A considerable number of baby boomers will probably find it hard to access treatment and diagnoses for mental health issues and substance abuse problems unless a major overhaul is undertaken, according to a new report issued by the Institute of Medicine (IOM). The authors (Committee) explained that the numbers of mental health care professionals and other service providers need to be boosted significantly.

The report is titled “The Mental Health and Substance Use Workforce for Older Adults In Whose Hands?”

According to the report, the problem has become so serious that no tinkering, single approach or isolated changes in some federal programs of agencies will have enough of an impact.

In order to make sure there is coverage for care management, counseling and other vital mental health and substance use problems, Medicaid and Medicare rules need to be changed, the authors wrote. Otherwise, doctors and health care professionals will be unable and possibly unwilling to provide proper care.

License providers, social service professional schools, and health accreditation organizations have to make sure that social workers, physicians’ assistants, nurses, and general practitioners (primary care physicians) are able to:

  • Identify the signs and symptoms of geriatric mental health conditions
  • The signs and symptoms of neglect
  • The signs and symptoms of substance misuse and abuse
  • At least provide basic care

Those currently in charge of the US Department of Health and Human Services (HHS) must make sure there are enough well trained professionals specialized in substance abuse care and geriatric mental health care. The HHS must ensure that all competent and relevant agencies and departments are taking this problem seriously and devoting time and resources to these conditions.

Committee chair Dan G. Blazer, J.P. Gibbons Professor of Psychiatry and Behavioral Sciences and vice chair for faculty development, Duke University Medical Center, Durham, N.C. , said:

“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.

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.”

From 5.6 million to 8 million American seniors have at least one mental health condition or a problem linked to substance abuse or misuse, the Committee has estimated, describing their estimate as “a conservative one”, i.e. between 14% and 20% of elderly Americans.

There is a particularly high rate of elderly people with depressive disorders and dementia-type behavioral and psychiatric symptoms, the authors explained. Accidental and intentional misuse of prescription drugs is becoming a progressively serious problem. As baby boomers age, the current low rate of illicit drug usage among America’s elderly population will probably grow significantly.

If elderly people are not treated promptly and properly for mental health problems and substance misuse, their health outcomes worsen and the overall economic burden is significantly greater. If an elderly patient with depression is not treated for his/her mental condition, they are more likely to forget to take medications for other conditions they may have, such as hypertension (high blood pressure), heart disease, and diabetes, resulting in longer and more frequent costly hospital stays.

Stress test
Elderly patients may have a number of different conditions and illnesses – for proper and effective care, they all need to be treated

The Committee stressed that proper training in geriatric care for these problems is crucial. Elderly people metabolize medications and alcohol differently from younger individuals. They are at a much higher risk of overdoses. These changes in how their bodies metabolize substances may sometimes make them more susceptible to alcoholism or some other addiction.

Seniors often have physical conditions and cognitive impairments that make it much harder to detect and diagnose some illnesses and conditions, especially mental ones and problems with substance abuse or misuse. If an elderly patient has problems with cognition, they are less likely to adhere to medication instructions.

The Committee found that health care professionals are frequently deterred from offering their skills and services for substance abuse and mental health conditions because of Medicare and Medicaid payment policies – with the current system, reimbursements for services and care provided are limited.

The Committee wrote:

“Effective care includes helping patients self-manage their conditions and monitoring to prevent relapses, services that can be provided by a range of trained providers and in a variety of care settings.

The Centers for Medicare and Medicaid Services should evaluate alternative payment methods that would better reflect and fund effective services and coordinated team-based care for mental health and substance abuse.”

The majority of primary care providers have little if any training on geriatric mental health and substance abuse. This is a pity, because they are the ones most in contact with elderly patients.

There are not enough financial incentives currently in place to encourage health care professionals to enter these medical fields, or even to stay in them.

Medical training across all disciplines should include competence in the areas of geriatric mental health and substance misuse and abuse. Health care professionals should be able to spot the signs and symptoms early on so that proper and prompt treatment may be provided.

There are provisions in the Patient Protection and Affordable Care Act for scholarships and loan forgiveness for those working with seniors in the fields of mental health and substance abuse. Congress should appropriate funds for these purposes.

The authors noted that less money has been going into supporting geriatric mental health and substance abuse, in fact, in some cases monies have been cancelled.

In 2010, there were 40.3 million seniors (aged 65+) in the USA, this figure is expected to reach 72.1 million by 2030. Over the next twenty years, the racial, ethnic and cultural makup of the country’s senior population will become much more diverse – experts say the costs resulting from these changes “are expected to be unprecedented”.

Written by Christian Nordqvist