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2007 Update and Interim Report to the 2006-2010 New York Statewide Comprehensive Plan for Mental Health Services

Kimberly Steinhagen, LMSW, Director, Geriatric Mental Health Alliance of New York, gave this testimony on July 30, 2007.

My name is Kimberly Steinhagen, and I am the Director of the Geriatric Mental Health Alliance of New York, an advocacy organization sponsored by the Center for Policy and Advocacy of the Mental Health Associations of New York City and Westchester. We are made up of over 2,500 members. We have workgroups on policy and advocacy in NYC and Albany. We sponsor consensus groups on topics related to geriatric mental health, sponsor a series of presentations on best practices with national experts, have co-sponsored numerous conferences, and provide technical assistance regarding service models and funding.

Beyond Just a Footnote

We have come a long way since January 2004, when OMH released a “population-based” 5.07 Plan that contained only a single footnote about geriatric mental health. Since then OMH has recognized older adults as a priority population; and the State has passed a Geriatric Mental Health Act, committed $2 million dollars to demonstration grants, and formed a Geriatric Mental Health Planning Council, which has met regularly and submitted a report and recommendations to the Governor and the Legislature.

All of this has been a great start, but we have much more work that needs to be done to assure that New York’s elders with mental disorders get the attention they deserve.

The announcement of this hearing asked us to focus our testimony today on three critical areas—children and families, housing, and coordinated care—and we will do so. This is not at all difficult because stable, accessible housing; coordination of mental health, health, and aging services; and family support are key issues for older adults with mental disorders.

Housing

Safe, accessible housing is critical to allowing people with long-term psychiatric disabilities who are aging and people with late-life serious mental illness to age in the community. We recommend developing housing alternatives for this population that take into account their need for physically accessible places, for additional ADL supports, and for assistance managing their health needs. This means developing new models of permanent supported and congregate housing.

Coordination of Services

People with Serious and Persistent Mental Illness Who Are Aging

People with long-term psychiatric disabilities are at high risk for obesity, high blood pressure, diabetes, cardiac conditions, and pulmonary disease. This contributes to their low life expectancy—at least ten years less than the general population and perhaps 25 years. Most mental health programs that serve people with serious and persistent mental illness do not have the capacity to address the health needs of the people they serve. We believe that it is critical to mount efforts in NYS to integrate health and mental health services for this population, especially by embedding health services in mental health programs.

Elders at Risk of Placement in Nursing Homes Due to Mental and Behavioral Disorders

Mental and behavioral problems contribute to unnecessary institutionalization in adult and nursing homes. In order to avoid institutionalizing older adults, we must (1) increase the capacity for in-home services, (2) develop cadres of home health workers and case managers who have skills working with people with mental and behavioral disorders, and (3) provide access to legal and advocacy services regarding housing and entitlements.

Older Adults with Chronic Health Conditions and Co-Occurring Mental Disorders

People with chronic health conditions such as heart disease, diabetes, or neuromuscular conditions are at elevated risk of depression and/or anxiety. And people with co- occurring chronic health conditions and mental disorders are at elevated risk for disability and premature death. In addition, the costs of their medical care can be double the costs of those whose physical conditions are not complicated by mental illness. Coordinated health and behavioral health services such as screening for mental disorders in health care settings, depression care management in primary care, and integrated treatment are critical to this population.

Older Adults with Severe Depression, Anxiety, Paranoia, and/or Addictive Disorders

People with severe depression, anxiety, paranoia, and/or addictive disorders are at high risk for suicide and social isolation. This population could benefit from treatment, but often cannot—or chooses not to get it because they cannot leave the home or will not go to mental health professionals. Outreach and services in the home or in community settings such as senior centers, NORCs, or adult social day care programs are often critical to be able to serve this population. This requires collaboration with both the aging and the health systems.

Family Support

Informal caregivers provide the vast majority of care for people with disabilities. They are vulnerable to depression, anxiety, and physical disorders and often “burn-out” from the caregiving role. Access to supports such as counseling, support groups, training, education and respite services is desperately needed.

Clinical and Cultural Competence

Meeting the needs of these populations is all the more difficult because of shortages of clinically and culturally competent service providers. This includes a particular dearth of providers in the mental health, health, and aging systems who are able to work collaboratively to provide integrated care and treatment. A vast workforce development effort needs to be part of the multi-year push to meet the mental health challenges of the elder boom.

OMH’s and OFA’s Joint Budget Priorities

At the Geriatric Mental Health Planning Council meeting on July 11, OMH and OFA presented budget priorities for geriatric mental health in 2008-9. These include:

• Depression screening education for primary care physicians,

• Medicare optimization,

• More service demonstrations, and

• Establishing a Center for Excellence.

More Needs to Be Done

While clearly much more needs to be done, we understand that it cannot all be done in one year. We support these priorities, with a few qualifications.

• Training of primary care physicians is easier said than done. The program mounted to better prepare primary care physicians should draw from experience and research and focus on using approaches that result in changes in physicians’ behavior.

• Additional service demonstrations should address concerns that emerged about the RFPs released in December 2006. New RFPs should focus on the needs of people with serious and persistent mental illness by promoting the provision of health care in mental health settings as well as the provision of mental care services in primary care settings (the approach of the current RFP.)

• Permit, indeed encourage, applicants to use other sources of funds, such as Medicare and Medicaid, in addition to grant funds to support the services provided through the demonstration grants program.

• Permit aging and health organizations to be lead applicants in response to the RFP.

• The Center for Excellence, which would be devoted to building an enhanced workforce, should recognize family caregivers as the primary source of support for older adults with disabilities and in need of education to inform and sustain their activities. In addition, the Center for Excellence should develop roles for older adults to help other older adults using peer-to-peer models.

Working Together

We are grateful for the opportunity to speak today as well as for the progress that has already been made and the collaboration that has developed between the Geriatric Mental Health Alliance and The Office of Mental Health. We look forward to continuing to work together.

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