APA Committee on Aging Comments on Interim Report of the President’s New Freedom Commission on Mental Health

The Committee on Aging of the American Psychological Association would like to commend the Subcommittee on Older Adults of the President's New Freedom Commission on Mental Health for their work on the interim report. We share their commitment to improving the quality of life experienced by older adults across gender, race/ethnicity, and in rural and urban areas. Although we recognize the limitations imposed by the interim report, we look forward to a more expansive discussion in the final report to include a range of mental health issues and treatment models pertaining to older adults. We would like to provide the following comments for consideration in your ongoing subcommittee work.

Mental Health Concerns of Older Adults

  • According to the U.S. Department of Health and Human Services, Administration on Aging (2001), the most common mental health concerns of older adults, in order of prevalence, are anxiety, severe cognitive impairment, and depression. In addition, older adults have the highest rate of suicide in the United States, and depression is its foremost risk factor.

  • A variety of behavioral health issues associated with aging beyond traditional psychodiagnostic categories significantly impact the mental health status of older adults. Coping with life transitions, loss of loved ones, relocation, multiple medical conditions, chronic pain and caregiving demands are critically important needs in this population that often go unmet.

  • Comprehensive healthcare of older adults must acknowledge the relationship between the physical and mental health of each individual, as these factors become increasingly difficult to disentangle as we age. Every year an estimated 2.1 million older Americans are victims of physical, psychological, or other forms of abuse and neglect. For every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five cases that have not been reported (American Psychological Association, 1999). 

Quality Mental Health Care for Older Adults

  • Anxiety: Research suggests that behavioral treatments for anxiety are effective with older adults (e.g., Barrowclough et al., 2001).

  • Dementia and Alzheimer’s Disease: Behavioral approaches and memory training target specific cognitive and behavioral impairments and help to optimize abilities of older adults (Kasl-Godley & Gatz, 2000). Psychosocial interventions for caregivers of older adults with Alzheimer’s disease have been associated with delayed nursing home admission (by almost a year) and decreased caregiver burden and depression (Mittleman, et al., 1996).

  • Depression: Psychosocial interventions are effective for both major depressive disorder and subclinical forms of depression among older adults (Scogin & McElreath, 1994). In both younger and older adults, psychotherapy in conjunction with pharmacotherapy may be more effective in treating mental health problems than is pharmacotherapy alone (e.g., Arean & Cook, 2002). In addition, numerous studies show that adults, including older adults, who receive cognitive behavioral therapy have significantly less relapse to further episodes of depression than do adults receiving only phamacotherapy.

  • Abuse/Neglect: Research suggests that a variety of tools can be utilized to prevent or intervene when elder abuse occurs, including education, respite care, social contact/support, and counseling (American Psychological Association, 1999).

Recommendations

  • Attain full parity in mental health coverage equal to that provided for medical and surgical care in both Medicare and private insurance plans.

  • Increase funding through Medicaid, the Older Americans Act, and the Community Mental Health Services Block Grant to expand the availability of mental health and related supportive services to older adults.

  • Enhance opportunities for professional training at the graduate level and beyond to prepare mental health professionals to work with older persons. This can be accomplished in part by funding geropsychology training in the Graduate Psychology Education Program of the Health Resources and Services Administration (HRSA), the Minority Fellowship Program of the Substance Abuse and Mental Health Services Administration (SAMHSA), and qualified clinical psychology internship training programs under Medicare.

  • Expand basic and applied behavioral research at the National Institute of Mental Health and the National Institute on Aging, together with increased funding for research training in clinical geropsychology, and the widespread dissemination of evidence-based interventions to aid older persons.

  • Increase mental health outreach and intervention through early identification, referral, and treatment in primary care settings, senior centers, residential settings, and other community sites.

  • Encourage Medicare carriers to increase coverage for mental health services through local medical review policies.

  • Encourage the development and implementation of collaborative, innovative, community-based mental health programs for older adults in collaboration with state and local departments of health, mental health, and aging.

  • Support policy and legislation that promotes the rights of older adults and helps to protect them from abuse and trauma in family and community settings.

References

American Psychological Association. (1999). Elder abuse and neglect: In search of solutions [Brochure]. Washington, D.C.: American Psychological Association.

Arean, P. & Cook, B.L. (2002). Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression. Biological Psychiatry, 52(3), 293-303.

Barrowclough, C., King, P., Colville, J., Russell, E., Burns, A., & Tarrier, N. (2001). A randomized trial of the effectiveness of cognitive-behavioral therapy and supportive counseling for anxiety symptoms in older adults. Journal of Consulting & Clinical Psychology, 69(5), 756-762.

Gallagher-Thompson, D., & Steffen, A.M. (1994). Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. Journal of Consulting and Clinical Psychology, 62(3), 543-549.

Kasl-Godley, J., & Gatz, M. (2000). Psychosocial intervention for individuals with dementia: An integration of theory, therapy, and a clinical understanding of dementia. Clinical Psychology Review, 20(6), 755-782.

Mittelman, M., Ferris, S., Shulman, E., Steinberg, G., & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer’s disease: A randomized controlled trial. Journal of the American Medical Association, 276(21), 1725-1731.

Scogin, F. & McElreath, L. (1994). Efficacy of psychosocial treatments for geriatric depression: A quantitative review. Journal of Consulting and Clinical Psychology, 62(1), 69-74.

U.S. Department of Health and Human Services, Administration on Aging. (2001). Older Adults and Mental Health: Issues and Opportunities Washington, D.C.