The Soon-to-Be-Underserved: Boomers and Mental Health

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Today there are approximately 6 million to 8 million Americans 65 years of age or older who have mental health or substance abuse disorders. A study from the Institute of Medicine indicates that this number will climb to 10 million to 14 million by 2030. The lack of mental health specialists, psychiatrists and psychologists, who are trained to treat older adults magnifies the impact of the problem. In terms of the aging population, those individuals with mental health problems are more likely to experience greater disability than older adults with physical illness. The current expense projections indicate that the costs of caring for the older person with mental health problems will be 47% to 200% higher due to poorer health outcomes and higher rates of hospitalization and utilization of emergency health services.

The solution requires some thinking outside of the box. The shortfall of qualified mental health providers for the aging population needs to be augmented by primary care physicians, nurses, specialized care managers, allied health care professionals and even trained lay counselors who will provide services in diverse areas of healthcare. One school of thought is to train paraprofessional workers to deliver screening and intervention services. This strategy may have specific value in certain population groups where there is a low level of trust in mental health professionals and a greater likelihood for participation in services coming from their own community. Other strategies being explored include use of internet and mobile technologies to provide screening, support self-monitoring and even provide brief interventions for depression, anxiety, psychosis and cognitive impairments. Telepsychiatry services have already proven to be of value in rural areas where there are limited numbers of psychiatrists. Social media has created another point of communication and interaction which can benefit mental health by encouraging and supporting social interaction to overcome the effects of isolation caused by mobility and health problems.

People are living longer lives including those who have physical illness and disability which in past years would have shortened their lives. The number of psychiatrists and psychologists who specialize in treating older adults is inadequate to meet the number of older people living with mental health and substance abuse problems. We need to look at different solutions and expand the number of professionals and paraprofessionals who have the skills and training to provide screening, intervention and monitoring. Several other countries have seen success with trained lay counselors in the community operating detection and intervention programs. The long-term answers will require innovation, the use of technology and expanding the network of helpers.

For further reading:

Institute of Medicine. The mental health and substance use workforce for older adults: in whose hands? Washington, DC: National Academies Press, 2012

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