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For most people, the hardest part about dealing with emotional trauma is not recognizing there is a problem, it is reaching out for help.
While therapy is an obvious resource for many young adults, for the vast majority of today’s senior population, there is negative stigma associated with therapy.
Annette Conway, Psy.D., director of Home-based Effective Living Professionals (HELP), explains that the negative stigma stems from the memories a senior has from their youth.
Only a few decades ago, society looked down upon people in therapy, often labeling them crazy, and believed that institutionalization was their only hope.
Many who suffered from mental and physical disorders that today require no hospitalization, where handed over to the state by their families, so they could care for them.
While many seniors have a hard time letting get of that stigma, things have certainly come a long way, thanks to a variety of in-home care services. As a result, many patients who are undoubtedly nearing their final days may even pass from this life to the next from the comfort of their homes.
One illness that often goes untreated and can have fatal results, is depression.
"Sometimes, people just need someone to talk to," Conway said, adding that while many seniors can still count on families, a large majority of their friends have passed, and sometimes they have no one. Having no one to speak to is difficult, especially for someone who is battling a crippling illness. That is where the services of HELP are the most useful.
"By treating people at home, HELP professionals open the door to therapeutic services they would not otherwise have access to, especially for home-bound patients," Conway said.
"Our number one diagnosis at HELP is major depression -- associated with chronic illness, or chronic pain. These patients are so focused on their pain that they become stuck in it, especially those grasping [with death], so they become depressed. If we can help pull them out, it helps to ease some of that pain."
In addition to depression, some of the many other problems HELP professionals can do is to resolve include anxiety, agoraphobia, addictive behaviors, relationship issues, trauma, postpartum blues, domestic violence, child behavioral and learning concerns, and psychological assessments.
HELP works with over 25 hospitals and community organizations throughout San Diego County, including Aging and Independent Services, Adult Protective Services, Elder Help of San Diego, and San Diego Hospice Aids Case Management.
While Conway points out that many of HELP's patients also suffer from HIV/AIDS, a large portion of those battling the disease are straight. Many other members of the LGBT community are receiving services from HELP, and of those, it is predominately the senior population.
"Sixty percent of our patients are seniors,” she added. “Of that percentage, roughly 20% are LGBT seniors. In my own practice, the number is slightly higher, at 25%.”
It is also true that a majority of the individuals dealing with chronic illness often find it difficult to leave their homes, as do others who are struggling with various degrees of phobias and hoarding. For Conway, visiting a person’s home and providing mental health service access for such individuals, is the most rewarding part of her work.
"I simply love what I do," Conway said. "There is a threshold that you cross, that you cannot cross when patients only visit you in an office. You get to experience their physical surroundings, their food, their culture, their ritualistic type of items, the dynamics of their families, etc. It usually only takes one session to establish the state of a patient and a treatment plan. It is easier for patients to open up, and in many ways you de-stigmatize mental health services for individuals."
Calling for HELP
HELP has been visiting patients in their homes since 1993. Throughout the years, their work has been so successful that they have expanded not only the number of organizations and medical providers with which they work, but also their reach.
Today, therapists also visit patients in Orange and Riverside Counties, and there are plans to expand HELP’s reach to all of Southern California. Eventually, with strategic partnerships, Conway hopes that HELP will provide mental services for patients statewide.
"Our goal is to provide everyone with mental health services,” she said. "Everyone at some point in their life needs a counselor and they should have access to one.”
Most health insurance plans, including Medicare and Medicaid, cover the services provided by HELP, with the exception of an HMO, because of the complexities of their provider networks. However, if your coverage is currently with an HMO, do not fret.
"We won’t turn anyone in need of help away," Conway explained. “Many of our therapists will work on a sliding scale.” A person seeking therapy need only call the number listed below for additional information.
A friend or a family member can often recognize someone’s need for therapy long before they can. Conway recommends approaching that type of person from a perspective of experience. "Speak to your friend about how therapy helped you with a crisis in your life. If you haven’t had therapy, you probably know of another good friend or family member who has, so use their positive experience as an example," she said.
