Behavioral Health Basics: Mood, Trauma and Person-Centered Support
Notice changes in mood, act on suicide warning signs right away, and support residents with trauma, mental illness or substance use.
ForNursing home staff
TimeAbout 65 minutes
Lessons8, each with a quick check
FinishA quiz (80% to pass) and a printable certificate of completion
What you will learn
Explain behavioral health in your own words.
Know that depression is common but not normal in older adults.
Take every mention of suicide or self-harm seriously.
Know that loneliness and isolation are linked to depression.
Explain trauma and trauma-informed care.
Use non-drug approaches to support mood and calm.
Treat residents with mental illness or substance use disorders with respect.
Recognize stress and burnout in yourself and others.
Written by Pact Compliance from federal rules and CDC, CMS, OSHA and NIH guidance (sources under each lesson), checked October 2026. Where your facility's policy is different, follow your facility's policy.
Lesson 1: What Behavioral Health Means
In this lesson you will:
Explain behavioral health in your own words.
Know that behavioral health care is part of every resident's care.
Know your role: notice, support and report.
Whole person
Mind and mood
Behavioral health means a person's whole emotional and mental well-being. The federal rule says it includes, but is not limited to, preventing and treating mental disorders and substance use disorders. Every resident has behavioral health, just like every resident has physical health. Some residents have a diagnosis, like depression, anxiety, bipolar disorder, schizophrenia, or PTSD. Others may be grieving, lonely, or scared.
The goal
Best possible
The rule says each resident must get the behavioral health care and services they need. The goal is for each person to reach or keep their highest practicable physical, mental, and psychosocial well-being. Highest practicable means the best they can be, given their health. Psychosocial means how a person feels and how they connect with others.
Show the answer
Playing a resident's favorite music to help her feel calm. Non-pharmacological means approaches that are not medicine.
Staff skills
Required
Nursing homes must have enough staff with the right skills to meet these needs. The rule names skills like caring for residents with mental and psychosocial disorders, and residents with a history of trauma or PTSD. It also names using non-pharmacological interventions. That means ways to help that are not medicine. Behavioral health training must match the needs the facility found in its assessment.
What training covers
Core skills
CMS lists the minimum skills for behavioral health training. Person-centered care that reflects the resident's goals. Communication that supports mental well-being. Meaningful activities that build engagement and good relationships. A setting that supports mental well-being. Non-drug approaches. And care for each person's needs, including mental illness, substance use, trauma, and dementia.
Watch for patterns
New changes
The rule also says a resident without a known mental health problem should not show a pattern of pulling away from people. The same goes for becoming more withdrawn, angry, or depressed, unless their condition made it unavoidable. So when you see these changes, they matter. Your job is to notice them and tell your nurse.
Your role
Notice, support, report
You are not expected to diagnose or treat. You are expected to notice, support, and report. Notice changes in mood, sleep, eating, and behavior. Support the person with kindness, respect, routine, and the approaches in their care plan. Report what you see to your nurse, with facts and the person's own words.
On your shift
A small change
Mrs. Cole has always chatted with you during morning care. This week she barely answers. She leaves most of her breakfast and stays in bed. You don't know why. You don't need to. You say, 'You seem quieter this week. I'm here if you want to talk.' Then you tell your nurse exactly what you've seen, and since when.
Quick review
Whole well-being
Let's review. Behavioral health is a person's whole emotional and mental well-being, including mental illness and substance use. Every resident should get the behavioral health care they need. Staff need skills in mental health, trauma, and non-drug approaches. Watch for new patterns of withdrawal, anger, or sadness. Notice, support, and report.
Lesson 2: Depression Is Not a Normal Part of Aging
In this lesson you will:
Know that depression is common but not normal in older adults.
Recognize signs of depression, including ones that look physical.
Report signs to your nurse.
Common
Not normal
NIA says depression is a common problem among older adults, but it is not a normal part of aging. In fact, most older adults feel satisfied with their lives, even with more illness or physical problems. Depression is a serious mood disorder. It can change how a person feels, acts, and thinks. It is also treatable. NIA says most people get better with treatment.
