MEETING SUMMARY
National Coalition on Mental Health and Aging
June 9, 2003

Sanford Finkel, Chair of the National Coalition on Mental Health and Aging called the meeting to order and welcomed the 30 members and 3 guests in attendance.

President's New Freedom Commission on Mental Health

Our guest, Stephen J. Bartels, Associate Professor of Psychiatry at Dartmouth Medical School, past president of the American Association of Geriatric Psychiatry, and consultant to the Older Adult Subcommittee of the President’s New Freedom Commission on Mental Health, provided an overview of the Commission’s mission and progress related to older adults. Initially there was not a subcommittee nor a specific time allocated for discussion of aging issues. However, advocacy efforts resulted in the establishment of a Subcommittee on Older Adults and presentations to the full commission on this topic. Steve became a consultant to this Older Adults Subcommittee and presented on older adult mental health issues to the full Commission at its October 2002 meeting. His testimony was followed by a panel presentation with panelists representing AAGP (Gary Kennedy), the National Coalition on Mental Health and Aging (Willard Mays) and the Older Adult Consumer Mental Health Alliance (Hikmah Gardiner and Bryce Miller). This caught the attention of the Commissioners. The Commission’s October 2002 interim report characterized the mental health service delivery system as being in shambles. It identified three policy areas that must be addressed to ensure adequate and appropriate mental health care for older adults: access and continuity of services, quality of services, and workforce capacity. [Editor’s note: The recent released final report identified barriers, model programs and policy options for each area to inform health care policy. The summary report on the Older Adult subcommittee as well as the final report can be accessed from the Commission’s main web page: www.mentalhealthcommission.com.] The Coalition discussed whether it would be worthwhile to take a stand on the report once it is released or if whether we’d have more of an impact in another venue. It was decided that after the report is released, the issue would be revisited.

Legislative and Regulatory Update

Nicholas Meyers, Deputy Director, Congressional Relations, American Psychiatric Association focused his remarks on Medicare and Medicaid issues. He gave an update of Medicare modernization efforts including the prescription drug benefit, mental health parity, coverage limits and provider-related changes such as payment updates. Related to Medicaid, Nick stated that some governors are prepared to trade away some portion of their federal Medicaid funds for greater flexibility in areas such as mandatory population coverage and coverage of drug costs. He noted that those with HIV and those with mental disorders have the highest drug costs. These issues related to Medicare reform, and issues such as dual eligibility for Medicaid and Medicare could have a profound impact on the delivery of mental health services for older adults. Mental health will be under siege if states cut back on optional beneficiaries and services. It was noted that the Bazelon Center is a good resource for up-to-date information on Medicaid and block grant proposals (http://www.bazelon.org) and the Kaiser Family Foundation on Medicare (http://www.kff.org).

Member Updates

Since member updates were abbreviated due to time constraints at our last meeting, a significant portion of this meeting was devoted to this agenda item.

Psychologists In Long Term Care - David Powers: PLTC became a member of the Coalition at its last meeting and was invited by the Chair to give a brief presentation to the Coalition at this meeting. It is a non-profit organization that was established in 1983 as a national network for psychologists working in long-term care settings. Its mission is to improve the access and quality of mental health services in long-term care settings, provide education and training to professionals who work with older adults, promote geropsychology research, and advocate for responsive public policy in this area. Most of its members provide direct psychological services in skilled nursing homes, assisted living facilities, and other geriatric settings. Members are also in academic and hospital settings where geropsychology research and training are conducted.

Center for Mental Health Services/SAMHSA - Paul Wolford: The PRISMe program is in its fifth year. Analyses will look at outcomes in participants who were randomized into either an integrated mental health/primary care setting or an enhanced usual care model with referrals to specialty care. The Positive Aging Resource Center project and its grantees are going well. A Policy Academy through the National Governors Association will be announced this fiscal year.

National Association of State Units on Aging - Sara Aravanis: NASUA has a leadership council of aging organizations addressing the implementation of caregiver support programs. They are encouraging states to integrate caregiving programs with existing OAA and state-funded programs. They also have a National Ombudsman Award Program.

