State Health Lawmakers' Digest: Mental Health and Aging (Vol. 3, No. 1), On the Horizon

ON THE HORIZON

Primary Care Research in Substance Abuse and Mental Health

The importance of mental health in older populations often has been overlooked. Current estimates suggest that two-thirds of older adults who need mental health services do not get the help they need. Older adults are less likely to seek mental health services through specialty providers and are less likely than their younger counterparts to be referred to specialty providers by physicians. The majority of older Americans receive mental health care from their primary care physicians, who may not have received sufficient training in geriatric mental health assessment or care. Although it is clear that integrating mental health assessment and services into primary care settings is necessary, it is less clear what is the most effective way to deliver services to older patients with mental health problems. A new initiative launched by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Veterans Affairs (VA) and the Health Resources and Services Administration (HRSA) hopes to examine mental health service models and provide information on best practices for addressing mental health in the primary care setting.

The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) Study, a multi-million dollar collaborative grant program, is looking at two mental health/substance abuse models that provide treatment to older adults with behavioral problems. The project will compare clinical and cost outcomes between models that refer consumers to specialty mental health and substance abuse services outside the primary care setting and those that integrate such services into the primary care setting. Researchers plan to look at variables such as engagement, participation in care, clinical outcomes, prevention, satisfaction, stigma, cultural sensitivity, provider attitudes and cost outcomes. In addition to comparing delivery models, the study will measure the effectiveness of these models on service utilization and identify the best screening and assessment methods used in primary care settings. Recruitment for the project began in March 2000.

The PRISMe project expected to last six years, has involved 2,271 patients over age 65 with mental health or substance abuse problems. The Harvard Geriatric Education Center (HGEC) in Boston, Massachusetts, is coordinating the study. SAMHSA funded six different sites for the study, and the VA funded an additional five sites. The participating sites include community health clinics, federally qualified health centers (FDHC), managed care organizations, university-supported health centers and group practice providers. The coordinating center will standardize data collecting procedures to enable cross-comparison of the different study sites. Project site locations include Little Rock, Arkansas; San Francisco, California; Miami, Florida; Chicago, Illinois; Brooklyn, New York; New York, New York; Rochester, New York; White River Junction, Vermont; Philadelphia, Pennsylvania; and Madison, Wisconsin.

A crucial component of the PRISMe study will be consumer involvement. Each study site is required to seek consumer input through a consumer review group comprised of adults who meet the minimum age requirement of 65. Although the focus is on individuals with mental health and substance abuse problems, family members, community advocates and caregivers also are encouraged to participate.

Although the PRISMe study will not be completed until 2003, the Center for Mental Health Services at SAMSHA has already begun looking for ways to use the lessons learned from the study. SAMSHA has included funds in its 2002 budget for nine targeted capacity expansion grants to states and communities and a National Technical Assistance Center for State Mental Health Planning to disseminate information to providers on evidence-based practices on assessment and treatment protocols for geriatric patients. The Technical Assistance Center will promote practices based on a variety of research, including the PRISME study.

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