to some folks.
Care management is really a model, and it’s a model that basically says, “The best way to overcome any condition is to set a plan and to make sure that the client family are surrounded by the appropriate healthcare providers.”
We’re not going to go through this tool, but you’ll see in the bottom left that the Center for Disease Control put out a press release, basically saying that “This is what we recommend for addressing depression in older adults,” and the highlight here is the emphasis on care management and care coordination.
When we say “care coordination” or “care management” in the context of mental illness and, again, particularly depression, this is a visual that we have developed so that you can see all the different healthcare providers and also support outlets that can be there for not only the older adults, but also for the family caregiver.
I recommend that you always start with advocacy. We talked about NAMI, the Mental Health Americo website, the National Institute of Health. Later, we’ll talk about Depression and Bipolar Support Association. So, that’s where you want to start, and will give you some of those resources.
We mentioned lack of appetite or loss of appetite and weight loss, as a key symptom of depression. So, you want to make sure that you’re working with the dietitian or an expert in nutrition.
We talked about the lack of motivation to stay active and the impact of depression on your physical health. So, we use the term “wellness coach” to really cover yoga instructors, plotting instructors, people who are doing aerobics with older adults, any type of activity that helps people to stay active and maintain their physical and mental health.
We talked about . . . The last slide talked about the importance of home care management. Obviously, home care professionals play a key role not only in providing companionship, but also being there in the front lines to notice when people are developing depression and also how they’re responding to treatment.
Somebody who was very isolative, not pursuing activities, [if] they start treatment, they become a great resource for the family and the healthcare providers, to let them know how things are progressing.
Occupational therapists can help, particularly if it’s an older adult who is working and interested in getting back to the workplace. From the standpoint of coordinating care and diagnosing and treating depression, family doctors, physician assistants, nurse practitioners, nurses.
For physical issues, particularly if someone has depression after a fracture or a fall, physical therapists can play a key role in helping to set a course and helping to provide motivation.
For those people who develop speech problems due to mental illness or disability, a speech therapist, a speech language pathologist are critical.
Then, from the standpoint of managing services and resources, we have social workers, geriatric care managers and psychologist.
So, the depression management care team here . . . You know, we talked about some of what we call “the healthcare extenders.” You’ll notice that we have the term “geriatric psychiatrist.” In reality, many people are diagnosed with depression through a neurologist.
It could be a geriatrician, but, for this webinar, we wanted to highlight the field of geriatric psychiatry, just because they have such a great blend of experience. In a bit, we’ll talk a little bit more about the geriatric psychiatrist.
So, the three innovative approaches that we called out through the clinical practice guidelines are psychotherapy, was one. One of the most common and effective forms of psychotherapy is what we call “cognitive behavioral therapy,” or you might hear the abbreviation CBT.
So, this is a form of counseling that really helps the person to understand their depression, the thoughts and feelings and beliefs that are behind that depression, and, in that one quote, you heard the person say, “I feel unwanted. I feel unloved. It would be better if I just move on.” You have to basically help a person understand those thoughts, and they’re not going to really be able to recover from depression until they change those thoughts and beliefs, and that’s really the spirit of cognitive behavioral therapy.
We talked about the importance of medicine. Again, the decision around which medicine to try is really a difficult decision and one that is best discussed between the physician specialist.
That could be a psychiatric nurse and the family and the client. Client and family education . . . So, a webinar like this goes a very long way in helping people to learn about best practices and feel confident.
Support groups . . . Wellness, we talked about. Then, electroconvulsive therapy or ECT is an example of what we call “brain stimulation therapy.” So, for many years, when other approaches haven’t worked, such as counseling, medicine, some of the things listed here, there are ways that you can actually stimulate the brain.
One way is through ECT, and, in many cases, that can help older adults to recover more quickly and respond maybe more effectively to treatment. Again, we have tools here that we’ll go through, that speak in more detail to some of these approaches.
