Collaborating to Help Rural Elders with Mental Health Needs

This April we’re running a four-part series of blog posts from our sponsors at the Cambia Health Foundation, which highlights the work of their local community partners.

In the Puget Sound Region north of Seattle, Homage Senior Services has been providing comprehensive nonprofit services for older adults and adults with disabilities in Snohomish County for 50 years. Snohomish County is the third most populous county in Washington, with an older adult population (ages 65 and older) of 125,000.

Homage’s mission to promote independence, preserve dignity, and enhance quality of life for older adults and adults with disabilities is realized through four core service areas—food and nutrition, health and wellness, home repair, and transportation, which together comprise more than 20 programs annually serving 20,000 individuals. These interconnected service programs create a support network that enables our clients to live independently and with dignity as they age.

In a recent survey with local senior centers, mental health concerns, specifically depression, was a consistent high priority issue. The three main contributors to depression in older adults are poor physical health, isolation, and loss. Older adults have been disproportionately impacted by the isolation of a years-long pandemic, but many elders do not seek mental health care due to stigma.

“The pandemic actually helped the cause of mental health and reduced stigma. The extended isolation issue made people realize it was okay to not be okay,” said Homage’s Mental Health Programs Manager, Nancy Brosemer, adding, “So many people decided they were not okay and came out seeking mental health care, but external counselors were overwhelmed. For a while, Homage had a waitlist of about 45 days.”

Older adults who wish to find mental health care often hit a roadblock, such as difficulty in finding a provider that will take Medicare, or a co-pay that is beyond the means of many low-income older adults. For elders who live in more rural areas of the county, the geographic isolation and limited services make access even more challenging. Homage’s goal was to bring more free mental health services to older adults where they live.

‘The extended isolation issue made people realize it was okay to not be okay.’

Homage already had a well-established presence in many senior centers throughout Snohomish County by providing regular hot lunches onsite with the Community Table Dining Program. These are places where older adults already feel welcome and comfortable and participate in activities that reduce social isolation.

With a grant from the Cambia Health Foundation, Homage has expanded relationships with some of those centers to increase access to mental health care for older adults, especially those who live in a more rural area. Homage recently hired Mental Health Specialist Erica Latrell who provides mental health services at rural senior centers, which now includes services in the cities of Marysville, Arlington, Darrington, Stanwood, Sultan and Monroe. Latrell often can be found ahead of her scheduled sessions sitting down to chat with the older adults having lunch at Community Table or watching a lively cornhole game. For those who may be skeptical about mental health services, these organic conversations have garnered interest.

Free Homage Mental Health programs for adults ages 60 and older include Geriatric Depression Screening (GDS), followed by five-session short-term counseling if indicated in the screening. Through community collaboration, Homage Mental Health Services has been able to connect with qualifying older adults in need of counseling services as well as provide referrals for additional community supports, ensuring that those experiencing this need have access and awareness of options available to them.

As services are implemented at the rural senior center locations, appointments have been filling up. About half of the participants are clients who find the program through a call to Homage and now can meet close to where they live, and half find the services by being at the senior center, via word-of-mouth, or seeing a flyer at their local library.

Latrell feels positively about the impact of the program. “On the first day at the Monroe Senior Center, a woman came in for a depression screening. She was answering the questions in the way that she thought was ‘right’ to score well. I said, ‘We are just here to talk, set goals and support you in a confidential way.’

“After taking that pause to discuss the purpose of the screening, the client was able to open up and report confidently on her areas of need. As a result, during the sessions we have been able to address some of her social isolation challenges and she’s been able to set realistic goals and boundaries for herself. As the client said, ‘I appreciate how we are able to set goals and use my voice instead of pushing an agenda.’ ”

Interestingly, when participants learn that this free mental health program is supported by a grant, it changes the dynamic. They trust the process more and are assured they aren’t being advertised to for expensive services. Latrell says of the beneficial impact of this work, “This grant has helped us break some stereotypes. It’s not a forever thing, it’s a right now thing. Some of them have never participated in counseling, but it opens the door and after five sessions, they are more willing to engage with a long-term counselor if they need it.”

Homage’s goal is to expand these mental health services to more older adults in rural areas and give them tools to improve their mental health and well-being. The next step is to begin working with local libraries, who are often at the front line of need.

Alicia Guy is a grants manager at Homage Senior Services.

Photo caption: Sunrise on the Snohomish River

Photo credit: Shutterstock/cpaulfell