National Coalition on Mental Health and Aging
February 4, 2004

Sanford Finkel, Chair of the National Coalition on Mental Health and Aging, called the meeting to order and welcomed the 36 members and five guests in attendance.

Report of the CMHS Roundtables on Stigma, Mental Health and Aging

Paolo del Vecchio, CMHS Associate Director on Consumer Affairs reported on the Elimination of Barriers Initiative that is being implemented in conjunction with eight state mental health authorities on the stigma associated with mental health and aging. Strategies include speaker bureaus and a public education campaign. They are currently in the second of three years of program implementation. CMHS has sponsored 2 roundtables attended by providers, researchers, consumers, educators and families. One roundtable was in Washington DC, and the other in Los Angeles. The impact of stigma on mental health services and on their utilization by older adults, barriers, strategies, and resources to address this problem were discussed. Barriers identified included: the double stigma of ageism/mental illness, the perception that older adults are "not worth being treated," the belief that depression is a normal part of aging, and lack of understanding by providers, workplaces and social policies. Recommendations include: public education and consumer empowerment, promoting a view of "mentally healthy" aging and not mental illness, and utilizing older adults as peer educators in outreach and in efforts to educate professionals. The immediate next steps involve continued public education and telephone training conferences. It was stated that this effort has a sense of urgency given the President's New Freedom Initiative. For more information about CMHS's efforts on discrimination and stigma go to:

SPRY Foundation Overview and Report on the Computer-Based Technology and Care giving for Older Adults Workshop

Russell E. Morgan, Jr., President of the SPRY Foundation began his presentation with an overview of The SPRY (Setting Priorities for Retirement Years) Foundation. The Foundation conducts problem-solving research and development in successful aging with regard to: (1) the inter-relationships of four basic domains - physical health and wellness, mental health and social environment, intellectual pursuits and financial security, and (2) the design, dissemination, and usage of accurate and reliable information involved in understanding choices and making life decisions. An area of current involvement is in caregiving, specifically the use of technology in the caregiving arena. To address this issue, the third bi-ennial conference entitled “Computer-based Technology and Caregiving for Older Adults” was held in October 2003. Key areas of focus were patient/consumer education and information, care coordination/delivery, and patient/consumer health records/information.

An overview of the characteristics of caregivers and the US caregiving challenge-the need for increased coverage and improved care and less cost was provided. While computer technology holds unlimited promise for communication, information dissemination, service provision and applications designed to support care giving, we must be vigilant to ensure that all Americans are able to benefit. In particular, the digital divide is an important factor to consider in directing efforts.

Five policy recommendations were proposed related to health information systems: develop national health infrastructure standards, develop a funding mechanism, create a system that involves patients more fully in their own care, formulate the system in a way that will support appropriate decisions, and develop more interactive linkage between computer technology and behavior change for older adults, particularly for preventative health. The presentation ended with descriptions of existing (but not yet widely available) technology that address caregiving needs including Nursebot, a robotic assistant for frail older adults. For more information about SPRY go to:

Update on Current Legislative and Regulatory Issues

Peter Newbould, Director, Congressional and Political Affairs, American Psychological Association provided the legislative update. In general, it is a difficult time for seeking appropriations even for existing programs. Even those budgets have the potential of losing money due to inflation. New initiatives are having an even harder time. Related to the New Freedom’s Commission, the Campaign for Mental Health reform is working to translate recommendations of the report into legislation action. However, there is only so much that can be done without an injection of money - even planning and accounting needs money. Reauthorization of SAMHSA will come up again in the Senate Health, Education, Labor and Pensions (HELP) Committee. [Editor’s note: a week after this meeting was held, Coalition members were notified by the AAGP Policy Office that the President’s FY 2005 Budget cut all $5 million for mental health outreach and treatment for older adults from the SAMHSA budget, and asked members to urge the appropriations be restored and increased funding for CMHS’s aging and mental health projects.]

