Service Program for Older People

Approaching the Tipping Point: It’s Time to Re-Think Mental Health Care for Older Americans

By Nancy Harvey, LMSW Chief Executive Officer, Service Program for Older People

Published in the Spring 2019 Issue Behavioral Health News
http://mhnews.org/back_issues/BHN-Spring2019.pdf

The statistics are clear: Older adults are the fastest-growing segment of the U.S. population – in fact, Americans over age 65 will soon outnumber children. Data indicate that older adults are at increased risk for mental health disorders, and elder suicide in particular is a growing public health crisis, especially among men. The need for mental health care is clear, yet the health care community is poorly equipped to handle increased demand and the complex challenges of caring for a population that may be isolated, fearful of treatment, or unsure of how to seek help.

Now is the time for a national conversation about how to meet the growing need for mental health care for older adults. Preventive care and early intervention can save lives, improve overall health and quality of life, increase independence, and reduce unnecessary demand on the health care system. Recent high-profile suicides have shed light on mental illness and suicidality, and hospitals have a strong incentive to include behavioral health in discharge plans to reduce readmissions. The mental health community now has an opportunity to develop creative strategies to serve older adults.

As one of the longest-serving agencies in the U.S. entirely dedicated to meeting the mental health needs of older adults living in the community, Service Program for Older People/SPOP has unique experience in the field. SPOP was established in 1972 in New York City to provide comprehensive mental health care for adults age 55 and older, regardless of financial need, language, or disability. Our founding mission was to treat homebound seniors, and we have provided community-based care and home visits for nearly 50 years.

There is no shortage of mental health providers in our region for adults with financial means and a high degree of medical literacy; however for those who are financially-disadvantaged, homebound, non-English-speaking, or unfamiliar with the health care system, the options are limited. SPOP is often the only appropriate provider for a referral, and we are known for our service to the most fragile and marginalized older adults in the community.

Most important, SPOP has demonstrated that geriatric mental health care saves money. In a recent clinic survey half of all respondents reported decreased usage of hospital emergency rooms since the start of treatment, and nearly 90% reported that they are now equipped to handle daily problems more effectively – outcomes that have a direct impact on health care costs.

“Alice,” age 67, is an example of how SPOP works in the community. “Alice” is homebound due to severe arthritis and at the time of admission was identified as an emergency room “super utilizer” (more than four visits per year). She was diagnosed with an anxiety disorder, and during the weekly home visit with her therapist she worked toward treatment goals of learning to manage anxiety symptoms and develop coping skills and relaxation strategies. Over two years of treatment Alice has made only two emergency room visits, and she recently initiated discharge on the basis of having achieved her goals.

Drawing on our own experience in advocacy, direct service, and fostering strategic alliances, we recommend a broad discussion to explore ways to meet the fast-growing need for geriatric mental health care. Among the topics we might consider are:

• Addressing the shortage of qualified professionals trained in geriatric mental health care, including psychiatrists, nurse practitioners, and bilingual psychiatric social workers, and advocating for Medicare coverage for service at different credential levels (e.g. LMSW vs. LCSW)

• Expanding the use of technology and Medicare coverage for it, particularly telehealth in urban settings

• Creating a clear interface between Medicare and Medicaid for the dual-eligible population

• Educating government leaders and the philanthropic community on the need for funding for geriatric mental health • Advocacy to restore or increase Medicaid coverage for in-home treatment for clients who are disabled and homebound

• Correcting a “silo” mentality and fostering greater coordination between mental health systems and government agencies

A national conversation will be an important first step toward developing a plan to provide care for all older Americans. Strategies to provide service may vary in rural communities, senior residential facilities, or urban settings, but the need is universal: let’s work together to keep older adults healthy, independent, and engaged in the community.

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