MEETING SUMMARY
National Coalition on Mental Health and Aging
May 2, 2005

Sanford Finkel, Chair of the National Coalition on Mental Health and Aging (NCMHA), called the meeting to order. He welcomed the 27 members in attendance, including two new members, the Geriatric Mental Health Alliance of New York and the Suicide Prevention Action Network.

New Members

Michael Friedman, Chairman of the Geriatric Mental Health Alliance of New York provided an overview of the organization and its activities. The Alliance is funded by the Mental Health Association of New York City, the Mental Health Association of Westchester, and grants from foundations. Their diverse membership of 400 consists of aging, health and social service groups, providers, consumers and government officials. A major initiative is the Comprehensive Geriatric Mental Health Act that has been introduced in both houses of the New York State Legislature. The major provisions of the legislation require the development of programs to expand the provision of geriatric mental health care in the state; require that the office of mental health consider the needs of older adults in the development of its plans; and establish demonstration programs, a public education program, an office of geriatric mental health within the Office of Mental Health, and a deputy director position for geriatric mental health within the Office for the Aging.

The Suicide Prevention Action Network (SPAN USA) had submitted a letter requesting membership in NCMHA. The Coalition approved membership and received an overview of SPAN by Melinda Moore on behalf of Jerry Reed, SPAN's Executive Director. SPAN, which was founded in 1996, is dedicated to preventing suicide through public education and awareness, community action and federal, state and local grassroots advocacy. SPAN's members include suicide survivors; people who have attempted suicide or struggled with suicidal thoughts, and their families; professionals serving families and communities; community leaders; and concerned citizens. It is the only suicide prevention organization dedicated to leveraging grassroots support among suicide survivors and others to advance public policies that help prevent suicide.

State and Local Coalitions as Affiliates of NCMHA

Willard Mays initiated a discussion on the relationship between NCMHA and the state and local mental health, aging and substance abuse coalitions. He noted that between 1996 and 2001, four federal contracts were received from SAMHSA to develop state and local coalitions. Currently, at least 27 states have such coalitions. Although in the past there was a feeling among these coalitions that they wanted to remain independent from NCMHA, recent feedback indicates that they would welcome a stronger and more specific connection. Willard, with the support of the NCMHA Executive Committee, proposed consideration of amending the NCMHA by-laws to formalize the relationship with the state and local coalitions. One suggested approach would be to create a state and local affiliates category. In addition, it was recommended that a standing committee on state and local coalitions be formed. This committee, possibly chaired by a Coalition representative on the Executive Committee, would focus on nurturing coalition building, including increasing coordination, and communication between state and local coalitions and the NCMHA.

In discussing this issue, members felt that there should not be a distinction between NCMHA full-fledged and affiliate members. State and local coalitions could individually apply for membership. NCMHA members also supported the idea of a committee to focus on state and local coalitions. It is important that NCMHA receive grass root input from across the country and that information and resources from the national level be shared with state and local coalitions. This is a powerful network that is not currently being fully utilized. The discussion continued on potential ways to set up an improved system of communication and interaction and of the possibility of securing funding once again to facilitate coalition building efforts.

In conclusion, it was decided that there should be a State/Local Coalition Representative on the NCMHA Executive Committee and that this person would spearhead a committee of state and local coalition representatives to discuss the type and mechanism for interaction and linkage between the groups and report recommendations back to NCMHA. At that time we can discuss modifying the bylaws.

Election of 2005 2007 NCMHA Officers

The initial two-year term and the allowed two-year consecutive term of office have ended for most of our officers: Chair (Sandy Finkel), Vice Chair (Anita Rosen), Immediate Past Chair (Willard Mays), and one of the two "at-large" officers (Bob Bernstein). At the last meeting, a Nominating Committee, as specified in the bylaws, was appointed. The nominating committee, in addition to proposing a slate of officers for 2005-2007 recommended that the following three positions be added to the Executive Committee: (1) A Consumer Representative, as we strongly believe that consumers should be full participants at all levels of Coalition activity. "Not about us without us" is a clear message we want to send and it serves as a reminder that the primary focus of mental health and aging coalitions is to address mental health issues affecting older adults and their families; (2) A Representative of State and Local Coalitions, as earlier discussed; (3) An additional At-Large Position, to allow greater representation of the organizational members on the Executive Committee, and to divide up the increasing work that has fallen on the Executive Committee in the interim periods between our three yearly meetings. NCMHA members approved the proposed expansion of the Executive Committee, and the following slate of officers.

