MEETING SUMMARY
National Coalition on Mental Health and Aging
Friday, September 22, 2006

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 guests, Eric Elbogen, PhD and David Shern, PhD.

Psychiatric Advance Directives

Eric Elbogen, PhD, a psychologist from the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center, discussed the importance of implementing Psychiatric Advance Directives (PADs). PADs are defined as legal instruments that may be used to document a competent person's specific instructions or preferences regarding future mental health treatment, in preparation for the possibility the person may lose capacity to give or withhold informed consent to treatment during acute episodes of psychiatric illness. Dr. Elbogen reported that since 1991, there has been increasing interest in PADS. Currently there are 25 states that have passed specific legislation allowing consumers to have PADs in place. The goal of the law is to improve consumer autonomy which may lead to future reduction in involuntary treatment. He also reported that research indicates that PADs allows consumers to process their health care decisions which may lead to an increase in the level of consumer competency in treatment as well as improve the continuity of care. It has been shown that approximately 70% of consumers want a PAD, but less than 10% have one in place.

There are two types of PADs: Instructional and Health Care Power of Attorney. The Instructional Directive is similar to a living will and documents the wishes, consent or refusal of future care. The Health Care Power of Attorney appoints another person to make decisions during crisis and may be designed with limited or broad powers. Consumers are able to indicate specific symptomology that identifies that he or she is in a state of crises. Additionally, it allows consumers to specify medication preference and allergies, choice of hospital in the event of emergency, emergency contacts, relapse factors, protective factors that buffer relapse, and other factors that prevent relapse.

A question was raised about the level of involvement of first responders such as emergency medical technicians in the PADs. Eric replied that the fact of the matter is that because these are relatively new laws, people in the health care system are not aware of PADs. The next step is to widely disseminate materials. Another question raised was whether there was compliance among professionals in a crisis situation with the wishes expressed in the PAD? Eric reported that the data indicates that very few professionals inquired whether the individual in crisis had a PAD, and that this emphasizes the need for broad education. Further information about PADs including the presentation to NCMHA are available on the web at: www.nrc-pad.org. Dr. Elbogen's study of PADs is available at: http://ps.psychiatryonline.org/cgi/content/full/ps;57/3/350.

David Shern, PhD, President and CEO, National Mental Health Association

NCMHA was honored to welcome David L. Shern, PhD, the recently appointed President of the National Mental Health Association (NMHA). Dr. Shern has more that 30 years of experience in mental health services research and system reform. Prior to joining NMHA in 2006, he served as Dean of the Louis de la Parte Florida Mental Health Institute (FMHI) at the University of South Florida. Dr. Shern began his remarks by stating that there is a multitude of issues that need to be addressed in our health care system, and that the demographics of the aging population are compelling and present major issues related to the affordability of healthcare. He noted that NMHA is not where it needs to be in terms of aging issues and that Dianne Dorlester, Senior Director of Adult Mental Health Services will be the new NMHA representative to NCMHA. NCMHA chair, Deborah DiGilio thanked Dr. Shern for taking the time to attend the NCMHA meeting and stated that NMCHA stands ready to work with NMHA on older adult mental health issues.