American Occupational Therapy Association - Marian Scheinholtz: The $1500 cap for outpatient rehabilitation services is going into effect July 1st. This is a very problematic issue. AOTA has also entered a partnership with University of Florida Occupational Therapy program to create a Senior Institute on Transportation that will focus on older driver safety.

National Association of Social Workers - Lisa Yagoda: Current projects include ASA’s CarePro project in collaboration with the American Nurses Association and the American Occupational Therapy Association to develop continuing education modules to help their constituents train informal caregivers.

Maryland Coalition on Mental Health and Aging - Kim Burton: They are promoting their Coalition as a vehicle for change in Maryland. Only 2% of foundation monies are allocated to aging issues, compared with 80% for children. They are linking with "Well Into Your Future - A National Health Promotion Campaign on Mental Health and Aging", described at the last Coalition meeting, to conduct a statewide education program via Maryland Public TV on Aging and Mental Health this fall.

American Psychiatric Association - Nicholas Meyers: A White paper responding to the Presidents New Freedom Commission can be found on their web page, www.psych.org. They also continue to work for passage of the Paul Wellstone Mental Health Equitable Treatment Act (parity) legislation.

National Association of Social Workers - Jim Finley: NASW’s Government Relations section has been mobilizing against the Medicaid block grant proposal as they are concerned about protections for mental health and non-mandatory coverage populations.

Jewish Federation of Metropolitan Chicago - Amy York: Amy introduced herself as the Washington lobbyist for the Federation that is concerned with "cradle to grave" social service issues.

American Association of Homes and Services for the Aging - Evvie Munley: They have been active in opposing the Medicaid block grant proposal and the outpatient rehabilitation therapy cap.

National Alliance for the Mentally Ill - Joel Miller: NAMI has been very involved in policy efforts related to mental health parity and Medicaid. They are working at the state level to defend the availability of medication under Medicaid against possible state efforts to control prescription drug costs. They are also working on minority mental health issues, suicide and dementia.

National Association of State Mental Health Program Directors - Willard Mays: NASMHPD and ASA will again have a Coalition track at the upcoming ASA/NCOA Annual Meeting, April 14-17, 2004 in San Francisco. NASMHPD’s Older Persons Division will have its 2003 Meeting in September.

Veterans Administration - Lucia Freedman: The VA’s Coalition building, consumer advisory councils, and homelessness program were discussed. The homelessness program focuses on the growing population of aging, homeless, Vietnam veterans. The VA has a joint grant with HUD, SAMHSA and HRSA to target this group.

National Depressive and Bipolar Support Alliance - Mildred Reynolds: Over 400 persons attended the Salute to Older Americans Day that she co-chaired. A book on Outstanding Programs in Older Adult Mental Health is also in process.

American Association of Geriatric Psychiatry - Stephanie Reed: The US Senate Special Committee on Aging held a hearing entitled: "Ageism in the Health Care System: Short Shrifting Seniors?" Dr. Joel Streim, president of AAGP testified that ageist attitudes and health care policies that discriminate against older adults prevent them from getting the treatment they need and deserve.

American Psychological Association – Jiska Cohen-Mansfield, Diane Elmore and Debbie DiGilio: APA has been successful in securing $1.5 million for a Graduate Geropsychology Education Program during FY2003 under HRSA’s Bureau of Health Professions. Policy efforts have focused on President’s New Freedom Commission, the Positive Aging Act, and the Elder Justice Act. APA’s Committee on Aging recently held a meeting with representatives of the ABA’s Commission on Law and Aging to begin an APA-ABA dialogue on the Assessment of Capacity in Older Adults.

National Citizens Coalition on Nursing Home Reform – Julie Meashey: NCCNHR has been actively working against the Medicaid block grants proposal. Their upcoming annual meeting "Elder Justice: Shaping Policy Saving Lives" will be held on October 18-21st. They also maintain an active advocacy presence related to mental health care for individuals in long term care settings.

