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Removing the barriers to counselling in care

As part of CMM’s ongoing commitment to improving the mental health of care staff, we asked the British Association for Counselling and Psychotherapy (BACP) to share the work they’ve been doing with care homes. Looking at ways to support staff and residents, Jeremy Bacon, BACP’s Older People Lead, reveals what they’ve found and what they’re planning next.

With many staff leaving care work each year as a result of the emotional pressures the work entails, there’s a definite need to explore a range of new approaches to promoting wellbeing at work.

In its 2019 report , the National Association of Care and Support Workers (NACAS) shared feedback from care workers that many described their work as ‘emotionally draining’, feeling the responsibility of their roles well beyond the paid hours worked. The report urges that the mental health of care staff be supported and that employers take steps to ensure staff have access to wellbeing support.

Meanwhile, the Royal Society for Public Health has reported that modern British society displays ageist attitudes to wellbeing, commonly associating low mood and depression with ageing. As a result, many older people are not being offered mental health support in later life.

BACP is committed to challenging these pervasive ageist attitudes that ascribe low mood and depression as natural parts of ageing and is working to develop the evidence base for a choice of talking therapies for those who need them, irrespective of age.

BACP is the leading professional body for counselling and psychotherapy in the UK, holding the registrations of over 50,000 members working across the professional disciplines in the fields of counselling and psychotherapy in a range of settings, including the NHS, schools and colleges and the third sector.

We are working to improve knowledge about the efficacy and impact of counselling and to increase access to and choice of therapies, and we are conducting research to find the best ways of offering these services to those in care.

Previous research

In her book, Living Well and Dying Well – tales of counselling older people, Helen Kewell shares her experiences of working with eight clients in their 70s, 80s and 90s, including a man aged 95 who was making sense of his new life in a care home following the death of his wife.

Her learning from her work with ‘Tom’ was that, ‘Even in these final years of life, through the gathering fog of dementia and the anguish of isolation, determination can indeed be alive and kicking’ and with all her older clients she identifies a potential for growth, change and acceptance regardless of age or ill health.

Of her work in care homes, Helen reflects that her introduction was via a request from a care worker to the bereavement charity that she was working for and that there is much to be learnt about how counselling can become more regularly available for people living in care homes.

As part of our research in this area, it has been vitally important to canvass opinions from care home managers, staff, residents and counselling practitioners with experience in the field.

My Home Life invited us to speak to a group of care home managers on their Leadership Support Programme, who informed us that talking therapies aren’t commonly available to care home residents and that there are difficulties with residents accessing therapy in a traditional way. These included practical and staffing implications to escorting residents to appointments outside the home. We discovered that the managers had no objection to residents accessing counselling services, but it just wasn’t part of the regular care home routine. Our conversation with the managers also clearly pointed to a need to take a whole-system approach – one that included the wellbeing needs of care home staff as well as residents.

BACP researchers also interviewed counselling practitioners who had experience of working in care homes. A common theme that emerged from this research was the value of the therapists establishing good relationships with care teams and managers as a critical lead-in to their visits to care homes. Rather than having to introduce themselves and explain the purpose of each visit, being known to the care team allowed the counsellors to work with their clients as part of the routine of the care home.

Other counsellors working in care homes have spoken of the need to be flexible in the way that they work, understanding that what works in dedicated therapy rooms may have to adapt to meet the physical surroundings of the care home or the routines that can interrupt therapy sessions. These findings led us to expand our research.

The next steps

The next phase of our care homes research project will therefore explore how professionally-qualified counsellors can support the wellbeing of both residents and staff in care homes.

This project is part of a wider focus by BACP on the mental health needs of older adults and the role of talking therapies in supporting wellbeing in later life. Much of the work to date has focused on issues of healthy ageing and the value of access to therapy through life transitions such as retirement, bereavement and adjusting to physical health conditions that are common in later life. The care homes project extends this interest to focus on the oldest members of society, including those at the end of their lives.

Three care homes in the Midlands have been recruited to take part in the next phase of research via the Enabling Research in Care Homes (ENRICH) network, each varying in size and with different CQC ratings. Three counsellors are also being recruited and trained to work in these care homes.

The counsellors will provide one-to-one counselling to residents and wellbeing support to care teams. The aim of the project is to provide evidence and an understanding of the potential benefits of counsellors working in care homes. The findings could in turn support an application for further research funding aimed at addressing the feasibility, impact and cost-effectiveness of providing this counselling to residents and support to care teams.

The study will incorporate the full introduction of therapists to care teams prior to them working with residents in the care homes. The research will also investigate adaptions to counsellors’ practice that may be needed to fit with the care setting.

Therapists will then introduce safe and confidential talking therapy for residents and use their core skills to provide a reflective space for care workers to provide support, training and signposting to wellbeing services.

Already, we have seen enthusiasm for the project; in preliminary discussions with staff at one of the care homes, care workers welcomed the opportunity to access support that is independent from the work management structure, citing the value of keeping personal concerns separate from their work.

The project is being led by researchers from BACP and has developed from our in-depth consultation with care home managers, staff, residents and counsellors who have worked with clients in care homes. The project will be completed later this year, and findings reported in 2021.

Altering attitudes

We know from other research that older people themselves often don’t recognise and act upon signs and symptoms of common mental health issues such as anxiety and depression. Often, they’ve internalised the aforementioned ageist attitudes that associate low mood and depression as a natural and inevitable part of ageing.

With high rates of depression amongst the estimated 400,000 care home residents in the UK and huge emotional strain on many staff working in care homes, the research team hopes to gain timely insights into the suitability and value of counselling for people who live and work in care homes.

We anticipate finding myriad benefits to both residents and staff. The team is eager to discover the best ways that the therapy and support can be supplied and we look forward to reporting on our results in 2021.

Jeremy Bacon is Older People Lead at the British Association for Counselling and Psychotherapy. Email: Twitter: @pogueface

Do you engage with counsellors in your service? What measures do you take to ensure the good mental wellbeing of your staff and the people you support? Pass on your knowledge by leaving a comment below, where you can also leave feedback on this article.

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