Deborah DiGilio, Chair of the National Coalition on Mental Health and Aging (NCMHA), called the meeting to order. She welcomed the 32 members in attendance. Members, in turn, introduced themselves to NCMHA's guest, Dennis O. Romero.
SAMHSA's Center for Substance Abuse Prevention (CSAP)
Dennis O. Romero, Director of CSAP stated that his goals are to redefine what we mean by prevention and to ensure that every state has money to implement a strategic planning framework. Currently CSAP is funding epidemiology work groups in every state to identify priorities. An additional focus is on enhancing the workforce through the development of credentialing criteria for professionals, and implementation of evidence based practices. Mr. Romero acknowledged that this is a tall task, but is confident that it is achievable through partnerships at the national, state, and local levels. He sees prevention as a mechanism for such collaboration.
The primary focus of the strategic planning framework is to implement systems which support community efforts to reduce substance abuse and related problems. There are five steps in SAMHSA's strategic planning framework: assessment (using data to determine substance use & related problem), capacity building (mobilize communities and resources through special projects designed to help states and communities), planning (identify comprehensive interventions to impact substance abuse and other related problems), implementation (implement evidence-based, resilience-building prevention programs), and evaluation (monitor progress and impact on selected change indicators). An underlying emphasis is on sustainability and cultural competence. In terms of older adults, Mr. Romero discussed the Older American TAC Partnerships, which consist of technical assistance to states, territories, and American Indian tribes and tribal organizations; the National Registry for Evidence Based Programs and Practices being developed by the National Council on the Aging and the U.S. Administration on Aging; and, the Mental Health Transformation State Incentive Grants. Mr. Romero reemphasized the role of prevention. He believes it is communities that help people stay healthy and support them in recovery. The strategic prevention framework is guided by three fundamental principles: local people solve problems best; people support what they help create; and science, particularly evidence based practices, matter. A top down approach will not work nor will operating in silos. Particularly when money is tight, we need to collaborate and this is what the strategic framework encourages. The role of the federal government is to assist states in developing effective strategies and implementing systems which support community efforts to reduce substance abuse and related problems.
The question was raised if CSAP, in its work with states in developing community strategic plans, requires that older adult populations be included in such plans? Mr. Romero replied that funding goes to states for epidemiology groups to identify local problems but that this needs assessment is open ended. Coalition members recommended to Mr. Romero that, at a minimum, a checklist from his office should be developed directing states and localities to consider older adults in their needs assessment and strategic planning efforts. It was noted that particularly in areas related to prevention, older adults are often not even considered. Mr. Romero stated that he is supportive of addressing the needs of older adults and as part of his advocacy efforts to Congress, within SAMHSA, and with other groups he always focuses on three issues - underage drinking, older adults, and professionalization and credentialing of the workforce.
A follow up letter thanking Mr. Romero for attending will be sent. In that letter NCMHA will also restate general concerns such as older adults being included in the SAMHSA reauthorization. In addition, NCMHA will reiterate its recommendation for a checklist to be provided to state and locals on which their consideration of older adult issues and needs within the strategic planning process would be documented. The letter will also note that creative outreach to the aging population will yield results. The discussion ended with the comment that aging also should be included as a component of cultural competence because aging is a diversity issue.
Regulatory and Legislative Update
Jim Finley, Senior Associate with the National Association of Social Workers' Government Relations Department, reported that "health week" occurred last week in Senate. However in the end, no health legislation was passed. A major issue was small business health insurance. Small businesses are increasingly being priced out of the market and most states do not do community ratings or modified community ratings, which play an important role in the provision of mental health care for underserved populations, including older adults. The Health Insurance Marketplace Modernization and Affordability Act (HIMMA) was offered as a solution to these problems, but the Act threatens to dismantle state mandates for behavioral health care. Although the bill was defeated and the repeal of these mandates was held back in this most recent round, we need to be prepared for Round II. There probably will not be enough time in the Senate's schedule to revisit this issue this session. However, if this makes it to conference, it could have a serious impact on underserved populations.
Jim noted that the NIH reauthorization will also occur in the next three weeks. However it is very low on the radar screen and it has yet to be marked up. A move is on to give more authority to the NIH Director. This will allow him to move money around the Institutes more freely. This may have a negative impact on the strength peer-review has in directing future funding. The next issue reviewed was HR 4157, the Healthcare IT Bill. There are many issues related to medical privacy and in particular for this group, psychotherapy notes. This bill creates a structure whereby the HHS Secretary can undo state rules. The groups that have joined in coalition with health care groups to advocate for the privacy of medical records are very diverse, including the National Rifle Association. It is critical to examine the issues that can arise from a national network of health records, including what standards will be set concerning what information is viewable and who it will be accessible to. Issues of confidentiality and consent are huge. Congressman Kennedy has stated that there will be an option for people to opt out of the IT medical records system. The outcome may be a minimalist bill, as there is a lot of controversy.