Risk factors
Who is at risk
NIA lists things linked to a higher risk of depression. They include medical conditions like stroke or cancer, sleep problems, and loneliness and social isolation. They also include not being active, and having trouble with daily activities. Many nursing home residents have several of these. Big losses, like moving from home, losing a spouse, or losing independence, can play a part too.
Show the answer
Possible depression, which can show up as physical complaints. Tell your nurse. NIA says depression in older adults may show mainly as aches and loss of interest.
Signs
Mood and energy
Common signs NIA lists include a sad, anxious, or 'empty' mood that won't go away, and feeling hopeless, guilty, worthless, or helpless. Others are being irritable or restless, losing interest in things they used to enjoy, and low energy. People may move or talk more slowly, or have trouble thinking, remembering, or deciding.
More signs
Sleep and eating
Other signs include trouble sleeping, waking very early, or sleeping too much. Eating more or less than usual, often with weight change. Using more alcohol or drugs. And thoughts of death or suicide, or suicide attempts. NIA says if several signs last more than two weeks, they should be checked by a doctor.
Hidden signs
Aches and pains
Depression in older adults can be hard to spot. NIA says sadness is not always the main sign. A person may seem numb, or lose interest, or not want to talk about feelings. In some cultures, depression may show up mostly as physical problems. Examples are aches and pains, headaches, cramps, or stomach problems. So 'I just don't feel well' can be a clue.
With dementia
Watch closely
NIA says depression is common in people with Alzheimer's and other dementias. Dementia can cause some of the same symptoms as depression, so it can be hard to tell them apart. Suicide attempts may also increase in people recently diagnosed with dementia. Report mood changes in residents with dementia, too. Don't assume it's just the dementia.
What you can do
Support and report
You can't treat depression, but you can help. Report what you see to your nurse: the signs, how long, and what the person said. Offer activities the person used to enjoy, but don't force them. Invite them to walk, if they can. NIA says physical activity can boost mood. Listen. Spend a few extra minutes. Small kindness matters.
Quick review
Notice and tell
Let's review. Depression is common but not a normal part of aging, and it is treatable. Risks include illness, loneliness, loss, and poor sleep. Signs include lasting sadness, loss of interest, low energy, sleep and appetite changes, and thoughts of death. It can look like aches and pains. It's common in dementia. Support the person, and report what you see.
Lesson 3: Suicide Warning Signs: What to Do Right Now
In this lesson you will:
Take every mention of suicide or self-harm seriously.
Ask directly and stay with the person.
Get help right away: your nurse, your emergency process, 911 or 988.
Take it seriously
Every time
NIA says that if serious depression is not treated, it can lead to death by suicide. Thoughts of death or suicide are a sign of depression. If a resident says anything about wanting to die, not wanting to live, or hurting themselves, take it seriously. Every time. Do not assume they are joking, confused, or 'just old.'
Warning words
Listen for them
Listen for words like: 'I want to die.' 'I'd be better off dead.' 'I won't be a burden much longer.' 'What's the point?' Watch for actions too, like giving things away, saying goodbye, or saving up pills. Also watch for the depression signs from the last lesson. Trust your gut. If something feels wrong, act.
Show the answer
Yes. Asking will not make her more likely to act, and it may help her open up. NIA says asking about suicidal thoughts does not increase the risk.
It's OK to ask
Ask directly
Many people are afraid that asking about suicide will put the idea in someone's head. NIA says asking if someone is having thoughts of suicide will not make them more likely to act on those thoughts. Asking may help the person open up. You can say, gently, 'Are you thinking about hurting yourself?' or 'Are you thinking about suicide?'
Stay with them
Get the nurse
If a resident says yes, or you are worried, do not leave them alone. Stay calm. Listen. Don't argue or lecture. Call your nurse right away. Use your call light or ask a coworker to get the nurse, so you can stay. Follow your facility's steps. Move anything they could use to hurt themselves out of reach, if you can do it safely.