Three care management approaches that we want to highlight, from the standpoint of our tools, [follow]. The Geriatric Mental Health Foundation has a great toolkit related to managing depression and mental illness. We also have, from The American Psychological Association, a great, great book about cognitive behavioral therapy, if you want to learn more about it.
Then, Mary Ellen Copeland is the author of “WRAP”, which is a recovery program, a wellness program, for not just older adults but adults with depression, and what I love about this program is Mary Ellen recovered from depression herself and is very open and honest about her journeys. So, it’s not just a researcher building a program; it’s actually someone who recovered from depression themselves.
I mentioned earlier this field of geriatric psychiatry, which I feel there’s a real lack of awareness. Geriatric psychiatrists are really valuable, because they have the training in medicine, geriatrics and psychiatry combined.
They play a huge role in discussing the need for medicine and then also making sure that we’re choosing the right medication regimen and also the right dose.
So, we’ve given you, here, a search tool that you can actually go in if you’re a client, family caregiver, healthcare provider. Let’s say you wanted to click on your state. You would hit the ‘submit’ and it would let you identify the geriatric psychiatrist in your area.
Again, I think this is a highly, highly underutilized profession, not at all minimizing the value of neurologists, geriatricians. I think that this is also a healthcare provider that we should consider, particularly with older adults who have depression, and particularly when the depression has psychiatric features.
We also have some great resources about cognitive behavioral therapy. The first tool just goes through from ABCT, a way that you can actually search and find a cognitive behavioral therapist in your area.
That’s a great resource if you’re interested in . . . you’ve learned about CBT, and actually want to reach out to a therapist. I would definitely work with your primary care provider, your psychologist or psychiatrist, before you do that.
Then, great tool or article from Current Psychiatry really speaks to how you can adapt cognitive behavioral therapy for older adults. So, it’s an approach that really can be applied to adults in general, but this article talks about how you can refine that to be more appropriate for older adults.
So, again, if your practitioner, that’s a great tool to look through.
Next, we want to talk about supporting family caregivers. We mentioned earlier that, obviously, this is a huge impact for older adults, but for the adult children, for siblings, for friends . . . You know, when we say “family caregiver,” were talking about the nonprofessional who’s providing support. In many cases, you’re living with depression or just exhaustion.
We want to call out two tools. One we’re going to walk through from the Caregiver Action Network, and I love it because it’s highly visual. I think the most challenging issue for family caregivers with any mental illness, particularly with depression is how do you coordinate care?
You know, when you have someone who is so depressed that they aren’t self-motivated and can’t manage care themselves, how do you do that for yourself? This is a great organized, visual way that you can literally put your [age] box and that can help you to coordinate care for the person you’re caring for.
The next slide will talk through is “ways that you can use technology.” There are some great apps out there. If you’re a healthcare provider, we’re getting the link here and will open it up really quickly.
There’s a great global application called “Geriatric,” and it gives you training tools that you can use for your iPhone, for your iPad. It’s a great technology, mobile application, for physicians that are working in the mental illness space with older adults.
If your client or a family caregiver, we have three tools here. The first is a three-minute screening online test that you can actually take yourself to identify mental health conditions, like depression, anxiety, bipolar disorder, and, again, I want to emphasize, this is not diagnostic, but it’s a way that you can self assess and, if you have concerns, share your concerns with your healthcare provider.
We also have a digital technology for the family caregiver. We’re going to scroll down to a great section of this website where they literally list all the tasks that a client or family caregiver would need to do. For example, if you’re looking to coordinate care, the aap related to that – you can see the URL – “Lots of Helping Hands.”
If you want to manage appointments and tasks, you can use Google Calendar. If you want to manage medication more effectively, you have Pillbox, MedMinder. So, it’s just a really, really robust way to find the need that you have and then use an application, mobile application, that the Association really recommends. Again, this is not an exhaustive list but it’s a great resource.
Then, finally, an organization, online organization, that many people aren’t aware of called “Lots of Helping Hands” can really help the family caregiver to organize support. Hamid times have you had somebody say to you, “How can I help?”