Regulatory and Legislative Update

Jim Finley, Senior Associate with the National Association of Social Workers' Government Relations Department, reported that Congress is preparing to adjourn this week to prepare for midterm elections. There are no major legislative plans being made, pending the outcome of these elections. Appropriations, including those for SAMHSA, NIH, and NIMH remain undone. They will return the week after elections. He reported that at the end of July, the House passed its version of the IT Health Privacy Act. They decided they were going to let current Health Insurance Portability and Accountability Act (HIPAA) policy prevail as they have very little latitude to change the current standards. They are working on possible breach notice changes, which relate to consumer notification in case of a security breach of computerized personal information. The current debate revolves around funding for IT legislation changes. The Senate has proposed $100 million in grants for start up efforts. The House has proposed that HMO's and large health care systems share information with smaller health care groups and providers for free. This IT issue is important to keep an eye on because it also relates to Medicare moving toward a pay-for-performance system. An essential part of that system is that providers would need an effective IT infrastructure in place to track required outcomes. The government is adamant about not raising provider reimbursement rates unless there are agreed upon standardized performance measures in place. It was noted that we are not where we need to be in terms of setting standardized processes and outcomes. There are a lot of problems in doing this. Bob Bernstein noted that, for example, if coverage for the optimal amount of psychotherapy is not available, how do you then show positive outcomes? It is vital that we intervene and use Congress as a referee in this CMS driven pay-for-performance effort. For further information on pay-for-performance, see: http://www.americangeriatrics.org/policy/2006p4p_primer.shtml.

Another relevant, major issue for Medicare mental health providers resulted from the five year statutorily mandated review of relative value units assigned by CMS. In June, CMS proposed an increase in payments for Medicare primary care physicians providing evaluation and management (E&M) services, increasing Medicare costs by $4.5 billion. As Medicare funding is a zero sum game, to be budget neutral, CMS decided to cut work relative value units (RVUs) for all Medicare services. This type of cut hits psychotherapists hard - a 15% cut by the end of 3 years. For example, licensed clinical social workers' hourly rate for providing psychotherapy to Medicare patients would be approximately $30 with the proposed cuts. This is a very difficult situation, having to pit important services against each other. The proposed timeline is completion by January 1st, but there is no bill to address this issue at this point.

Older American Act/Positive Aging Act Update

Diane Elmore, Senior Legislative & Federal Affairs Officer in the Public Policy Office, American Psychological Association gave an update on the Positive Aging Act (PAA) and Older Americans Act (OAA) reauthorization. She noted that NCMHA member organizations have been working on the (PAA) since 2002. She distributed a side-by-side summary comparing the PAA language in the Senate and House bills reauthorizing the Older Americans Act. She explained that the Senate bill includes several exact provisions from Title I of the PAA, along with some modified PAA language. In contrast, the House bill includes language "inspired" by the PAA, however does not include exact provisions. Therefore, PAA supporters are urging support for the Senate language. While there is bipartisan support to complete the OAA reauthorization prior to adjournment next week, it is still important for organizations to mobilize their grassroots networks in support of this legislation. Diane noted that Title II of the PAA will be raised within the context of the SAMHSA reauthorization, which may occur in early 2007. This title supports the integration of evidence-based mental health services by geriatric mental health specialists in primary care settings and the establishment of community-based mental health treatment outreach teams in settings where older adults reside or receive social services.

The Elder Justice Act and the principles of the Choices for Independence Program (that focuses on community based long term care) have been woven into other parts of the OAA, although demonstration programs for the later are not included. The Administration on Aging is working independently on instituting some of the components of the Choices for Independence Program. They are planning Choices for Independence: A National Leadership Summit in December.

Diane also noted that the Lifespan Respite Care Act has gotten through the Energy and Commerce Health Subcommittee and it is hoped that the full House may take it up before the end of the 109th Congress.

Medicare Part D: "Doughnut Hole" Dilemma

Alixe McNeil, Vice President of Program Development at the National Coalition on Aging distributed two handouts, Tips for helping people in the coverage gap, developed by NCOA and the Access to Benefits Coalition, and How the Coverage Gap works for People with Medicare Prescription Drug Plans developed by CMS. Alixe then introduced Robert Tiller, Deputy Director for Public Policy and Advocacy at NCOA who updated NCMHA on Medicare Part D.

