A story worth telling

Overcoming the challenges of engaging residents with mental health conditions. By Darragh O Keeffe.

An innovative program combining reminiscence, cognitive behavioural therapy and digital storytelling at a NSW facility is having a profound impact on residents with depression and anxiety.

Before the program began last May, 76 per cent of residents at IRT’s Dalmeny Village had symptoms of depression, as diagnosed on the Cornell Depression Scale.

Now, says welfare officer Kate O’Leary, participants of the ‘My story matters’ program are more engaged with staff and demonstrating far fewer depressive symptoms.

“One resident became depressed when he had to be separated from his wife of 70 years because of her dementia. He’s 93 years old. He came to the group and in just a few months he says he’s been inspired and motivated. He says it kept him sane,” says O’Leary.

The program aims to improve the mental health of residents through the implementation of a cognitive behaviour therapy program using narrative, reminiscence and photographs.

“We have an activities program, but I was looking to developing something with a more psychological therapeutic aspect.”

O’Leary’s inspiration for the program came from her years nursing and in social work.
“Whenever I was on the geriatric wards I always wished I had more time to stop and talk to the residents, and to listen. I always carried that with me.

“I was interested in person centred care – the idea that residents need one-on-one time, and to be listened to. The importance of reminiscence, what the famous psychologist Erie Erikson called the therapeutic value of life review.”

With depression levels far higher than the 45 per cent average for Australian aged care residents, O’Leary set about developing her therapeutic, person-centred program.

She reviewed a European study which used a series of phased, multidisciplinary interventions as an effective approach to the prevention and treatment of mental health conditions, including anxiety and depression. This involved using a cognitive behaviour therapy-based narrative exercise. The results of the study showed up to a 50 per cent reduction in depression for people aged over 75.

Based on this approach O’Leary developed the ‘My story matters’ program.

“Reminiscence is an age old therapy and its use among the elderly is well known and accepted. I added to it by incorporating a digital storytelling aspect and focusing on cognitive behaviour therapies, which basically means guiding the resident to think positively.

“Erikson talked a lot about the importance of life review, reflecting on your life, particularly when you’re older. It’s an opportunity to put things into place, tie up the ends and to reflect and make peace. It’s a step on from reminiscence,” she says.

The program got underway last May and the pilot involved six residents and six family members.
During weekly meetings, the family member would prompt the resident to tell stories – using a set of prepared questions. They would then record their story. Other story prompts, such as photography, were also used.

“We use a meeting room, so as to give structure and atmosphere. It also allows for conversation across the participants, which is very effective also. We provide coffee and cake to provide a sense of occasion.”

The family members and volunteers were trained in cognitive behaviour therapy before the sessions began, to ensure they could guide the resident towards positive thoughts and reflection.
“If they get onto something negative in their story, we of course listen, but the goal is to guide them where possible back to reflecting positively on life,” says O’Leary.

O’Leary says the results of the program have been fantastic.

“For the staff, it’s been a new platform to get to know the residents. When they watch the DVDs they get a richer picture of who the resident is. I’ve seen staff get excited and teary once they see the resident as a once young, active, vibrant person.

“Residents come back to the ward after a session and they’re more talkative, they’ll start conversation and they’ll say things they’ve never said before. That can last for days,” she says.

The program has also had a profoundly positive impact for families.

“One woman who regularly comes in to visit her mother told me the program has transformed their relationship. Her mother has dementia and anxiety. She said it was a godsend to come in and visit and not have the 30 second conversations they used to have, saying the same things over and over again. She has learned, through the program, how to converse with her mother.”

The ‘My story matters’ program continues to go from strength to strength, O’Leary says. Further to being sustainable, it is also possible to replicate the program in other facilities.

Last year the program was a finalist in the ‘Positive living in aged care’ awards’, a joint initiative from ACS NSW/ACT, ACAA-NSW and NSW Health.