This actually allows you to set up a micro-site just for you and for the client that you’re supporting. It helps you stay connected with the people who are offering support.
You can create a community of support people. You can also add tasks to your calendar and update, so those family members and friends that are wondering how your loved one is doing . . . So, another great resource.So, we want to emphasize the importance that technology can play.
I think every webinar we’ve talked about the value of support groups. It’s very, very important and beneficial for depression and mental illness. We have two tools.
We have the DBSA. [It’s] a great organization, advocacy organization that’s focus on both depression and bipolar disorder. You can actually click on a state and find a support group in your area. We’ll show you how that . . . you know, so you can click on your state and find out where the support groups are.
What I love about it is you get the phone, fax and email for easy access in contacting.
Then, on the NAMI website, it’s a little bit different. You’re not getting the navigation through a map, but they’re basically giving you links for their help line, education and training programs, their peer support center, social networking, Facebook and Twitter pages.
So, again, there are face-to-face support groups that you can find through DBSA and NAMI, but there are also online support groups, if you’re not able to get out and go to those support groups, and I want to emphasize, those groups are for clients, older adults with depression and mental illness and also for family caregivers.
We went through a lot of tools, a lot of tools, and a lot of great information. I’m hoping, as we walk through, this was helpful for you.
Again, one last Brain Writing, if there are stories, tools, anything that we discussed that has worked for you, if there are things that you’d like to share that we didn’t discuss, you can go right into your chat bar and add that.
As always, we want to close the main part of the section with what we call “Our Key Takeaways,” the things we want to make sure that you take with you.
First, depression and mental health issues are not a normal part of aging, and hopefully we’ve said that enough. Untreated mental health conditions in older adults do have a serious impact, as serious a suicide, which we talked about. Education, discussion, screening and diagnosis are challenging but essential, and older adults and their family caregivers, as we discussed, can benefit from treatment and support.
Derek: As Chris mentioned, that was tools, tools, tools, and if you talk about kind of finding the needle in the haystack, I think . . . Chris, really, thank you to you and the team for going out and finding the resources that are very specific for families, caregivers and those who are living with depression.
We have a lot of questions that have been typed in. So, keep those coming in. We’re going to start taking those. We have a good 10 to 15 minutes to really answer any questions.
As Chris mentioned, if you want to share any stories, any tools that we did not mention, any feedback, anything that came to your mind, please type those into the chat bar and we will go right into addressing some of these questions.
Chris, let’s take the . . . We have several questions around the topic of how caregiving can support a client who is depressed. Another question around perhaps an at-home care is an option for a family.
“What are the tasks, activities and routines that a caregiver, either professional or family caregiver can do inside the home to really assist with someone who might either be depressed or might have symptoms of depression or mental health issues?”
Chris: Yes. Great question. If you think back to the symptoms of depression that we walked through, when you talk to older adults who acknowledge depression, the idea is . . . people talk about it’s hard to get out of bed.
If getting out of bed is an effort, think about what it’s like to brush your teeth, get dressed, if you have friends you want to visit, get your schedule together.
If you’re someone who needs to take medication, and your developing memory, concentration problems, due to depression, it’s just an amazing, amazing support to have either professional caregivers or family caregivers there to help with those tasks that you and I take for granted every day but are so, so hard to do if you’re a person living with depression.
Derek: Fantastic. Keep the questions coming in. We had an early question, before the webinar started, from Barbara, and let’s read through this. “An elderly person in a facility who had only dementia, initially, but, after three months, now has visual hallucinations, this seems to be exhausting for her, and her experience throughout the day is very challenging. Aside from the Alzheimer’s medication that can be done to help, what else can be done to assist in remedying this issue?”
Chris: Wow. Barbara, great, great question. I’ve worked for years in facilities and this happens very commonly. It’s very important that any time someone has what we call “psychotic features,” an example would be hallucinations, that that person is evaluated.
Most healthcare facilities will either have a medical director or have nursing staff who can help the family and the healthcare provider to evaluate the person.
