Public Policy Update

Research conducted by psychologist Patricia Arean, PhD, the University of California, San Francisco, has found that integrated care dramatically decreased depression, pain and suicide; erased mental health access disparities in older persons of color; and was cost neutral over a two-year period.

Outcomes like that are the kind psychologists and other health professionals want to see more of to improve care for older Americans. Congress can help by supporting integrated health care in its upcoming reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA), expected later this year. This reauthorization offers a critical opportunity to strengthen and enhance the federal agency, whose mission is to build resilience and facilitate recovery for people with or at risk for mental or substance use disorders.

Over the past year, APA's Government Relations team has identified four areas for Congress to consider in SAMHSA's reauthorization:

  • The integration of mental and behavioral health in primary care.
  • Prevention and early intervention.
  • Suicide prevention.
  • Work force development.

In particular, the Public Interest Government Relations Office (PI-GRO) is garnering support for several key SAMHSA reauthorization policy priorities, including enactment of the Positive Aging Act (S. 982/H.R. 1669), which would authorize grants through SAMHSA to integrate mental health services into primary-care and community settings where older adults reside and receive services.

Interdisciplinary teams of mental health professionals working in collaboration with other health and social service providers would provide the evidence-based services authorized under this legislation.

To this end, PI-GRO staff have reached out to congressional offices to encourage support for the APA SAMHSA priorities, including the Positive Aging Act. In response, the Senate Health, Education, Labor and Pensions Committee--which has legislative jurisdiction over SAMHSA's reauthorization--invited PI-GRO to present at a bipartisan congressional staff briefing. At the briefing, Gregory Hinrichsen, PhD, an associate clinical professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, urged congressional staff to prepare for the mental health needs of the aging population. Specifically, Hinrichsen discussed the significant barriers to successful treatment of mental disorders in older adults, including stigma, the lack of mental health parity under Medicare, the insufficient geriatric mental health care work force, poor coordination of physical and mental health care, and a lack of financial support for health-care coordination. As a member of the APA Presidential Task Force on Integrated Health Care for an Aging Population, Hinrichsen highlighted the critical role of psychologists as members of integrated health care teams and urged Congress to support the Positive Aging Act in the upcoming SAMHSA reauthorization.

Also at the briefing, Arean described the promising findings from her studies on integrated health care for aging Americans. Arean also emphasized that there is strong demand among agencies who work with older adults to implement "one-stop care" models. She pointed to the important role that SAMHSA funding played in supporting her work in this area and urged policymakers to continue federal support for integrated health care for older adults as a key priority area.

The briefing also featured remarks from Michele Karel, PhD, a staff psychologist at the VA Boston Health-care System and assistant professor at Harvard Medical School. Karel explained that a variety of resources help facilitate integrated care within the VA, such as the physical proximity of staff, electronic health records, telehealth programs, and virtual health-care teams. Karel also described her close collaboration with the team she works with, which includes psychologists, psychiatrists, social workers, psychology fellows and interns, primary and specialty care professionals, community providers and families.

APA has strongly promoted integrated health care and the Positive Aging Act as one of its key mental health and aging policy priorities since 2002. In 2006, APA led a coalition of aging and mental health organizations in successfully securing the inclusion of several provisions from the Positive Aging Act in the reauthorization of the Older Americans Act. The inclusion of these provisions established new authority to focus on mental health screening and treatment for older adults at the Administration on Aging.

Further Reading

For more information on aging policy issues, please contact Diane L. Elmore, PhD. For a comprehensive overview of APA SAMHSA reauthorization recommendations, visit APA's Government Relations Web site. For more information on the APA Presidential Task Force on Integrative Health Care for an Aging Population, contact Deborah DiGilio. Diane L. Elmore, PhD, is a senior legislative and federal affairs officer in the Public Interest Government Relations Office and codirector of the APA Congressional Fellowship Program.

How you can help

APA and its members must work to ensure that older adults' mental health needs are a priority in the congressional reauthorization of the Substance Abuse and Mental Health Services Administration. You can help by encouraging Congress to support integrated health-care initiatives, such as the Positive Aging Act. For more information, visit the Public Interest Government Relations Office Web site.