5.4: Mental Health, Mental Illness, and the Home Care Worker

Guidelines for Observing Behavior:

• Describe the unusual behavior. When does it occur? How often does it occur? How long does it last? Does it seem to occur during certain situations?
• Does the behavior indicate a change in the patient’s personality?
• Is the behavior or thought extreme (bizarre and seem abnormal)? Is the behavior or thought appropriate to the situation, or does it seem out of the ordinary and abnormal?
• Is the behavior harmful to the patient, to their loves ones, or to the Home Health Aide/Personal Care Aide?

It is important to remember not to draw conclusions about the behaviors observed. The job of a HHA/PCA is not to diagnose or interpret behaviors or thoughts the patient expresses. Their job is to observe, record, and report what they see and hear.

Role of the HHA/PHA with Mentally Ill Patients and their Families

Home Health Aides/Personal Care Aides play an important role in helping a patient with mental illness and their family function normally and safely. They assist patients with medications as allowed by their state, agency, and the Care Plan. They observe, record, and report any changes in mood, behavior, or side effects from medications. They should take note of what is happening in the home. Is the home unkempt? Is the patient’s personal appearance unkempt? Are children neglected?

People who suffer from a mental illness may not be able to provide for their personal care needs or to maintain a clean and safe home. It is the responsibility of the HHA/PCA to assist them to complete their activities of daily living (ADLs). This includes assisting with bathing, dressing, toileting, and self-care. This also may include assisting with light housekeeping and helping to plan, shop, and prepare meals. A HHA/PCA may also be asked to observe whether a patient is compliant (follows) their treatment plan. Do they take their medications as ordered? Do they attend psychiatric appointments?

Home Health Aides/Personal Care Aides play an important role in providing emotional support and assisting a person with mental health issues to use positive coping strategies. They also work to support the family members during the process of recovery. They must use their communication skills to listen to concerns and provide emotional support and role model healthy coping skills and effective communication skills. Be aware of including the patient in the treatment plan. Respect their confidentiality. Just because they have a mental health issue does not mean that they lose the right for confidential and respectful treatment. Be patient, compassionate, kind, and respectful of the patient and family. Most importantly, always offer hope that people with mental illness may recover.

Maintain Safety

Home Health Aides/Personal Care Aides should discuss the Care Plan with their supervisor and treatment team on a regular basis to ensure that they are always following the directions outlined in the Care Plan. This is to ensure the safety of them and their patient, and to ensure that their patient receives the proper care. In some instances, patients may require very close supervision and constant attention. These patients may be at risk to harm themselves or others. Never leave these patients alone unsupervised.

Home Health Aides/Personal Care Aides should provide observations as asked and report any concerns immediately. Maintain careful documentation and accurately record observations. Remember not to include judgments within documentation. Do not include interpretations of behaviors such as, “Mr. Alman is talking to himself today. I think he needs a higher dose of medications.” Interpreting behaviors and making diagnoses is not the responsibility of the HHA/PCA. Maintain objectivity at all times. Only report what you see, hear, smell, and can touch.

It is important to always maintain safety within the home. Never leave a patient unattended if it is required they receive constant supervision or if they have made statements to hurt or kill themselves. Help to keep the home environment clean and free of debris and pests. Provide personal care to the patient as directed in the Care Plan. People with mental illness may be unable to provide personal care for themselves and may rely on the HHA/PCA to help remind or assist them with these activities.

Observe and report noncompliance with medications and psychiatric treatment. Noncompliance means that a patient is not following the treatment plan or medical recommendations as directed. There may be many reasons for this. Some medications that people take to help them recover from mental illness may make them feel drowsy, not like themselves, have no energy, or even diminish their sexual drive. Patients may not like these side effects. Patients may also be non-compliant with treatment because they have difficulty remembering to take medications or to attend appointments. If Home Health Aides/Personal Care Aides notice noncompliance in their patient, they should try to ask them what may be happening to make them not want to take their medications or miss their treatment appointments. Whatever the reason may be record and report noncompliance and any reasons discovered. Without following the treatment plan, patients will be unable to recover from their mental illness and live a safe and functional life.

In the case of extreme, dangerous, or unsafe situations or behaviors, immediately call 911 or the emergency phone number in your area. Home Health Aides/Personal Care Aides should use their communication skills and appropriate telephone skills to accurately and calmly report the situation. Provide only the facts to emergency services and try to remain calm. Then, when it is safe, call a supervisor to report the situation.Never stay in a situation that is unsafe.