The Medicare Drug Law has received alot of attention. The mental health advocacy community was disappointed as there are no improvements for mental health care. The cost will be 6 billion over 10 years. Mental Health Parity looks promising. Senator Bill Frist said it will be the first item to move to the floor in 2004. It has a record number of supporters in the House. Dual eligibility (Medicare-Medicaid beneficiaries) is a ticking time bomb. It will need to go back to Congress for discussion. Not expecting anything to happen with Medicare parity in the near future. Not much will happen with the Positive Aging Act until resources become available.

National Institute on Mental Health Update

Barry Lebowitz, Chief of the new Aging Treatment and Prevention Intervention Research Branch, in the Division of Services and Intervention Research at NIMH, told the Coalition that NIMH director Thomas R. Insel had just announced the creation of the branch he has been named to head. He will also assume leadership of the NIMH-wide Aging Consortium, which has been managed by Bruce Cuthbert since the departure of Jason Olin. George Niederhe will join the new Aging branch. There is a big agenda but it is not yet fully formed. There are not a lot of new resources. In the upcoming 6 months there will be lots of conversations/meetings/discussion with key groups.

Some areas of interest are:
(1) Medication in Medicare- Do we know what we are doing? We have learned over the last few years that drugs can kill older adults. Can we tie the Medicare drug benefit legislation on to a request for research in drug safety issues such as adequacy, appropriateness, and use of drugs in older adults? (2) Science development – Look at chronic stress models and what it does to the brain. Caregivers would be an excellent pool of individuals to study. (3) Neuroprotectives – Some older people have been taking these drugs for years. They could provide an important source of information. The global burden of disease was then discussed. Mental health disorders are the most debilitating. Depression is a fatal disease in older adults. A Coalition member asked about health services research for older adults-will this be a mission of NIMH’s Aging Branch? It was stated that we know what we need to do but how do we get it done. We need interventions between NIMH and CMHS around the New Freedom recommendations.

NIH’s recent budget growth was also discussed. The budget has doubled in the past 6 years. The increase will be 3% next year, but this is not the double digit increases of the recent years. Half of the recent budget increase of NIH is for biodefense. Mental health was lost in the conversion from bioterrorism to biodefense. 0% of the money is for trauma or stress related conditions. All of the money is for vaccine development. All initiatives will have to capitalize on the growth of the past 6-7 years. The focus is on reprogramming, not growth and new programming. The Coalition’s Chair offered the assistance of the Coalition to support the endeavors of the aging branch

Medicare’s Future: The Integration and Coordination of Healthcare Services for the Nation’s Elderly Report

Betsy Beckwith, Principal, BWB Partnerships described her work on a White paper summarizing integration and coordination efforts related to older adult health. It was developed for the Mental Health and Aging Network of the American Society on Aging. Its purpose is to help policymakers identify ways to create a collaborative system of healthcare based on a continuum of care that is both integrated and coordinated. Under such a system, consumers would receive an individualized mix of medical, mental health and long term care services to promote optimal health, function and independence. Health programs would be collaboratively linked to ensure that consumers would have access to any service they needed regardless of what entity they encounter first. A common medical record is a part of this system.

Current Federal Government initiatives were then discussed including: PACE, that has a capitated Medicare permanent benefit with eligibility for frail elderly and nursing home residents and care through interdisciplinary teams; S/HMO, a capitated plan with standard Medicare benefits, plus home and community-based, outpatient drug and care coordination services; Evercare, a capitated through waivers program with more intensive primary care provided by nurse practitioners to supplement physician care and care managers; Coordinated Care Demonstration is a disease management program with no out of pocket costs for beneficiaries and use of case managers and disease care managers and; PRISMe which looked at a referral vs. staff-integrated approach for mental health/substance abuse service delivery. This was followed by an overview of private programs including the California Care Advocate Program, a social case management service through a Medicare capitated plan; Partners in Care, in which a social worker and physician collaborate to identify mental health issues; Project Impact, a disease management model for late life depression in which a depression clinical specialist and physician collaborate and; Partners in Care, a collaboration between specialists and generalists with active case management.

