The Mental Health and Substance Use Workforce for Older Adults In Whose Hands? (2012) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-38
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The U.S. Census Bureau projects that the number of adults age 65 and older will increase from 40.3 million to 72.1 million between 2010 and 2030 (Vincent and Velkoff, 2010)
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The IOM Committee on the Mental Health Workforce for Geriatric Populations was appointed in early 2011 to carry out the charge. The 16-member committee included experts in geriatric psychia try, substance use, social work, psychology, and nursing; direct care workers; and those with specialties in epidemiology, workforce development, labor economics, long-term care, health care delivery and financing, and health care disparities.1 Brief biographies of the committee members are provided in Appendix E
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will convene an ad hoc committee to determine the mental and behavioral health care needs of the target population -- the population of Americans who are over age 65 years -- and then make policy and research recommendations for meeting those needs through a competent and well-trained mental health workforce, especially in light of the projected doubling of the aged population by 2030. The committee will • Provide a systematic and trend analysis of the current and projected mental and behavioral health care needs of the target population.
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See Chapter 2 for definitions of each condition and re lated epidemiological data and analysis. DSM-IV-TR Mental Disorders Other Conditions • Adjustment disorder • Anxiety symptoms • Anxiety disorders (includ- • At-risk drinking or drug use • Behavioral and psychiatric ing posttraumatic stress disorder)
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Many terms and labels are used to describe mental health conditions and problems related to abuse or misuse of substances. This report uses the term "mental health condition" to describe mental disorders defined
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Supreme Court decision regarding the constitutionality of the Patient Protection and Affordable Care Act.3 The outcome has substantial implications for older adults with MH/SU conditions because the Act contains numerous provisions related to the 2 DSM, or DSM-IV-TR, refers to the Diagnostic and Statistical Manual of Mental Disorders . During the course of this study, the Fourth Edition-Text Revision (DSM-IV-TR)
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Many of the older adults seeking physical health care services in primary care settings, hospitals, and elsewhere will have coexisting MH/SU conditions. Considerable evidence shows that older adults with MH/SU conditions are among the most costly Medicare beneficiaries (Alecxih et al., 2010; Cummings and Kropf, 2011; MedPAC, 2011)
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This law man dated parity in the coverage of physical and MH/SU conditions by employer-sponsored group health plans with more than 50 insured employees.a The health plans are not required to provide MH/SU benefits but, if they do, the benefits must be no more Changing Face of the Older Population The older adult age cohort is not only growing rapidly, but the age distribution within the cohort is changing, as is the racial and ethnic makeup of the population (Vincent and Velkoff, 2010)
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aThe Patient Protection and Affordable Care Act (ACA) extends the mandate to other types of private health insurance plans.
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There are numerous and substantive concerns about the workforce as a whole, as well as its specialty sectors. Understanding these concerns is critical to grasping the enormous obstacles to building a strong work force that can meet the MH/SU needs of the growing geriatric population.
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For members of the general workforce, professional education provides little training related to the assessment and treatment of older adults and little exposure to geriatric populations. Whatever is provided tends to occur late in the sequence of educational experiences, minimizing its potential to influence interest in specialization.
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. These reports captured the enormous complexity of the behavioral health workforce with its numerous professions, variation in educational approaches, and varied workforce type, including professionals, direct care workers, persons in recovery, and family members.
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ORGANIZATION OF THE REPORT Chapter Objectives This introductory chapter has described the background, charge to the committee, scope, methods, and context for this report. Chapter 2, "Assessing the Service Needs of Older Adults with Mental Health and Substance Use Conditions," presents prevalence and use data and considers the impact of population trends, particularly the aging of the baby boomer cohort and growing population diversity, on the makeup of the older population and future needs for MH/SU services.
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• Medicaid -- nearly 10 percent of Medicare beneficiaries over age 64 have dual Medicaid and Medicare coverage. A significant proportion has serious mental illness (SMI)
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, Bundled Payments for Care Improvement, the Comprehensive Primary Care Initiative, the Health Care Innovation Challenge, State Demonstrations to Integrate Care for Dual Eligibles, the Medicaid Emergency Psychiatric Demonstration, and others. RESEARCH Agency for Healthcare Research and Quality (AHRQ)
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The Primary Care Research Program supports studies that Research examine what types of MH/SU care can be integrated into the primary care setting. The and Clinical Systems Research Program supports studies on organization and coordination of MH/SU Epidemiology care settings, including schools, community organizations, and criminal justice facilities.
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supports research on related topics. • Administers the National Aging Network, a national service infrastructure that funds state-level organizations that provide home- and community-based services (including the Aging and Disability Resource Center and the National Family Caregiver Support Program)
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-- Bureau MH/SU content is not required in geriatric training programs. of Health • Administers several grant programs open to geriatric MH/SU professionals, including Professions Comprehensive Geriatric Education Program Geriatric Academic Career Awards Geriatric Education Center Program Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions • From 2007 to 2010, the above programs provided training and education in mental health (88 percent)
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Enhancing Older Adult Behavioral Health currently funds five of the former TCE grantees. This 18-month initiative focuses on suicide prevention and prescription drug misuse/abuse among older adults.
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2011. Title VI and Title VIII geriatrics program data on the geriatrics mental and behavioral health and substance abuse workforce.
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2003. Effect of improving depression care on pain and functional outcomes among older adults with arthritis -- a randomized controlled trial.
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2011. Mental health parity and the Patient Protection and Affordable Care Act.
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