Spurred by Lack of Mental Health Therapists in Rural Central California, Researchers Make House Calls to Seniors

Seniors and people who live in rural areas suffer from higher than average rates of depression. Yet California’s rural areas suffer from a shortage of mental health professionals. Photo: Thinkstock

For Steve, a senior in rural Stanislaus County, problem-solving therapy helped him conquer mild depression.

“The first step in improving is finding the problems,” said the 63-year-old Oakdale resident, who requested that his last name not be used because he doesn’t want to be stigmatized for having depression. “Once you find and define them, then you can work on how to overcome them.”

Steve is one of about 80 seniors who have participated in a study to determine the effectiveness of problem-solving therapy in reducing depression in rural seniors who live in the Central California counties of Stanislaus, Tuolumne and Calaveras.

Depression in older adults brings significant health risks, and is associated with a higher risk of suicide and cognitive impairment. Older adults are also less likely to recognize their symptoms of depression and seek help.

The study, which began in 2013, is a project of the UC San Francisco Institute for Health and Aging and Catholic Charities Mother Lode Office in Sonora. The inquiry is funded by a $2.5 million five-year grant from the National Institute on Aging. Researchers hope to get a total of 125 seniors to participate by the time funding ends in April 2018.

Known as the Senior Peer Alliance for Rural Research on Wellness program (SPARROW), the project gives seniors who have screened positive for depression 12 weeks of therapy at home. Patients meet once a week with a counselor. All participants work with a licensed professional counselor initially and then some continue working with the professional while others work with a volunteer peer counselor trained in problem-solving therapy. The results of each approach will be compared for effectiveness.

The program is open to people who are 60 and older. Researchers recruit study participants through newspapers and radio, senior centers and newsletters, and senior housing and meal programs. Some medical providers and home-health social workers also refer patients.

Higher Rates of Depression

A similar study in the Bay Area showed that problem-solving therapy was effective in reducing depression. Researchers are now trying to determine if the approach works just as well in a rural setting. The current study is the first of its kind in comparing treatment by peer counselors to treatment by clinicians.

Carlene Maggio, SPARROW coordinator for the Catholic Charities Mother Lode Office, hopes the study will help her agency better serve seniors dealing with depression. “Rural communities are desperate for behavioral health services,” she said. “Ultimately we hope to continue to provide these services in the agency once the grant is over.”

Catholic Charities is researching possible funding sources to pay for the continuation of the program.

Rural communities often have higher rates of depression than more urban areas. According to the Centers for Disease Control, the percentage of older adults living with depression is 12.8 percent in Tuolumne County, 11.5 in Stanislaus County and 10.4 percent in Calaveras County. Meanwhile, in nearby Alameda County, an urban area, the rate is 9.8 percent.

The 2017 Community Health Needs Assessment shows that there are far fewer mental health professionals in Tuolumne, Stanislaus and Calaveras counties than in California as a whole. Tuolumne County has 1 mental health professional for 730 residents as compared to 1 for every 580 in Stanislaus and 1 for every 680 in Calaveras. Statewide, the rate is 1 mental health professional for every 350 residents.

Using Basic Skills to Solve Problems

Problem-solving therapy is an approach that concentrates on what patients can do in the here and now rather than delving into their childhood histories.

According to C’Anne Johnson, a Sonora marriage and family therapist participating in the SPARROW program, it has two components: behavioral activation and finding solutions.

For the behavioral activation part, counselors try to get patients to take a simple action that makes them feel better, whether that’s going on a walk, knitting or calling a friend. This is to stop a downward cycle from getting worse. For example, someone might feel depressed, so she isolates herself, so she feels even more depressed and so on. By taking a positive action, the patient can take an immediate step to feel better.

For the solution-finding component, counselors help a patient break down a problem into manageable pieces and brainstorm possible solutions. Counselors help patients set goals and then check back in regularly to see how progress is going. For instance, a person might say they feel lonely. The counselor could help them look into local senior activities to meet friends.

“It’s not revolutionary,” Johnson said. “A lot of places use these basic skills. But it does help people slow things down and take things one step at a time.”

‘This is my chance’

Maureen Mousseau, a senior peer counselor for the SPARROW program, said she has helped patients address issues like being overweight, anger and strained relations with a child.

She has found that it sometimes takes six or seven sessions to find out what the real problem is for a patient. What the person initially identifies as a concern often turns out to be a surface issue.

As she has been trained to do, the Oakdale resident never attempts to solve problems for patients. Instead, she helps them clarify issues and come up with their own solutions.

A challenge of the study has been getting seniors to participate. “In older populations, there’s a stigma around depression,” she said. “There’s a reality that people don’t seek out services as often.”

The researchers offer $20 gift cards for groceries or gas as incentives for participation but haven’t attracted the numbers they would like. Brooke Hollister, principal investigator for the study from UCSF, believes seniors may be reluctant to identify themselves as needing help. Hollister said the project may seek to roll over grant funding and get an extension past the April deadline so the researchers can get enough study participants.

Steve, the Oakdale resident who found the therapy helpful, said he was amazed at how quickly he got results from the approach.

“I had a counselor who was incredible,” he said. “In a very short period of time, she showed me things I hadn’t seen or had seen and refused to admit.”

He is such a fan of the therapy that he has now signed up to be a volunteer peer counselor in the SPARROW program. Like the other peer counselors, he will receive a day-long training from Catholic Charities in general peer counseling strategies like how to respond to a crisis, and will then get a four-hour training from the SPARROW clinical supervisor which includes role-playing activities. All the peer counselors then get to check in regularly with clinicians to get feedback on their counseling sessions.

“I love helping people,” Steve said. “I get satisfaction and joy out of seeing others succeed. This is my chance to pay it back and hopefully pay it forward.”

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