Emotional wellbeing support

Risk Factors

Risk factors are elements in a person's environment that can increase the likelihood of them engaging in behaviours that compromise their physical, emotional, spiritual and psychological health.  The following provides a list of potential risk factors:

• Limited or no active community involvement
• Family conflict
• Low commitment to self-care
• Economic disadvantage
• Little to no support

Protective Factors

These are elements in a person's life where their environment can have an increase that is likely to have the person engaging in healthy behaviors that support themselves, their community, family, and peers. Protective Factors can form as a buffer to change as opposed to acting out in behaviours that compromise their physical, emotional, spiritual, and psychological health. 

Emotional health can be dependent on internal and external factors in the person’s life. Emotional well-being is to have an understanding about our emotions and feelings and how we are able to manage these through different types of life situations.

Myths and Stereotypes About Age and Disability

In the past, people with disabilities were not usually visible in the community. Children or babies with physical or intellectual disabilities were often cared for in institutions, and special schools were provided for children with many types of disability.

Access for wheelchairs in many public places was limited, employers were not encouraged or supported to employ people with disabilities, and there were very few laws around discrimination. The result of this widespread segregation in our community meant that people with physical or intellectual disabilities were invisible.

People are more likely to be afraid of things they are not familiar with, and myths and stereotypes are more likely to evolve.

A stereotype is the tendency to make generalisations, or have broad beliefs about a group of people, such as people from a certain culture, or people who are older or who have disabilities. For example, it is easy for some people to believe that all older people have dementia, or that people with disabilities do not have sex.

Watch

Aging Myths and Facts

The Effect of Devaluation

Older people and people with disabilities can sometimes be made to feel less important, or less valuable than others because of a problem in society called social devaluation. Devaluation happens when large parts of the community automatically look down on people from certain groups. This devaluation can lead to fewer opportunities to make friends, to gain employment or to feel included as a valuable member of society. People can be devalued because of the way they look, such as being older or having a disability, because of the way they speak or because of how they dress. People who live in poverty, or have fewer financial means than others, are frequently devalued. Unfortunately, having less money can go hand-in-hand with being older or experiencing disability, and so devaluation becomes a cycle.

Here is how that cycle can happen.

You can help to reduce the effects of devaluation by:

• Calling out ageism or ableism whenever you see it
• Reporting discrimination to the manager of a service or business, or even to the Human Rights Commission
• Helping the person to dress and present in ways that help them to be accepted by others, if that is what the person would like
• Avoid talking down to the person, or making it clear to others around you that they have dementia or a disability
• Helping the person to learn skills that they may have missed during their lives because of exclusion, such as employment skills or social skills
• Using positive language that focuses on their strengths and abilities.

Discrimination

Discrimination happens when a person or group of people actively treat a person differently because of a factor that is irrelevant. For example, it is discrimination to refuse to give a person employment simply because of age or disability, if the person is able to do the job in the same way that a younger, non- disabled person can do. People who belong to certain groups, such as people with disabilities, mental health conditions, people from certain races and ethnicities, people who identify as LGBTIQ and people from low socio-economic backgrounds can find that they are not able to access the same opportunities as other people in society. This can lead to further disadvantage, including cycles of poverty, poor health, social exclusion and increased incidence of mental health issues. Discrimination, both direct and indirect, still contributes to this cycle in Australia. Direct discrimination is illegal. It refers to treating a person differently or unfairly in their access to services or venues in society on the basis of a protected and irrelevant trait, including gender, sexuality, cultural background, religious beliefs, English-speaking status, age, race and disability. People with mental health conditions frequently find themselves the victim of direct discrimination. This means that the person has been directly refused fair access because of traits that are not relevant to the situation. This can affect their ability to obtain work because they have disclosed a mental illness; their ability to access rental accommodation; and their access to the full recreational, creative, spiritual, sporting and other opportunities in society that most of us enjoy. Other people are victims of indirect discrimination. This means that the person is not able to fully access public and private services because of rules that make it more difficult for them to pass through.

