State Advisory Council on Aging, 2006:
EXECUTIVE SUMMARY and RECOMMENDATIONS

The scope of concerns about mental health in late life is broad and mixed.  First, there are research studies that confirm older adults are less likely to experience major depression, but more likely to experience minor depression.  There are the changes in the funding and priorities of the publicly funded mental health system that make it less likely that older adults will be served, unless they meet the serious mental illness criterion and are not on Medicare. There is a growing awareness of the link between physical health and mental health from people concerned with public health, those studying healthy aging and those reimbursing health care providers. People with untreated mental health problems use more health care resources and depression, a common problem, is treatable. Nationally and federally, the focus on mental health has re-emerged. There are numerous reports on mental health, older adults and the impact of stigma in dealing with mental illness.

Throughout the discussion, several key points remained constant: mental illness is treatable and treatment can relieve symptoms, if not provide a cure.  Yet the fear of stigma for receiving mental health treatment prevents many people from seeking help.  If this were diabetes or hypertension, there would be a public outcry denouncing discrimination against people with those diseases and support for those who seek treatment. Age bias combines with mental health stigma and reduces the likelihood of receiving any treatment.  And finally, there are behavioral-cognitive approaches, medications, and social support that improve the quality of life for older adults with mental health problems. Even physical exercise such as walking can improve one’s mood.  Hopelessness is a symptom of depression, not an accurate perception of mental health care.

The Council identified several areas for actions to address the mental health needs of older adults.  Stigma is a key factor that impedes people from being diagnosed and treated. The report lists many anti-stigma resources and asks the aging network to reduce stigma in its language, policies and programs. Stigma is supported by assumptions about older adults and mental illness that create the classic “catch-22:” if you are miserable and seek help, you could be socially ostracized for seeking help to end your misery. Society uses stigma to trap people with mental illness and then punishes them for trying to get better.

Finally, the Council recognizes that even if an older person was aware of depression and willing to overcome the stigma to seek help, there are insufficient mental health resources to use.  As noted in the U.S. Surgeon General’s report on mental health, for older adults, the most frequent source of mental health assistance is the primary care physician.  The public mental health system has evolved over the past decade to focus on people with serious mental illness, a criterion that older adults generally fail to meet.  For people in health plans, mental health services may be limited.  For those on Medicare, 50% co-pay may be a barrier.

The State Advisory Council on Aging, therefore, recommends that the Commission on Services to the Aging and the MI Office of Services to the Aging develop a statewide older adult mental health initiative encompassing strategies of advocacy, education, programs and training.

The State Advisory Council on Aging suggests the following action steps to implement this recommendation:

Advocacy:

·        The Commission and the Office should lead or participate in activities to:

o      Promote mental health awareness across the state, including aging service providers, older adults and family caregivers;

o      Support a message of recovery, in conjunction with the Department of Community Health’s Recovery Council;

o      Work to reduce the stigma of mental illness; and

o      Encourage access to mental health treatment and support services.

Education:

·        The Commission and the Office should lead or participate in activities that educate the public about mental health and mental illness. Older adults and their families need information on common symptoms of mental illness, identification of depression, and resources that can provide assistance.  Suggested methods include:

o      Brown bag forums held locally to provide information about mental health;

o      Public awareness campaign about depression;

o      Prepare and distribute a booklet on mental health concerns for the public and older adults;

o      Recruit older adults to share their stories with stigma and mental health treatment; and

o      Provide mental health information at health fairs, senior centers, faith organizations and community centers.

Programs:

·        The Commission and the Office should be leaders in the development of strong programs that promote good mental and physical health for older adults.  The aging network of services can play an essential role in creating positive opportunities for older adults and reducing the stigma of seeking treatment for mental health problems. The Council suggests:

o      Programs and agencies receiving funding from the Office of Services to the Aging be required to demonstrate successful outcomes from a mental health component, by increasing the identification of depression, coordination with mental health service providers and assessing depression as part of the physical functioning assessment.

Training:

·        The Commission and the Office should lead or participate in activities that provide education and training to providers of older adult programs and services on mental health. Suggested activities include:

o      Provide health care providers and direct care staff with information on the link between physical and mental well-being in older adults;

o      Educate/inform professionals on depression as a disease to remove institutional-based stigma.  The stigma of seeking help for depression prevents people from being treated;

o      Senior center and senior service staff should understand their role in reducing stigma, know how to recognize possible depression among older adults and what to do; and

o      Use long-term care and other health service discussions to educate health professionals on the need to identify and treat older adults with depression. Older adults have many interactions with health care systems.