Who Knows
An interview with Linda Powell, executive director of the Older Adult Consumer Mental Health Alliance, housed at the Bazelon Center for Mental Health Law; Paula Hartman-Stein, a clinical geropsychologist, who is president-elect for the American Psychological Association's Division of Clinical Geropsychology; and Eileen Elias, special expert in the Office of Planning, Policy and Budget at the Substance Abuse and Mental Health Services Administration (SAMHSA).
What are your biggest concerns about the mental health of senior citizens?
LP: My concerns are these: During the past 10 years, mental health advocates have been very successful in ensuring that more people have access to the new generation of new psychiatric medications. Many of these people are in the state mental health system. I see these consumers as a volcano, which will bulge higher and higher as these baby boomers begin to reach age 65. Medicare does not pay for these medications, so either there will be an "eruption" that will fall to the states to handle or many people will be without their medications.
PHS: The lack of integration between physical and psychological needs of patients is my biggest concern. The norm is that the primary care provider has the role of gatekeeper; if he/she thinks that a mental health specialist is needed, then a referral is made. The integrated system of care has a good chance of working if the behavioral and medical practitioners share the same office suite, but this is unrealistic in terms of widespread applicability at present. One solution is to have greater communication between practitioners via email and phone. Under Medicare regulations, the mental health practitioner is required to communicate with the referring physician, but I think it needs to go both ways. Another major concern is that older Americans often need behavioral services but do not receive them. Both depression and dementia often are missed in older adults.
EE: Government agencies-federal, state, regional and local-and public and private mental health and substance abuse providers need to understand the issues of aging. At this time the focus is primarily on addressing the mental health service needs of older adults. Other behavioral health issues-in particular, substance abuse and co-occurring substance abuse and mental disorders-are not of such high priority for this population.
What are the most pressing issues regarding the funding of mental health services?
PHS: Parity, parity, parity with medical treatment. Currently, Medicare pays for 80 percent of medical treatments and visits and only 50 percent for mental health treatment. This especially affects the indigent elderly because state Medicaid money often covers a paltry sum of the balance of the mental health care costs after the Medicare share is paid. Consequently, many practitioners do not accept Medicaid patients.
EE: All levels of government are inconsistently prioritizing the mental health needs of older adults. There is a lack of mental health service capacity. Mental health for older adults needs to be prioritized at the same level as for children and adults.
What are the three biggest policy recommendations that you would make to state legislators?
LP: Three policy priorities could be viewed as preventative measures. One, provide funding for better training for professionals-a specific line item for geropsychiatry and certified nurse assistants. The lack of training among health and geriatric professionals, at all levels, is an issue that needs to be addressed to prevent future problems with providing services to older adults. Second, upgrade mental health screenings in nursing home admissions. Third, and last, provide specific funding for medications for older adults.
PHS: States should look at innovative preventive programs that, in the long run, can reduce costs. Demonstration projects using focused group psychotherapy for lonely, depressed older adults or those with chronic health problems should be encouraged. Data suggests such programs can reduce-not increase- health care costs.
EE: 1) The development of a comprehensive systems initiative-similar to the one Congress supported for children about 10 years ago- needs to be implemented. It should include at least primary health care, senior social services, and substance abuse and mental health services. These services need to be coordinated, and providers need to work collaboratively to meet the biopsychosocial needs of older adults. SAMHSA has included this objective as part of its Comprehensive Aging Action Plan and intends to work with its...partners [including NCSL]...in planning how this systems recommendation can occur. 2) Enhancement of training for all health care and social service professionals on the mental health and substance abuse service issues and needs of older adults. 3) Enhancement of research and evaluation studies, emphasizing science to practice.
There have been many debates at both the state and federal levels over prescription drug coverage. How do you think this will affect older adults with mental illness?
LP: The two groups that need to be addressed are those individuals who have had a mental illness in life and are now getting older, and those older adults who suffer from a late onset mental illness. In addition to these two groups, there are also those individuals with a mental illness who are functional with their medications and support but, once they reach age 65, they lose that support and no longer are functional. These individuals switch from employee based insurance to Medicare; they will face problems because Medicare does not fully pay for medications and treatment. This will become a significant problem because those individuals have come to expect a certain level of care that they no longer will receive. Mental health patients without their medication affect the public safety arena and need to be addressed in a timely manner.
EE: Many states are experiencing serious budget reductions, which can adversely affect Medicaid and Medicare services. Many individuals on Medicare are paying for their medications, which include psychotropic medications. They may not be able to afford the newer medications; thus, they are taking older medications that may have serious side effects and interactions. The resulting cost offset, i.e., hospitalizations and/or inappropriate use of emergency room care, can be prevented.
TO NEXT SECTION (WHAT WORKS)
BACK TO MAIN
|
