National Coalition on Mental Health and Aging
October 18, 2002

Sanford Finkel, Chair of the Coalition called the meeting to order and welcomed the 21 members in attendance.

Legislative and Regulatory Update

Nicholas Meyers, Deputy Director, Congressional Relations, American Psychiatric Association provided the update. Congress adjourned for the election campaign season without acting on mental health parity legislation (S543/HR4066). There is broad bipartisan support for the measure with 67 Senate cosponsors, 243 House cosponsors and support from the President. Major roadblocks to parity are the opposition of employer and insurance groups and state pre-exemption. There is slight possibility of movement in the lame duck session. Related to Medicare, the House approved a prescription drug benefit package, provider givebacks and a 5.4% payment update, but again, no action was taken before adjournment. This year, the House and Senate Appropriations Committees are as far apart as they have been in recent memory.

The President's New Freedom Commission on Mental Health is focusing on structural issues and consumer empowerment. The final statement is expected to be positive but it appears unlikely to have resources allocated to back it up. Additional issues mentioned included: 1) The CMS One-Hour Rule, which requires a face-to-face consultation within one hour in instances of patient seclusion and restraint. It was mentioned that there are questions in the provider community regarding this rule. 2) States are cutting Medicaid rates and in turn private practitioners are cutting back on care provided in long-term care facilities. Overall, Congress has been consumed by security issues, and there has not been a vehicle to move issues of import to the Coalition.

Update on the President's New Freedom Commission on Mental Health

Willard Mays, National Association of State Mental Health Program Directors, and immediate past chair of the Coalition, represented both the Coalition and NASMHPD at the Commission's October meeting. Initially, older adults were not on the agenda for any of the Commission's meetings. Steve Bartels of AAGP was asked to serve as an advisor and he asked that time be allocated to older adults and that a subcommittee on aging be instituted, which was done. At the October meeting there was a panel presentation on older adults. The panel included Willard, Gary Kennedy (AAGP) and Hikmah Gardiner and Bryce Miller (Older Adult Consumer Mental Health Alliance). In addition, Steve Bartels presented an overview of this issue, the evening before.

The major policy recommendations made repeatedly by panelists and others who made public comments were: mental health parity, prescription drug coverage, consistent national Medicare policy, need for specialized mental health practitioners, education regarding the needs of older adults, need to translate research into practice, and the need for coordination of funding streams. A concern was raised that the majority of the Commission's work was being conducted behind closed doors. The question was raised if the Coalition could take a role in reviewing the interim report. It was stated that it was too late to have input into the interim report but perhaps the Coalition could outline three major areas of concern to share with the Commission. A conference call will be scheduled with the Executive Committee to discuss this issue further.

Olmstead State Coordinators Conference

Willard Mays also reported on the Olmstead State Conference. A panel was conducted on mental health and aging issues and PASSAR. State Olmstead coalitions are being formed as part of state efforts. At the conference, Willard stated that the Olmstead coalitions could be natural partners with the 30 existing state coalitions on mental health and aging. This is the third year of the three-guaranteed funding for the Olmstead project.

The SAMHSA publication, Overcoming Barriers to Serving Older Adults in the Community is in its final editing stage. Willard was an author of the publication and Sandy Finkle wrote the introduction. The Coalition will assist in disseminating the publication upon its completion.

Older Adult Consumer Mental Health Alliance (OCHMA) Update

Linda Powell, Executive Director provided an update on OACMHA. In their first eight months of existence they have established a national office at the Bazelon Center, published a newsletter, produce a brochure, conducted a survey to determine the extent of older adult services in state mental health offices, identified consumer representatives in 28 states and presented testimony to the President's New Freedom Commission on Mental Health. They are currently developing an outreach and education how-to kit to promote consumer advocacy and participation in older adult mental health and substance abuse issues.

One of the OCHMA's goals is to work toward National Standards of Care based on the California Mental Health Directors Association's Older Adult System of Care Framework. OCHMA is looking for funding for national and regional focus groups to solicit opinions and secure agreement on what national standards of care should look like. A number of Coalition members stated they have long been interested in this issue. It was decided that this document will be sent to all Coalition Members for their review and feedback, and that a subcommittee will look at the document by the end of November. Members interested were: Sara Aravanis, Anita Rosen, Alixe McNeil, Sandy Finkel and Willard Mays. In summary, Linda stated that she would like the National Coalition and/or its members to sponsor OCHMA members to attend national meetings, sponsor attendees for the focus groups, and reduce conference fees for consumers attending professional meetings.

Member Updates

Veterans Administration - William Van Stone and Lucia Freedman: The VA's experience with seclusion, hospital based home care, integrating care of patients with substance abuse, mental health, and medical illness within primary care, and the development of the VA consumer councils was discussed.

