Assessing and Working with Mental Health Behaviors

According to the National Institute of Mental Health, about one in four adults suffers from a diagnosable mental disorder in any given year. Among people 65 years and older, Alzheimer’s disease is the most common form of dementia; in fact, one in ten individuals over age 65 is affected by Alzheimer's disease. Currently, 4.5 million Americans are affected, doubling the number of individuals affected by the disease since 1980.

With such an increase in numbers, long term care facilities are seeing more and more residents with dementia-related illnesses, such as Alzheimer’s disease and other mental illnesses. Mental illnesses can cause residents to present with a myriad of behaviors, including outbursts or confusion. As more and more of the population ages, facilities will see an increased number of residents with behaviors that are a result of a mental illness.  The challenge will be to ensure that appropriate care is being provided to residents, and individual needs are being met.

Residents with mental illness may or may not exhibit behaviors that can be challenging. When they do, however, it is important to remember that the person is reacting to his or her environment and illness and is not attacking staff or loved ones with his or her reactions.  It is vital to distinguish the behavior from the resident. The resident is not the problem; the behavior is.  Focusing on the behavior and not the personality of the resident allows staff to explore various interventions geared to decrease that behavior.  Facilities can address behaviors successfully in order to ensure a safe environment for the resident exhibiting the behaviors, as well as for other residents living in the facility. When behaviors are first noted, staff should begin to monitor them. For example, some residents may react to certain staff differently or exhibit the behavior in the morning, but not in the evening.  Monitoring the behavior can help determine the cause of it.

Assessing the resident is an important step that should coincide with behavior monitoring. Social workers are trained to assess psychosocial aspects of an individual.  If a facility has a social worker, the social worker should be notified so that he or she may provide an assessment.  Family members can often offer vital insight into an individual’s behavior. This is important because a person’s life experiences can impact his or her behavior. For instance, a resident who is awake at night and wandering or calling out, may have previously worked nights and is used to sleeping during the day.  From this assessment and knowledge of previous life experiences, the social worker can make a number of recommendations to address behaviors.

If the facility does not have a social worker, or the social worker believes it could be helpful to do so, the facility can request a psychiatric consult. A psychiatrist can be requested to come in to assess the behaviors and determine if the behavior is a result of a mental illness.  Psychiatrists can prescribe medications to address some of the symptoms that result from a mental illness. For example, a resident who is exhibiting symptoms of depression can begin to have difficulty getting out of bed or enjoying activities. Some medications can help with these symptoms. It is important to remember, however, that psychiatric medications can have unwanted side effects and may not completely address the behavior.

Residents who are showing symptoms of mental illness, such as depression, can benefit from counseling services. Residents can go out to see a therapist or a therapist can come in to the facility to see the resident on a regular basis. Therapists can assess the emotional, social and cognitive aspects of the illness and assist the resident in developing coping skills.

Furthermore, residents who continue to exhibit behaviors that are difficult for staff to handle could also benefit from a behavior specialist. Behavior specialists are trained to develop plans that specifically address a behavior. The behavior specialist can assess the behavior and develop an individualized plan for that specific resident. The behavior specialist will train the staff in implementing the plan consistently.  Behavior plans can be changed and adapted to how successful the plan is at reducing the target behavior.

Often, staff can feel powerless when they see behaviors in residents with mental illness.  The staff member may not know how to react in order to decrease the behavior.  It is important to recognize that another person’s reaction to the behavior is a key factor in escalating or de-escalating the behavior itself. Therefore, staff training is critical in addressing challenging behaviors.  Those staff members trained in responding appropriately to challenging behaviors will feel more empowered and will be better able to address behaviors.

Resources are often available from the Community Service Board (CSB), which provides mental health services to the community. Case management, psychiatric, and counseling services are often available through the CSB. In addition, CSB or other mental health professionals can provide staff training.

In conclusion, more and more residents in long-term care facilities are exhibiting symptoms of mental illness that result in challenging behaviors. Facilities can address behaviors in a way that allows all residents to be cared for properly.  It is also important for the staff, therapists/specialists and authorized family members, to meet periodically to formulate and implement a treatment plan to address the behaviors.


Following is a checklist on steps to take to address behaviors as well as what types of questions to ask:

  1. Has the facility monitored the behavior? Are there any specific patterns? If so, has the facility made changes to address this?

  2. Has the social worker or responsible staff assessed the resident and spoken to family members to determine possible causes of the behavior?

  3. Has a psychiatrist assessed the resident? Could the resident benefit from medications? Are medications being administered and is the resident being monitored for side effects?

  4. Could the resident benefit from counseling services? Have they been offered?

  5. Has a behavior specialist been consulted and a plan developed?  Has the staff been trained in the behavior plan?

  6. Has staff received training in responding to challenging behaviors?


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