The number of adults ages 65 and over in Massachusetts with behavioral health conditions is growing rapidly. With the aging of the baby boomers, the number of elder adults, in general, is increasing as a proportion of the total population. By 2035, twenty-three percent of Massachusetts residents will be age 65 and over. At the same time, thanks in large part to advances in treatment and medications, people with behavioral health conditions are living longer. According to SAMHSA, it is estimated that nearly one in four older adults has a mental health condition, such as a mood disorder not associated with normal aging.Tragically, based on numbers from the CDC, males age 75 and over have a higher rate of death by suicide than any other age group.

Unfortunately, as was discussed in the Summit on Older Adults, less than 33 percent of elder adults with mental health conditions utilize mental health services. Adults ages 65 and over face unique challenges to accessing prevention, early intervention, evidence-based treatment, and recovery services. Misinformation such as “depression is a normal part of aging” and “elders don’t use illegal drugs” is pervasive. Additionally, elder adults may experience transportation barriers, affordability challenges, social isolation, cultural differences, and issues around guardianship/proxies. Treatment can also be complicated by co-occurring cognitive and physical health conditions, as well as changes in metabolism. Moreover, as the number of elder adults increases, trends from the National Academies suggest that the number of geriatric psychiatrists will decrease. As a result, elder adults are struggling to get the behavioral health care they need, when they need it, and in the most appropriate settings. They are more susceptible to greater disability, poorer health outcomes, and higher rates of hospitalization and ED usage than their peers with no mental health or substance use conditions.

Leaders in the Massachusetts Executive Office of Health and Human Services, specifically the Department of Mental Health and the Department of Public Health, and the Massachusetts Executive Office of Elder Affairs are working together to advance the health and well-being of elder adults with mental health and substance use conditions. They are committed to strengthening the capacities of entities experienced in serving elder adults (e.g., Councils on Aging, senior centers, Aging Service Access Points, etc.) to engage in prevention efforts, better identify signs and symptoms of behavioral health conditions, and collaborate with public and private behavioral health providers to connect individuals to the care they need. Historically, aging services and behavioral health providers have not worked closely together; they have distinct cultures, vocabularies, staff training and certification requirements, care delivery models, and financing mechanisms. Successful partnerships will require new knowledge and skills for both sectors, as well as willingness to explore both evidence-based and promising practices in community-based integrated care delivery such as elder mental health outreach teams, certified older adult peer specialists, telephonic behavioral health, and self-management Smartphone applications.

Fortunately, work is currently underway to better integrate aging services and behavioral health care in the Commonwealth and to develop a front line workforce which is knowledgeable about, and prepared to adequately respond to, mental health and substance use conditions experienced by older adults.  There is much work to be done to ensure that the vast and varied caregivers who touch older adults’ lives, have sufficient training and support to properly address behavioral health conditions.

As baby boomers age, the older adult population in Massachusetts is expected to grow from 14% in 2010 to 21% of the state population by the year 2030. Today 59% of older adults age 65 or older in Massachusetts are female, 50% are married, and 32% live alone. Per 2016 US Census Data there are 1.08 million people 65 and older in Massachusetts or 15.9%.

Nationally, it is estimated that 1 in 4 older adults has a mental health condition, such as a mood disorder, not associated with normal aging. Less than 33% of these older adults utilize mental health services. 

MAMH

MAMH Perspective

MAMH’s Mission is to advance mental health and well-being for individuals across the age spectrum by promoting prevention, early intervention, effective treatment and research to address social, emotional, and mental health challenges. Given the size and growth of the older adult population, the delivery reform changes that promote community-based or home-based care, and the prevalence of mental health and substance use conditions among seniors, there is no question that community caregivers require training and expertise to enable them to provide appropriate culturally competent care.

The aging population that requires close attention fall into two categories: 1) older adults who have had a serious chronic mental health condition and will experience co-occurring physical and/or mental health problems including dementia as they age, and 2) older adults who develop conditions for the first time, or have disease burden escalation, associated with a mental health or substance use conditions as they age.

Older adults in the community receive care from many different types of individuals including professional, paraprofessional and allied health care providers, and LTSS providers such as transportation and meals on wheels providers, case managers at an Aging Service Access Point (ASAP), home care workers, home health aides, and residential care coordinators at an elder housing project. In order to support older adults in the community, everyone who touches a senior, should be trained on how to identify mental health and substance use problems, how to relate to the older adult exhibiting symptoms, and how, when, and where to seek additional help.

The reality of this broader diverse workforce makes it imperative the front line staff in the field of aging receive training in mental health and addiction and, conversely, that behavioral health professionals receive training in aging. Leveling the playing field in terms of standardizing knowledge competencies across the workforce will enable a more coordinated and effective approach to serving older adults with behavioral health conditions.