The Slate of Officers for 2005-2007:

Chair:   Deborah DiGilio, APA (1st Term)
Vice-Chair:   Bob Bernstein, Bazelon Center (1st Term)
At-Large:   Anita Rosen, ASA, CSWE (1st Term)
At-Large:   Alixe McNeill, NCOA (2nd Term)
At-Large:   Laurie Young, OWL (1st Term)
Consumer Representative:   Mildred Reynolds, NDBSA (1st Term)
State/Local Coalition Representative:   Bob Rawlings, OK Coalition (1st Term)
Immediate Past Chair:   Willard Mays, NASMHPD, ASA
(Sandy Finkel will not be able to serve in this non-elected position and Willard has agreed to continue in this role.)

Farewell to Sandy Finkel

As a token of appreciation for his leadership as chair of NCMHA for the past four years, and for his career-long contribution to mental health and aging, Anita Rosen, on behalf of NCMHA, provided Sandy with an engraved rememberance cup. Sandy thanked NCMHA for the opportunity to serve them and described his early involvement in the field, including serving on the steering committee for the Mini-Conference on the Mental Health of Older Americans prior to the 1981 WHCoA, and advocating for the establishment of NCMHA.

Update on Current Legislative and Regulatory Issues

Jim Finley, Senior Associate of the National Association of Social Workers provided the policy update. In terms of Social Security, both the House and Senate have begun the legislative drafting process. The House Ways and Means Committee wants to quickly move legislation out of committee by June. It will likely be a very partisan bill focusing on both the solvency of government sponsored pension plans, private accounts and tax incentives. There is also an incentive for purchasing long term care insurance in this bill and a provision to disallow transfer of assets to secure Medicaid within a 5-year period (although they don't have jurisdiction over this issue). The Senate Finance Committee does not have a majority bill and its Chair, Senator Grassley wants bipartisan support. Their timeframe is way behind Ways and Means. In addition, the potential filibuster on judicial nominees is taking a lot of time and effort.

Related to Medicaid, the budget reconciliation bill shows $10 billion in Medicaid savings, mostly related to lengthening the time for transfer of assets and reducing payments to pharmacists and case managers. The Congressional Budget Office recently said the language regarding these cuts was vague and that no savings will result. It was noted that it is very difficult to maintain frail, mentally ill older adults in the community without case management. It's important to gin up grass roots opposition to this bill. An eighteen month Medicaid study commission has just been approved, to be headed up by Gordon Smith. Its mission is to look at the Medicaid growth rate and determine ways to pull costs down. Unfortunately, once again, the penalized population will be the most vulnerable. Also, they are looking solely at Medicaid and not at other cost drivers in the health care marketplace. The framework of commission will be determined in the next few months.

Related to Medicare, there was talk about budget reconciliation, however the current thought is that this won't happen right now. A big Medicare issue is provider payments. Providers have been facing cuts each year and professional organizations have worked hard to fight against the cuts each time they are proposed. However, they have only been able to get a 1-year fix. It would cost $150 billion to fix this issue forever. Pay for performance is an idea that the Medipac CMS Advisory Committee is looking at - in particular, developing a set of quality indicators as a condition for Medicare B provider payments. For example, there would be a starter set of data that would demonstrate quality of mental health care.