Robert reported that the issue of the coverage gap in Medicare Part D is a very serious problem and the term "doughnut hole" seems to trivialize the issue, it should be named something else. No changes in Part D are expected this year. However it is important to assess how it is going, to collect stories of its pitfalls and on how people have been adversely, as this data will be useful in recommending changes in 2007. The CMS handout that was distributed explains that the coverage gap begins when an individual reaches $2,250 in total annual drug costs (not including premiums). Coverage restarts after the person has spent an additional $3,600 out of pocket at which point they reach the "catastrophic coverage" portion of the Medicare drug benefit. Individuals pay %% of drug costs under the catastrophic coverage. There is a misconception that individuals need to spend $3600 before their benefits ever restart, not realizing that at the beginning of 2007, the plan payments start anew. Another problem is that once individuals reach the coverage gap, many often go to out of network pharmacies or drugstore.com for their medications to find the cheapest drugs. However, costs of drugs bought out of network and non-formulary drugs do not count. It is also estimated that many more individuals will reach the coverage gap in 2007, then in this first year.

Legislation is being considered that would waive the premium penalty for those who did not sign up for Part D by the enrollment deadline. The waiver will not be a stand alone bill, it will attached to another Medicare-related bill (currently there are 38 active bills dealing with Medicare Part D policies). The low income subsidy redetermination letter will be mailed to beneficiaries next week. If there has been no change in one's current plan, it will be fine. However, for those with dual eligibility who are not in one of the benchmark plans (basic drug plans with premiums below a certain rate), this will be difficult. If someone was randomly assigned in 2006 to a plan that will no longer be a benchmark plan in 2007, they will be switched to a benchmark plan unless the person chooses another plan. Medicare will send letters informing beneficiaries to what plan they had been assigned. If in 2006, an individual selected a plan that will no longer be a benchmark plan in 2007, they will need to switch to a benchmark plan to avoid paying premiums. For more information on Medicare Part D, see http://www.accesstobenefits.org/. To utilize NCOA's Benefits CheckUpRx to learn about extra help with prescription drug costs, go to: http://www.benefitscheckup.org/ . The Medicare Rights Center also has additional information on Part D: http://www.medicarerights.org/Index.html.

2005 White House Conference on Aging: Discussion of the Final Report and Follow-up Planning to its Release

Deborah DiGilio began the discussion by congratulating the Coalition on their hard work in advocating for inclusion of the implementation strategies in the Final Report of the 2005 WHCoA. She distributed a handout that provided a rough overview of those implementation strategies that NCMHA had advocated for that were included in the Final Report. Some of those were: mental health care parity and removing institutional bias in Medicaid, parity in Medicare, geriatric education and training including cultural competence, assuring access to affordable, comprehensive, quality mental health and substance abuse services in multiple settings, passing the Positive Aging Act, eliminating pre-existing clauses and the lifetime cap for inpatient psychiatric services, assessment and treatment that is evidence-based and age appropriate, mental health and substance abuse services integrated into primary care, implementing Recommendation 1.1 of the President's New Freedom Commission, a national strategy for supporting informal caregivers, caregiver assessment for both mental and physical health status, coordinated health and aging networks, innovations in aging research, healthy active aging programs and interventions, federal support of aging research, and research training to encourage career development in aging, doubling of the NIH budget devoted to mental and physical wellness, and evidence-based research on drugs and psychosocial treatments.

Willard Mays noted that response he has heard thus far about the Final Report is that it is overwhelming. It is so large it will be hard for policy makers to "get their teeth into it." Also, the disclaimer on the bottom of each page that "the implementation strategies are not intended to convey the sense of all delegates who attended, and don't have the endorsement of the Policy Committee" is troubling.

Gail Hunt, President and CEO of the National Alliance for Caregiving and a member of the WHCoA Policy Committee reported that there is some ongoing action within the states' delegations. Delegates are meeting with their governors and moving forward to follow up with post WHCoA activities. However, it was noted that there are no tracking mechanisms in place at the national level to monitor and follow up on these activities. Dorcas Hardy, Chair of the Policy Committee made a presentation at the ASA/NCOA in March. Some of the conference participants who were delegates to the WHCoA discussed the plans that had been made in their states to follow what happened at the conference. It was noted that NCOA tried to create an e-mail listing of WHCoA delegates but only have about 25% of the delegates. It was noted that perhaps NCMHA members can help by providing names of delegates they are aware of, so that we can continue communicating with the delegates.