Example

If a service, club or group requires the person to access the internet in order to join, this can create often unintentional barriers for people who are unable to afford an internet connection and device, or for people who do not speak English or people who do not know how to use the internet.

Unfortunately, these same disadvantages can also make it harder for the person who has been illegally discriminated against to access and understand information about their rights, along with the skills and means to address breaches in their rights.

People working in all areas of community services need to be aware of the layering effect of discrimination and disadvantage over the person’s lifetime. You will come up across many such opportunities to address direct and indirect discrimination in a mental health worker role. It is important that you take steps to help the person to understand their rights under discrimination law, including the Disability Discrimination Act (Cwth) and to self-advocate where they can. Where needed, you should also consider it part of your role to advocate directly for social justice for the person. You might also refer examples of discrimination to advocacy services or help the person to complain to the Human Rights Commission where the person has given consent to do so.

Challenging society’s attitudes by being involved in community discussions, and educating individuals in services and business, can be one of the most important ways for social justice principles to be more widely understood.

By recognising the effects of disadvantage, you can be more proactive in helping to link people opportunities that can help them to overcome indirect discrimination, and the cycle of poverty and disadvantage. For example, linking a person to initiatives that provide access to computers, job skills programs or language skills.

Read

You can learn more about Human Rights, along with real examples of discrimination that has been investigated and resolved on the Australian Human Rights Commission website by clicking on the link here.

Ageism

Ageism is using language or actions that put down individuals or older people because of their age. Ageism is rampant in our community, and most of us are guilty of using ageist terms about ourself or others. Calling older people names or categorising all older people as being unable to drive or work, are common examples of ageism. Ableism is the tendency to use terminology that devalues people who have different abilities. Examples of ableism include assuming that a person who uses a wheelchair cannot work, or that they cannot make their own decisions.

Watch

Take a look at this video providing an explanation and description about ageism.

Confidence

People usually feel more confident and secure when they like themselves and feel good about who they are. People with disabilities sometimes struggle self-esteem, because of the attitudes of others, and because of lifelong experiences of bullying, discrimination and disempowerment. They might feel conscious that they are being stared at when they are around strangers.

Give sincere praise when the person achieves something new, but do not be condescending in your praise. Most people with disabilities want to be recognised for real achievements, the way that we all do. Try to practice praising the person for things that they have achieved in terms of their disability.

They might feel conscious of the way others might focus on their weakness rather than their strengths. You can help to promote self-esteem and confidence in the way you support and communicate with the person. Be supportive of the person for who they are, and for the strengths that they have, without judgement. Try never to compare an individual to any other person.

Think

• When you praise a person with a physical disability simply for getting dressed or performing tasks they do every day, you are implying that your expectations are low. For example: ‘It’s amazing that you finished high school, given that you have a disability’ or ‘What an achievement to get a job, especially since you use a wheelchair’.
• Routines and rituals can also help the person feel a sense of control over their lives. When they are familiar with a certain way of drying their toes, or with where they like to have their mobility equipment placed, respecting these habits shows the person that they are in charge, and that they do not need to worry about having to do what other people want instead.

If a person prefers to stick to a routine, try to make sure that you help to avoid interruptions wherever possible. This might mean planning your workday around that person’s preferred routines. If there will be a change in the way or time that things are done, let the person know as far in advance as possible, and reassure them about what they will expect to have happen. This helps to instil trust and helps the person gain some control over the situation.

Resources for Safe and Secure Routines

Visual reminders of where the person is, and what will be happening next, are useful in many support settings. Networks such as Communication Resource Centres can help you and other staff to create images and other resources to foster safety and aid understanding.

