Health + Behavior

Public mental health care for older Californians is lacking as need grows

Study calls for standardized data reporting and geriatric training, outreach and more integrated services

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Hands on shoulder of elderly woman
iStock.com/KatarzynaBialasiewicz

“California’s older adults have unique needs but are often treated generically,” said Janet Frank, faculty associate at the UCLA Center for Health Policy Research and leader of the evaluation.

California’s older adult population will increase 64 percent by 2035, and with it the need for more mental health services. Yet the state’s public mental health system lacks adequate services specifically tailored to older adults, according to a study and other documents released today by the UCLA Center for Health Policy Research.

Notably, the state has no systematic record of which local agencies used state mental health care funds to provide services for older adults or data to measure whether treatments worked.

This is the state’s first evaluation of mental health services for adults 60 and older in the public mental health system. In the study, authors report that the mental health needs of older adults are often “lumped in” with those of all adults, although older adults’ needs can be very different based on their stage of life.

“California’s older adults have unique needs but are often treated generically,” said Janet Frank, faculty associate at the center and leader of the evaluation. “Older adults often have multiple chronic illnesses which complicate mental health care.”

Funds not specifically mandated for elders’ mental health care

As of 2014, the Mental Health Services Act of 2004 generated $13 billion to fund delivery of public mental health services, according to documents reviewed in the study. However, no money is specifically earmarked to develop a system of care for older adults. In contrast, children’s mental health programs do receive earmarked funding.

Mental health issues among older adults range from anxiety and depression to serious mental illness, and conditions can be complicated by dementia, the loss of thinking, remembering and reasoning skills that interfere with a person's daily life. Most older adults receiving public mental health services have “aged into” the older adult category after receiving decades of mental health services, the study found. The authors say more information is needed about older adults who develop late-onset mental health problems and how they find their way to public mental health services. Today, less than one-third of all older adults in the United States who need mental health care receive it, the study reports.

To analyze how and whether older adults in the public health system received mental health services, the researchers reviewed more than 100 publications and reports. They also conducted six focus groups and 72 interviews at the state level and across six counties — San Diego, Los Angeles, Tulare, Monterey, Alameda and Siskiyou. The counties represented designated mental health regions; California’s differences in geography, population size and density; ethnic and racial diversity; income level; and the range of programs being developed for older adult mental health care.

Recommendations

The study’s authors make several recommendations to improve delivery of public mental health services to Californians who are 60 and older with mental illness:

Create an administrative structure dedicated to older adult mental health: Each county, as well as the state, should have at least one person who is the “watchdog” and departmental lead for older adult mental health services.

Require mandatory and standardized data reporting: Counties should document the unmet needs of older adults with mental illness in their area. They should better document the impact of treatment. Oversight at the state level would ensure program effectiveness.

Standardize geriatric training for providers: All mental health personnel — from professionals such as psychiatrists to case managers — should have appropriate geriatric training. Diversity training should also be included.

Conduct outreach: Do more to identify and reach older adults who are not getting services. Many older adults are already in the public health system, but it is unknown how many others are undiagnosed or going without treatment.

Increase integration of services: Older adults should be able to receive medical, behavioral health, aging and substance abuse services at one location.

“California will have more challenges in meeting the mental health needs of older adults than other states because we are more diverse and have more adults who are older,” said Kathryn Kietzman, a research scientist at the center and study co-author. “In addition to the broader issue of stigma that still surrounds mental health care, there are cultural, racial and language barriers to overcome that prevent people from seeking help for mental health problems.”

California Mental Health Services Oversight and Accountability Commission supported this study. The study team developed five documents published today detailing the state of mental health care services for older Californians and the need to support a system of care for older adults, including a publication that introduces statewide indicators to assess mental health in seniors.

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