Emergency
Call 911
If there is immediate danger, like a resident with a weapon, pills in hand, or who has already hurt themselves, it is an emergency. NIMH says in life-threatening situations, call 911. In a facility, follow your emergency process. In a home, call 911 first, then your agency. Your safety matters too. Don't try to take a weapon from someone by force.
988
Crisis line
The 988 Suicide and Crisis Lifeline is available 24 hours a day. NIA and NIMH say you can call or text 988, or chat at 988lifeline.org. For TTY, use your relay service or dial 711, then 988. 988 can help residents, families, and you. In a facility, 988 does not replace telling your nurse. Do both.
After
Report and follow up
Tell your nurse exactly what the resident said and did, in their own words, and when. Write it down as your facility says. Keep checking on the resident as the care plan says. And take care of yourself. These moments are hard. Talk to your supervisor, and reach out to 988 yourself if you need to.
Quick review
Ask, stay, get help
Let's review. Take every mention of suicide or self-harm seriously. Listen for warning words and watch for warning actions. It's OK to ask directly. Asking does not raise the risk. Stay with the person and get your nurse right away. In immediate danger, use your emergency process or call 911. 988 is there, any time, for anyone.
Your facility's policy (ask your supervisor):
Your facility's exact steps when a resident talks about suicide or self-harm
Know that loneliness and isolation are linked to depression.
Help residents stay connected to people and activities they value.
Report residents who pull away.
Connection
A basic need
NIA says everyone needs social connections to survive and thrive. As people age, they often spend more time alone. Studies show that loneliness and social isolation are linked to a higher risk of depression. Moving into a nursing home can mean losing neighbors, friends, church, and routines all at once.
Signs
Pulling away
Watch for residents who stay in their rooms, stop coming to meals or activities, or stop calling family. Watch for residents who have few or no visitors. The rule says residents should not develop a pattern of decreased social interaction unless their condition makes it unavoidable. So a resident who pulls away is a change to report.
Show the answer
Tell your nurse, and look for small ways to connect her with people and activities she might enjoy. A pattern of less social contact should be reported, and connection helps.
Their rights
To connect
Residents have rights that support connection. They can have visitors they choose. They can join activities inside and outside the facility. They can join resident and family groups. They can use phones and video calls in private. Your job is to make these rights real, every day.
Small moments
Big impact
Connection does not have to be big. Learn one thing about each resident's life and ask about it. 'How's your grandson's baseball team doing?' Sit for a minute when you can. Share a smile. Use their name. Introduce residents with something in common, like two retired teachers or two fans of the same team.
Meaningful activity
Their interests
CMS says behavioral health care should include meaningful activities that build engagement and good relationships. Meaningful means it matters to that person. Bingo is great for some. Others want to fold laundry, read the paper, pray, garden, or listen to old music. Tell the activities staff what you learn about what a resident likes.
Help them reach out
Calls and visits
Help residents keep up with the people they love. Charge their phone. Help set up a video call. Help write a card. Remind them when a family member is coming. If a resident has no visitors, ask your nurse or social worker about volunteer visitors or other programs your facility has.
On your shift
Two minutes
Mr. Ames sits alone at the end of the hall every afternoon. You learn he was a mail carrier for 30 years. Next time you pass, you say, 'Mr. Ames, did you ever deliver in the snow?' He lights up and tells you a story. Two minutes. That's what connection can look like. Then tell activities staff he might enjoy a men's coffee group.
Groups
Resident council
Residents have the right to organize and take part in resident groups, and families have the right to take part in family groups. The facility must give these groups a private place to meet, and help let people know when meetings are. Let residents know when the resident council meets, and help them get there if they want to go. Groups give residents a voice, and a way to connect with each other.
Quick review
Stay connected
Let's review. Loneliness and isolation are linked to depression. Watch for residents who pull away, and report it. Residents have the right to visitors, activities, groups, and private calls. Small moments of connection matter. Help residents find activities that are meaningful to them. And help them stay in touch with people they love.