In this case, I would want to have a comprehensive evaluation to figure out are the hallucinations related to depression, are they related to Alzheimer’s or dementia, are they a medication side effect?
If the client or resident is able to communicate, that’s great, because they can talk to you a little bit about what they think the challenges, but, usually when people are hallucinating, they’re too disoriented to give you their perspective. So, that’s why it’s really important to involve a geriatric psychiatrist or psychiatrist, the entire [PR] team in the facility, to really do the detective work to find out what the problem is.
If it’s medication-related, in many cases, those are the easiest to fix because you can change medications, you can lower doses.
If it’s related to Alzheimer’s disease, there are many, many antipsychotic medications that can actually help with not only Alzheimer’s but also help with some of those psychotic features, but my first step would be to make sure that the facility evaluates this resident for the cause of the hallucinations but, again, great question.
Derek: Excellent. We’ll keep cranking through. A question/comment from Bob Bayless, “Would it be possible to share the info from this and future webinars with staff and/or attendees of a senior center?”
Absolutely. What we’ll do, Bob, is not only send this content, but we have an entire resource Center on the Griswold Home Care website, with all the webinars, presentations and tools from the Griswold Solution Series.
We have, let’s see, another few questions. We’ll go to a question from Kathleen Wall [SP]. Let’s see. “In south-central PA, home health agencies which have psychiatric nurses who make home visits won’t accept patients with Medicare Advantage. This is a huge barrier for a large part of the senior population.”
Chris: Yes. Absolutely. We talked about NAMI, the National Association of Mental Illness. They are a national advocacy organization. One of the platforms of all the mental illness advocacy organizations is to make sure that people have adequate access to assessment and appropriate care.
If you come into that issue, I would definitely reach out to your local NAMI chapter, to let them know the challenges you’re having and to see if they would actually be able to intervene.
You know, the other solution is really to make that, again, if you have a barrier of having someone come in to assess, most healthcare facilities have a medical director, have a social worker, have internal staff that may not be able to do as adequate assessment as a psychiatric nurse, but, obviously, great at their field and can help to assess the situation and bring in the appropriate [services].
Derek: Fantastic. Okay. We’ll go to a question from Marty Grimm [SP], and Marty asks, “How do you effectively distinguish between normal grief and depression? Is there a screening tool to make this distinction?”
Chris: Yes. Great question. Again, when we send the presentation out, as want to the presentation, there was one slide where we called out what we believed from our research to be the most reliable screening tools, but, to your question, those screening tools are not diagnostic.
So, what we recommend is work with your family doctor and a specialist. It could be a psychiatrist. Make sure that not only is the person screened, but that you go through the formal diagnostic process, the comprehensive evaluation for depression, so all the things we talked about, like medical exam, physical exam, family history, clinical interview, review of medication.
It’s a combination of the screening and the formal diagnosis that really gives you a confirmed diagnosis of depression.
Grieving, many times it’s easier to detect because it can be situational. If someone, let’s say, had to move from their home into a facility, there’s a natural grieving process that people go through. They may be depressed for a month. They may be depressed for two months. That is a more situational depression that, many times, will resolve either with medication or without medication.
When you have somebody who is not able . . . you know, when you think about the symptoms of depression that we went through, it’s not tied to an event, someone hasn’t passed away, they’ve not had a life change, in many cases, that is a chemical change in the brain that is causing a clinical depression, and that’s why the diagnosis is so important.
Derek: We have a few other comments. One is from Melissa, and Melissa comments, “I believe the cultural discussion around elderly is also a variable that needs to be considered. For example, that the elderly are, quote, ‘a drain on the medical system,’ is often heard.” Chris, can you address that?
Chris: Yes. That’s great point. I think culture and mental health is a whole . . . you know, just another great topic that we actually could think of for a future webinar, but you bring up a great point, because, I think, depending on the culture you’re from, mental illness, in general, there are several beliefs about what causes mental illness and how a person with mental illness should be treated.
I really like that idea and I think it’s a great point that you bring up, that culture plays a huge role.