Policy Recommendations related to financing were: (1) Redesign the Medicare program to include interagency collaboration, care coordination, pooling of resources, and establishment of care service units with continuum of care basis. Care service units could be state, county or regionally based. (2) Medicare needs to recognize and appropriately pay for all health care providers crucial to the care of the elderly, including multi-disciplinary patient assessments. (3) Medicare needs to reimburse geriatric care managers who would be responsible for coordinating care and movement across sites. (4) Establish payment policies to support integrated collaborative care models in a full range of settings including primary care, mental health, long term care and senior service programs. Policy recommendations related to quality were: (1) Medicare must require a common medical record and, (2) Medicare must provide for an explicit patient/family education benefit. The final policy recommendations related to training were: (1) Adopt incentives to encourage training in geriatric subspecialties. (2) Establish multi-disciplinary training sites so that all health care professionals can be trained in settings that more accurately reflect actual practice. (3) Convene a federally-sponsored conference on collaboration of payers, systems and providers of health care services.

The paper’s conclusion was that the federal government must lead the change to a collaborative model of care based on integration and coordination of settings, services, providers and resources. In addition, the coalition and like-minded entities need to partner with the federal government to hold a series of exploratory and educational conferences to achieve this goal. The Coalition decided to have a subcommittee look more closely and the report and determine the best mechanism to foster implementation of its recommendations. In addition to Betsy Beckwith, Anita Rosen, Leslie Fried, Robyn Golden and Debbie DiGilio will work on this.

Mental Health Principles of Care for Older Adults

Linda Powell, Executive Director, Older Adults Consumer Mental Health Alliance (OACMHA) discussed the Principles to Guide Mental Health and Substance Abuse Care for Older Adults OACMHA used two documents in the development of these principles, NIMH’s Community Support Program Principles and the Center for Mental Health Services Child Adolescent Service System’s six core statements. In addition, the voiced comments and concerns of OACMHA members were used to compile a Draft Statement. In the past six months, OACMHA, with support from CMHS, brought together stakeholder focus groups in Philadelphia, Portland (OR), Seattle and Topeka to assess and discuss the Draft Principles’ merits and deficiencies. Diverse groups of consumers, providers, family members, mental health administrators and advocates aired a broad range of ideas and concerns and helped to improve the document and validate its intent and direction. The document was shared with Coalition members. Core Principles include: Equality, Recovery Focused-Care, Self-determination and Choice, Early Identification and Diagnosis, Individualized Holistic Care, Coordinated Services, Comprehensive Community Services, Aging in Place, Geriatric Workforce Capacity, Sufficient Standards, State Responsibility and Public Education.

Member Updates

Jewish Federation of Chicago - Amy York, Washington Office Director discussed her role in lobbying and regulatory work for her umbrella organization, Jewish Council for the Elderly. Part of what they work on is mental health issues. Faith based organizations can play a prominent role in this arena. It was noted that other faith based groups are welcome to join the Coalition. Amy agreed to provide these groups with information.

National Association for Caregiving - Gail Hunt described her organization’s focus on family caregiving. It is a 40-member group that works in the areas of research, public awareness, and policy analysis. They did a National Caregiving Survey with AARP in 1997 and plan a new one in April. They will over sample for minority caregivers and those in the +18-50 and 50+ age groups. They will also look at urban and rural self reported health of caregivers. Other activities include surveys of Corporate Caregiving, Long Distance Caregiving and Young Caregivers (ages 8-18). They are also developing a palliative care brochure and a family caregiving guide for discharge planners.

National Citizens Coalition for Nursing Home Reform - Julie Meashey – NCCNHR’s focus is on communicating the needs of long term care residents. They are interested in mental health. They have citizen’s advocates in the states and long term care ombudsmen. They also review policy affecting residents, families and caregivers. Their Executive Director is Alice Hedt and their annual conference is October 17-20.

Older Women’s League - Laurie Young described their grassroots initiative on women and aging. They are the bridge between women’s groups and aging groups. They distribute a Mother’s Day Public Policy Report annually in which they discuss issues such as the crisis in health care financing and it’s impact on women in midlife. Last year they established Older Adults Mental Health Week during the last week of May. They would like others to join, as partners.

American Geriatrics Society - Ira Katz of the AGS’s Board of Directors described this multidisciplinary organization focusing on practice, research, training and advocacy. Mental health is an important issue for AGS and for geriatric care. Recent projects in mental health include the AGS/AAGP Consensus Statement on Improving the Quality of Mental Health Care in American’s Nursing Homes and another position paper on assisted living. They would appreciate knowing about initiatives of other Coalition members. AGS has not participated in the Coalition recently and was welcomed back to the group.