National Association of State Units on Aging - Sara Aravanis: They are currently involved in projects including: one with NCOA/RWJ to develop tools for states and communities to evaluate services using a consumer-directed model; an AOA grant to develop a caregiver support program to help states integrate caregiving programs with existing OAA and state-funded programs; a nursing home quality initiative in 6 states to increase ombudsman understanding of the issues; and a CDC funded program of small grants to states to bridge the gap between state aging offices and state health departments.

National Council on the Aging - Alixe McNeil and Diane Lifsey: The Benefits Check-Up program will be expanded to include 200 federal, state and private programs including pharmacy assistance programs; the Hartford Foundation is funding a project to identify evidence-based model community programs; they are also looking at the role of home health agencies in the area of depression. On the policy front, Medicare legislation especially the prescription drug benefit has been their area of focus.

Council on Social Work Education - Anita Rosen: They have developed curriculum materials and on aging and have disseminated to hundreds of social work faculty with the goal of all social work graduates having training in aging issues. CSWE will also sponsor the second National Gerontological Social Work Conference in February 2004.

Bazelon Center for Mental Health Law - Robert Bernstein: A mock "grand jury" was held in November to highlight America's treatment of people with mental illnesses. One woman's journey from involuntary commitment in a psychiatric hospital to her residence in a board-and-care home was presented to highlight the barriers people with mental illnesses face in participating in their communities and in the courtroom.

American Psychological Association - Diane Elmore and Debbie DiGilio: Recent activities include preparing testimony for the President's New Freedom Commission, an appropriations effort to secure increased funding under the Graduate Psychology Education Program (Bureau of Health Professions/HRSA) for Geropsychology, and development of a Medicare Local Medical Review Policies Tool Kit.

American Occupational Therapy Association - Marian Scheinholtz: The Association's efforts in the area of older adult driver rehabilitation, including plans for a consensus conference were discussed. A future area of focus will be expanded activities in the area of transportation alternatives.

Gerontological Society of America - David Powers: GSA's annual conference is planned for November 22-26 in Boston. One of the continuing education programs held will be Psychological Services and Consultation within Long-Term Care Settings.

SAMHSA Aging Plan Update

Paul Wohlford of SAMHSA's Center for Mental Health Services discuss the block grant program which has a set aside for special state activities, including those related to Olmstead. A matrix outlining SAMHSA Priorities for specific programs/issues (i.e. Aging) was distributed. Cross cutting principles for all programs/issues include: data and evidence-based outcomes, collaboration with public/private partners, recovery/reducing stigma and barriers to services, cultural competencies/eliminating disparities, community and faith based approaches, addressing trauma and violence, financing strategies/cost-effectiveness, rural/other specific settings, and workforce development. These priorities will be refined based on their budget, which is unknown at this point. Data from the PRISM-E project will be available to discuss at the next Coalition meeting. It was also noted the Coalition building activities are absent from SAMHSA budget.

SAMHSA's Targeted Capacity Expansion (TCE) on Aging Grants and the National Tech Technical Assistance Center on Mental Health for Older Adults

Betsy McDonnell Herr discussed two SAMHSA Initiatives, PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) and TCE (Targeted Capacity Expansion): Older Adult Mental Health Services Expansion Program. PRISM-E is a major multi-state, eleven site study began in 1998. Participants (n=2300, 70% retention) are randomized into an integrated mental health/primary care setting or enhanced usual care with referrals to specialty care. The initial research question is under which conditions are the integrated or referral models most effective in terms of access, adherence, patient outcomes and costs. Early learnings include: there is quite a lot of undetected mental illness in older adults, practitioners do not understand how to deal with subclinical substance abuse in older adults, help was needed in implementing brief alcohol interventions, consumer advisory councils improved participation and helped evaluate local programs for sensitivity to older persons.

The TCE: Older Adult Mental Health Services Expansion Program is a $5 million program to foster the delivery of evidenced based, high quality mental health services to older adults. It was a very competitive process that resulted in nine service sites being selected and the establishment of a National Technical Assistance Center on Mental Health for Older Adults at Harvard Medical School. Betsy McDonell Herr is the Project Officer and Sue Levkoff is the Director of the National Technical Assistance Center on Mental Health for Older Adults. The Center will support the service sites and disseminate findings though national professional, consumer, family and aging advocacy organizations.

Other Business

The issue of how to actively disseminate information more proactively regarding Coalition member activities and offerings was raised. Perhaps a member organization's marketing department could assist.

Next Meeting

The next Coalition meeting will be held on Monday, February 10, 2003.