Once you have shared the positive experiences with therapy, encourage the individual, but do not push the subject matter.
"Simply say, ‘take the risk, here is the number, it is simple and it will help change your moods, your behavior and your life.’ There really isn’t much else you can say," Conway continued.
"People just need to give HELP a try. Research has shown that what pulls most out of depression more than anything else, is interconnectedness with other people. For severe depression, it is a combination of dedication, medication and therapy, but connecting with someone is the key factor for pulling someone out of a black hole."
Treatment plans at HELP generally begin with therapy meetings once a week for three-to-four weeks. As the patient begins to feel better, the sessions are spread out to every other week.
For patients struggling with depression, it takes about six months for them to learn the cognitive behavior skills that allow them to manage depression on their own. The first part of the treatment begins with understanding the root causes of the problem, and then developing a plan of action.
"Every case differs, though, sometimes it can take a year or longer for some patients,” Conway said. "After we terminate our sessions, we always let clients know that at any point, if a crisis occurs, or if there’s simply a need to talk to someone, we are always available to help them. We leave it open for them to come back.
“Sometimes we even treat entire families," she said. "I have shown up to a session, and the whole family is there. The mother or father will usually say ‘we are having a family crisis’ and that is OK, the more the merrier. We can help people in a group session, as well.”
The Men & Women From HELP
Conway’s extensive career in psychology dates back more than 30 years. Her first husband was diagnosed with cancer in the late 80’s. Three years later, when he passed, she took a two-year career break to help manage the family business, before returning to her practice and eventually obtaining her doctorate in Clinical Psychology.
She has always viewed mental health services both as essential and a way of helping to integrate a person back into a community. She was drawn to the uniqueness and value of home therapy visits from the moment she first heard about HELP.
“In 1993, I read an article about HELP’s founder Mary Adams,” Conway recalled. “I immediately connected with the program’s idea and knew that was the kind of practice I wanted to be involved with. I have always viewed psycho-therapy as an array of services, and I really like how HELP works with a variety of community organizations like The Center, to offer free opportunities for individuals struggling with issues to find solace through community building.”
Conway worked with Adams for several years, and in 2005 she bought the business from her when she was ready to retire. Today HELP employs 52 licensed clinical psychologists, neuropsychologists, social workers, and marriage and family therapists, as well as bi-lingual therapists. Together they all make roughly 200 home visits a week.
"It takes a special kind of therapist to succeed in this type of practice," Conway said. "There is a lot more involved than people realize, and a huge part of the learning process is learning professional boundaries in order to keep the lines from friend and professional from blurring together.
"A lot of our therapists have a private practice, but see home clients as an opportunity to expand that or to get out of the office. We also have a lot of new graduates who are looking for an opportunity to network and establish a practice, and our senior therapists, who are semi-retired, and don’t want the burden of running a full-time practice, but want to continue helping patients for a few hours a week."
There was a time when HELP spent a great deal of effort recruiting therapists through medical magazines, but today, a lot of recruits call HELP because they have heard of the service or have been referred by another doctor. Standard background checks are conducted and new therapists are given some time to decide whether HELP’s traveling demands suit them.
It is also a very affordable way for new graduates to get their foot in the door because they do not have to worry about leasing a space or any of the marketing. HELP provides everything from the business cards to the patients.
"At the end of the day, we help people establish a private connection with someone,” Conway said. “By doing so, we help people resolve their issues, often reintegrate them with their communities and families, and overall, improve their quality of life through the appropriate treatment plan."
HELP’s website offers several informative articles that can help individuals with a variety of needs, from stress-reducing tips, to helping you identify serious signs of suicide and depression, or simply learning more about the mental health services available.
Due to patient confidentially agreements, we were unable to speak with a patient; however, there are a few testimonials available online from former patients who have taken the time to write a brief note about what the HELP services have meant to them. For anyone debating treatment, they are a good place to start.
HELP’s main office: 3636 Fourth Avenue, Suite 302 San Diego, CA 92103
Toll free #:: 1-855-760- HELP (4357)