Improving the Behavioral Health of Older Adults Through Multisector Plans for Aging

ASA is partnering with West Health and The John A. Hartford Foundation on a series of blog posts and On Aging programming to foster Multisector Plans for Aging across the country.

According to the 2022 National Survey on Drug Use and Health, 1 in 5 adults ages 50 and older (25.6 million people) reported having either a substance use disorder (SUD) or any mental illness (AMI) in the past year. AMI is defined as a mental, behavioral or emotional disorder, ranging from no impairment to mild, moderate or severe.

Considering recent West Health–Gallup survey results indicating 9 in 10 U.S. adults think mental health is at least as important as physical health, and as younger populations with higher reported rates of behavioral health issues age, it is critical to ensure behavioral health supports are in place for older adults today and into the future.

Many states are developing or implementing Multisector Plans for Aging (MPAs), which are government-led, cross-sector, whole person–focused plans that coordinate and prioritize the state’s goals and initiatives to address the aging population. These plans bring together stakeholders and leaders from across the spectrum to collaboratively plan for the ongoing demographic shift.

As of May 2024, half of the states are working toward an MPA. Among these, seven (California, Colorado, Massachusetts, Pennsylvania, Texas, Utah and Vermont) have developed plans. Along with addressing elements such as housing, transportation, nutrition and employment, many states are using MPAs to promote the mental well-being of older adults. What follows are examples of how states are using MPAs to improve the behavioral health of older adults.

Emphasizing Behavioral Health as Part of MPA Goals

One way states are working to include behavioral health in MPAs is by emphasizing it as part of the plan’s goals. For example, in Vermont, one MPA objective includes reducing comorbidities by exploring how to integrate mental health and substance use disorder strategies and treatment into clinical and facility protocols.

Vermont contracts with the National Behavioral Health Network for Tobacco and Cancer Control on leadership goal setting, coalition development, frontline training, and data monitoring.

One impactful strategy some states use to address behavioral health via their MPAs is to seek input from consumers with lived experience to influence MPA development.

Another objective is reducing the rate of suicide deaths for male Vermonters ages 65 and older, by expanding access to group activities that may be meaningful for older men, such as woodworking groups and other socially interactive settings.

In Pennsylvania, one of the five main priorities of its MPA is “unlocking access,” including addressing barriers to behavioral health care. This means 1) advocating for mental health parity in Medicare, 2) exploring the use of community mental health block grant funds to bridge access gaps (especially in rural areas), to connect older adults to behavioral health services (e.g., promoting telehealth), and 3) increasing access to behavioral health providers for long-term care patients.

Additionally, Colorado’s MPA includes a recommended goal in its 2020 Strategic Action Plan on Aging report to improve behavioral health planning and access for older Coloradans by encouraging the Behavior Health Task Force and other state-level groups to focus on aging and barriers to care for older adults.

Addressing the Behavioral Health Workforce

While behavioral health care needs continue to grow, the United States also is facing a shortage of mental health providers. As a result, some states are leveraging their MPAs to tackle behavioral health workforce issues.

Utah’s draft MPA emphasizes workforce expansion as a means of addressing behavioral health, specifically by pushing licensing standards for professional workers managing patients with mental health issues, working to determine the need and create a plan for transitional housing requirements for people with behavioral health conditions, as well as abuse victims, and ensuring that mental health resources are available and utilized.

In February 2024, Utah passed a bill to remove barriers to licensure and enlarge the behavioral health workforce by creating new certifications for entry-level workers and creating a pathway for those with related 4-year degrees to become licensed as behavioral health coaches. This exemplifies how MPAs are not just a tool for planning—they result in concrete actions.

Gaining Input from People with Lived Experience

Another way states address behavioral health through their MPAs is by first seeking input from consumers to influence how their MPA is developed. California used roundtable sessions of more than 150 people to hear directly from affected members of the community about the unmet needs of older adults experiencing behavioral health challenges, with a focus on people of color and members of the LGBTQIA+ community. These sessions uplifted the lived experiences of older adults, their family caregivers, and providers from various communities. In the 2024–2025 California budget, Gov. Gavin Newsom made critical new investments in transforming the behavioral health system, including targeted funding for older adults.

Similarly, in 2021, Texas conducted an online, cross-sectional survey to assess the needs and priorities of older adults, their caregivers and organizations providing services to older adults. Informal caregivers identified their mental health as a top priority, leading to these actions to be included in its MPA: increasing access to behavioral health resources, finding ways to increase awareness of and expanding access to behavioral health services for elders, and assessing access issues and the system for mental health services.

Looking Ahead

MPAs are a tool states can use to plan for the growing behavioral health needs of older adults. Governors and other state leaders are using strategic planning to address behavioral health, but it will take all voices to ensure the collective well-being of older adults. MPAs are not just a tool for planning but include priorities and actions states are pursuing to meet these goals. MPAs can help ensure that all people in the United States can look forward to aging with dignity.

How Can I Get Involved?

Find out if your state is developing an MPA using the map on the website. This map includes links to states’ Executive Orders, legislation and plans. Also on the website are resources and news related to MPAs, as well as a signup form for our newsletter to remain updated. If your state is working on an MPA, get involved. If not, encourage your states’ leaders to look to others for examples.

Amy Herr, MHS, PMP, is director of Health Policy for the nonprofit, nonpartisan West Health Policy Center in Washington, DC. Elvira Makk Frid is a research associate at West Health Policy Center.