Experts Predict Huge Shortage Of Programs for Mentally III Elderly

There are more community programs for seniors with schizophrenia, bipolar disorder, or other major mental illnesses than existed a few years ago, geriatric health authorities told Psychiatric News.

For instance, in New York City on-site health clinics for older people with serious mental illness have been set up in Brooklyn, as well as in Manhattan, where a housing development with links to local health care providers has also been established. In the Hudson River Valley region north of New York City, a community residence for older adults with major mental illness is on the drawing board.

Some suburban homes for older people with serious mental and medical illnesses can be found in Anne Arundel County, Md. (see article above). Plans are also under way in Ohio and Iowa to assist seniors with serious mental health problems at the community level. But “the number of programs is still woefully short of the numbers that we need,” said Carl Cohen, M.D., director of the Division of Geriatric Psychiatry at SUNY Downstate Medical Center in Brooklyn, N.Y.

The need will become even greater as the population of seniors with serious mental illness skyrockets during the next few years, said Dilip Jeste, M.D., a professor of psychiatry and director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego. Being part of the baby-boom generation is one reason this population will explode, Jeste said. But “there are also data suggesting that people born after World War II have a higher risk of mental illness than people born before World War II.”

In fact, “Somewhere within the next 10 years,” predicted Michael Friedman, director of the Center for Policy and Advocacy of the Mental Health Associations of New York City and Westchester, “the number of older adults with serious mental illness is going to be larger than the number of all people [with serious mental illness] who were institutionalized at the peak of institutionalization in the United States. That was 575,000.”

Thus, there is a pressing need to find new ways to care in the community for a rapidly expanding population of older people with psychiatric disorders. Fortunately, some researchers are rising to the challenge.

Innovative Programs Introduced

For example, Jeste and his colleagues have conducted a study to see whether seniors with serious mental illness could benefit from a combination of cognitive-behavioral therapy and social-skills training to help them live successfully in the community.

“One might think that with older people who have schizophrenia, there is not much that one can do,” he said. But “we found that the functioning and skills of people in the treatment group improved more than did those of people in the [study] control group.”

Stephen Bartels, M.D., a professor of psychiatry and community medicine at Dartmouth Medical School, and his colleagues have been conducting a trial to see whether a one-year intensive intervention called HOPES (Helping Older Persons Experience Success) can assist such individuals.

In the trial, 183 participants with major mental illness were divided between HOPES and standard care. Those in HOPES were taught basic living skills, social skills, management of medications, and other abilities—which they had to practice in real community settings. Those getting the intervention were also assigned a health-management nurse who helped them negotiate the health care system. Early findings “are very promising,” Bartels said in an interview.

The Geriatric Psychiatry Program and the Memory Center at Johns Hopkins University could serve as national models, said Constantine Lyketsos, M.D., vice chair of psychiatry at Johns Hopkins.

“The Geriatric Psychiatry Program is a team of geriatric psychiatrists, nurses, and social workers at two campuses who provide care and outreach for older people with all forms of mental illness,” Lyketsos explained. The program includes out-patient care in city housing, assisted living, and nursing homes, and is linked to an inpatient unit, day hospital, and psychosocial program. The Memory Center is a similar operation, but focuses on dementia and Alzheimer's disease. It includes physicians in neurology and geriatric medicine, as well as two nursing homes—and is integrated with dementia research.”

Shortage Needs to Be Reversed

Another challenge to providing community care for a rapidly increasing number of seriously mentally ill seniors is finding a workforce to look after them.

“There is a tremendous shortage of geriatric psychiatrists, geriatric nurses, geriatric psychologists, and geriatric social workers,” Friedman said. “I think a significant part of the answer is.. .that most older adults are healthy and can be a big part of the solution. Developing roles for them—and for older people with mental illnesses—can help solve the problem.”

Jeste concurred. “One of my younger colleagues is working on work rehabilitation for older people with schizophrenia,” he said. Many of these older individuals are interested in doing either paid or volunteer work.

But perhaps the biggest challenge to meeting the community-care needs of an exploding number of severely mentally ill seniors is to raise awareness of the problem.

“Only when society becomes aware of this issue will it pressure lawmakers to put more money [into such programs],” Jeste asserted.

Friedman agreed: “It has certainly been our experience in New York state. We've been the first in the country to pass a geriatric mental health act.”

The act was signed into law in 2005, and the governor included $2 million in his budget request for 2006-2007 to implement it. The law finances innovative programs to care for the mental health needs of New York State's elder boom. ▪