Calendars or timetables that show the day’s schedule can include pictures or photos to help understanding. A Who’s Here Today chart can contain the names and photos of the staff who are working today, so that people with cognitive disabilities feel informed and safe. Clocks can include large face or large format digital numbers. They can be used to show when the current task or activity begins and ends. Large font menus can show pictures or words about what might be for lunch in a facility or group house. Process charts or stories can be used to explain or show step-by-step instructions for routines or new activities.

Dementia Australia has an excellent website with ideas for how to promote safety and security for people with dementia. They have online stores where resources such as those described above can be purchased. They also provide ongoing training and support for families.

People who are supported in facilities or by disability services sometimes seem to be surrounded by other people. It can be difficult for an outsider to see how someone being supported in this way could be lonely or could need help and support to make friends. Consider this, though.

Support workers who work with people with disabilities should not be considered as natural friendships. You might consider yourself a friend, but you are also in a work role. This means that you have professional boundaries and requirements that are not the same, and cannot be the same, as a real friendship.

Just because people are the same age, or all have disabilities, does not make friendships a natural thing. People who live in a facility, or who are supported in groups, are usually as diverse in their interests, culture and personalities as any other people in the general community. Having friends is not as simple as meeting other people or being around other people. Friendships are one of the most important, rewarding and enduring parts of our life. Forming or maintaining friendships can be more difficult for some of the people you support. People with disabilities might not have had the opportunities to learn social skills or how to make friends.

Older people and people with disabilities might have difficulty with communication, with hearing or with transport. They might feel a lack of confidence about forming friendships. They might have English as a second language and find it difficult to meet people from their culture and language background.

There are several ways that you can help and encourage the person to make natural friendships. The first step is to get to know the person’s individual physical needs, where they might make friends, and the way that they like to socialise.

• Help the person to learn social skills, such as how conversation naturally unfolds and popular topics of conversation. You can do this by practicing holding a friendly conversation with them as a role-play or by letting them know better ways when they use inappropriate social conversation or behaviour
• Help them to make phone calls or to visit friends Support them to arrange visits from friends, for occasions such as a dinner or morning tea Talk to them about their culture, hobbies or interests, and support them to find groups in the community where they can follow these interests with other people.

Understanding their interests, including their cultural and spiritual preferences can be a good first step. Cultural and religious groups in the community can offer a wide range of social opportunities for people who might have particular cultural and spiritual interests.

When an older person has first entered an aged care facility, encourage family and friends to help them to make connections with other residents. Let them know that the older person can still take part in the social, cultural and spiritual activities in the community that they have previously enjoyed.

Try to encourage family to participate in their local community groups.

Let them know that your service welcomes them at any time to help take the person out on visits to friends or to continue to belong to other groups in the community.

Participation

The people you support can benefit greatly from a little bit of help to participate in social, cultural or spiritual activities, such as art or craft groups, going to church or taking part in cultural festivals and rituals with others. But getting them there is only the first step. Some people give up easily on forming friendships, often because of past experiences. Try to get to know the person’s preferences for social interactions. Are they shy? Do they prefer to talk to one person at a time? Do they need help to open up a conversation? What do they like to talk about? Try to work with these preferences. Never force someone to take part in a group activity if they do not want to. We are all different.

Remember that participation in group activities can be passive. Some people, such as people with dementia, may not join conversations with others around them. But they can often still absorb social benefits from being around others and from listening to conversations, smiles or laughter. Help them to feel part of a group with smiles and open body language, even if they do not seem to be actively taking part.

Think

In a facility, make an effort to find out which residents might have things in common, or who enjoy each other’s company. Help residents to sit near people they like in the day room or at mealtimes. Help them to visit each other’s rooms, an outdoor area or a smaller common space if they prefer, so that friendships can be formed one on one, rather than just in large groups.

Resources to Help Participation

There are many different types of aids to help people to make and maintain friendships and social activities.

A Light writer is a portable communication device that allows the person to type in what they want to say and have the machine read it aloud.

