When Should You Refer a Home Dialyzor to the Social Worker?

In a recent blog by Dori Schatell, she referred to the wave of emotions that patients have that must be addressed to provide CKD education. Social workers wear many hats in most dialysis clinics. One of the often overlooked hats the social worker wears is as the on-staff mental health professional. Many people in dialysis—patients and staff alike—do not realize that social workers provide most of the mental health counseling in the U.S. Social workers who work in dialysis have training to help them address home dialyzors’ emotions.

One of the most common emotions in those on dialysis is depression. According to the NIMH, only 1.2% of those in the US are mildly depressed.¹ Compare this to the Dialysis Outcomes and Practice Patterns that found that 43% of those receiving in-center hemodialysis are mildly depressed. ² It’s important for staff and patients to recognize the signs and symptoms of depression and to reach out to the dialysis social worker first for help.

So what signs or symptoms should you look for? Does the patient look sad or anxious? Does s/he express feelings of hopelessness, helplessness, or worthlessness? Does s/he indicate no pleasure in doing things that s/he previously enjoyed? Does s/he talk about sleeping too much or too little and feeling tired all the time? Does s/he complain of a loss of appetite? Although it’s easy to attribute these to inadequate dialysis or anemia, it’s also possible that the patient is depressed. It’s time to call in the social worker to assess whether depression is present. If so, the social worker may be able to pull a “tool” out of his/her “toolbox” to address the patient’s depression.

Some people on dialysis are in denial. Although many of us believe denial is not a good coping means, recent research found that those patients who don’t have other coping mechanisms may use denial to avoid feeling anxious or depressed and its use is not harmful.³ However, when denial prevents someone from sticking to their treatment plan, the social worker can help the patient learn other ways to cope.

Some home dialyzors may be angry about being on dialysis. They may feel as if they have been betrayed—by doctors, the healthcare system, their body, or even God. Women are socialized to not express anger easily. Men may express depression as anger. Anger can lead to problems relating to spouse and/or family and dialysis staff. It can put patients at risk of involuntary discharge. The social worker can help the patient identify the source of the anger and look for ways to overcome it.

Home dialysis is seen as a way to regain some degree of control over one’s life and schedule with home dialysis. However, it’s not uncommon for home dialyzors to feel uncertain about their ability to self-cannulate without problems and to deal with all possible emergencies, to worry about the burden on care partners, health setbacks, and many worry about how long and how well they’ll live. The social worker working with the rest of the home dialysis team can help the home dialyzor gain the confidence and competence s/he needs to have a positive home dialysis experience.

The National Institute for Mental Health is a great resources for information that can help you identify signs or symptoms in your patients that your social worker could address to reduce their discomfort. Mindfulness teaches us:

“If you are depressed you are living in the past.
If you are anxious you are living in the future.
If you are at peace you are living in the present.”

Lao Tzu