The importance of mental health care for the elderly has been recognised in recent years. In the 2006 census, people aged 65+ made up 11 per cent of the population – by 2041 this will have increased to 22 per cent.
We find that elderly clients accessing counselling services often present with issues around losses and loneliness – they can be isolated from family members and have poor social networks. They also have a high likelihood of health problems and disabilities, which often results in a loss of independence.
In this context older adults often struggle between the wish to be cared for versus the need to be in control of their lives. These circumstances result in older clients presenting with symptoms of social distress, involving worthlessness, inadequacy, fear of abandonment, anger and vulnerability.
Counselling can help them come to terms with loss, negative emotions, feeling a lack of meaning, reminiscence, failing health and death.
Older adults affected by homelessness are more likely than their younger counterparts to present with mental health issues. Their needs in this context are often more complex than those of older adults in the general population, in that they may also include alcohol or drug use, traumatic incidents in the past and limited opportunities for meaningful activities.
Living without a home can be especially challenging in later life, making older adults’ needs to access housing particularly urgent. Older adults affected by homelessness also have unique needs regarding safety. They may have encountered violence on the streets or in shelters and are considered more at risk than their younger counterparts because of their poor health and because they could be seen as easy targets.
It is often hard for older adults to be assessed for mental health issues, whether they are experiencing homelessness or not. This is mainly due to the perception of these problems as an unavoidable consequence of ageing rather than a treatable problem. Also, due to the stigma in society, older people often do not report problems around their mental health.
Therefore, there is frequently a focus on treatment with “pills” and an “encouragement” to “go out and socialise more”. Mobility or hearing problems as well as faltering concentration or memory issues can make it difficult to engage and retain older clients.
Older clients often also lack an understanding of what counselling is and have difficulties sharing problems with a stranger. The fact that they are often suffering from financial difficulties tends to affect their access to treatment.
The counselling process with older clients mainly involves dealing with the above mentioned losses and meaning-making. We help clients provide a narrative of their lives, not just a mere description of the facts but rather of the role they played in it. This helps them find new meaning and a renewed purpose in life and enables them to find acceptance and an ability to live in the present.
What is important is to stress the individual’s independence, in spite of their physical or emotional circumstances, and not letting them become infantilised which they could feel in shelters or nursing homes. This is essential for them to maintain their self-esteem.
History of trauma
Clients who are homeless and have a history of trauma can often feel unsafe therefore the counselling process needs to work towards rebuilding their physical and emotional safety and a sense of control over their lives.
We support our clients in identifying and highlighting their own strengths and develop coping skills to further develop their own resiliency.
What we find useful with older clients is to adapt the counselling process to the needs of this client group and each client individually. This may involve additional reminders for appointments or adapting the session length to a client’s physical and mental capacity on a particular day.
For many clients, learning to trust their counsellor is a first step towards rebuilding trust with others. The importance of our work lies in recognising and accepting our clients as human beings – or in other words, simply listen to them tell their story.
A lack of validation is a common theme among clients in general, but in particular those affected by homelessness. They feel judged, they feel nobody listens to them, nobody cares about them. They feel powerless, and a sense of shame that is overwhelming.
It is essential for us counsellors to change this paradigm, build a relationship with them and improve their experience within “the system”. We accomplish this by listening non-judgmentally, validating a client’s experiences and building a relationship of trust.
What we know is that change is possible even at an advanced age. People who are elderly, too, can benefit from psychotherapeutic intervention. They are generally eager to reflect on their past and naturally tend to sum up their lives.
Working with older adults, where major developmental issues revolve around anxiety about loss and bereavement, may raise emotional issues for therapists as they are consistently confronted with fears about their own mortality.
In the homeless sector, we also often experience a sense of helplessness and frustration in view of our own limitations to facilitate change. What is important is to find the value in what we are doing and appreciate that success might not come in huge leaps and bounds.
Accepting this truth is essential – we often may just be planting a seed by creating an environment and experience for the person that is different. This is all we have control over.
The Dublin Simon Community Sure Steps Counselling Service was established in 2012 and is currently providing psychological support to an average of 70 clients per month presenting with a wide variety of issues.
The range of services encompasses 1-to-1 counselling, weekly drop-in clinics, in-reach and outreach crisis intervention, and a counsellor-led emotional wellbeing group programme. For further information on Simon Sure Steps Counselling Service please visit www.dubsimon.ie.