Derek: Fantastic. We’ll keep cranking through, here. Another question/comment from Barbara, “Do you find there is a correlation of positive life-satisfaction level among the elderly who live in states where there are teaching universities available that are close by? I’d like to think that such outreach or research on the topic makes a difference.”
Chris: Well, Barbara, great. I’m one of these people who, if I don’t know the answer, I’ll admit it. What I do know, just based on the research we did for this webinar and some of the past research, is that when people – and this makes sense – have access to services, resources, related to screening and diagnosis, obviously, it’s found earlier, it’s treated earlier and effectively.
When that happens, you have a lower prevalence of depression in that demographic, and that’s why those maps are so important, that we showed in the beginning of the webinar, because, in some way, it lets you know where the pockets are and where services are being helpful.
Derek: We had a comment from Barry Griffin. He Brain Wrote about what barriers, social stigmas. “Seniors are used to being very independent and don’t think they need to help.” Great Brain Write there, Barry. We’ll continue to go through some other barriers that were written.
Marianne Durrant [SP] wrote, “Another barrier for the elderly person is awareness of one’s mortality and the loss of others, family, friends, which further contributes to depression or adds to the mental health issue. The elderly live by themselves, without any family, families living far away, in many instances.”
Chris: Marianne, what I love about that point is that we shouldn’t think that because this is so common in older adults that there isn’t a need for treatment, and that’s what we mean by “stigma.” What you say is so, so prevalent, but we shouldn’t minimize the fact that because it happens in so many older adults, that’s part of aging.
We want to make sure that every single person who is dealing with those feelings and challenges is assessed. Again, not everyone has depression, but we want to make sure we diagnose it early and start effective treatment.
Derek: Another really thought-provoking question here from Barbara, “How much of the lack of depression care is possibly due to not having the right health insurance?”
Chris: Yes. He gets to . . . Again, it gets to access. How many people are out there that . . . Think about all the services that we just talk about, access to a geriatric psychiatrist, having the ability to, actually, from a transportation standpoint, to get to a healthcare provider for an assessment, having the resources to afford a facility, assisted living, to afford homecare.
I think, in general, when you look at the platforms by NAMI and DBSA, their number one platform is to make sure that we’re increasing the resources so that there is equal access across all people to all the services that will improve quality of life, related to mental illness.
Derek: I think another comment from Debbie, here, that dovetails into that . . . Debbie comments and asks the question, “What about the cost of mental health treatment? I have a hard time getting a provider to accept Medicare. Even then, the co-pay is too high.” So, [I think it’s comments on that], that access.
Chris: Yes, and again, anything related to access challenge, I would absolutely reach out to the National Association of Mental Illness. Their link is in the presentation, when we send it out, and also DBSA. I mean, that’s really why those groups are out there, so that they can be your voice.
There’s also a sense of helplessness, I think, with depression, and when you reach out to those groups, there are walks, there are events. You can march on Washington and advocate and tell your story, and that’s one of the greatest ways we can impact change.
Derek: Let’s see. Another question/comment, here, from By Bayless. “I fought the term ‘hallucinations’ four years because I knew the perceptions were not real. I was equating hallucinations with what I learned medically were labeled ‘delusions.'”
Chris: Right. I guess, in my training, the way to differentiate those is a delusion would be a distorted thought. A hallucination would be where you see, hear or feel something that’s not real, and, what I would emphasize, there’s a great movie with Russell Crowe called “A Beautiful Mind.”
I don’t know if you haven’t seen it. It really shows how real hallucinations and delusions are for the people who are dealing with them and how challenging it is for them when they’re told that what they believe, think, see, here or feel isn’t real. So, it’s really challenging and, again, really speaks to the importance of working with specialists.
Derek: Another great question that intersects into the home care question, Chris. “Do elderly people who are depressed or suffer with mental illness respond better to nonfamily care providers versus those who are maybe their immediate family?”
