We’ve Come a Long Way, But Advocacy Still Needed for Mental Health Services

For all those interested in mental health issues, please join us Jan. 30–Feb. 2 for the newest Generations Forum, Mental Health & Aging.

When I joined the Indiana mental health agency in 1979, I quickly learned what many already knew: older adults were a significantly underserved population. It was estimated that only about half of older adults with mental health problems were getting treatment, and the majority of those who did were not being served by qualified mental health professionals. The most common treatment was medication prescribed by family phisicians with little, if any, training in mental health. Although the need for older adult mental health services was well known, little was being done to address the problem.

There were multiple reasons for the lack of services, including the stigma of mental illness and the shortage of geriatric mental health specialists. Another barrier that discouraged older adults from seeking help was how to pay for it. The lack of adequate mental health coverage by Medicare, Medicaid and private insurance was a major obstacle. Plus, older adults were not a priority in the mental health system, and mental health was not a priority in aging programs. It was obvious that progress would require major legislative, policy and regulatory changes.

Mental Health Committee Forms

Beginning in 1961 a White House Conference on Aging (WHCoA) has been held every decade. The early conferences paid little attention to mental health. Following the 1981 WHCoA, a committee was formed, chaired by former U.S. Secretary of Health, Education and Welfare Arthur Flemming, to develop strategies on how to implement the few mental health recommendations that came out of the conference. That committee’s report helped lay the groundwork for things to come.

In 1985 the National Institute of Mental Health (NIMH) held an invitational conference on older adult mental health. The National Association of State Mental Health Program Directors (NASMHPD) attended and, as a result, formed an aging division, now known as the Older Persons Division (OPD). Each state mental health agency designated a representative, and annual meetings began. This organization brought together state and federal policy makers and fostered relationships that led to future collaborations such as conferences, increased federal grants and older adult technical assistance centers.

In 1991 AARP hosted a meeting of agencies and organizations interested in older adult mental health. As a result the National Coalition on Mental Health and Aging (NCMHA) was formed, which now includes more than 80 professional, consumer and government organizations. The American Society on Aging and NASMHPD were charter members. A forum was created where interested parties could come together to discuss mental health and aging issues, work collaboratively and make necessary recommendations to the appropriate policy makers. Prior to the formation of the National Coalition, there had been successful coalition-building activities in Michigan and Oklahoma. In support of this effort, the Substance Abuse and Mental Health Services Administration (SAMHSA) provided grants to promote the development of state and local mental health and aging coalitions, which resulted in coalitions formed in more than 30 states.

Coalition Elevates Mental Health as a National Issue

The National Coalition demonstrated its effectiveness at the 2005 White House Conference on Aging (WHCoA). Mental health had not been identified as an issue on the pre-conference agenda. A mental health mini-conference was held prior to the WHCoa, resolutions were developed and submitted to the WHCoA. Hundreds of resolutions were submitted from across the country, but only 50 could be adopted. The Coalition created a strategy, and their primary resolution was voted No. 8 overall at the conference. In fact, all of the Coalition’s issues were addressed in the top 50 resolutions. The Washington Post reported that mental health was one of the top three issues emerging from the WHCoA.

‘The more recent progress toward mental health parity coverage, especially in Medicare, has been monumental.’

In 1993 the American Society on Aging created the Mental Health and Aging Network (MHAN). This group was important because it brought together aging and behavioral health professionals, advocates, researchers and policy makers. MHAN partnered with the National Coalition to provide an annual two-day track of clinical and public policy sessions, along with many other sessions, at ASA’s Aging in America Conference.

Another achievement was that several MHAN members served on the Institute of Medicine committee that issued the “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” consensus study report. This report clearly documented the workforce shortage and provided recommendations to address the problem.

Other significant advances include the federally mandated Pre-Admission Screening and Resident Review Program (PASRR-OBRA 87) and the U.S. Supreme Court Olmstead Decision (1999). These initiatives addressed inappropriate institutionalization, helped increase mental health services for long-term care residents, and promoted the development of community-based care. Another positive change, thanks largely to research, has been the development and implementation of older adult behavioral health evidence-based practices. The more recent progress toward mental health parity coverage, especially in Medicare, has been monumental.

A lot of progress has been made, but there’s still much to do, and advocacy is key. Two upcoming events provide great opportunities for ASA members to get involved. You can participate in the ASA Generations Forum on Mental Health and Aging, which will be held virtually Jan. 30–Feb. 2, 2023. Also, the 5th Annual Older Adults Mental Health Awareness Day is scheduled for May 11, 2023, as part of Older Americans Month. And consider joining your state or local mental health and aging coalition. If one doesn’t exist start one!

Willard Mays, MA, is past chair of the NCMHA and of MHAN, was previous chair and currently serves on ASA’s Leadership Advisory Council, and is a past recipient of the ASA MHAN Award. He retired in 2011 from the state mental health agency in Indiana and continues to advocate on older adult behavioral health issues.