Health Policy Fact Sheet January 2018 Promising Older Adult Mental Health Programs Danielle Dupuy, Kathryn G. Kietzman, JoAnn Damron-Rodriguez, Alina Palimaru, Homero E. del Pino, and Janet C. Frank T his fact sheet and the accompanying compendium provide information about 25 promising older adult mental health Those 60 years of age and older are more likely than those in other age groups to have limited mobility and to be socially isolated, programs that were identified through the both of which can make it difficult to access California Mental Health Older Adult System care.2,3 The perceived stigma associated of Care Project. The two-year study assessed with seeking mental health services is a older adult mental health care service delivery in more significant barrier for older adults six counties through key informant interviews compared to other age cohorts,3,4 and with administrators, county-contracted treatment of mental illness among older providers, and consumers of county mental adults may require specialized care due to health services. Specifically, stakeholders were increased comorbidities.5 Overcoming these interviewed about their views on facilitators for challenges to provide effective mental health implementing an integrated and comprehensive care demands integrated and collaborative system of mental health care for older adults approaches across services, with skilled and also on strategies for overcoming barriers providers trained in eldercare. to implementation. Through this process, the interviewees described mental health programs Research has shown that programs that and services that they believed were beneficial involve peer support, use integrative or for older adults based on firsthand experience. collaborative models, incorporate medication These older adult mental health programs are management, and have providers that deemed promising in that, per the dictionary specialize in older adult care achieve better definition of that word, they “are likely to mental health outcomes.3,5,6 In California, succeed or to yield good results” and also may county mental health service providers, be of interest to other counties across the state. consumers, and administrators identified promising programs that include these and Promising programs incorporate the values of other targeted strategies. Funds are allocated the Mental Health Services Act (2004), which to these programs through the state’s include a strength-based approach, consumer/ county mental health and behavioral health family focus, a continuum of services, and departments; the programs are operated by outcome accountability. They are based on county behavioral/mental health agencies Funding for this fact sheet was evidence that older adults are best served and by contracted organizations, agencies, provided by California’s Mental through age-appropriate programs that consider and clinics. Health Services Oversight and Accountability Commission. their specific needs.1 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 1 Promising Older Adult Mental Health Program Service Settings and Strategies Community Service Strategies Field-Mobile Home-Based Clinic Residential Integrated/Collaborative Care Case Management Service Strategies and Practices Peer Support Medication Management/Support Housing Resource or Service Linkage Substance Misuse and Abuse Services 0 2 4 6 8 10 12 14 Number of Programs Exhibit 1 presents the care settings and It is important to note that the service strategies used by the programs Compendium of Promising Older Adult Mental listed in the compendium (http://healthpolicy. Health Programs is not an exhaustive ucla.edu/publications/Documents/PDF/2018/ list of all older adult programs in the PromisingPrograms-compendium-jan2018.pdf). six study counties.† Programs described Two of the twenty-five programs are specific in the compendium were identified by to workforce development and are oriented participants in the study and reflect the for service providers in the field of older adult experiences of those who administer, mental health care. These programs do not provide, or participate in the programs on have a “service setting” or “service strategy” a regular basis. and are therefore not represented in Exhibit 1. The remaining 23 are programs targeted for The mental health needs of older or inclusive of older adult consumers either Californians are an important statewide diagnosed with serious mental illness or at risk priority, and programs that are successful for developing mental illness. The majority should be recognized and information of these 23 programs are provided in the about them shared widely. The older adult community setting and use an integrated or population in the state is expected to grow collaborative care model that involves either to 13.9 million by 2050, representing coordinating care between service providers or an increase of 128 percent from 2010.8 providing multidisciplinary services within one The California Board of Behavioral team or setting. All programs use strategies that Sciences asserts that paying attention to reflect at least two of the four recommended older adults’ mental health is critical, Older Adult System of Care7 service types: prevention, access to care, recovery, and † Additional sources that describe mental health programs in counties can be found