Introduction Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern & Mental Health Foundation, 2006) and 40% suffer from depression (The Royal College of General Practitioners, 2014). Antidepressant prescribing has been reported to be nearly four times greater in care homes than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas, Malouf, McCleery & Dening, 2018). With two-thirds of care home residents having some form of dementia, there is a need to find alternative interventions. Talking therapies, such as counselling, may be a useful alternative. Method Adopting a qualitative approach using semi-structured interviews and focus groups with counsellors (N = 12) who have experience of working in this context and with care home managers (N = 3) and care teams (N = 6), this study aimed to explore the feasibility of implementing counselling in a care home setting. We explored the views of care home staff towards counselling and identify barriers to service implementation, alongside the experience of counsellors who have delivered counselling in care homes to understand what service delivery models are currently adopted. Data were analysed thematically. Results Findings fell under the following key themes: The funding and referral process for counselling in a care home; skills and competences required; training needs; adaptations to practice; barriers to implementing counselling in a care home. Conclusions It is timely to consider the role of psychological therapy in supporting the mental health of care home residents. There is a need for further research to explore a service delivery model of counselling in care homes.

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Chairman Dorfman: We thought that this subject was so broad and had so many ramifications that an attempt at complete coverage would result in nothing but a listing of the diseases in which ACTH and cortisone have been used. Therefore, it would seem instead worth while to consider general problems relating to ACTH and cortisone and then proceed to a discussion of a limited number of diseases. It is going to be difficult for us to give an expert opinion on every possible phase of this subject. We should consider first of all: (1) What type of therapy these drugs represent and (2) how the effects observed relate to the pathogenesis of the diseases in question. When the announcement of the effect of ACTH and cortisone was made in 1949, they were heralded widely by many people as a new approach to the disease state and consequently these agents were studied in a wide variety of apparently unrelated diseases. Originally there was great enthusiasm. I can recall attending the first Armour conference; it was more like attending a meeting of a mystic cult than a scientific meeting. Everybody arose and shouted, "I, too, have seen the miracle!" Since that time investigators have come to a more careful assessment of the usefulness of these drugs. We now are in the process of a swing toward a more pessimistic viewpoint, with some people saying, "they are not any good for anything, they are just poison and shouldn't be used at all." Most people who have thought about the problem feel that the truth lies somewhere between the extremes. ACTH and cortisone are not effective in all diseases.