Reducing antipsych meds: 5 ways psychologists can help
Eleanor Feldman Barbera, Ph.D.
With the mandate to reduce the use of antipsychotics, many facilities are looking for alternative methods to address the behaviors often associated with dementia. There are several good resources available for training staff (such as the Center for Medicare & Medicaid Services' Hand in Hand toolkit and the Pioneer Network's programs).
Within each facility is another good resource — your consulting psychologist. Here's how psychologists can help:
1. Psychology is all about nonpharmocological alternatives. The most frequent question for any psychologist during their career is, “What's the difference between a psychologist and a psychiatrist?”
The answer: “Psychiatrists go to med school and prescribe medications to help people feel better. Psychologists go to graduate school to study interpersonal interactions and talk with people to help them feel better.”
The cornerstone of what psychologists do is to look at behavior and find ways to treat people without medication. While psychologists might not be able to use the exact same techniques for those with memory loss, they can offer behavioral insights that aid the team.
2. Psychologists are trained to understand group dynamics. They can support ways in which your treatment teams are working well to help those with dementia and offer alternatives in areas where conflicts arise. For example, if psychologists have observed that mealtimes are stressful for staff and residents, they can offer suggestions that reduce triggers for behaviors on the part of persons with memory loss.
3. As part of their studies, psychologists collect and synthesize data. Combined with their group/team experience, this makes psychologists ideal sleuths to gather information from various team members about particular residents and identify the cause(s) of agitation.
The fact that they don't necessarily leave at change of shift allows them the opportunity to discuss the cross-shift behaviors of the residents.
4. Your psychologists have likely been consulting on various units of your facility and know the treatment teams and residents quite well. They've observed the interactions between various staff members and residents and have heard from the residents (and often from workers) what's going on behind the scenes.
Psychologists can use this firsthand knowledge of your teams, plus their education, to train staff on communication skills, conflict resolution, and other essential behavioral techniques.
5. Psychologists have been trained to observe the environment and assess its impact. In addition to assisting with group and individual resident/staff interactions, they can help identify elements in the environment that can be adjusted to facilitate a calmer setting.
For example, psychologists can train staff to recognize the impact of an overly warm or chaotic day room, or help transform a frightening or unpleasant shower room into a more inviting atmosphere that reduces agitation at shower time.
While some of the above might be covered in the usual fee-for-service method through Medicare, Medicaid and private insurers, facilities are increasingly recognizing that investing in mental health experts to address behavioral issues more than pays off in the long term. (For example, see The Eldercare Method: Using psychology for positive outcomes.)