Communication aids are becoming smarter and more portable. Many people use apps on their phone or tablet to help overcome language barriers, such as translation apps. It has become possible to hold a detailed and enjoyable conversation with another person who speaks a different language using these aids.

Other apps can translate people’s unique and individual way of speaking, such as when a person has cerebral palsy and is difficult to understand. These apps learn the person’s sounds and meanings over time and convert unintelligible language into speech that can be understood by others. Less technical communication aids can include picture or word boards.

Financial issues, such as not being able to access or pay for transport can be a major barrier for some people who live alone, or who cannot walk or drive to visit the community.

You can help the person to access transport through options like subsidised taxi fares, community transport such as free buses or teaching the person to use public transport.

Other types of financial assistance are available to help support people to access social opportunities.

There is often funding available to help supplement the cost of aids and equipment to help the person to communicate.

NDIS provides planning and funding options to support people to access the community, so that they can participate in social, cultural or spiritual activities.

Watch

Watch the following video from Uniting Care which presents a perspective on aged care and the unique approach being taken enabling active participation with their residents.

Financial issues, such as not being able to access or pay for transport can be a major barrier for some people who live alone, or who cannot walk or drive to visit the community. You can help the person to access transport through options like subsidised taxi fares, community transport such as free buses or teaching the person to use public transport. Other types of financial assistance are available to help support people to access social opportunities. There is often funding available to help supplement the cost of aids and equipment to help the person to communicate. NDIS provides planning and funding options to support people to access the community, so that they can participate in social, cultural or spiritual activities.

Humans are sexual beings. It is a myth that older people or people with disabilities do not want or need sex. This can be an area that has a big impact on the person’s physical and emotional health. In the past, the sexual needs of people supported in aged, or disability settings were often either ignored or actively suppressed. Supporting the person’s sexual needs is an area we are just starting to learn about. We are beginning to understand that some behaviours of concern, such as aggression, can be triggered by sexual frustration. We know that for many people, being happy, and having a full and enjoyable life, includes having sexual experiences. We now consider a person’s sexual needs as a part of the whole person, and support can be provided in a professional way to address these needs.

Gender and Sexual Identities

Respect and support the person’s own expression of gender and sexuality, whatever that might mean to them. Feeling attractive is an important part of our gender identity and sexual life. You must help the person to dress, put on makeup and groom in the way they wish, and without judgement.

Older people who identify as lesbian, gay, bisexual, transgender or intersex (LGBTI) have often experienced discrimination, trauma and abuse. They may have tried to hide their gender or sexual identities from others in the past. It is important to respect the person’s wishes in disclosing or not disclosing their sexual or gender identity, and to support them to feel safe if they do.

Here are some ways that you can do this:

• Explain to all people you support that they can disclose gender or sexual preferences if they wish, to you or another person in your organisation. Let them know that if they choose to disclose this information, you will support them and that you may be able to help them to access resources, groups and support that can help them. If they do not wish to do so, that is OK too.
• When a person does disclose previously hidden sexual or gender identities, respect that this may have been difficult for them, and support them to maintain confidentiality of this information if they wish.
• Do not tolerate homophobic or transphobic comments or judgements from others, including other residents in aged care.
• All people you support have the right to feel safe, especially in the place where they live.

Sexual Activity Support

Some people with physical or intellectual disabilities might need help to access sexual activities, partners or resources. Some workers may feel more comfortable in this rile than others. Let your supervisor know if you do not feel comfortable or have concerns about supporting a person’s sexual life.

Some funding bodies such as the Transport Accident Commission (TAC) and National Disability Insurance Scheme (NDIS) consider that funding for sexual activities is an important part of meeting the person’s holistic care.

The person may be able to access funding to visit a sex worker, access sexual aids to help them overcome disabilities that prevent them engaging in sexual activity or supporting sex education. Some sex workers specialise in working with people with disabilities.