In terms of budget, the House passed its budget which includes no new Medicaid cuts (there is no protected vehicle in which to move cuts forward at this point). They don't expect a reconciliation budget. There also has been discussion regarding a technical amendment to address the issue of American elders who don't have documentation, which is a big problem for many older minority elders. The issue has arisen now because of new immigrant documentation requirements. The House would like to address this in a cost-free manner, which is what a technical amendment would accomplish. Related to Medicare Part B, there will be a 5% provider statutory cut each year starting in 2007. Without a reconciliation vehicle, things could get cloudy. In closing, Jim noted that reinstating the funding for Title VII may not get support. This is a huge and very sad turn of events for the gerontology community.
Older Americans Act/Positive Aging Act Update
Diane Elmore, Senior Legislative & Federal Affairs Officer in the Public Policy Office, American Psychological Association, reported that the Older Americans Act (OAA) is currently up for reauthorization. There are no new programs in this reauthorization and everyone is looking for cuts. Historically, the OAA includes markers for mental health. She is working to infuse additional language that incorporates older adult mental health into the bill. Diane distributed a handout describing the Positive Aging Act. The current effort would result in Title I of the Positive Aging Act being integrated into the OAA and Title II into the reauthorization of SAMHSA. Title I would amend the OAA to create an Office of Older Adult Mental Health in AoA, provide grants for delivery of mental health screening and treatment services, and establish demonstrations for the delivery of mental health screening and treatment in naturally occurring retirement centers (NORCs) and rural areas. Title II would require SAMHSA to more fully integrate primary and mental health services for older adults. It was noted that SAMHSA should include multidisciplinary aging services within its multidisciplinary research centers and specify that older adults should be a part of the block grant program.
In terms of recent movement, in February, there was a OAA roundtable of aging groups at which mental health was not represented nor mentioned. In March, the Senate reviewed the Title V program and in April held a series of feedback hearings that included aging groups and was attended by House members. The Senate appears to be truly interested in aging related issues. NCMHA expressed interest in being sent an action alert regarding OAA reauthorization to share with their constituents.
Consideration of State and Local Mental Health and Aging Coalitions for Membership
As determined at the last NCMHA meeting, NCMHA membership is now opened to state and local coalitions. An invitation was developed and sent to all known mental health and aging coalitions. The following coalitions requested membership and were welcomed to NCMHA: The Aging Wellness Coalition of Kansas; Elder Reach Coalition in Cincinnati, Ohio; Florida Coalition for Optimal Mental Health and Aging, Indiana Mental Health and Aging Coalition, Kansas Mental Health and Aging Coalition, Kentucky Mental Health and Aging Coalition, Maryland Coalition on Mental Health and Aging; Mental Health and Aging Coalition of Eastern Kansas; New Hampshire Coalition on Substance Abuse, Mental Health and Aging; Oklahoma Mental Health and Aging Coalition; Pennsylvania Behavioral Health and Aging Coalition, and NJ Partners: Aging, Mental Health, and Substance Abuse.
2005 White House Conference on Aging Update
Gail Hunt, President and CEO of the National Alliance for Caregiving and a member of the 2005 WHCoA Policy Committee stated that the current plan, which is subject to further revision, is for the implementation strategies developed by the delegates at the WHCoA to be categorized as having strong, moderate, or little support and placed in a Volume II of the Final Report. Volume I will contain the resolutions and it will be a blueprint for aging for the next ten years. The Administration reviewed the most recent draft and has made changes. The report is viewed as a Policy Committee and not a delegate report. It will be signed off on by the Administration. A congressional mandate specifies the report must be completed by June 30 and then it will go to the Government Printing Office. Gail could not comment on the reports' inclusion of mental health issues.
WHCoA Next Steps for NCMHA and Member Organizations
Deborah DiGilio began the discussion with a review of NCMHA's activities around the WHCoA since the last meeting. A handout was developed to encourage inclusion of the delegates' implementation strategies in the WHCoA preliminary report to be sent to the Governors, and to request that the delegates, and those who appointed them, demand the same. Although this did not happen, we continue to remain on alert until the Final Report is released in July and then determine the best course of action. Deborah then noted that the following states recognized mental health as a priority in their response to WHCoA policy Committee's Preliminary report: West Virginia, Puerto Rico, New Mexico, New Hampshire, Nevada, Massachusetts, Maine, and Kansas. Slightly less than half of the state's governors responded and provided feedback to the Policy Committee.