Other policy issues relevant to older adults include outpatient physical therapy caps, and mental health parity legislation was introduced in the House. There is no comparable bill in the Senate. Also, the Association of Health Plans is promoting small business insurance products. The problem is that these plans do not meet state plan guidelines. There would be no state mandated benefits, including provision of mental health services. The House is expected to pass this in the next two weeks. The House has passed this legislation four times in the past, although the Senate has not. However, this time, the Senate Chair is much more sympathetic. The White House and small businesses support this measure. This legislation could undermine the insurance mandates that cover so many. Finally, Congress is adamant about not reopening the Medicare Part D issue.

Jim was thanked for his comprehensive overview of these issues!

Member Updates

American Association of Geriatric Psychiatry - Stephanie Reed provided an overview of the WHCoA mini-conference sponsored by the Geriatric Mental Health Foundation, the Older Adult Consumers Mental Health Alliance, the University of California, San Diego, San Diego County Adult and Older Adult Mental Health Services, and the San Diego Coalition for Older Adult Mental Health and Substance Abuse, held in March in San Diego. The resulting post-event summary report that outlined barriers and proposed solutions to mental health care among older adults was made available to NCMHA members. It is also available at www.whcoa.gov.

The National Conference on the Aging - Alixe McNeill reported that at the NCOA/ASA Annual Meeting in March, NCOA developed and approved as policy WHCoA resolutions including mental health. Other current initiatives include collaborating with the Positive Aging Resource Center, promoting the Get Connected Tool Kit, reverse mortgages, and preparing for Medicare Part D implementation. Alixe introduced Robert Tiller, NCOA's new Deputy Director for Public Policy and Advocacy.

Senator Hilary Rodham Clinton's Office Diane Elmore of the Senator's office reported that Senator Clinton's involvement in aging issues has expanded since her appointment to the Senate Special Committee on Aging. She is utilizing that forum to raise health and aging issues. The Senator is working on many aging issues including reauthorization of the Older Americans Act, advanced directives (including state transferability, Medicare payments for discussion of such directives, and an education campaign in conjunction with the DMVs similar to organ transplant education), substance abuse treatment parity, the WHCoA, the Alzheimer's Disease Task Force (which she chairs) and the OWL briefing on Older Adult Mental Health that she will sponsor May 25th.

National Mental Health Association - Sara Thompson announced that they are working with the Older Adult Consumer Mental Health Alliance (OACMHA) in conjunction with their National Consumer-Supported Technical Assistance Center's grant programs. They are also educating consumers on Medicare Part D via their website.

American Psychiatric Association - Rachel Audi reported that they are currently focusing attention on Medicare parity.

American Association of Marriage and Family Therapists - Melissa Stamps reported that current efforts include a leadership conference with representatives from all states and Canada, advocating for Medicare provider status, and pursuing representation at the WHCoA.

Department of Veterans Affairs - William Van Stone reported the good news that $100 million in funding as been attached to efforts for returning soldiers, the strategic plan for mental health (which was a response to the New Freedom Commission on Mental Health), and telehealth. They are looking for educational materials, particularly posters that address misconceptions about mental health that many medical professions hold. Kristen Day mentioned the VA's fully electronic medical record that includes bar-coding of prescription medications. The VA is spending $30 million developing telehealth for their geriatric and mental health populations. Outcomes thus far look positive. There is a new Deputy Secretary for Health Care, Dr. Jonathan Perlin.

National Alliance for Caregiving - Gail Hunt announced a fall conference on Caregiver Health, focusing both physical and mental health. It is supported by CDC and ASPE. They are also working with CMS on how to involve family caregivers in the selection of Medicare Part D options.

Council for Social Work Education and American Society on Aging - Anita Rosen noted that NCMHA's WHCoA resolutions were presented to the National Gerontological Social Work Conference in February, which was a WHCoA officially recognized event. NCMHA's resolutions were incorporated into those submitted to the WHCoA by CSWE. She is also the ASA representative to the Leadership Council on Aging Organizations (LCAO) and is working on its health committee to prepare WHCoA resolutions. She is advocating for the inclusion of mental health into their resolutions also. Anita noted that NCOA/ASA's Annual Meeting will have additional mental health programming. NCMHA has recently had a coalition track as part of the Annual Meeting which typically has 4,000 attendees and a large mental health contingent. Related to ASA, Willard Mays mentioned the summer edition of Dimensions will focus on Mental Health and Aging policy including NCMHA's WHCoA advocacy efforts.

