Effective Use of External Collaborators to Address Mental Health Needs of Long-Term Care Residents: Composite Case Reports
Main Article Content
Abstract
Background. Long-term care facilities are experiencing rapid increases in the number of residents with serious persistent mental illnesses (SPMI) and substance use disorders (SUD).
Aims. The purpose of this paper is to propose a new model for long-term care, the Collaborative Care Model, to bring expert mental health care to these residents more effectively.
Methods. Two composite case studies of long-term care residents, one with serious persistent mental illnesses, the other with substance use disorder, are presented. One represents the traditional model of expert external consultation, the other represents the use of the Collaborative Care Model. The cases are analyzed in terms of the similarities and differences in the problem presented and the approach used, as well as interpretation of the outcomes of these long-term care stays.
Results. The most striking differences between the two approaches to obtaining external expert guidance were 1) the multifaceted nature of the Collaborative Care Model, which included staff education, consultation with the facility pharmacist, discussions with both the resident and family members, and meetings with the staff and management of the facility, and 2) improved outcomes for the residents
Conclusions. The Collaborative Care Model promises to offer a more person-oriented, interdisciplinary approach to obtaining expert mental health care for a resident in need of it. The model should be subjected to rigorous testing to evaluate the effect of its use on long-term care resident outcomes.
Article Details
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References
2. Hanan, D. M., Lyons, K. S., Mahoney, E. K., Irwin, K. E., & Flanagan, J. M. (2024). Barriers and Facilitators to Caring for Individuals with Serious Persistent Mental Illness in Long-Term Care. Archives of psychiatric nursing, 51, 25–29. https://doi.org/10.1016/j.apnu.2024.05.006
3. McCasland, L. A. (2007). Providing Hospice and Palliative Care to the Seriously and Persistently Mentally Ill. Journal of Hospice & Palliative Nursing, 9(6), 305–313. https://doi.org/10.1097/01.njh.0000299313.99514.0c
4. Fashaw, S., Thomas, K, McCreedy, E., Mor, V. (2020). Thirty Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act. Journal of American Medical Director Association. 20 (2020) 233–239. DOI: 10.1177/23337214221101260
5. Čížková, J., Dostálová, V., Bártová, A., Holmerová, I., & Valeš Jelínková, P. (2024). Care of Older Adults with Mental Illness in Long-Term Care Residential Facility: A Scoping Review. Journal of the American Medical Directors Association, 25(10), 105218. https://doi.org/10.1016/j.jamda.2024.105218
6. Helmly, V., Rask, K., Berelowitz, J., & Craft Morgan, J. (2024). Serious Mental Illness, Substance Use Disorder, and Nursing Home Care: A Narrative Review of the Literature. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 7334648241307448. Advance online publication. https://doi.org/10.1177/07334648241307448
7. Matos Queirós, A., von Gunten, A., Martins, M., Wellens, N. I. H., & Verloo, H. (2021). The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice. Dementia and geriatric cognitive disorders extra, 11(1), 38–44. https://doi.org/10.1159/000514118
8. Orth, J., Li, Y., Simning, A., & Temkin-Greener, H. (2019). Providing Behavioral Health Services in Nursing Homes Is Difficult: Findings from a National Survey. Journal of the American Geriatrics Society, 67(8), 1713–1717. https://doi.org/10.1111/jgs.16017
9. Sanvisens, A., Hernández-Rubio, A., Zuluaga, P., Fuster, D., Papaseit, E., Galan, S., Farré, M., & Muga, R. (2021). Long-Term Outcomes of Patients with Cocaine Use Disorder: A 18-Years Addiction Cohort Study. Frontiers in Pharmacology, 12, 625610. https://doi.org/10.3389/fphar.2021.625610
10. Bucy, T., Moeller, K., Shippee, T. (2022). Serious Mental Illness in the Nursing Home Literature: A Scoping Review. Sage Journals. DOI: 10.1177/23337214221101260
11. Jester, D.J., Hyer, K., & Bowblis, J.R. (2020). Quality Concerns in Nursing Homes That Serve Large Proportions of Residents with Serious Mental Illness. Gerontologist 60(7),1312–1321. doi:10.1093/ geront/gnaa044
12. Reist, C., Petiwala, I., Latimer, J., Raffaelli, S. B., Chiang, M., Eisenberg, D., & Campbell, S. (2022). Collaborative Mental Health Care: A Narrative Review. Medicine, 101(52), e32554.
