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Meeting the Challenges of Aging People with Serious, Long-Term Psychiatric DisabilitiesBy: Michael Friedman, LMSW; Kimberly Steinhagen, LMSW Workgroup on People with Long-Term Psychiatric Disabilities Who Are Aging Co-Sponsored by The Geriatric Mental Health Alliance Of New York and The Urban Institute for Behavioral Health of New York City For further information contact: Michael Friedman Executive Summary(The full report is available here.) As the elder boom unfolds over the next 25 years, the mental health system in the U.S. and in NYS will need to make significant changes to meet the needs of people with severe, long-term psychiatric disabilities who are aging. Currently services for people with long-term psychiatric disabilities are designed primarily for working age adults and are not geared to respond to the developmental challenges faced by those who are aging. As a result, many aging people with psychiatric disabilities are forced to shift from residential, rehabilitative, and treatment programs in the mental health system to nursing homes and to other programs that stress health care. In addition, the life expectancy of people with long-term psychiatric disabilities is at least 10-25 years less than the general population because of poor health (1) and high rates of suicide and accidents (2). People with long-term psychiatric disabilities are prone to chronic health conditions such as obesity, hypertension, diabetes, heart disease, and pulmonary conditions. In addition to driving down life expectancy, co-occurrence of these conditions and severe mental illness combined with lack of appropriate treatment drive up the costs of care for this population. Sadly, the chances of getting good treatment are limited because of the fragmentation of the health and mental health systems. In cooperation with the Urban Institute for Behavioral Health of New York City, The Geriatric Mental Health Alliance established a workgroup on people with long-term psychiatric disabilities who are aging in the spring of 2006. This workgroup has concluded that, in addition to the provision of good psychiatric treatment, changes in housing, rehabilitation, and health care models could make it possible for many more older adults with psychiatric disabilities to live in the community and to survive and even thrive into old age. RecommendationsNew York State currently is pursuing a vision of long-term care reform, which is unfortunately narrow. It focuses exclusively on services provide under the aegis of the health care system—nursing homes, adult homes, home health, adult medical day care, etc. In fact the mental health system is also a long-term care system and one that feeds into the health-based long-term care system, causing disruptions in the lives of people with mental illness and driving up the cost of long-term care. The Workgroup on Meeting the Needs of People with Long-Term Psychiatric Disabilities Who Are Aging(*) recommends that New York State include the mental health system in its pursuit of long-term care reform and develop services responsive to its aging population with long-term, severe mental illness. Our recommendations are designed to:
These recommendations focus on:
Recommendations to Improve Health
Recommendations to Improve Rehabilitation
Mobile Services As they age, many people find it increasingly difficult to get around or become reclusive. Outreach and mobile services to reach people in their homes or in community settings they will go to, such as houses of worship or doctors’ offices are essential to help people remain in community settings. This is particularly true of crisis services. An ambulance ride to an emergency room frequently begins a process of hospitalization and discharge to a nursing or adult home rather than to a community setting. Mobile crisis services help to avert such placements, which often are unnecessary. Workforce Development The workgroup noted that there is a great shortage of staff qualified to work with older adults with long-term psychiatric disabilities. In general there is a shortage of geriatric mental health professionals. But there is an even greater shortage of those trained to work with people with psychiatric disabilities. The workgroup recommended that a number of efforts be undertaken to increase the supply of qualified workers including:
Financing Models The workgroup agreed that there is a need to further explore financing models that support:
Notes (1) Colton, C.W. & Manderscheid, R.W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3 (2), Available from: URL: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm (2)Dembling, B.P., Chen, D.T. & Vachon, L. (1999). Life expectancy and causes of death in a population treated for
serious mental illness. Psychiatric Services, 50(8), 1036-1042.
(*) Age: In response to the ongoing debate about the age at which a person with long-term psychiatric disabilities should
be regarded as geriatric, the workgroup recommended 55 rather than 60 or 65. It did so because people with long-
term psychiatric disabilities frequently have had hard lives on the streets as well as substance abuse problems and
physical illnesses that make them old before their time. The workgroup also believes that 55 makes more sense
because the life expectancy of this population is as much as 25 years less than the general population. A great many people
with long-term psychiatric disabilities just don’t survive to 60 or 65.
(**) NYS regards adult homes as community settings. The Workgroup regards them as institutional settings.
The full report is available here
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