SAMHSA - Center for Mental Health Services – Betsy McDonnell Herr reported that the Targeted Capacity Expansion (TCE) Program to foster the delivery of evidenced based, high quality mental health services to older adults was ongoing with nine service sites and the National Technical Assistance Center supporting the service sites. Paul Wolford’s Program at SAMHSA supported the Older Adult Consumer Mental Health Alliance’s focus groups on the Principles to Guide Mental Health and Substance Abuse Care for Older Adults described earlier.

National Association of State Units on Aging - Sara Aravanis spoke about efforts to “beef up” state health insurance counseling programs (SHIP). They expect many questions about what the Medicare changes will mean and are ready for the onslaught.

Positive Aging Resource Center - Maria Laurente, a geriatric psychiatrist from Miami represented PARC at the meeting. PARC was established in 2002 as part of SAMHSA’s TCE program described earlier.

National Mental Health Association - Sara Thompson reminded members of NMHA’s June 9th -12th Annual Meeting in DC. Nominations for awards for Consumer Advocacy and Outstanding Programs are currently being accepted.

Psychologists in Long Term Care, Gerontological Society of America and the America Psychological Association are represented at the Coalition by David Powers. He announced the March 15th deadline for GSA’s Annual Meeting in DC.

American Association for Marriage and Family Therapy - Brian Rasmussen of their Government Relations department spoke of efforts to secure Medicare provider status for marriage and family therapists. They are also working on efforts related to mental health parity and the Positive Aging Act.

Mental Health Association of Pennsylvania - Thomas Volkert described efforts to develop a Call Center for counseling related mental health and aging. At the state level, they are working to expand the definition of mental illness beyond those with a chronic mental health problem to include those who develop mental disorders in late life. They are also working on mental health parity. In the past, their state did not include an older adult category on county reporting forms related to mental health service provision, but they have recently changed this.

National Association of State Mental Health Program Directors - Willard Mays announced that Indiana will hold its first state Coalition meeting on March 24. State block grant monies will fund this meeting.

Depression & Bipolar Support Alliance - Mildred Reynolds discussed their Mental Health Needs of Older Adults with Mood Disorders brochure.

American Association of Geriatric Psychiatry - Stephanie Reed announced that AAGP’s Annual Meeting will be Feb 24-25th in Baltimore. In conjunction with the meeting, a Town Hall Meeting to which mental health consumers and others are invited, will be held.

National Council on Aging - Alixe McNeil spoke of the NCOA’s Benefit check up (on-line benefits availability and calculation tool). It is being expanded to incorporate pharmacy benefits. They will also sponsor a full day training related to their “Get connected! Tool kit” on April 14th at the NCOA/ASA Annual Conference.

Council for Social Work Education - Anita Rosen described the Hartford National Gerontological Social Work conference to be held in conjunction with the national social work conference in California. A book is being released with the proceedings of last year’s conference. She also announced the NCOA/ASA conference on April 14-17th. The National Coalition on Mental Health and Aging will be sponsoring a full day Coalition track again this year.

American Psychological Association - Deborah DiGilio described a brochure currently being designed that will highlight the contributions of psychologists to mental health and aging through research and practice.

National Coalition on Mental Health and Aging Website Update

A recent conference call was held concerning the website. Larry Dupree is still graciously maintaining the website. It was reported that it is a wonderful, well-done site, however it is an underutilized resource, and some information is out of date. It could provide a great networking function for national, state and local coalitions. Willard Mays will explore whether a more updated listing of state and local coalitions could be obtained from NASMHPD. A recommendation was made to establish a standing website subcommittee to work with Larry Dupree as the best mechanism to keep the website up-to-date. It was noted that the National Coalition is very grateful for Dr. Dupree’s continuing contribution.

Next Meeting

The next meeting of the National Coalition on Mental Health and Aging will be held on Monday, June 14, 2004 from 8:30am to 12:30pm in the 6th floor Board Room of the American Psychological Association.

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