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SAMHSA News - July/August 2004, Volume 12, Number 4

Older Adults: Improving Mental Health Services (Part 1)

By 2030, the population of Americans over age 65 is expected to rise to about 71.5 million, compared to 35.6 million in 2002. Yet even today, a shortage of mental health professionals qualified to treat older people means that many aren't being treated. Stigma keeps others from seeking help even when adequate treatment is available.

Meeting these needs is the goal of SAMHSA's Targeted Capacity Expansion (TCE) Grant Program To Improve Older Adult Mental Health Services. Launched by SAMHSA's Center for Mental Health Services (CMHS) in 2002, this 3-year effort is designed to increase both the quantity and quality of mental health services offered to people age 65 and older. With guidance from the Positive Aging Resource Center, a technical assistance organization in Boston, MA, nine grantees are expanding or enhancing their programs using methods that have a proven track record of success.

"One way to improve services for older Americans is to take what we know works—evidence-based practices—and translate that into the field," said TCE program officer Betsy McDonel Herr, Ph.D., at CMHS. "We don't have the money to teach everybody these evidence-based practices, so we're hoping these nine sites will become model programs that can teach others. We're planting seeds in the field."

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Older people tend to have a different attitude toward mental illness and treatment than younger generations. "They grew up in an era when having such problems meant you were considered 'crazy,'" explained Sue Levkoff, Sc.D., S.M., M.S.W., director of the Positive Aging Resource Center. "They also grew up thinking that if you're sad, you just need to pull yourself up by your bootstraps." Even those people who know they need help may be reluctant to seek treatment for fear of being stigmatized.

Health care providers may also have misguided notions about older people and mental illness. Many providers assume that depression, anxiety, and other mental health problems are just a normal part of aging, said Dr. Levkoff, an associate professor of psychiatry at Brigham and Women's Hospital, and an associate professor of social medicine at Harvard Medical School. Others don't even realize that such conditions can be treated. Even when health care providers do recognize the importance of identifying and treating older patients' mental illnesses, many simply don't have time to make mental health a priority.

"Most older people go to primary care providers who aren't really trained in providing care to older people in general and to older people with mental health problems specifically," Dr. Levkoff explained. "When they have a 6- or 7-minute visit to deal with medical issues that demand attention, asking about things like sadness or anxiety doesn't even get on the agenda."

And while there's plenty of evidence demonstrating the effectiveness of various approaches to diagnosing and treating older people's mental health problems, Dr. Levkoff adds, many health care providers don't have time to learn about such practices.

"There's a huge amount of information about evidence-based practices out there, but providers don't have access to it," she explained. "People are busy. And the health care system has become so bureaucratic, there's little time for health care professionals to provide the kind of care they want to provide, much less do all the extra things they need to do to keep up."

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