The plan might ask you to: Support the person to visit or prepare to see a sexual partner (or a sex worker) Help the person to access legal sexual material, such as online or magazines

Help the person to position themselves during sex, or during masturbation, particularly if both partners have a physical disability. While this is rare, it is important to remember that this can be a crucial support to the person, who might otherwise not be able to experience sexual activity.

It is important to maintain strict professional boundaries when providing support in this area. This can mean that you provide only the support that is documented on the person’s plan, and to avoid situations that might cause misunderstandings or working outside of your work role.

Choice and Consent

It is not your business who the person has sexual contact with, unless you are concerned that the person is not able to consent. A person can only give full sexual consent when they are aged 16 or over, and when they are able to express their consent in some way.

When this is the case, the person’s legal sexual choices in a private place are their own choice. Respect and support the person’s privacy, by allowing them private space and time to meet their sexual needs, either alone or with a partner. You must not show or imply disapproval, regardless of your own values.

A person with a significant intellectual disability or dementia is usually not able to consent and can sadly be vulnerable to sexual abuse or rape. It is important to understand the person’s ability to consent to sexual contact with another person, and to immediately report any concerns that you might have about illegal sexual activity or abuse.

It is never, under any circumstances, appropriate to propose, conduct or groom a person you support, or who you have supported in the past, to have any type of sexual contact with you. It does not matter whether the person is able to consent or not. This is an illegal act, reportable to police, and you can be severely punished by the legal system if you are found guilty of any act of sexual conduct with a client or resident.

Inappropriate Sexual Behaviour

Sometimes, people with dementia or people with intellectual disabilities are not able to understand or follow sexual boundaries.

It is important that a person who is using inappropriate sexual behaviour, such as masturbating in public, is helped to express these needs in a more appropriate place.

Stop the person gently and remind them or support them to go to a more private place. If you notice that this behaviour happens at a certain time of day or in certain situations, you can use this knowledge to provide the person with privacy and the opportunity to express sexual needs in private before they are in that situation.

Never scold or express negative opinions about a person’s sexual needs.

Activity

Visit the Australian Human Rights Commission website and read this article here, then reflect on the following questions.

1. What issues do LGBTIQ older people often face later in life?
2. Why are these issues unique to people from the LGBTIQ community?
3. What are the rights of LGBTIQ people in accessing care that allows them to be who they are and make choices about their own life?

Awareness of the importance of good mental health is quite new to the world we live in. However, it is now known that there can be strong links between stress and diseases such as cancer. We also know that depression and anxiety can cause us to feel tired, and less likely to take part in exercise, selfcare and social activities. Many of the people you support can be at higher risk for depression. Older people have often experienced many life changes, and grief can be ongoing. This can be increased when they enter an aged care facility. People with disabilities sometimes experience issues that put them at higher risk of depression, too. Ongoing pain, loss of a function that they could once perform, or the experience of repeated discrimination and disadvantage can lead to feelings of hopelessness or despair.

Signs of mental health concerns

Depression and anxiety are the most common mental health conditions in our community. Sometimes these can be difficult to recognise, as some people will attempt to hide how they are feeling from others. Some signs that can indicate the need to report potential emotional concerns include:

• Withdrawing from others and wanting to be alone
• Expressing or showing a lack of interest in activities that the person used to enjoy
• Talking a lot about themselves in a negative way
• Complaining excessively about physical problems and ailments
• Crying
• Showing little reaction to the things around them
• Worrying excessively
• Wanting to sleep more than usual.

If you recognise signs of depression in a person you support, talk to them about the help that is available, or report what you have noticed to a supervisor. It is also important to document your observations, such as in a file note, to help professionals determine how long the person has been showing these signs. You should also recognise the limits of your own role if you suspect that a person might be experiencing mental health issues.

