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Testimony

FY 2010 Appropriations for Mental Health Research and Services (Oral Testimony)

U.S. House Appropriations Subcommittee on Labor, Health and Human Services, and Education

Board Member Paul D. Kerwin, MD

3/18/2009

Written Testimony

Mr. Chairman and members of the Subcommittee, I am Dr. Paul Kirwin, a practicing geriatric psychiatrist and member of the Board of Directors of the American Association for Geriatric Psychiatry -- the AAGP. I am the Program Director of the Geriatric Psychiatry Fellowship, Department of Psychiatry at Yale University School of Medicine.

AAGP appreciates the work this Subcommittee has done in recent years in support of funding for research and services in the area of mental health and aging.

It’s a distinct privilege to share with you today the need for our nation to focus attention on the mental health of our elderly citizens.

As medical school faculty, I often ask my students if they have a grandparent still alive because a connection to a person we know and love makes the abstract real and personal. As I look to this committee I can imagine that some of you have an aging parent or grandparent that might one day need assistance with their emotional health. Like patients I saw yesterday… the decorated Korean War veteran frozen with Parkinson’s disease, isolated in a nursing home by illness and circumstance; or the 79-year-old man fighting depression in the context of recently diagnosed prostate cancer; or the 80-year-old woman struggling to hold on to names and memories of those dear to her as dementia takes its ruthless, irreversible hold.

These could be our loved ones: the favorite, raucous uncle who took you skiing with your cousins, the grandmother who had everyone to her house for Sunday dinner, and the mother who laughed and cried with joy as you stepped off that graduation podium. They are with us now—the mental health of our nation’s aging population is not an abstract issue. Illness knows no boundaries.

As you know the baby boom generation is nearing retirement. Shortly, there will be approximately 40 million people in the United States over the age of 65. Over 20 percent of those people will experience mental health diseases and disorders. The economic, emotional, and family costs of dealing with late-life mental illnesses are staggering. Efforts to prevent and treat these disorders are critical to our nation’s health.

AAGP believes that three key issues need to be addressed.

First – workforce issues. Last spring, the Institute of Medicine released a study of the readiness of the nation’s healthcare workforce to meet the needs of its aging population, which called for immediate investments in preparing our health care system to care for older Americans and their families.

While providing vital information on the many issues regarding the health workforce for older adults, that 2008 report did not delve deeply into the composition of the mental health workforce needed to meet future needs of the elderly. The small numbers of specialists in geriatric mental health foretells a crisis in health care that will impact older adults and their families nationwide. AAGP believes that a complementary study must be undertaken to consider this vital area of concern. We have the support of IOM for this study and have been advised by IOM staff that the study would cost approximately $1 million.

Second -- the lack of funding for mental health research focused on older adults. Funding increases for NIH and the NIMH did not result in comparable increases in funding that specifically address problems of older adults. If current trends in research funding for aging and mental health continue at NIMH, we will dramatically fall behind in our need to understand the causes of mental health problems in older persons and develop effective prevention and treatment.

As NIMH utilizes the new funding from the recently enacted economic stimulus bill and as Congress considers FY 2010 funding levels, it is essential that a portion of those funds be invested in evidence-based treatments for our nation’s seniors to address an unprecedented explosion in the number of people over age 65 with potentially disabling chronic mental illnesses.

Third: the need for adequate funding for the mental health outreach and treatment program for the elderly under the Center for Mental Health Services. Adequate funding for this geriatric mental health services initiative is essential to disseminate and implement evidence-based practices in routine clinical settings across the states. We urge that the $5 million currently provided for this program should be increased to $20 million for FY 2010.

I would like to thank the Subcommittee for the opportunity to testify today, and I will be happy to answer any questions that you may have.

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