Nurses, alert janitors boost seniors' mental health

June 06, 2000

"We often get discouraged that the most vulnerable people are the least likely to benefit from care -- that's clearly not the case here."

In the case of older adults with psychiatric problems, a four-year Johns Hopkins study has shown that a program combining observations by janitors, building managers and others who frequently see elderly people and the skills of a highly accessible psychiatric nurse can significantly increase seniors' mental health and stability.

The research, reported in today's Journal of the American Medical Association, highlights the first large-scale, low-cost, medically successful approach to the dilemma that elderly people on their own are far less likely to be diagnosed or treated for mental illness than younger adults, according to psychiatrist Peter Rabins, M.D., who directed the study.

Elderly people are less likely to get treated for mental illness for a host of reasons, Rabins says: "Their generation's reluctant to admit to mental health problems; they may have insufficient insurance or even a simple lack of transport to the doctor's office. No single solution tackles all the reasons," he adds, "but this new program, based on quickly recognizing mental problems and improving access to care shows large populations can be helped affordably."

In a test of the PATCH program --for Psychogeriatric Assessment and Treatment in City Housing --involving 945 senior residents of six public housing sites in Baltimore, residents in the three test sites scored 17 percent higher in a test of general mental health than those in the three sites without it. The PATCH group also scored 32 percent lower on a standard test measuring depression.

"We often get discouraged that the most vulnerable people are the least likely to benefit from care-- that's clearly not the case here," says Rabins. Though still experimental, PATCH has proved so successful that it now operates in every public housing site in Baltimore, Rabins says.

In the PATCH system, a psychiatric nurse trains housing staff --custodians, maintenance workers, managers --to recognize changes in a resident's behavior that may clearly signal a psychiatric problem. In hour-long sessions, staff learn about normal and abnormal aging, mood disorders, schizophrenia, substance abuse, dementia and death/dying issues. They become "case finders" who weekly refer at-risk residents to the nurse.

The PATCH nurse then approaches residents, asking to administer a short series of mental diagnostic tests. A mini-medical exam including vital signs and medical/psychological histories is part of the work-up.

Finally, the nurse and a team psychiatrist confer about the best treatment approach with the resident, arranging in-home or off-site care. They back off when a system's in place to provide needed resources, Rabins says.

"A key feature of this study," he adds, "is that it depends heavily on nurses who have both mental health and medical training. Having them provide care where people live seems to overcome the stigma of mental illness for elderly residents as well as solve transportation difficulties and the complicated interaction between medical and emotional problems that often prevents people from getting help."

The nearly 1,000 residents in the study received psychiatric screening before researchers divided them into sociologically similar PATCH and non-PATCH groups. Neither the nurse nor housing staff knew which residents had previously tested at-risk for psychiatric problems. At the study's end, the researchers re-surveyed and interviewed all the residents, again measuring psychiatric symptoms. "We picked this particular population," Rabins says, "both because of ease of access and because we knew from earlier studies that people in public housing tend to be in greater need of psychiatric help."

The PATCH project involved an unusually tight collaboration between an academic center and state and city agencies --in this case Hopkins, the Maryland Department of Health and Mental Hygiene and the Housing Authority of Baltimore City. One city housing administrator, for example, was on the PATCH program's board of directors. "The teamwork surely contributed to success," says Rabins.

The study was funded by the National Institute of Mental Health and the Maryland Department of Health and Mental Hygiene. Other researchers were Betty Black, Ph.D., Beatrice Robbins, R.N., Rebecca Rye, R.N., of Hopkins, Robert Roca and Marsden McGuire of the Sheppard and Enoch Pratt Hospital in Baltimore, and Larry Brant with the National Institute on Aging in Baltimore.
Johns Hopkins Medical Institutions' news releases are available on an EMBARGOED basis on
EurekAlert at
Newswise at
and from the Office of Communications and Public Affairs' direct e-mail news release service. To enroll, call 410-955-4288 or send e-mail to

On a POST-EMBARGOED basis find them at
Quadnet at
and ScienceDaily at

Johns Hopkins Medicine

Related Mental Health Articles from Brightsurf:

Mental health strained by disaster
A new study found that suicide rates increase during all types of disasters -- including severe storms, floods, hurricanes and ice storms -- with the largest overall increase occurring two years after a disaster.

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

World Mental Health Day -- CACTUS releases report of largest researcher mental health survey
On the occasion of 'World Mental Health Day' 2020, CACTUS, a global scientific communications company, has released a global survey on mental health, wellbeing and fulfilment in academia.

Mental illness, mental health care use among police officers
A survey study of Texas police officers examines how common mental illness and mental health care use are in a large urban department.

COVID-19 outbreak and mental health
The use of online platforms to guide effective consumption of information, facilitate social support and continue mental health care delivery during the COVID-19 pandemic is discussed in this Viewpoint.

COVID-19 may have consequences for mental health
The COVID-19 pandemic appears to be adversely affecting mental health among hospitalised patients, the healthcare professionals treating them and the general population.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental ill health 'substantial health concern' among police, finds international study
Mental health issues among police officers are a 'substantial health concern,' with around 1 in 4 potentially drinking at hazardous levels and around 1 in 7 meeting the criteria for post traumatic stress disorder and depression, finds a pooled data analysis of the available international evidence, published online in Occupational & Environmental Medicine.

Examining health insurance nondiscrimination policies with mental health among gender minority individuals
A large private health insurance database was used to examine the association between between health insurance nondiscrimination policies and mental health outcomes for gender minority individuals.

Mental health care for adolescents
Researchers examined changes over time in the kinds of mental health problems for which adolescents in the United States received care and where they got that care in this survey study with findings that should be interpreted within the context of several limitations including self-reported information.

Read More: Mental Health News and Mental Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to