Mental Health Services for Older Adults Lacking
Today's Americans who are over 65 years of age are the people about whom Franklin D. Roosevelt said: "This generation of Americans has a rendezvous with destiny." Destiny in terms of mental health treatment does not currently look promising for this age group or the 20% of Americans who will be 65 or older by 2030.
The age of 65 as the demarcation between old and young is a somewhat arbitrary one. Gerontologists now attempt to divide old age into two groups: early old age from 65 to 74 years and advanced old age, 75 and above. The 75 and 85 plus age groups are the fastest growing segments of the US population.
Today older people constitute 13% of the population, but their use of mental health services falls far below that. They account for only 7% of inpatient services, 6% of mental health centers and 9% of private psychiatric care. Less than 3% of all Medicare reimbursement is for psychiatric treatment of older consumers. Yet it is estimated that 18-25% of elders are in need of mental healthcare for depression, anxiety, psychosomatic disorders, adjustment to aging and schizophrenia. Tragically, the elder suicide rate of 21% is the highest of all age groups.
The first person elders turn to for help with problems which may require mental health treatment is their primary care physician. Interestingly, a 1990 study of elder suicides in Chicago found that 84% of them had seen their primary care doctors within the previous 30 days. 20% had seen them within 24 hours of their suicide.
One reason for the disparity between service needs and utilization is pervasive ageism in western culture particularly. It is the sacrifice of older people by our society for the sake of "productivity" and of the youthful image that the working world feels compelled to project. A society that places great emphasis on youth and the importance of looking young does not lend enthusiastic support to better mental healthcare for the geriatric population. Other reasons include the stigma associated with mental illnesses, unresponsive service systems, the disparity in reimbursement rates for psychiatric care and the lack of organized consumer support for this age group.
There is good news in regard to elder consumer organizing. The Center for Mental Health Services is supporting the development of a new senior consumer advocacy organization that will advance the needs of this age group in the near future. For more information on this group, contact Brian Cooper, Director of Consumer Advocacy at NMHA at 703-837-4788.