Use safety, trust, choice and collaboration to avoid triggers.
Trauma
Lasting effects
CMS describes trauma as an event, or a series of events, that a person experiences as physically or emotionally harmful or life threatening. Trauma can have lasting effects on how a person functions and on their mental, physical, social, emotional, or spiritual well-being. CMS cites a federal estimate that 70 percent of U.S. adults have had some kind of traumatic event at least once.
Survivors
Among residents
CMS lists examples of trauma survivors who may live in nursing homes. Military veterans. Survivors of natural disasters or violent crime. Holocaust survivors. Survivors of physical, sexual, or mental abuse, in the past or now. People who have been in prison or homeless, or who have suffered the traumatic loss of a loved one.
Show the answer
Care by a man may be a trigger. Stop, reassure her, and tell the nurse. Trauma-informed care seeks to remove or reduce triggers that cause re-traumatization.
The rule
Avoid re-traumatizing
The federal rule says residents who are trauma survivors must get culturally competent, trauma-informed care. That care must account for their experiences and preferences. The goal is to remove or reduce triggers that may cause re-traumatization. A trigger is something that brings back the feelings of a past trauma, like a sound, a touch, a smell, or a kind of care.
Common triggers
In daily care
Daily care can be full of possible triggers. Being undressed by a stranger. Being touched without warning. A door locked or a curtain closed. A loud alarm. A man giving care to a woman who was abused by a man. Bathing, toileting, and nighttime checks can be especially hard for some survivors. The care plan should name known triggers for each resident.
Safety and trust
Principles
CMS lists principles of trauma-informed care. Safety: help the resident feel physically and emotionally safe. Trustworthiness and transparency: build trust with clear, open communication. Explain what you will do before you do it, and keep your word. These sound simple. They mean a lot to someone who has been hurt.
Choice and voice
Partnership
Other principles are collaboration and empowerment, voice, and choice. Collaboration means partnering with the resident and their family in planning care. Empowerment means honoring their choices and building on their strengths. So ask: 'Would you like a woman or a man to help with your shower?' 'Would you like the door open or closed?' Small choices give back a sense of control.
When triggered
Stop and support
If a resident suddenly becomes scared, panicked, or angry during care, it may be a trigger. Stop. Step back. Speak calmly. Tell them they are safe and that you will not continue until they are ready. Do not force care. Afterward, tell your nurse what happened, what you were doing, and what seemed to help, so the care plan can be updated.
Quick review
Safe, trusted, chosen
Let's review. Trauma is a harmful or life-threatening experience with lasting effects. Many residents are trauma survivors, such as veterans and abuse survivors. Trauma-informed care is required. Its goal is to reduce triggers. Use safety, trust, collaboration, and choice. If a resident is triggered, stop, support, and report.
The rule says staff need knowledge and training in non-pharmacological interventions. Those are ways to help that are not medicine. CMS says behavioral health training should include individualized, non-drug approaches to care. Individualized means fitted to the person. What calms one resident may upset another.
Music and memories
Familiar things
NIA suggests music, a favorite TV show, a book, or looking at photos to help calm or redirect a person. Familiar things, like well-loved objects and photos, can make a space feel safe. Ask families for favorite songs, old photos, or stories. A playlist from a resident's teenage years can work wonders.
Show the answer
Play some of her favorite music during the afternoon. Familiar music is a non-drug approach NIA suggests.
Move the body
Mood lifts
NIA says physical activity can improve mood and sleep, and can be great for boosting mood. A short walk, a stretch, a chair exercise group, or a trip outside can help. Follow the care plan and safety rules for each resident. Some residents also like useful tasks, like folding towels, setting tables, or watering plants.
Calm spaces
Less noise
CMS says care should include an environment that supports mental and psychosocial well-being. NIA says to reduce noise and clutter, and let in natural light during the day. Turn off TVs nobody is watching. Lower your voice. Dim lights at night. A calm space helps calm people.