Chris: Yes. I would hate to make a blanket statement. What I would say is that even with companion services, things like activities, helping people to get through their day, helping people, maybe, who aren’t able to get to the bathroom and get dressed, I mean, there are certifications. I think it’s really important that you have a professional who’s trained, who has been trained to do that.
Having said that, there are great informal caregivers. That’s the term that we use, “informal caregivers” who aren’t professionals, who have learned just from being there and just from trying to support the person.
I would say the best combination would be having family caregiver and friends there for emotional support, for helping with the daily needs that maybe don’t require the skills of a professional caregiver, but we talked a little bit earlier about the fact that the CDC stated that homecare/depression care management is critical.
There are additional skill needs, both medical and nonmedical skill needs that I believe only a professional caregiver should be providing.
What that does is it gives the family caregiver a break, and it’s also very difficult, if you’re an older adult parent, to have your child come in and take care of you in the bathroom, in the shower. It’s a very awkward thing.
If you have a great caregiver, professional caregiver, in a lot of ways, that can reduce a lot of those awkward emotions, but, in some cases, there are amazing informal caregivers out there who, just by necessity, have provided a lot of great care and support, but I would recommend a combination of professional caregivers and informal support.
Derek: Chris, we’ll take one or two more questions, here. This question comes from Sydney Fray [SP]. “What would you recommend telling and explaining are the basic differences between depression, delirium and dementia, since there are so many similar symptoms?”
Chris: Yes, and there’s a lot of overlap. In my mind, and I think the presentation is a great . . . you know, when we send the presentation, you’ll have a lot of great information to share with others.
Depression, again, is a mental illness, a mental health condition, that causes the person’s loss of initiative, loss of desire to pursue hobbies, loss of appetite. So, it’s a mental health condition.
Delirium is actually what we call a “psychotic symptom” or a “psychotic feature.” So, it’s not that the person has psychosis, but, if they have depression, if they have Alzheimer’s or other forms of dementia, they can develop distorted thoughts. Those are more psychotic features.
Dementia is a neurological disorder. It’s actually in a totally different class of condition than depression and delirium, and, typically, this is where people have . . . You know, it’s an umbrella term, meaning that a person has memory loss to the point that they cannot function independently, and it’s progressive.
I know that was a mouthful. If you’re willing to share contact information, I can send you some more at length about it, but there are really three different conditions. Delirium is actually a symptom, but there is a lot of crossover, which creates a lot of confusion.
Derek: If we have other questions, comments, we’ll address those one-on-one, but we see some additional questions from Barbara, By and a few other individuals, and, really, thank you for those questions or comments.
[I] want to really thank our panelists and host Chris Kelly for a fantastic presentation, to the design team who really created a very impactful presentation that can be shared for anyone, after the webinar, and, as a host, and as a representative of Griswold Homecare, we’re honored to have shared the content.
Griswold Homecare is a purpose-driven company. We celebrate, educate and advocate the choice to remain independent at home. Our founder, who you can see here on the screen, started Griswold Homecare, back in 1982. She was the wife of a minister and founded Griswold Homecare after seeing the nonmedical needs of her church not being met in a formal way.
Today, Griswold Homecare assists with personal care, companionship and light housekeeping services, across almost 40 states and over 250 offices, and we like to think all those who are part of the process, professional caregivers, the owners/operators, the dedicated care coordinators and healthcare professionals, which we work with each day to service thousands and thousands of clients.
Again, we want to thank the audience. Thank you for your attendance today. Thank you for your feedback. Thank you to Chris for the presentation and great information.
We will send out the recording and all the tools to this webinar within a couple of days, once we compile that and have the webinar transcribed.
Now, the fun part. You have tools to help. Whether you’re caregiver, family caregiver or healthcare professional, the webinar is just a moment in time and just a start.
We hope that you’ll take these tools and help apply them and use them to help further create awareness about mental health, but also to help those who are dealing with challenges around mental health and depression.
We will now conclude the webinar. Thanks everybody, and have a fantastic, great week.
For more information, please review our Mental Health Resources.