Willard Mays continued the WHCoA discussion with a review of other WHCoA events that are occurring across the country. At the National Council on Aging/American Society on Aging meeting in March, there was a session focusing on the 2005 WHCoA that WHCoA Policy Committee chair, Dorcas Hardy attended. At the meeting, the WHCoA delegates present stated that they want to continue on as a group to work on the implementation strategies after the Final report comes out. Many state delegates have declared that they plan to be delegates until the next WHCoA. New Hampshire delegates had a face to face meeting with their Governor regarding implementation and to assist in crafting a response to the preliminary report. There will be a joint conference sponsored by CMS and SAMHSA on mental health and aging as a result of the WHCoA. Willard Mays will present on NCMHA efforts. In addition, NCMHA Chair, Deborah DiGilio and Michael Smyer wrote an article for Public Policy and Aging Report titled, "Mental Health and Aging at the 2005 White House Conference on Aging: Two Steps Forward, One Step Back," that chronicled the Coalition's work to ensure mental health's placement within the WHCoA "top ten" resolutions. Diana Lawry of AOA stated that she is using the WHCoA mental health resolution in her work with SAMHSA's Senior Workgroup of the Transformation of Mental Health effort. Alixe McNeil, NCOA, described planning programming related to the WHCoA for the NCOA/ASA March 2007 meeting. Diane Elmore of APA reported that they are going to host a Congressional briefing to highlight the mental health resolution and explore next steps for the WHCoA. Diane invited NCMHA to be a cosponsor of the event. A motion was made for NCMHA to co-sponsor the event. The motion carried. In closing, Anita Rosen recommended that the 17 presentations from the NCMHA January 2005 Listening Session and our detailed resolutions be posted on www.ncmha.org.
Strengthening the Relationship between NCMHA and Local Coalitions and Creating Mechanisms for Increased Participation
Willard Mays noted that connecting the state WHCoA delegates to the state and local level mental health and aging coalitions could be one real way to revitalize interest in the development and growth of these coalitions. Currently there are eight states and three local coalitions. NCMHA will spend more time determining how these linkages can be enhanced so that we are able to tap the state and local voice and bring those issues to the national level. Amy York noted that there are a number of local Jewish Federations that provide mental health services who might be interested in linking with a coalition. It was discussed how this is the case for most NCMHA members. It was decided that NCMHA should develop a document for its' members that provides guidance on how to link their state and local constituent groups with existing mental health and aging coalitions, and how to include WHCoA delegates in their efforts. NCMHA members can put this information into their electronic newsletters. NCMHA will also determine the costs of conferencing in to NCMHA meetings.
American Association for Geriatric Psychiatry - Stephanie Reed reported that they have been involved in efforts to restore funding for Title VII of the Public Health Services Act's Health Professionals training programs that have been eliminated. The cuts include three geriatric training programs.
Administration on Aging - Diana Lawry described their Memorandum of Understanding with SAMHSA to identify evidence based programs and practices that might be suitable to include in the EBP Registry. One of the 12 areas being looked at is depression. As part of their work with the Senior Mental Health Transformation Workgroup, AoA is involved with integrating behavioral health and suicide prevention into primary care.
American Counseling Association - Brian Altman reported that they are working to expand access to mental health services for older Americans via expansion of Medicare. They had a mini-victory with the approval of the Senior Mental Health Access Improvement Act (HR5324) introduced by Representative Barbara Cubin (WY). It allows for licensed professional counselors to receive reimbursement under Medicare Part B. This bill has had success in the past with support from Senators Thomas and Lincoln but has never made it on the House side. There is a real need for providers, particularly in rural areas, as only 3 % of mental health workers work in rural areas. Those interested in this issue should contact Brian at firstname.lastname@example.org.
American Psychological Association - Diane Elmore, PhD reported that recently the Public Policy Office has been monitoring and working on issues including the OAA, elder justice, caregiving and long term care. APA sent a letter to all governors encouraging them to include mental health as a top priority in their response to the WHCoA preliminary report and to request the inclusion of the implementation strategies in the WHCoA final report.