Routine
Predictable days
NIA suggests keeping to a routine, such as bathing, dressing, and eating at the same times each day. Predictable days help many people feel safe, especially people with anxiety or dementia. Routines should be built around the resident's own choices. When the routine must change, explain it and give extra support.
Listen
Be present
Sometimes the best approach is simply to listen. CMS lists communication that promotes mental and psychosocial well-being as a core skill. Sit down. Make eye contact if it fits the person's culture. Let them talk. Repeat back what you hear. 'It sounds like you really miss your home.' Feeling heard can ease worry.
Care plan
Use it, add on
Each resident's care plan should list the approaches that work for them. Read it, and use them. When you find something new that helps, like a song, a snack, or a certain word, tell your nurse so it can be added. When something in the plan stops working, tell your nurse too. You are part of building the plan.
On your shift
Try, then tell
Mrs. King gets tearful every evening and asks for her husband, who died years ago. You try sitting with her, looking at her wedding photo together, and letting her talk about him. She smiles and settles. You tell your nurse, 'Looking at her wedding photo and talking about Frank helps her in the evening.' Now the whole team can use what you learned.
Quick review
Try these first
Let's review. Non-drug approaches are a required skill, and they should fit each person. Music, photos, and familiar things can calm and comfort. Physical activity can lift mood and help sleep. Calm spaces and steady routines help people feel safe. Listening is powerful. Use the care plan's approaches, and add what you learn.
Lesson 7: Mental Illness and Substance Use: Respect and Support
In this lesson you will:
Treat residents with mental illness or substance use disorders with respect.
Follow the care plan and report changes.
Avoid labels and judgment.
Respect
No labels
Some residents live with a mental illness, like schizophrenia, bipolar disorder, major depression, or PTSD. Some have a substance use disorder, like alcohol or opioid use disorder. These are health conditions. They are not character flaws. NIMH says depression is an illness that can affect anyone, regardless of age, race, income, culture, or education. Avoid labels like 'the psych patient' or 'the drunk.' Use the person's name.
Right care
Their plan
The rule says a resident who has, or shows signs of, a mental disorder or psychosocial adjustment difficulty must get the right treatment and services. This also applies to a resident with a history of trauma or PTSD. CMS says care should match each person's needs. Know what each resident's care plan says about what helps them, what to avoid, and when to call the nurse.
Show the answer
Remind her to use his name. Labels like that are disrespectful and can harm care. Stigma and negative attitudes are risk factors for abuse.
Recovery
Treatment works
Many mental illnesses can be treated and managed. NIMH says depression can be treated with medicine, talk therapy, and other treatments. NIA says most people with depression get better with treatment. Recovery often means good days and hard days. Your steady, respectful support helps.
Substance use
Watch and report
Behavioral health includes preventing and treating substance use disorders. NIA notes that depression can be linked to using, misusing, or stopping alcohol or pain medicine. NIA also lists using more alcohol or drugs as a possible sign of depression. If you notice a resident drinking more, seeming intoxicated, or asking often for more pain pills, tell your nurse. Do not judge.
Talk with care
Calm and clear
Use the communication skills you have learned. Speak calmly and clearly. Use short, simple sentences. Listen and repeat back. If a resident is upset or says something that doesn't make sense to you, don't argue. Stay calm, keep everyone safe, and get your nurse if needed.
Stigma hurts
Speak up
Stigma means negative attitudes about a group. It can make people feel ashamed, alone, or afraid to ask for help. CMS lists negative attitudes toward people with disabilities and staff prejudice as factors that can lead to abuse. If you hear coworkers mock or talk down to residents with mental illness, speak up. Mocking a resident can be mental abuse.
On your shift
A steady presence
Mr. Long has bipolar disorder. On some days he talks fast and has big plans. On other days he is very low. You don't need to know his diagnosis to care for him well. Greet him by name, follow his routine and his care plan, and notice changes. Tell your nurse when he seems very different from his usual self, like not sleeping for days or talking about hopelessness.