A GP, or a person who is professionally trained in counselling or supporting depression and anxiety, can help provide the best support. There are many ways in which the person can be helped and supported. For example:

• The Australian public health system provides funded visits to a registered psychologist for a person who may be experiencing mental health issues. This is begun by first visiting the GP, who can determine if they qualify, and then provide a mental health plan as a referral.
• Exercise is known to be beneficial in helping to overcome the symptoms of depression and anxiety. A gentle exercise program can be tailored to suit the person.
• Mindfulness and meditation help many people to learn to focus on what is happening in the present, and reducing negative thoughts. The person can learn these techniques through formal programs with a teacher, by reading about the process or through guided apps such as The Smiling Mind.
• Talking can be useful. Let the person talk, and listen rather than trying to tell them what you think they should do. Remember that your job role does not always qualify to help with counselling people with severe or ongoing depression.

The person might find improvement in their mental health through joining groups or starting hobbies that interest them, taking courses or using podcasts or self-development in:

• Meditation and mindfulness
• Activities that have had a proven effect on the Mindbody connection, such as sport, walking, yoga, Pilates or tai chi
• Expressing spirituality through organised or individual religious or spiritual pursuits
• Using creative outlets such as painting, craft, writing or singing

Forms of Abuse and Neglect

Abuse is when someone’s human rights are violated from the actions of another person. Abuse happens when a vulnerable person is subjected to physical, emotional, sexual or financial trauma, usually by a person who is in a position of power. It can be committed by support staff, other professionals, family members, friends or people in the general community.

A report conducted by the Aged Care Royal Commission stated that around 39.2 per cent of people living in Australian aged care facilities had experienced elder abuse. This was in the form of physical or emotional abuse and neglect.

Also, people with disability may be especially vulnerable to experiencing violence. The Australian Institute of Health and Welfare reported the following findings. You can learn more about this by clicking on the link.

Physical Abuse

Physical abuse can include deliberately hurting a person or using excessive force. It can include hitting, kicking, pinching or using unnecessary force when providing personal care. It can also include using restraints without the correct legal process or authority, such as tying a person to a chair.

Signs of physical abuse can include:

• Unexplained injuries such as bruises, cuts or broken bones
• Showing fear or anxiety, such as cowering or guarding the body, especially when around certain people.

Sexual Abuse

The definitions of sexual abuse have been widened to include staff members using sexual behaviours of any kind towards a client or resident.

This means that sexual jokes, grooming, showing sexual materials, touching a person in a sexual way can be considered sexual abuse. Sexual abuse also includes sexual behaviour between two people, such as between residents or clients, or by a visitor, where one person cannot or does not consent. Signs of sexual abuse can include:

• Unexplained bruises, bleeding or cuts on the genitals, anus or breasts
• Sexually transmitted infections

Fear of a certain person or people. Psychological or Emotional Abuse Emotional abuse can include yelling, using humiliating or degrading terms or names, making a person feel frightened or using threats to force a person to comply with your wishes.

Signs of emotional abuse can include:

• Excessive compliance or wanting to please
• Expressions of fear
• Withdrawal
• Low self-esteem

Financial Abuse

Financial abuse can include stealing, using deception, convincing or pressuring a person to give you money or items of value, preventing the person from accessing their money or acting dishonestly in the role of power of attorney. It can be committed by family members or staff members.

Signs of financial abuse include:

• Having less or no money to spend
• Items and money going missing.
• Excessive worrying over money

Neglect

Neglect happens when a person who is responsible for providing care to the person deliberately withholds care, food, warmth, social interactions or other basic needs.

Signs of neglect include:

• Weight loss
• Dehydration
• Poor personal hygiene
• Medical problems such as pain left untreated.

Activity

Review Questions

1. Give an example of a myth or stereotype that contributes to devaluation of older people.
2. Give two examples of what you can do to reduce the effect of devaluation.
3. Give two signs of sexual abuse that you might notice in a person who cannot talk to you.
4. Explain the meaning of mandatory reporting.
5. Give two examples of how you can encourage a person in aged care to find friends.