1. The York Training Programme1 RECOGNISING AND REDUCING DEPRESSION IN OLDER PEOPLE Developing Skills – Improving Practice The York Training Programme Session 2

2. The York Training Programme2 Aims and Objectives – session 2 To understand how depression affects feelings,behaviour and thinking To identify ways of responding to negative statements To explain the principles of the intervention - a person centred approach to goal planning To be able to identify problems and redefine them in terms of needs To be able to identify a person’s strengths To be able to choose a goal to work with

3. The York Training Programme3 You are walking along the street when someone you know walks straight past without acknowledging you How do you feel? Upset? Relieved Not bothered Dejected? sgildene:

4. The York Training Programme4 What makes the difference to how you feel? What are you thinking? I must have done something to annoy her I haven’t got time to talk just now She probably didn’t notice me She doesn’t like me – nobody does

5. The York Training Programme5 How do you behave? Sulk? Carry on your way Withdraw more from people

6. The York Training Programme6 Feelings experienced in depression Sad Angry Anxious Guilty Rejected Hopeless Helpless Loss Can you think of more? Have you ever felt any of these feelings?

7. The York Training Programme7 Behaviour which may be shown in depression Social withdrawal Irritability Complaining Self-harm Crying Inactivity Agitation Unco-operativeness Can you think of more? Do you ever behave this way?

8. The York Training Programme8 Mrs Brown Friends ask her to join them on a trip to the coast – she says she can’t go “they don’t really want me – I’d be the odd one out – I’d be a burden” Asked “would they ask if they didn’t want your company?” “They just feel they have to” She believes this enough to feel they have actually rejected her – she feels even more lonely

9. The York Training Programme9 Mrs Brown continued “What is the evidence they don’t want you?” “Not close friends but got on well enough” “Is there another way of looking at this?” They feel concern and want to help? They like you and want your company? They are doing it because they feel they ought to but are pleased to? I need to get out socially – it’s nice to be asked

10. The York Training Programme10 Mrs Brown is jumping to conclusions without knowing enough about her friends Are there advantages to thinking this way? “I don’t put people to any trouble” “I don’t have to make a commitment to a less important relationship” “I don’t have to put on a good face” Disadvantages? “I cut myself off from people” “I don’t give myself a chance to rebuild my life”

11. The York Training Programme11 Types of depressed thinking All or nothing e.g. “if I can’t do something as well as I used to there’s no point in doing it at all” Generalising from the particular e.g. “I spilt my tea – everything I do goes wrong” Ignoring the positive e.g. If I do something well it’s a fluke” Jumping to conclusions e.g. “If I join those people they are bound to reject me”

12. The York Training Programme12 Negative opinion of self, self-criticism and self-blame e.g. “I’m a burden” “My life hasn’t amounted to much, I’m a failure” “ I’ve made other people unhappy” Negative expectations of the future e.g. “As I get older things will only get worse” Negative view of events e.g. “I’ve lost my home and my health – I’ve no control over what happens to me”

13. The York Training Programme13 Answering negative statements Will just reassuring by disagreeing be helpful? “of course you’re not a nuisance” Be careful about asking “why” and “what” questions that are hard to answer e.g. “why did you do that?” “what’s the matter?” Find out what evidence there is for thinking that way e.g. what happened to make you think that?” Gently challenge ‘black and white’ statements e.g. “ is it really always like that?” Look at the effect of thinking that way e.g. “what difference would it make if you didn’t think like that?”

14. The York Training Programme14 Explore alternative ways of looking at the situation e.g. “is that the only way of looking at it?” or “would you look at it that way if it happened to someone else?” Explore changes in mood e.g. “have there been times when you have not felt so low – what was different about those times?” Help the person to see what they still can do and still have whilst accepting their sadness about losses

15. The York Training Programme15 Problems can be missed if we only focus on Problems – “the resident is a problem so we must…….” And don’t look at Needs – the resident has a problem and needs…….”

16. The York Training Programme16 Deficits – “the resident can’t/wont/hasn’t…..” Without looking at Competencies and strengths – “the resident will/can/likes/ has……” Disabilities – “the resident doesn’t……” And forget Abilities – “the resident does…..”

17. The York Training Programme17 Basics of person centred care Empathy – tuning in to emotions Genuineness - warmth Non-judgemental acceptance Active listening Reflection of feelings Tuning in to the person’s language and pace Asking questions the person can answer Seeing things from the person’s point of view

18. The York Training Programme18 Reframing problems as needs Needs are the problems a person faces restated in positive terms They state what a person needs to do, not what they should stop doing Stating what needs to be done is the first stage of planning a strategy to help with problems

19. The York Training Programme19 problems needs He is unfriendly and withdrawn She is bored and uninterested He is dirty She is always complaining She say life is not worth living He shouts at everyone He needs appreciative attention She needs stimulating interests He needs a wash She needs her complaints listened to She needs something to look forward to He needs to express himself in a normal tone of voice

20. The York Training Programme20 Mrs Jones’ problems Mrs Jones’ needs Spending too much time in bed Doesn’t do anything Won’t socialise Complains about noise Complains about medication Feels homeless Brooding on losses – husband - home -possessions Nothing to look forward to Needs to get up after breakfast Needs some interesting activity Needs social contact she is comfortable with Needs a quieter environment Needs explanation of med’n Needs to feel more ‘at home’ Needs opportunity to talk about losses and do some ‘grief work’ Needs to be more aware of positive aspects of her life

21. The York Training Programme21 Finding a person’s strengths A person’s strengths are all the positive things about that person – what they have going for them Looking at what what their skills were when they were younger A person’s strengths can be used to help make plans to fulfil identified needs

22. The York Training Programme22 A person’s strengths are What the person can do What the person likes to do Other people who are willing to help Positive aspects of his/her personality

23. The York Training Programme23 Mrs Jones’ strengths Can do Likes People who can help Express herself Mostly independent self care Better in evening To read the paper Some TV programmes Her son’s visits One-to-one conversation Painting Nice clothes Music Her son Care workers she likes Professionals

24. The York Training Programme24 Expressing needs as goals A goal describes what the person will be doing or have done when the goal is achieved It must be something the person wants to do

25. The York Training Programme25 SMART goals A SMART goal is one which is Specific Measurable Achievable Realistic Time limited

26. The York Training Programme26 Goals which could be helpful in depression Goals that encourage activity Opportunities to listen Encouraging life review and reminiscence Responding to negative thinking Building self esteem Is a focus of distraction – not too hard