| 2005 White
House Conference on Aging
Post-Event Summary Report
Spanish Version
Name of Event: Geriatric Mental Health Foundation
Conference
Date of Event: March 3, 2005
Location of Event: San Diego, California
Number of Persons attending: 120
Sponsoring Organizations: Geriatric Mental Health
Foundation; Older Adult Mental Health Consumer Alliance; University
of California, San Diego Division of Geriatric Psychiatry; San Diego
County Adult and Older Adult Mental Health Services; San Diego Coalition
for Older Adult Mental Health and Substance Abuse.
Contact Name: Catherine Paschal
Telephone Number: 301-654-7850 x114
Email: cpaschal@GMHFonline.org
Priority Issue:
The 2005 White House Conference on Aging mini-conference convened
by the Geriatric Mental Health Foundation in San Diego, California,
recommends that mental health care for older Americans of all cultures
be given a high national priority for funding, research, and workforce
development.
Barriers:
Mental illness is the leading threat to independence and quality
of life of older adults. In 2001, the Office of Inspector General
reported that the prevalence of mental illness among nursing home
residents is particularly high: Two-thirds of residents have diagnosable
mental disorders and one-fourth have depression. These startling
numbers demonstrate that fostering good mental health and providing
treatment and support in the community for those who have mental
illnesses are crucial for meeting the goals of older adults and
their families in their quest for a good quality of life and independence.
Numerous problems arise in this quest. Among them are a lack of
affordable, acceptable housing that provides necessary support;
a lack of affordable and acceptable home-based services and transportation
to meet the comprehensive needs of older adults, especially those
with mental health problems; and disincentives in the health care
system for professionals to enter geriatric mental health disciplines;
and inadequate community-based group activities and models such
as adult day centers, senior centers, life-long learning programs,
and mental wellness activities. Inadequate treatment and services
for those with late-life mental health problems have profound effects
on family members as well. Caregiving is often an enormous drain
on the financial security and health of family members, too many
of whom become depressed as a result.
The existing health care system is inadequate, inaccessible,
and inappropriate to meet existing mental health needs of older
adults. The Older Adults Subcommittee of the President’s
New Freedom Commission on Mental Health noted the need for integrated
mental health services in primary and long-term care since those
are the settings in which the vast majority of older adults receive
all health care services. A frail, older adult suffering from depression
is simply not going to be willing or able to take public transportation
to a mental health services center and wait there with young men
who are coping with psychosis and addictions. In any case, the vast
majority of mental health professionals are inadequately trained
to address the particular issues presented by older adults who typically
are dealing with numerous comorbidities that complicate their treatment.
The lack of cultural competence that is pervasive in the health
care system is an even greater problem in an area as sensitive as
mental health. Medicare discriminates against those with mental
illness by requiring beneficiaries to pay a 50% copayment for outpatient
mental health services, as opposed to a 20% copayment for all other
conditions. Finally, financial disincentives for mental health professionals
to treat older adults as well as the stigmas associated with mental
illness and old age have led to a serious shortage in the mental
health workforce for older adults and for inadequate training in
both mental health and primary care specialties.
Stigma and lack of cultural awareness limit access to quality
care, services, and treatment. People with mental illness have
experienced a long history of discrimination and stigma. As cited
in the final report of the President's New Freedom Commission on
Mental Health, "Achieving the Promise: Transforming Mental
Health Care in America," this practice has an even deeper impact
on those who are minorities, rural residents, and older adults.
Older adults themselves may be fearful of acknowledging that they
have a mental illness or seeking treatment because of a number of
concerns. They worry that if they identify themselves as in need
of mental health services, they may jeopardize their health care
and their insurance. Other fears include loss of financial security
and independence, embarrassment, further isolation, or of being
declared incompetent. The public view of mental illness in older
adults is intertwined with ageism. Stigma against older adults who
suffer a mental illness is enhanced by the combined "double
jeopardy" of society's negative views of aging and mental illness.
As a general population, older adults experience discrimination.
Older adults are subject to stereotypes of being childish, resistant
to change, stubborn, and requiring many resources. Yet, older adults
with mental illnesses are further isolated by society, viewed as
untreatable or not worth being treated for mental illness.
Proposed Solutions:
Funding. Much of the focus of the White House Conference
on Aging is on setting the stage for the baby boomer generation
to live into old age with good health and a good quality of life.
It is clear that some investments – both by the government
and by the private sector – must be undertaken to rectify
policies that lead to institutionalization and poor health outcomes.
Investments in better mental health will ultimately be cost efficient:
more seniors will be able to live in the community instead of in
institutions if they have appropriate housing and transportation,
if there are community centers to provide care and meaningful activities,
and if there are adequate and acceptable respite services for family
caregivers. Because mental illness aggravates and worsens a wide
range of medical conditions, mental health treatment is critical
to reducing hospital stays. Improvement of the quality of life of
older adults also demands that both the private and public sectors
of our society work to eliminate the stigma associated with late-life
mental illness through a national campaign and through requirements
for research and health services agencies to implement plans to
reduce stigma.
Research. The U.S. Surgeon General’s Report on Mental
Health (1999) and the Administration on Aging Report on Older Adults
and Mental Health (2001) underscore the prevalence of mental disorders
in older persons and provide evidence that research has led to the
development of effective treatments. These reports summarize research
findings showing that treatments are effective in relieving symptoms,
improving functioning, and enhancing quality of life. Preliminary
findings suggest that these interventions reduce the need for expensive
and intensive acute and long-term services. However, it is also
well demonstrated that there is a pronounced gap between research
findings on the most effective treatment interventions and implementation
by health care providers. This gap can be as long as 15 to 20 years.
These reports stress the need for translational and health services
research focused on identifying the most cost-effective interventions,
as well as creating effective methods for improving the quality
of health care practice in usual care settings. A major priority
is the development of a health services research agenda that examines
the effectiveness and costs of proven models of mental health service
delivery for older persons.
Workforce development. Workforce issues may be addressed
by expanding geriatric traineeships for psychiatrists, social workers,
nurses, psychologists and other health professionals and through
financial incentives such as loan forgiveness programs and continuing
education funding. To address problems of inadequate training for
general mental health practitioners and primary care providers,
the government and the education system should introduce geriatric
course work or rotation for all students that includes promotion
of evidence based and emerging best practices and skills in treating
people with co-occurring mental and addictive disorders. Finally,
it is crucial that disparities in reimbursement between geriatric
mental health, behavioral health and substance abuse practice and
other areas of mental health and health care practice be eliminated
in both the public and private sectors.
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