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.
