However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive.

Worldwide 46.8 million persons are living with dementia and many are requiring assistance with performing daily living or instrumental functions. It is often the task of family members to provide care for their relatives with dementia. However, they are often the silent, unseen and unacknowledged figures in the lives of people living with dementia. In 2015, we used a phenomenological design utilising visual participatory methods in the form of collages and interviews to explore and describe the transition experiences of eight family members (seven females and one male) living in a South African city regarding how they became caregivers of their relatives with dementia. They often entered their caregiving roles unexpectedly, often not having much choice regarding whether or not to take on the caregiving role. Family members caring for relatives with dementia have unique support needs as they transition into the caregiving role.

As mental health care nurses (MHCNs), guided by Zubin and Spring's (1977) stress vulnerability model, we are acutely aware of the coronavirus disease 2019 (COVID-19) pandemic as a stressor influencing both the physical and the mental health of the elderly, increasing their vulnerability. The stress vulnerability model describes three critical factors that influence the emergence of symptomatology, namely: stressors, protective factors and vulnerability (Anderson, Ramo & Brown 2006). A year ago, in 2020, global protective initiatives to curb the spread of the virus in the elderly involved restrictions of movements (CDC 2020; WHO 2020), which appeared counter to their mental health needs. The restrictions were protective in nature, but highlighted the elderly's psychosocial vulnerability contributing to loneliness, anxiety, depression and accelerating dementia (Carbone 2020), which created a need for counselling (Galea, Merchant & Lurie 2020). Counselling, a further protective factor, is critical in mitigating the mental health effects of COVID-19 (Schlögl & Jones 2020), and in so doing, attempts to flatten the mental-illness curve. However, we as MHCNs in the mental healthcare facilities experienced a challenge in executing our roles as counsellors to the elderly. The beneficent intent of the World Health Organization (WHO) guidelines and the South African Government COVID-19 regulations (SA Gov 2020) is to decrease the contagion of the virus through, inter-alia, the physical barrier of mandatory mask-wearing. However, an unintended negative barrier manifested in the interruption of non-verbal communication.Mask wearing is familiar to nurses, and infection control is not a new practice (Karimi & Alavi 2015). However, the context was unfamiliar and initially novel for people not in health care. As unusual as it was for us as MHCNs to wear a mask while counselling, it was strange for the elderly. At the start of the pandemic, as MHCNs, we functioned in a trial and error, survival mode, similar to the uncertainty described by nurses in other specialities (Nelson, Hubbard Murdoch & Norman 2021). As we began counselling the elderly, our practice could be likened to unconscious incompetence as described in the stages of learning (Peel & Nolan 2015). We did not consider or reflect on the mask's influence on psychosocial counselling and the need for practice changes. As the pandemic continued, through reflections-on-actions (Fitzgerald 1994), while we were counselling the elderly with both parties wearing masks, we became conscious of what was challenging our previously considered level of competency. In this commentary, we aim to The stressors caused by the coronavirus disease 2019 (COVID-19) pandemic have influenced both the physical and the mental health of the elderly, increasing their vulnerability. Counselling by the mental healthcare nurse is a critical protective factor in mitigating the mental health effects of COVID-19. However, counselling is unintentionally interrupted by the effects of the mask as a barrier t...

The findings showed that inter-professional collaboration is an important aspect of successful inpatient adolescent therapy programmes. Such programmes benefit from the involvement of a wide variety of professionals. However, professionals who are part of a multi-professional team need to be suitably skilled and prepared to meet the needs of the adolescent. Professionals working in therapy programmes for adolescents should have certain personal attributes that make them suitable for working with adolescents. An adolescent inpatient therapy programme requires a team leader or a coordinator to lead the programme to ensure its success. Continuous assessment of each adolescent is essential. Therapy should take place in an adolescent-friendly environment and should be structured yet flexible. The involvement of the adolescents' families is critical, and the programme should be designed with the family in mind. Group therapy is a major component of an adolescent therapy programme and individual therapy is also an important aspect of the programme. Finally, adolescents should only take part in the programme for a short time to avoid institutionalisation.