American Society on Aging / National Council on Aging - Anita Rosen reported that they are working on many of the issues that we have been talking about. At the ASA/NCOA conference, ASA's Mental Health and Aging Network (MHAN) and NCMHA will sponsor a track on mental health and aging, Mental Health and Aging Coalitions: Effective Approaches and Innovative Practices.
Bazelon Center for Mental Health Law - Bob Bernstein reported that the Bazelon Center and Duke University Department of Psychiatry are collaborating on a project on psychiatric advance directives. They are developing a virtual community to inform people about national and state specific information related to psychiatric advance directives. The website will focus on special implications for Alzheimer's disease, etc. Bob volunteered to arrange for Morgan Schwartz from Duke to present at our next meeting. The group supports such a presentation and asked Bob to invite Dr. Schwartz to attend.
Geriatric Mental Health Alliance of New York - Kim Steinhagen reported that New York's Geriatric Mental Health Act was passed and signed. $2 million was devoted towards implementation of the Act, including the development of an interagency geriatric mental health planning council. The Commissioners of the Departments of Aging Services and Mental Health met together and are very supportive of the Act and its provisions which include service demonstration programs, community integration, work force development, family support, an information clearinghouse and building cultural competence.
Department of Veterans Affairs - William Van Stone reported that two well known aging and mental health advocates have just been hired at VA Central Office: Ira Katz, MD as Deputy Chief Patient Care Services Officer for Mental Health, and Antonette Zeiss, PhD as Deputy Chief Consultant in the Office of Mental Health Services. Lucia Freedman described the VA efforts in establishing mental health consumer advocate councils. They are about to formalize a plan that each medical care facility develop a consumer advisory group. She mentioned that they are also talking about a national training conference to bring together Council representatives and medical centers.
Jewish Federation of Metropolitan Chicago - Amy York reported that 30 individuals participated in a DC advocacy effort for mental health parity. They met Senator Brent Hassert (R) who is opposed to parity. It was noted that Jewish Federations across the country can be utilized to become involved in many of our efforts and areas of interest.
Maryland Coalition on Mental Health and Aging - Kim Burton reported that they have successfully passed legislation in Maryland that mandates mental health training of workers in assisted living facilities. They are very dismayed that Johns Hopkins Geriatric Education Center may be closed due to Title VII funding cuts.
National Alliance for Caregiving - Gail Hunt reported that on September 26th there will be a Caregiver and Health conference in DC. It will look at caregiving as a health issue. She will send conference information to NCMHA members. Also, they will host a Latin American Caregiver Conference in Miami this November with 10 countries from Latin America participating to develop five-year plans for family caregiving in their countries.
National Association of State Mental Health Programs Directors - Willard Mays reported that his state, Indiana will be hosting the Annual Meeting of the Older Persons Division of the National Association of State Mental Health Program Directors on Sept. 25-27. They will be meeting jointly with the Indiana Mental Health and Aging Coalition's 3rd Annual Indiana Mental Health and Aging Conference. Nationally recognized speakers including Steve Bartels and Fred Blow will participate.
National Council on Aging - Alixe McNeil reported that one of their focuses is depression. They are participating in SAMHSA's mental health transformation project. Their Get Connected: Linking older adults with medication, alcohol, and mental health resources is still often requested and the publication, Promoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems is available online at: http://www.ncoa.org/Downloads/PromotingOlderAdultHealthSAMHSAToolkit.pdf
Older Women's League - Laurie Young discussed OWL's annual Mother's Day Report, which this year focused on women and long term care issues. Five organizations collaborated on the report that includes strategies and recommendations for both informal caregivers and professional caregivers on this topic. The report Women and LTC: Where will I live and who will take care of me? is available for download on the OWL website (www.owl-national.org).
Older Adult Consumer Mental Health Alliance - John Piacitelli suggested that all national mental health and aging conferences should be encouraged to foster attendance of older adult mental health consumers. Every NCMHA member should think about what we can do to get Congress to pass something that ensures that older adults are addressed in the state plans, and the block grant programs.
Substance Abuse and Mental Health Services Administration - Bill Foley is new to SAMHSA within the Center for Mental Health Services Block Grant Division. He was previously involved in NIA's epidemiology division. He believes that SAMHSA needs the underpinning of research in all of its efforts. His areas of interest include driving cessation in old age and sleep disorders and its relationship to substance abuse. He was welcomed and encouraged to continue his participation.
The meeting was adjourned at 12:30 pm. The next NCMHA meeting will be held on Friday, September 22nd from 9:30 am - 12:30 pm at the American Psychological Association in the 6th floor boardroom.