b'MENTAL HEALTHBIPOLAR DISORDER, NOT DEPRESSIONAuntie is an 83-year-old woman with dementia whose only family is a nephew who says he doesnt know her well. Auntie was quite unhappy about her move into long-term care, and she was tearful, asking repeatedly to go home. After a few months, staff became concerned about possible depression, and the family doctor started her on an antidepressant medication. There was no improvement. In fact, her requests to go home became more intense and irritable. She began yelling insults at staff using quite salty language. Her sleep worsened and, very unusually for her, she made a few sexual advances towards co-residents. A referral was made to the geriatric psychiatry outreach team for responsive behaviours in dementia. On review of her chart, they found a mention of a diagnosis of bipolar disorder in a hospital discharge summary from a decade earlier, but no other past mental health history. The antidepressant was stopped and treatment adjusted for management of bipolar disorder. Her symptoms resolved and she settled well into the home.people with mental health conditions to allow long-term care staff to deliver care with confidence and compassion.Within long-term care homes, the interdisciplinary team supports residents with mental health needs through a comprehensive approach focused on safe, effective, individualized care. It starts with education about mental health conditions, including an understanding of symptoms, treatments, side effects and evidence-informed approaches, and how to recognize a mental health crisis.Tools such as Mental Health First Aid, Gentle Persuasive Approach and other de-escalating techniques are invaluable. Behaviour mapping, such as the ABC model, helps identify triggers and interventions (what works, and what doesnt) and can further guide care from the long-term care team and their mental health supports. Care plans are most effective when they focus on consistency, routine and clear interventions to support autonomy, safety and well-being, with compassionately set boundaries. This work is often complicated by the combination of a mental health condition and dementia. It is not always straightforward to distinguish symptoms of a mental health condition (for example, psychosis and disorganization as symptoms of schizophrenia) from dementia with responsive behaviours. Getting it right is important, because the treatment approach is different.Another classic example is mania (see sidebar above), which presents quite atypically in older adults, often with intense www.oltca.com LONG TERM CARE TODAY 31'