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Focus on Geriatric Mental Health: Testimony Regarding the New York State Office of Mental Health’s 5-Year Plan, June 4, 2004Michael B. Friedman, our public policy consultant, gave this testimony to a hearing of the New York State Office of Mental Health, June 4, 2004. My name is Michael Friedman. I am the Chairman of the Geriatric Mental Health Alliance of New York. The Center for Policy and Advocacy of The Mental Health Associations of New York City and Westchester convened the Alliance at the end of 2003. Our goal is to develop, and advocate for, changes in mental health policy that are essential in order to respond adequately to the mental health needs of older adults, both now and when the elder boom hits. We appreciate the opportunity to testify today and to share with the Office of Mental Health (OMH) our deep concern that the 5-Year Plan, which is the first “population- based” plan offered by OMH, does not relate to the mental health needs of older adults (except by reference to a short document prepared by OMH for the State Office of the Aging’s 2015 Plan.) As we all know, older adults are the fastest growing population in the nation. Their numbers will increase nationally from 35 million to 70 million between 2000 and 2030. And as a proportion of the population, they will grow from 13% today to 20% by 2030. Consequently, the numbers of older adults with mental illnesses will grow nationally from approximately 7 million to approximately 14 million. (For more information on this, read our Briefing Book entitled Geriatric Mental Health Policy for the 21st Century, which includes background information about demographics, prevalence, utilization and frequently identified issues.) Because current mental health services for older adults are generally inadequate and in order to avert the mental health crisis which otherwise will occur when the elder boom hits, we believe that it is essential for OMH to focus considerable attention on issues of geriatric mental health. As a first step, we urge you to include a separate section on aging in next year’s 5.07 plan. To develop this plan, there are a number of critical factors which OMH should address, some of which I will discuss now, others of which you can find in our report “Issues in Geriatric Mental Health Policy". Diverse Population Older adults with mental health problems are a diverse population. Some are people with serious and persistent mental illnesses who are facing new issues as they age. Some are people, many of them isolated and homebound, suffering from severe anxiety and/or depressive disorders. Some are people with less severe, but still troubling, diagnosable disorders. And some are people who will develop potentially preventable mental illnesses. We believe that OMH should focus attention on the service needs of all these populations and also pursue opportunities for prevention including suicide and accident prevention, relapse prevention, prevention of disability, and even primary prevention. Community Support We share OMH’s strong commitment to helping people with mental illnesses to live in the community and believe that this commitment should be as strong with regard to older adults as to younger adults. For aging people with serious and persistent mental illnesses, however, this will entail modifying community support concepts and models. For example, the concept of “recovery” may need to be modified to apply appropriately to older people who prefer “retirement” to vocational rehabilitation. The community support philosophy that was developed for people with serious and persistent mental illness should also, we believe, be extended to other older adults with functional limitations so as to help them “age in place.” In this regard, there is a great opportunity for OMH to provide leadership in the field of aging. Housing Central to helping aging people with mental illness to lead satisfying lives in the community is assuring the availability of appropriate housing. In this regard we believe that New York State should do far more than it has to date to address the adult home scandal and to examine the adequacy of mental health services in nursing homes. In addition we urge OMH to review its current housing models and to develop new models, which are responsive to the needs of older adults, especially those with co- occurring, chronic physical conditions. Family Support In building greater community support, OMH also needs to address the needs of family members and caregivers. Remaining in the community frequently depends on the ability of families to care for aging, mentally ill relatives. But these family caregivers are themselves at high risk for depression. They need support to reduce stress, and they need treatment when they develop mental disorders. Integrated Services Most older adults with mental health problems also have chronic physical problems. And most older adults who seek treatment for mental health problems turn to their primary care physicians rather than to mental health professionals. For these reasons it is critical to build linkages between mental health and health services, indeed to design new structures of service which are inherently integrated. Similarly, many of the needs of older adults with mental health problems are addressed through the “aging” service system. This system offers potential for prevention, opportunities for identification, sites for community-based treatment, and more. Linkages and new, integrated service models between mental health and aging are, we believe, a key to better service provision. In general we believe that developing models that bring together mental health, health, and social services is essential to responding adequately to the mental health needs of older adults. We urge OMH to take the lead in seeking such models. We also urge OMH to take the lead and advocate for an administrative infrastructure at the state level bringing together the Departments of Mental Hygiene, Health, and Aging. Access and Utilization Older adults underutilize mental health services for a variety of reasons including barriers to accessing services and their personal choice not to seek mental health services. Barriers include:
Older adults with mental health problems, their families and their primary care physicians choose not to use available mental health services because:
In order to respond to these problems it is essential to provide widespread public education about geriatric mental health. It is also essential to address issues of capacity, mobility, access to medication, and affordability. Workforce Issues There is a tremendous shortage of competent staff to provide services to older adults with mental health problems. We urge OMH to develop an initiative to promote careers in geriatric mental health and to develop new roles for mental health professionals and for paraprofessionals and volunteers, including the use of older adults themselves. We believe, for example, that it would be very valuable to develop a role for older adults comparable to the peer worker positions that OMH created for people with serious mental illnesses. Competence Of particular concern is the clinical and cultural competence of those who provide mental health services for older adults. It is essential, we believe, for OMH to extend its Winds of Change program (as promised in the 2015 plan) to promote the use of state-of-the-art practices regarding geriatric mental health. (See Psychiatric Clinics of America, Volume 26, Number 4, December 2003 for a recent review of evidence-based mental health practices for older adults.) It is also essential to anticipate that issues of cultural competence will become more and more important as minorities and immigrants become a larger and larger portion of the geriatric population. Finance Finally we believe that OMH should address problems of the methods of finance currently used for geriatric mental health services. In general, financing models need to be redesigned to align with service models and clinical goals. This includes:
OMH Leadership We believe that there is a great need and opportunity for OMH to provide leadership in preparing NYS to meet the mental health needs of older New Yorkers. We urge OMH to seize the opportunity by:
Thank you again for the opportunity to speak today. Return to the top of the page.
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