Baby
boomers in need of mental health and
substance abuse services may have a hard
time finding health professionals to
provide that care unless the treatment
system is revamped, according to a new
study from the Institute of Medicine.
"The Mental Health and Substance Use
Workforce for Older Americans: In Whose
Hands?" report concludes that Medicare and
Medicaid payment codes must be revised to
ensure counseling care and other critical
services are covered so that doctors are
willing to treat patients with these
conditions.
"There is a conspicuous lack of national
attention to ensuring that there is a
large enough health care work force
trained to care for older adults with
mental health and substance use
conditions," said Dan G. Blazer, one of
the report authors and the J.P. Gibbons
Professor of Psychiatry and Behavioral
Sciences at Duke University Medical Center
in Durham, North Carolina.
"These conditions are relatively common,
they can be costly, and they can have
profound negative impacts on people's
health and well-being. This report is a
wake-up call that we need to prepare now
or our older population and their extended
families will suffer the consequences."
The report centers on older adults who had
at least one mental health or substance
use issue. It found that while most
primary care physicians regularly see
older patients, they have little training
or education in mental health and
substance use in the geriatric population.
The IOM committee estimates between 5.6
and 8 million elderly Americans have at
least one mental health or substance abuse
or misuse issue. Most common are
depressive disorders and dementia-related
problem.
Allowing these problems to go unresovled
can mean higher costs and negative health
effects. For example, elderly people with
untreated depression are less likely to
take their medication for other diseases
like diabetes or high blood pressure and
therefore are more likely to need
repeated, costly hospitalizations.
The committee recommends organizations
that accredit health and social service
schools and license providers make sure
all health care providers working with
older patients can recognize signs and
symptoms indicating a problem. They
recommend financial incentives and
mentoring programs be put in place to
encourage doctors and other healthcare
professionals to get into the field - or
if they are already there, stay.
Dr. Eric De Jonge, director of Geriatrics
at MedStar Washington Hospital Center,
says a shortage of geriatricians and other
trained personnel is a critical problem
and that the health care workforce must be
better prepared to handle the special
mental health needs of an elderly
population.
"You need to have a team of staff with a
variety of skills and that includes home
health aides, nurses, nurse practitioners,
social workers, psychologists and
physicians such as psychiatrists and
geriatricians... Due to the shortage of
geriatric psychiatrists - which are
profoundly rare - and geriatricians, we
need to elevate the skills of all these
other team members, tap in to the
expertise and increase the skills of all
this other workforce."
More mentorships and financial incentives
to specialize in elder care is critical,
De Jong said, since nationwide about 40%
of geriatric fellowships and training
slots are currently unfilled.
"You have to level the financial playing
field for medical students and residents
who are coming out of training. They make
roughly twice as much money if they go
into specialties that are procedure based
- fancy procedures which have much higher
reimbursement. People with lots of debt
come out of medical school and choose a
specialty that will help them pay off
their debt. Psychiatrists and
geriatricians are at the lowest end of the
pay scale."
The American Medical Association says
starting in 2011, the country's 78 million
baby boomers, born between 1946 and 1964,
will start turning 65 years old a the rate
of 3 to 4 million a year.
An article on the AMA website says: "The
statistics are staggering. By age 65,
around two-thirds of all seniors have at
least one chronic disease and see seven
physicians. Twenty percent of those older
than 65 have five or more chronic
diseases, see 14 physicians - and average
40 doctor visits a year. Situations like
these are a nightmare for patients and the
physicians who treat them. Variations in
therapies, medications and even differing
instructions can be confusing, conflicting
and hard for patients to remember."
The IOM recommendations the Department of
Health and Human Serivces, which sponsored
the report, makes sure its agencies take
responsibility for building the mental
health/substance use workforce for the
elderly in order to provide competent
care, and called on the agency to restore
funding of the Older Adult Mental Health
Targeted Capacity Expansion Grant program
to the Substance Abuse and Mental Health
Services Administration.
The report also calls on Congress to
designate funds/earmark funds for programs
that specifically target the elderly
saying, "Congress should appropriate funds
for the Patient Protection and Affordable
Care Act workforce provisions that
authorize training, scholarship, and loan
forgiveness for individuals who work with
or are preparing to work with older adults
who have mental health/substance use
conditions."
The American Psychological Association
(APA) has three member psychologists that
were part of the committee. “This IOM
report provides a foundation for our
nation to build a psychology and mental
health workforce to meet the needs of our
rapidly growing and increasingly diverse
aging population,” said APA CEO Norman B.
Anderson. “The report reflects successful
advocacy by the mental and behavioral
health community and includes key policy
recommendations, which the APA looks
forward to promoting in partnership with
federal, professional, and community
leaders.”
In September, the APA plans to brief
members of Congress on the report's key
findings and recommendations.