American Psychological Association - David Powers reported that a symposium will be held at the APA Annual Convention in August titled, Psychology and Public Policy: Contributions to the 2005 White House Conference on Aging. It is a WHCoA Independent Aging Agenda Event. David also shared information on the ABA/APA Capacity Assessment in Older Adults Project, in particular the first product of the working group, Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers. More information is available at http://www.abanet.org/aging/. Currently, efforts are being directed to developing a companion document related to guardianship for judges, and continuing education offerings for psychologists and attorneys.

National Association of State Mental Health Program Directors - Willard Mays reported that NASMHPD's Older Person's Division meeting will be held in Baltimore on Sept 25-28. The focus is on community integration of older adults with mental illness. He also reported that CMS is putting together a panel to look at PASSAR implementation including the lack of consistency in rules and procedures across the country. Willard is representing NASMHPD on this panel.

2005 White House Conference on Aging: Update and Next Steps

NCMHA is fortunate to have one of the WHCoA Policy Committee members, Gail Gibson Hunt, as one of its members. Gail graciously provided a brief update on a number of items. In terms of at-large delegate slots, the 412 slots will be determined by two (bipartisan) members of the WHCoA, who will review all submissions received. The deadline for submission is June 1st. It was noted that thousands of resolutions are expected from the completed and planned events, such as listening and solution sessions, mini-conferences and independent aging agenda events. The Policy Committee will review all resolutions and recommendations and decide upon the 100 that will go to the delegates. Current plans have the delegates voting on the 50 final resolutions on the first day of the WHCoA. Unlike past conferences, no word-smithing will be allowed. The remainder of the Conference will be spent developing implementation plans for the resolutions. There is a strong sense on the Policy Committee that this year should be purposefully different than past conferences, with the focus being on implementation rather than resolution development. It is hoped that this will result in an increased likelihood of action resulting from the conference.

NCMHA members discussed next WHCoA steps and determined that once we know who the delegates are, and which 100 resolutions they will receive, additional planning can resume. NCMHA should be ready to take action, as there will be a very short turn-around time for planning, once this happens.

SAMHSA's Older Americans Substance Abuse & Mental Health Technical Assistance Center

Lisa C. Patton, Senior Study Director provided an overview of the Center. The Older Americans Technical Assistance Center was funded in October 2004. It was created to bring attention to individuals ages 55 and older with substance use/abuse and/or mental health issues. The Center's priorities are to provide technical assistance with respect to the prevention and early intervention of substance abuse, medication misuse and abuse, mental health disorders and co-occurring disorders; and dissemination and implementation of evidence-based and promising practices. Year 1 will be spent reviewing the latest literature and statistics around mental health and substance abuse issues for older adults, developing a training and technical assistance plan for Phase II, and developing and implementing strategies for evaluating National Registry of Evidence-based Programs and Practices (NREPP) candidate programs. Phase II will provide training and technical assistance to states, communities, and health and social service providers, assist States in developing plans around substance abuse and mental health, and provide technical assistance to NREPP candidate programs. A discussion ensued about how the Center might best coordinate with existing, ongoing technical assistance efforts in the mental health and aging arena and with NCMHA.

American Society on Aging/National Council on Aging Annual Meeting: Coalition Programming

NCMHA has offered a coalition track at past ASA/NCOA annual meetings. The number of attendees at track sessions has been growing every year. This past year there were sessions on NCMHA and its WHCoA resolutions, Federal programs and opportunities for mental health and aging efforts, and a clinical training session. NCMHA members are invited to help in the planning of the 2006 track.

Adjournment

The meeting was adjourned at 12:30 pm. The next meeting will be held on Friday, September 23rd from 9:30 am 12:30 pm in Room 4054 of the American Psychological Association.

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