Mental Health and Social Service Needs
Psychosocial questions ask how you respond to feelings. The right answer acknowledges the feeling and does not try to fix, dismiss, or debate it.
Core concepts
- Maslow's hierarchy: physical needs first, then safety, love and belonging, self-esteem, and self-actualization. A resident who is hungry, in pain, or short of breath cannot work on emotional goals.
- Common conditions: depression, anxiety, bipolar disorder, PTSD, schizophrenia, and substance use disorder. Depression in older adults often appears as withdrawal, poor appetite, sleep changes, or irritability rather than obvious sadness.
- Grief and loss: residents grieve health, home, spouse, pets, and independence. Denial, anger, bargaining, depression, and acceptance are common responses.
- Defense mechanisms: denial, regression (bedwetting or thumb-sucking under stress), projection (blaming others), rationalization, and displacement. Recognize them; do not confront them harshly.
- Therapeutic responses: open-ended questions, reflection, silence, and simply being present. Non-therapeutic: false reassurance, advice-giving, "why" questions, and talking about your own troubles.
Traps
"You shouldn't feel that way," "Everything will be fine," and "My mother had the same thing" are always wrong. Promising confidentiality is wrong. Any hint of self-harm must be reported to the nurse immediately, not kept as a confidence.
Rule of thumb
Acknowledge, don't argue: name the feeling, offer your presence, and report what you observe.
Worked example
A resident says, "Nobody visits me. I might as well be dead." Wrong: "Oh, don't talk like that." Right: "That sounds very lonely. Are you thinking about hurting yourself?" Then stay with the resident and notify the nurse immediately.