Feature

In December, 929 of the 1,200 national delegates at the White House Conference on Aging (WHCoA) voted to improve "recognition, assessment and treatment of mental illness and depression among older Americans," making the resolution one of the conference's top 10 priorities in dealing with America's aging population.

Moreover, mental health was included in numerous other resolutions' "implementation strategies." For example, a resolution seeking to "strengthen and improve the Medicare program for seniors" included a call for mental health parity that will be included in the conference's final report. Throughout the past 15 months, both APA's Office on Aging and Committee on Aging have advocated for mental health's inclusion into the conference's agenda.

The White House Conference on Aging, which happens every 10 years, is a nonpolitical, cross-disciplinary event, where delegates formulate nonbinding policy recommendations to the president and Congress. The conference aims to guide the next decade's national aging policies so that they promote the health, independence and economic security of older adults.

With more than 36 million Americans already older than 65, and the first of the 77 million baby boomers turning 60 this year, the problems associated with an aging population-such as shortages of family and professional caregivers, lack of proper housing and transportation for seniors and shortages of geriatric physicians-are poised to come to a head.

However, mental health's prominent position in helping to moderate those issues at the conference may reflect the start of a societal shift, says APA Past-president Ronald F. Levant, EdD, a conference delegate.

"We may be seeing the start of people viewing mental health as part of health overall," he says.

A tightly controlled agenda

Although past conferences have contributed to the establishment of aging programs such as Medicare and Medicaid, the Older Americans Act and the National Institute on Aging, many resolutions that have emerged from past conferences are revisited at subsequent conferences because the White House and Congress have yet to act on them, says Deborah DiGilio, APA's aging issues officer who coordinated APA's conference efforts.

To help initiate quicker action on conference resolutions, conference organizers changed the conference's format: Unlike previous conferences in which delegates could debate resolutions as well as introduce resolutions with 10 percent of the delegates' support, delegates were unable to introduce new resolutions. Instead, organizers e-mailed 73 potential resolutions to delegates five days before the conference. The conference's policy committee developed the resolutions based on WHCoA Listening Sessions, Solutions Forums, Mini-Conferences and Independent Aging Agenda events held during the past two years.

The delegates then voted for up to 50 resolutions-without debate-on the conference's opening day, Monday, Dec. 12. The following day they developed "implementation strategies" to help policy-makers put the recommendations in place.

Some conference participants felt the procedural changes were counterproductive.

The day of the vote, a group stood up following a speech by Mark McClellan, MD, PhD, administrator of the federal Centers for Medicare & Medicaid Services, demanding the right to introduce and modify resolutions from the floor.

The protesting delegates sought to offer a resolution for a substantial overhaul of the Medicare drug law by providing drug coverage through the Medicare program rather than private insurers, and by allowing the government to negotiate the price of drugs. However, Dorcas R. Hardy, chairman of the conference's policy committee and Gail Gibson Hunt, a committee member who was moderating the session, stymied their request.

Many delegates were also disappointed at the absence of President George W. Bush. In lieu of the conference, Bush spoke to seniors about the new Medicare prescription drug plan at Greenspring Village, a gated retirement community in Virginia.

"It seemed to be a symptom of a larger problem," says Delegate Michael Smyer, PhD, a psychologist and dean and co-director of Boston College's Center on Aging and Work/Workplace Flexibility. "There was a great deal of expertise and experience at the conference, but the structure did not allow it to come forth."

Outcomes

Despite his frustration over the conference's structure, Smyer and other delegates were pleased with their colleagues' inclusion of mental health concerns in a number of the resolutions' implementation strategies.

"We saw mental health get a very broad base of support," he says.

A few of the resolutions (ranked according to total votes) with implementation strategies that included mental health concerns are:

  • Resolution 2: Develop a coordinated, comprehensive long-term care strategy by supporting public and private sector initiatives that address health-care financing, choice, quality, service delivery and the paid and unpaid work force. Conference delegates included mental health in their conception of the paid and unpaid work force.

  • Resolution 6: Support geriatric education and training for all health-care professionals, paraprofessionals, health professional students and direct-care workers. Conference delegates sought to require that professional mental and behavioral health education programs that receive federal funding introduce geriatric coursework or rotations for all students, while promoting evidence-based and emerging best practices and skills.

  • Resolution 8: Improve recognition assessment and treatment of mental illness and depression among older Americans. Among the delegates' plans were calls to support the integration of older adult mental health and substance abuse services into primary health care, long-term care and community-based services.

  • Resolution 9: Attain adequate numbers of healthcare personnel in all professions who are skilled, culturally competent and specialized in geriatrics. Conference delegates aimed to actively seek new providers in mental health, behavioral and substance abuse for older adults by expanding financial incentives, such as geriatric traineeships, loan forgiveness programs and continuing education.

  • Resolution 12: Promote incentives for older workers to continue working and improve employment training and retraining programs to better serve older workers. Conference delegates expect psychologists to be involved in improving employee training and retraining programs.

  • Resolution 14: Remove barriers to the retention and hiring of older workers, including age discrimination. Among the delegates' plans are calls for psychologists to assist in training and development of older worker reintroduction strategies in both the public and private sectors.

  • Resolution 29: Promote innovative evidence-based and practice-based medical and aging research. Among the delegates' plans were calls to promote older adult mental health and substance abuse research and to coordinate and finance the movement of evidence-based and emerging best practices from research to service delivery and work force training programs.

  • Resolution 35: Educate Americans on end-of-life issues. Conference delegates sought to identify older adults as a priority population for public mental health and substance abuse program funding, as well as guarantee parity in coverage and reimbursement for mental health and substance abuse services as compared with physical health services.

Although many were pleased with the conference's resolutions, some wondered about its long-term effects.

"The whole question is, 'Will this do any good?'" says former APA President Norman Abeles, PhD, a delegate at both the 1995 and 2005 conferences. "And time will tell."