Health Policy Fact Sheet January 2018 California’s Public Mental Health Services: How Are Older Adults Being Served? Kathryn G. Kietzman, Danielle Dupuy, JoAnn Damron-Rodriguez, Alina Palimaru, Homero E. del Pino, and Janet C. Frank ‘‘ Lack of data on older adults makes it difficult to determine T his fact sheet presents information from a six-county study of public mental health services for older adults funded by the Mental Health Services Act (MHSA) of 2004.1 This is the first study to assess whether MHSA-funded services meet the complex needs and address the recovery goals of older Early Intervention (PEI) programs3 that reach older adults in familiar community settings. While these programs have promise, the extent to which county mental health departments and community-based programs are working together to assess and address unmet need how many are adults with mental illness by supporting an among the older adult population varies being served Older Adult System of Care (OASOC). greatly from one county to the next. and what Study Findings More information is needed about the outcomes There is unmet need among older adults older adults who receive public mental health services. are for those with mental illness. Most county reports in our sample do not who complete The availability of a complete system of describe program participants by age, ’’ services for older adults with mental illness is treatment. a work in progress. While all study counties race/ethnicity, gender, or other defining offer programs that serve older adults, there is characteristics. The absence of information more need for programs to engage in targeted by age category makes it difficult to outreach and to be specifically tailored for determine how many older adults are older adults. In addition, more counties need being served, the characteristics of those to include older adults in planning, which is who access services, and the outcomes an MHSA requirement. Some counties have of those who complete treatment. developed model older adult programs that Counties that include older adult-specific have been tested and found to be effective.2 information show a steady increase in the Access to care across counties varies. To the numbers served since passage of MHSA. extent that our study findings generalize, a Yet, most of these reports do not track how relatively small proportion of older adults many older adults in need of services are are served. While many older adults who being reached. Furthermore, few counties receive public mental health services have document the effectiveness of services aged within the system, the pathway to care provided to older adults; those that do Funding for this fact sheet was for those who first experience mental health are not always using this information for provided by California’s Mental issues as older adults is less clear. Some are decision-making and planning. Health Services Oversight and Accountability Commission. accessing services through Prevention and UCLA CENTER FOR HEALTH POLICY RESEARCH ‘‘ Co-located mental health and primary care services were highly Mental health providers need more training. There are challenges to developing a mental health workforce that meets the special needs of older adults. While the MHSA has bolstered county capacity to support workforce training and education, training gaps remain with regard to support groups were especially important. Some older adult consumers, especially those with a history of substance use disorders, emphasized the value of incorporating family and spirituality into their recovery process. Many consumers also discussed how important it was to valued by older adults.4 Older adult consumers, be engaged and to have a purpose, often older adults, program administrators, and providers through volunteer work. Other strategies to improve access to care identified by who participated in the study highlighted particularly cultural responsiveness training and the consumers and providers included home- those with recruitment of staff who speak other based services, smoother referrals between mobility languages as particularly important for the services, improved transportation options, and financial supports. Study participants effective delivery of older adult mental health limitations services. Consumers also pointed out that agreed on the value of integrated services and/or complex providers need to be more knowledgeable that co-locate mental health services with ’’ medical needs. about generational differences that may affect older adults’ needs and preferences within the mental health delivery system. primary care services and/or substance use services. These “one-stop shopping” options, where they exist, were highly valued by older adults, particularly those There are barriers to the provision of public with mobility limitations and/or complex mental health services to older adults. medical needs. Consumer, administrator, and provider Recommended Actions study participants independently identified many of the same barriers to care, such as Recognize older adults as a distinct unmet basic needs (e.g., food and housing), mental health service population. bureaucratic burdens (e.g., excessive In this study, counties with a formal, paperwork), inadequate transportation, and designated Older Adult System of Care the lack of programs that help consumers (OASOC) offered more programming transition from one level of care to another. and services tailored to older adult needs Consumer participants also brought attention than those without an OASOC. It is to geographic disparities in the availability therefore recommended that an OASOC of services. One consumer described the be designated in all counties that have the consequences associated with one’s place capacity to do so. Optimally, the OASOC of residence: Equity is one of the issues…[It] would connect and provide MHSA depends on…where you live, whether you’re going programs in all geographic areas of the to get connected with the service you need, or be on a county, and have dedicated leadership waiting list, or really have your issues addressed in (e.g., an OASOC coordinator) and staff an effective way. (e.g., an older adult program specialist). Stakeholders identified best practices Identify and improve outreach to older for the delivery of older adult mental adults who need mental health services. health