13. American Psychiatric Association (APA). (2025). Collaborative Care Model https://www.psychiatry.org/psychiatrists/practice/professional-interests/integrated-care/learn
14. Hu, J., Wu, T., Damodaran, S., Tabb, K. M., Bauer, A., & Huang, H. (2020). The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review. Psychosomatics, 61(6), 632–644.
15. Callahan, C. M., Boustani, M. A., Unverzagt, F. W., Austrom, M. G., Damush, T. M., Perkins, A. J., Fultz, B. A., Hui, S. L., Counsell, S. R., & Hendrie, H. C. (2006). Effectiveness of Collaborative Care for Older Adults with Alzheimer's Disease in Primary Care: A Randomized Controlled Trial. JAMA, 295(18), 2148–2157. https://doi.org/10.1001/jama.295.18.2148
16. Willis, R. (2019). The use of composite narratives to present interview findings. Qualitative Research, 19(4), 471–480. https://doi.org/10.1177/1468794118787711
17. Duffy, M. (2010). Writing about Clients: Developing Composite Case Material and Its Rationale. Counseling and Values, 54(2), 135–153. https://doi.org/10.1002/j.2161-007x.2010.tb00011.x
18. Hart, S. M. (2024). A Composite Narrative Case Study of Postschool Transition for Young Adults with Significant Disability. https://doi.org/10.4135/9781529683202
19. Johnston, O., Wildy, H., & Shand, J. (2023). Student voices that resonate—Constructing composite narratives that represent students’ classroom experiences. Qualitative Research, 23(1), 108–124. https://doi.org/10.1177/14687941211016158
20. Samenow, C. P., Worley, L. L., Neufeld, R., Fishel, T., & Swiggart, W. H. (2013). Transformative Learning in a Professional Development Course Aimed at Addressing Disruptive Physician Behavior: A Composite Case Study. Academic Medicine: Journal of the Association of American Medical Colleges, 88(1), 117–123. https://doi.org/10.1097/ACM.0b013e31827b4cc9
21. Cruz, N., Bart-Plange, E.-L. B., Zeledon, I., West, A., Unger, J., Meca, A., & Hudson, S. M. (2024). The 123s and Affective, Behavioral, and Cognitive of Unaccompanied Latinx Minors: A Trauma-Informed Composite Case Study. Cultural Diversity & Ethnic Minority Psychology, 30(4), 907–916. https://doi.org/10.1037/cdp0000693
22. Kumar, D., Kakran, N., Chaudhary, L., Solanki, B., Bharti, N. R., Chauhan, A., Jadon, R. S., Chaturvedi, T., Gautam, S., Huidrom, H., Tiwari, N., & Das, R. (2022). A Review of the Quality of Mental Health Care Provided to Nursing Home Residents. NeuroQuantology, 20(9), 2350–2353. https://doi.org/10.14704/nq.2022.20.9.NQ44275
23. McElhinney, Z., & Kennedy, C. (2022). Enhancing the collective, protecting the personal: the valuable role of composite narratives in medical education research. Perspectives on medical education, 11(4), 220–227. https://doi.org/10.1007/s40037-022-00723-x
24. Zwick, J., Appleseth, H., & Arndt, S. (2020). Stigma: How it Affects the Substance Use Disorder Patient. Substance Abuse Treatment, Prevention, and Policy, 15, Article 50. https://doi.org/10.1186/s13011-020-00288-0
25. Centers for Medicare and Medicaid Services. (2025). Behavioral Health Integration Services. Medicare Learning Network [Booklet]. Retrieved from https://www.cms.gov/files/document/mln909432-behavioral-health-integration-services.pdf