MMN 048: – Counseling Older Veterans – with Erin Patel

On this episode of the Make a Mental Note podcast, Erin Patel, a licensed psychologist, discusses older veterans that seek mental health care and methods of helping them improve their mental health. Give it a listen and find out why this episode is worthy of a mental note!

Erin Patel interview (click on Erin’s name to listen to interview)

Mental Notes:

* The Veterans Administration offers different types of mental health care to veterans and their families including inpatient and outpatient services and long-term treatment (e.g., nursing home-type facilities). In some cases, VA therapists provide services to veterans in their homes – either by visiting them at their homes or via telemental health (the VA system version of Skype).

* Older veterans present with various types of problems such as long standing mental health problems that continue late into life (e.g., depression, anxiety, PTSD), adjustment issues relating to late life (e.g., difficulty adjusting to retirement, health conditions, loss of a spouse, role shifts) and providing care for a loved with a cognitive disorder (e.g., dementia).

* Not all issues that veterans deal with are combat-related. A lot of the issues are everyday types of problems/current stressors that are impacting their lives now.

* The VA provides training experiences to psychologists and other mental health professionals.

* Oftentimes, older veterans present with co-morbid health problems (e.g., diabetes, COPD) that play a role in their mental health problems. Sometimes physical problems will give the appearance of mental health problems while in other cases they exacerbate them.

* In some cases, veterans do not seek treatment until they are seniors when something has happened that they are unable to deal with successfully on their own (e.g., loss of a loved one).

* Differences in working with older adults vs. young adults. First, helping break down the stereotype of what mental health treatment is is important. Many older adults were raised at a time when it was not acceptable to talk about mental health problems or seek out services for those problems. Thus, helping break down that barrier, normalizing the process of mental health help-seeking and providing them with psychoeducation about mental health treatment all play roles. Also, if the client exhibits cognitive problems then therapy must be adjusted to accommodate them.   A client with a mild cognitive disorder/dementia can still benefit from psychotherapy services, but they may need things to go at a slower pace and have things presented in multiple modalities (i.e., seeing, hearing, touching). In some cases, it is helpful to have a loved one participate in the therapy process to help support the client and put recommendations/suggestions into practice outside of the therapy office.

* Being aware of other issues with which older clients must contend is important for the therapist to be aware of such as how Social Security and Medicare work or the process of getting into a nursing home. Bottom line – understanding how to link older clients with resources is very important.

* Interpersonal Therapy (IPT) – is an approach that is often used with depressed clients. This approach focuses on four areas in a person’s life that might be causing them problems. 1) Role changes/transitions (e.g., transitioning from full-time employment to retirement), 2) Role disputes (e.g., adult children getting into disputes as to who is going to care for an elderly parent or engage in other roles), 3) Bereavement/grief (e.g., adjusting to the loss of a loved one), and 4) Interpersonal deficits (e.g., a person who has limited social skills which makes it difficult for them to establish and/or maintain relationships).

* Psychoeducation is an important component of therapy with older adults.

* Highlighting clients’ strengths and helping them access/utilize those to deal with their mental health problems is key. In some cases, clients need to modify the way they use their strengths due to physical or other types of limitations. Helping clients brainstorm how they can do this in a supportive way is helpful. Letting them know that they are not alone is also important to the IPT approach.

* Families can play an important role in helping clients cope with transitions/mental health problems. For example, perhaps a family member can drive the client to a senior citizens center so as to engage in activities with others, which might be an important from social support and social skills practice perspectives. In other cases, family members serve as “champions” for older clients – letting them know that someone “has their back” and will be there for them to support them in their efforts to improve their mental health. Some clients have limited family support due to by-products of PTSD (e.g., placing strain on relationships), solitary personalities of veterans and other veterans that have moved away from their families or vice-versa.

* In terms of challenges in working with older veterans – one is that they are complex in that they frequently have multiple problems (e.g., physical and financial problems in addition to mental health problems). In other cases, older clients are experiencing cognitive problems that makes it difficult for them to communicate, problem-solve, etc. Limited social support – family members that are dementia caregivers oftentimes feel as though they are on their own and do not have much support/have someone they can reach out to.

* Mental health tips – it is important to take good care of oneself (e.g., eat well, exercise, nurturing relationships) as this promotes a healthy aging trajectory.

Mental Notes Takeaway:

* As a mental health professional, when working with older adults – including veterans – it is important to not simply ask them about their mental health symptoms and to treat those, but to operate from a broader perspective. In other words, understanding the client within the context of their health, relationships, culture, financial situation and religious orientation – if any – provides for a richer framework from which to help these clients.

Check It Out:

* Veterans Administration – Murfreesboro (TN) phone number: 615-867-6000

* Erin Patel’s e-mail address:

209 Castlewood Drive Suite D
Murfreesboro, TN. 37129
(615) 403-5227

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