care.2 Counties need to improve efforts to Older adult study participants emphasized document and understand unmet need the value of getting information and services among older adults with mental illness, from trusted sources. Peer and other social including those who present symptoms UCLA CENTER FOR HEALTH POLICY RESEARCH ‘‘ The complex needs of older adults with mental health problems later in life. Outreach strategies should be specific to older adults, take into account where and how best to identify those in need, and reach out to locations in the community where older adults are more likely to gather. County needs assessments should include age categories across the life course. All Area Agencies on Aging) should work together to integrate medical, behavioral health, aging, and substance use treatment services. At the point of service delivery, the integration of these systems would support more opportunities for physical co-location (e.g., embedding mental health require special planning efforts should ensure that older services in aging services locations) and the training for adult representation reflects the diversity of the local community. use of interdisciplinary teams (e.g., nurses, social workers, and psychiatrists) to better mental health address the needs of older adults. ’’ care providers. Collect better information about how older adults are being served. To better understand how older adults fare Funder Information Funding for this work and brief was provided by the California Mental Health Services Oversight within the public mental health delivery and Accountability Commission. system, it is essential for counties to systematically measure and monitor their Author Information progress. Current county-level data reporting Kathryn G. Kietzman, PhD, MSW, is a research is insufficient and needs to be strengthened. scientist at the UCLA Center for Health Policy Many older adults who need services have not Research and an assistant researcher at the UCLA been identified. Fielding School of Public Health, Department of Community Health Sciences. Danielle Dupuy, MPH, is a doctoral candidate at the UCLA Provide training in mental health Fielding School of Public Health, Department and aging. of Community Health Sciences, and co-founder The complex needs of older adults with of the Justice Work Group. JoAnn Damron- mental health problems require special Rodriguez, LCSW, PhD, is an adjunct professor training for mental health care providers. at the UCLA Luskin School of Public Affairs, Department of Social Welfare. Alina Palimaru, Professional providers (e.g., psychiatrists, MPP, is a doctoral candidate at the UCLA psychologists, social workers, nurses) require Fielding School of Public Health, Department in-depth training on evidence-based practices of Health Policy and Management. Homero E. for older adults and assessment of older adult del Pino, PhD, MS, is an assistant professor at outcomes. Workforce training also needs to the UCLA David Geffen School of Medicine, take into account the rich cultural differences Department of Psychiatry and Biobehavioral Sciences. Janet C. Frank, MS in gerontology, that exist across the aging population, DrPH, is an adjunct associate professor at the including the diversity represented by UCLA Fielding School of Public Health and a generational cohort, race/ethnicity, gender faculty associate at the UCLA Center for Health identification, sexual orientation, and Policy Research. culturally held beliefs about mental illness. Acknowledgments Provide more “one-stop shopping” services. We are deeply grateful for all of the study participants who made this work possible. State and county agencies (e.g., California’s We are further indebted to the members of the departments of Health Care Services, California Mental Health and Older Adults Aging, and Managed Health Care, and Project Advisory Committee, who provided county mental health departments and invaluable guidance all along the way. UCLA CENTER FOR HEALTH POLICY RESEARCH Suggested Citation Kietzman KG, Dupuy D, Damron-Rodriguez J, Palimaru A, del Pino HE, and Frank JC. 2018. California’s Public Mental Health Services: How Are Older Adults Being Served? Los Angeles, CA: UCLA Center for Health Policy Research. Endnotes 1 San Diego, Los Angeles, Tulare, Monterey, Alameda, and Siskiyou counties were selected to represent the geographic, economic, and racial/ethnic diversity of California. The research team conducted 72 interviews with consumers, family members, program administrators, providers, and clinicians, as well as 6 focus groups whose members included 33 consumers and 11 family members. In addition, the team reviewed 100+ publications and evaluation reports that included both statewide and individual county-level information. 2 Promising Older Adult Mental Health Programs. http://healthpolicy.ucla.edu/publications/search/pages/detail. aspx?PubID=1712 3 The goal of PEI is to help counties implement services that promote wellness, foster health, and prevent the suffering that can result from untreated mental illness. The PEI component requires collaboration with consumers and family members in the development of PEI projects and programs. While the Mental Health Services Oversight and Accountability Commission (MHSOAC) has the authority to write regulations for the PEI component of the MHSA, all funding decisions within PEI are determined locally. Only the Department of Health Care Services (DHCS) has the authority to enforce those regulations, through its performance contracts and audit functions. http://www.mhsoac.ca.gov/components 4 California Mental Health Older Adult System of Care Project, Deliverable 3 Report: Secondary Data Analyses MHSA Evaluation: and Key Informant Interviews. http://healthpolicy.ucla. This policy brief is part edu/publications/search/pages/detail.aspx?PubID=1651. of a six-county study of Deliverable 4 Report: Focus Groups: http://healthpolicy. ucla.edu/publications/search/pages/detail.aspx?PubID=1714 public mental health services for older adults funded by the MHSA. For more information on this evaluation, and to see all related publications, please visit: http://www.healthpolicy. ucla.edu/Older-Adult- Mental-Health For a detailed examination of these findings, visit: http://healthpolicy. ucla.edu/publications/ search/pages/detail. Read this publication online aspx?PubID=1708 FS2018-1