through MHSA Annual Updates for integration/collaboration. Counties as well as the National Alliance on Mental Illness (NAMI) in California, which publishes reports on mental health programs provided in all California counties. UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 2 Promising Older Adult Mental Health Care Programs in the Six Study Counties Alameda County San Diego County Geriatric Assessment and Response Team (GART) Uptown Safe Haven Transitional Housing Senior Advocates for Hope and Justice Senior Impact Behavioral Health Education and Training Academy Homeless Senior Services (BHETA): Geriatric Certificate Programs Pool of Consumer Champions Project One for All for Homeless Afghan Elderly Association Programs Positive Solutions Los Angeles County Telecare AgeWise Geriatric Evaluation Networks Encompassing Services REACH CALMA Intervention Support Program (GENESIS) Jail Transition and Linkage Services CREST Seeking Safety (SS) Siskiyou County Program to Encourage Active, Rewarding Lives Six Stones Wellness for Seniors (PEARLS) UCLA Geriatric Psychiatry Fellowship Tulare County Check In with You: Monterey County Older Adult Hopelessness Screening Program Drake House Visalia Adult Integrated Clinic Senior Peer Counseling Transitional Living Center (TLC) Bienestar because hundreds of thousands age 65 and is an adjunct professor at the UCLA Luskin over are in need of mental health services.9 School of Public Affairs, Department of Social Welfare. Alina Palimaru, MPP, is a doctoral This includes both those aging with serious student at the UCLA Fielding School of Public mental illness and those encountering high Health, Department of Health Policy and levels of depression, anxiety, and substance Management. Homero E. del Pino, PhD, MS, is abuse beginning in late life. Mental and an assistant professor at the UCLA David Geffen behavioral health care departments can use School of Medicine, Department of Psychiatry this compendium as a menu of potential and Biobehavioral Sciences. Janet C. Frank, MS in gerontology, DrPH, is an adjunct associate options to implement as a way of enhancing professor at the UCLA Fielding School of Public services for older adults. Consumers can also Health and a faculty associate at the UCLA use the compendium to determine whether Center for Health Policy Research. local mental health programs share features of the successful approaches listed here. Funder Information Funding for this work provided by the Author Information California Mental Health Services Oversight Danielle Dupuy, MPH, is a doctoral student at and Accountability Commission. the UCLA Fielding School of Public Health, Department of Community Health Sciences, and Acknowledgments cofounder of the Justice Work Group. Kathryn G. We are deeply grateful for all of the study Kietzman, PhD, MSW, is a research scientist at the participants who made this work possible. We UCLA Center for Health Policy Research and an are further indebted to the members of the assistant researcher at the UCLA Fielding School of California Mental Health and Older Adults Public Health, Department of Community Health Project Advisory Committee, who provided Sciences. JoAnn Damron-Rodriguez, LCSW, PhD, invaluable guidance all along the way. UCLA CENTER FOR HEALTH POLICY RESEARCH Suggested Citation Dupuy D, Kietzman KG, Damron-Rodriguez J, Palimaru A, del Pino HE, and Frank JC. 2018. Promising Older Adult Mental Health Programs. Los Angeles, CA: UCLA Center for Health Policy Research. Endnotes 1 Bartels SJ, Dums AR, Oxman TE, et al. 2002. Evidence- Based Practices in Geriatric Mental Health Care. Psychiatric Services 53(11). 2 Gilmer TP, Ojeda VD, Fuentes D, Criado V, Garcia P. 2009. Access to Public Mental Health Services Among Older Adults with Severe Mental Illness. International Journal of Geriatric Psychiatry 24(3):313-318. doi:10.1002/gps.2123. 3 Chapin RK, Sergeant JF, Landry S, et al. 2013. Reclaiming Joy: Pilot Evaluation of a Mental Health Peer Support Program for Older Adults Who Receive Medicaid. Gerontologist 53(2):345-352. doi:10.1093/ geront/gns120. 4 Centers for Disease Control Disease Control and Prevention and National Association of Chronic Disease Directors. 2008. State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? 5 Karel MJ, Gatz M, Smyer MA. 2012. Aging and Mental Health in the Decade Ahead: What Psychologists Need to Know. American Psychologist 67(3):184-198. doi:10.1037/a0025393. 6 Substance Abuse and Mental Health Services Administration, Older Americans Behavioral Health Technical Assistance Center. 2012. Issue Brief 5 : Prescription Medication Misuse and Abuse Among Older Adults. 7 Frank JC, Kietzman K, Damron-Rodriguez J, Dupuy D. 2016. California Mental Health Older Adult System of Care Project: Proposed Outcomes and Indicators for Older Adult Public Mental Health Services. Los Angeles, CA: UCLA Center for Health Policy Research. 8 California Health and Human Services Agency, California Department of Aging. California State Plan on Aging 2013-2017. 9 California Department of Consumer Affairs, MHSA Evaluation: Board of Behavioral Sciences. Aging and Mental Health. http://www.bbs.ca.gov/consumers/info.html. Accessed January This policy brief is part 6, 2017. of a six-county study of 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- Read this publication online Mental-Health FS2018-2