Quick review
Person first
Let's review. Mental illness and substance use disorders are health conditions, not character flaws. Residents with these conditions must get the right care, matched to their needs. Treatment works, and recovery has ups and downs. Watch for changes, including more drinking or drug use, and report them without judgment. Use calm communication. And speak up against stigma.
Recognize stress and burnout in yourself and others.
Use healthy ways to cope and ask for help.
Know that 988 is there for staff too.
Hard work
Real stress
Caring for people is meaningful work. It is also hard. You may care for people who are sad, angry, scared, or dying. You may see things that stay with you. NIA says caregiving can be rewarding, but it can also be demanding, difficult, and stressful. Your well-being matters, for you and for the people you care for.
Stress and care
The link
CMS says abuse training must cover staff burnout, frustration, and stress, because they can lead to abuse and neglect. NIA says a caregiver under stress may not even notice they are being neglectful or abusive. Taking care of yourself is not selfish. It is part of giving safe care.
Show the answer
Stress and burnout can lead to rough or careless care. CMS and NIA both link caregiver stress to neglect and abuse risk.
Warning signs
In you
Watch for signs of stress in yourself. Feeling short-tempered, numb, or tired all the time. Dreading work. Trouble sleeping. Using more alcohol or other substances to cope. NIA lists some of these as signs of depression too. If these signs last, talk to someone you trust, and see a doctor.
Healthy coping
Small steps
Small steps help. NIA suggests making time to rest and taking care of your own needs. Take your breaks when you can. Eat and drink water during your shift. Move your body. NIA says physical activity can boost mood. Stay in touch with friends and family. Do things you enjoy on your days off.
Ask for help
At work
Tell your nurse or supervisor when a resident's care is wearing you down, or when your assignment isn't safe. CMS asks facilities how they encourage staff to raise concerns and ask for help in hard situations. Ask if your workplace has an employee assistance program or counseling. Asking for help early is a sign of strength.
Look out
For each other
Notice your coworkers too. Someone who seems unusually short, quiet, or tearful may be struggling. Ask, 'Are you OK? Do you want to talk?' Offer to help with a hard task. If a coworker says anything about wanting to die or hurting themselves, take it seriously and help them get support right away.
988 for you
Any time
The 988 Suicide and Crisis Lifeline is for anyone, including you. NIMH says if you or someone you know is struggling or having thoughts of suicide, call or text 988, or chat at 988lifeline.org. In a life-threatening situation, call 911. Depression is treatable. Help works.
Know your resources
Before you need them
Find out today what support your workplace offers. Is there an employee assistance program? A chaplain or social worker who supports staff? A quiet place to take a break? Save 988 in your phone. Knowing where to turn before a hard day comes makes it easier to reach out when it does.
Quick review
Care for you
Let's review. Caregiving is meaningful and stressful. Stress and burnout can lead to rough or careless care, so caring for yourself protects residents too. Know your warning signs. Rest, move, eat, and connect. Ask for help at work early. Look out for coworkers. And 988 is there for you, any time.
Answer every question. You need 80% to pass. You can try again as many times as you like.
Your quiz covers the lessons for: Nursing home ( questions). Change your setting
Please read
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state.
Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse.
California: it does not count toward CNA or HHA renewal hours.
Your name and quiz answers stay in your browser and are never sent to Pact.
Pact Compliance LLC, Cordova, TN
Certificate of Completion
This certifies that
completed the online in-service course
Behavioral Health Basics: Mood, Trauma and Person-Centered Support
Setting
Completed
Seat time
Quiz score
Certificate ID
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state. Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse. California: it does not count toward CNA or HHA renewal hours.
Part of this topic needs a hands-on check with your supervisor; this online course does not cover that part.
Pact does not keep a record of this certificate. Print it or save it as a PDF and give a copy to your supervisor. pactcompliance.com/free-training/behavioral-health-basics/
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