Public Comment
Presented on behalf of the American Psychological Association (Washington, D.C.)
by Deborah DiGilio, Aging Issues Officer
Before the President's New Freedom Commission on Mental Health

October 4, 2002

Good morning. On behalf of the American Psychological Association, I would like to commend the President's New Freedom Commission on Mental Health for directing your attention to the mental health needs of older adults. The American Psychological Association shares your commitment to improving the quality of life experienced by older adults across gender, race/ethnicity, and in rural and urban areas. Our 155,000 members and affiliates include approximately 2,500 psychologists who specialize in adult development and aging in their research, clinical, and academic endeavors. In my role as the association's Aging Issues Officer, I would like to take this opportunity to highlight three overarching issues concerning the mental health of older adults.

First, the unmet mental health needs of older adults are significant and expected to increase over time. Thus, it is of great concern that mental disorders often go undiagnosed and untreated among older adults. The most prevalent disorders are anxiety, depression, and those involving cognitive impairment. Symptoms of depression in older adults are often overlooked, because they coincide with other medical illnesses or life events that commonly occur as people age, for example loss of loved ones. Older adults have the highest rate of suicide in the United States, with depression as the foremost risk factor.

Second, psychological services have proven effective in treating mental health problems experienced by older adults. Research reveals positive outcomes for psychological and behavioral interventions for anxiety, dementia, substance abuse, sleep disorders, and pain. It is worthy of note that these interventions have been consistently demonstrated to be as effective for the treatment of depression with older adults as they are with younger adults and as compared to medication use. In addition, the combination of psychotherapy and medication is the most effective treatment for older adults with severe depression.

Psychologists possess the necessary training and skills to assess and differentiate between cognitive, emotional, and behavioral disorders. They utilize these skills independently and as members of interdisciplinary teams in a variety of settings, including home, community, hospital, and long term care facilities. Psychologists assist older persons in dealing with age-related changes, including loss of loved ones; behavioral challenges; such as medication management, incontinence, and injury prevention; and problems in daily living, such as maintaining independence.

In addition, psychosocial interventions provided to caregivers have been associated with delaying nursing home admission by almost a year and decreasing caregiver burden and depression. Psychosocial interventions in long-term care facilities not only address the high rates of mental illness and negative behaviors, such as aggression and wandering, but they also enhance staff interventions and morale, thereby reducing staff turnover and elder abuse.

Third, concerted efforts must ensure that psychological services are more widely accessible. We know that many older adults struggle with mental health concerns, value good psychological health, and are becoming increasingly receptive to mental health services. However, research suggests that up to two-thirds of older adults with a mental disorder do not receive the services they need. A variety of barriers are often encountered by older adults including accessibility and reimbursement policies, negative professional attitudes about working with older adults, and low rates of referral by general practitioners.

To address these concerns, we recommend the following:

1. The attainment of full parity in mental health coverage equal to that provided for medical and surgical care in both Medicare and private insurance plans.

2. Increased 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.

3. Enhanced 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.

4. Expanded 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.

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

On behalf of the American Psychological Association, I would like to thank you for your consideration and for your ongoing efforts to improve our mental health service delivery system for Americans of all ages. Psychology has an important role to play in the health care of older adults, and we, as an association, stand ready to assist you in this vital and laudable effort.

Information and links on the President's New Freedom Commission on Mental Health