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Testimony on the Mental Health Budget

Delivered to the New York State Legislature January 29, 2008 on Behalf of the Geriatric Mental Health Alliance

My name is Michael Friedman. I am the Chairperson of the Geriatric Mental Health Alliance of New York, an advocacy organization with about 3,000 members: mostly New Yorkers, but with a smattering of members in 38 additional states. I appreciate the opportunity to speak to you today about what the proposed budget will do for older adults with mental disorders.

Let me begin by acknowledging that for younger people with mental disorders, this is a very good budget. It calls for stabilizing funding, more housing, more for children and their families, a beginning of confronting the problems of serving people with co-occurring disorders and more.

Sadly, however, this budget request does exceedingly little for older adults with mental disorders. Why does this matter?

Here are the facts:

The population of adults 65 and over will grow from 35 million to 70 million over the next 20 years. In New York State it will grow from about 2.5 million to about 4 million.
The proportion of older adults in the population will grow from 13% to 20%. The population of working-age adults will decline by 5%. Who will be the workforce of the future?
The minority proportion of the elderly population will grow from 15% to 25%. How will we build a culturally competent workforce?
The number of older adults with diagnosable mental or substance abuse disorders will grow from about 500,000 to about 800,000. How will we expand the system in time?
Older adults complete suicides 50% more often than the general population, rising to 600% more among white men 85 or older.
Currently about 125,000 of 500,000 older adults with mental disorders get treatment from mental health professionals. Others get treatment from primary care physicians, but at most 40% get treatment from anyone.
The quality of treatment is uneven. A recent study indicates that fewer than 13% of people treated for mental illness by primary care physicians get minimally adequate treatment. Sadly, fewer than 50% get minimally adequate treatment from mental health professionals.
For older adults, the co-occurrence of mental and physical illness is virtually universal. How will we overcome the barriers to integrated treatment built into the laws and regulations of our state?
Many older adults need treatment in the home or in community settings such as senior centers. Here too there are barriers to be overcome.
As many as 50% of people in nursing homes are there largely because of their mental disorders or those of their family caregivers, who burn out from the stress. Eighty percent of care for disabled older adults is provided by family members. The fiscal value of the care they provide is about $350 billion per year. They need and deserve support. Will New York State ever recognize that addressing mental health issues is critical to its long-term care restructuring efforts?
There is a vast shortage of clinically and culturally competent mental health providers, including psychiatrists, psychologists, social workers and nurses. Imagine how bad this is going to get as the working-age population drops by 5%.

More Funding Needed

In 2005, thanks to the leadership of Senators Morahan and Golden and Assemblymen Rivera and Engelbright, the Legislature recognized the growing imperative to prepare to meet the mental health challenges of the elder boom. It passed the first Geriatric Mental Health Act in the nation. The Governor signed it and added $2 million in 2006/7 to provide services demonstration grants. Sixty-eight groups of organizations applied for these grants. Nine were awarded, which means that there are 59 groups of organizations from all around New York State that are ready to go. But last year no additional funding was provided, and none is included in this year’s budget request. I can’t emphasize enough that 59 groups of organizations are ready to go. Our localities are ready, but they need support.

We find it particularly sad that this year’s budget request ignored the Commissioner of Mental Health and the Director of the Office for the Aging, who announced at the July meeting of the Interagency Geriatric Mental Health Planning Council that their priorities for geriatric mental health were (1) to increase services demonstration grants, (2) to start a Center for Excellence that would build clinical capacity around the state, (3) to provide training for physicians and (4) to carry out a training and technical assistance project to bring more Medicare funding to New York State. All of this could be done for under $5 million.

We – and 220 supporting organizations – are turning to you, the State Legislature, to again provide the vision and the leadership that this State needs to recognize that this is an aging society and to plan to meet the needs of our senior citizens, rather than to wait for the crisis that will begin to hit in force in about three years if we do not prepare.

Fund more grants; these are terrific projects. Fund a Center for Excellence to develop a workforce and provider organizations with the skills to serve older adults with mental disorders well. Fund a project to optimize Medicare reimbursement for mental health services and to invest this new funding in desperately needed service growth. In addition, please insist that long-term care restructuring in New York State address the mental health needs of disabled older adults and their families.

Thank you again for the opportunity to address you today.

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