Council on Social Work Education – Anita Rosen: CSWE is involved in the Care Pro Project described earlier and in ASA’s Summer Series on Aging. They hosted their first national Gerontological Social Work Conference that created a huge amount of visibility for aging issues within the field of social work. They also provided input into the revision of the minimum data set for nursing homes and the OIG’s report on Psychosocial Assessment and Services in Skilled Nursing Facilities.

Older Adult Consumer Mental Health Alliance – Linda Powell: One of OACMHA’s current projects is working with NAMI to bring older adult mental health issues to the forefront of the policy consciousness. Two of their members testified before the Presidents’ New Freedom Commission.

Presentation: Medicare Rights Center

Kim Glaun, Washington Counsel of the Medicare Rights Center, provided an overview of the Medicare Rights Center, a national non-profit organization. The Center maintains a hot line in New York for consumer counseling on questions related to Medicare. The DC/Baltimore office is involved with Medicare policy issues. Together with the Center for Medicare Education they will issue a number of operational reports on issues that can impede the availability and accessibility of services provided under Medicare. The two most recent reports on Medicare Mental Health Coverage and Medicare and Long Term Care can be found at: http://www.medicareed.org/Publications.cfm. They also have an advisory board of former CMS officials working on crafting potential administrative reforms to address problem areas. Mental health issues are one of Kim’s focus areas and she is interested in learning about problems related to Medicare access from Coalition members.

Presentation: Positive Aging Act

Michael Zamore, Policy Advisor to Congressman Patrick Kennedy provided the Coalition with an overview of the Positive Aging Act, which was introduced in the House of Representatives (H.R. 2241) on May 11 by Congressmen Kennedy and Hoyer and 14 Democratic cosponsors. The basic principles underlying this Act are that: mental health services integrated within primary care provide an effective means of coordinating care and improving mental health outcomes; and that the treatment of mental disorders in older patients can improve health outcomes and quality of life. Currently, older adults are in the health care system but they are not receiving needed mental health care. Under the Act, grants from SAMHSA will be made available to implement evidence-based collaborative care in primary care settings. In addition, grants will be available to allow mental health outreach into older adult environments such as adult day care centers, senior centers, congregate living and meal sites, to make care as available and comfortable as possible. Finally the Act calls for raising the profile of older adult mental health issues in SAMHSA and other organizations by designating a Deputy Director for Older Adult Mental Health Services within CMHS. Mike asked for support from Coalition members, especially those with a strong voice representing the needs of older Americans, in supporting this bill, and in identifying potential House and Senate cosponsors. [Editor’s note: On Friday, July 25th, Senator Breaux introduced an identical companion bill in the Senate (S. 1456).]

Election of Officers

Every two years the Coalition conducts elections. Officers are elected by the Coalition and serve a term of two years, with the right to be elected for a second, two-year, consecutive term. The initial two-year terms of office have come to an end for our officers: Chair (Sandy Finkle, American Association of Geriatric Psychiatry), Vice Chair (Anita Rosen, Council on Social Work Education), Immediate Past Chair (Willard Mays, National Association of State Mental Health Program Directors and American Society on Aging), and the two “at-large” officers elected by the Coalition (Bob Bernstein, Bazelon Center for Mental Health Law; and Alixe McNeil, National Council on the Aging). As directed in the bylaws, a three member Nominating Committee consisting of Willard Mays (NASMHPD), Enid Light (NIMH) and Linda Powell (OACHMHA) was appointed to establish a slate of candidates for these offices. All current officers agreed to serve a second, consecutive, two-year term, and the Coalition voted to approve their continuance.

Next Meeting

The next Coalition meeting will be held on Tuesday, October 14th 2003 from 8:30 am -12:30 pm at the offices of the American Psychological Association. Please note the new starting time for the meeting. Coalition members approved the Executive Committee’s suggestion that the meeting length be expanded by one hour due to the increasing volume of items on each meeting’s agenda. Hope to see you then!

Minutes prepared by:
Deborah DiGilio
Office on Aging
American Psychological Association