The discussion then turned to: "now what?" The point was raised that perhaps NCMHA could form a committee to respond to the Final Report and formulate an action plan to encourage action on the resolutions and implementation strategies that are important to NCMHA. It might be beneficial to look into grant money to form and staff such a committee. This was done after the 1981 WHCoA. After further discussion, it was recommended by the Chair that a committee be established of NCMHA members who are interested in developing a framework for a WHCoA Mental Health Follow-up Report, rather than securing grant funds to do so. And, at our January meeting, rather than a usual meeting, we will use the meeting model we used in September 2004 when we developed our 2005 WHCoA resolutions. That is, we will have an all day, work-bench meeting, with large and small group work, during which we develop concrete, specific, action steps that can be taken at the federal, state and local levels to foster implementation of the WHCoA recommendations/implementation strategies that NCHMA supports. Then perhaps, grant money can be secured to roll out the product. Paul Wohlford of CMHS stated that it would be important to cull from the WHCoA Final Report information that federal, state and locals can tie into Transformation Grants and SAMHSA/CMS priorities.

Diane Elmore mentioned that APA has been looking for aging champions that may want to sponsor the post-WHCoA Hill briefing event discussed at the last NCMHA meeting. Emerging speakers include Public Policy Committee members Bob Blancato and Gail Hunt. Because of the later than expected release of the WHCoA Final Report, the event is projected to take place in December or January when Congress reconvenes, which is also the one year anniversary of the 2005 WHCoA. NCMHA reaffirmed its interest in cosponsoring this event.

NCMHA presentations at the SAMHSA/CMS Invitational Conference on Medicaid and Mental Health Services and /Substance Abuse Treatment and the SAMHSA Training Institute for State Mental Health Olmstead Coordinators

Willard Mays, National Association of State Mental Health Program Directors reported that he and NCMHA chair, Debbie DiGilio recently conducted workshops at two conferences. At the SAMHSA/CMS Invitational Conference on Medicaid and Mental Health Services and /Substance Abuse Treatment, White House Conference on Aging: Recommendations on Mental Health Services was presented. At Celebrating Olmstead and the New Freedom Initiative: Reflections and New Directions for Community Integration - the 6th Annual SAMHSA Training Institute for State Mental Health Olmstead Coordinators, Moving From Words to Action: Strategies to Implement the Mental Health Recommendations of the White House Conference on Aging was presented. Utilizing a power point presentation and handout created for this purpose, NCMHA's history, purpose, efforts, and current membership were reviewed prior to describing our efforts specific to the WHCoA. The sessions then focused on describing strategies for advocating on the behalf of older consumers and to help build upon the momentum of the WHCoA to achieve a transformation of mental health services for older adults.

State and Local Coalition Update

Bob Rawlings, State and Local Coalition Representative to the Executive Committee provided the names of the state and local coalitions who are applying for membership in NCMHA. They are: Aging and Mental Health Coalition of Northland, Georgia Coalition on Older Adults and Mental Health, and Metro Atlanta Area Coalition for Mental Health and Aging. Membership was granted and they were welcomed to NCMHA. They join those state and local coalitions that became members at our last meeting: 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.

Bob has been asked to plan a program on aging for next year's CMHS Mental Health Block Grant Conference. Given the discussion at this meeting, he thinks that it would be a great idea to highlight states that are using the WHCoA report to make some changes, as well as those targeting their mental health transformation grants to aging populations. Bob would love to hear from states and locals that are progressing in these areas.

Member Updates

Administration on Aging - Diana Lawry reported that they are entering the fourth year of their Evidence Based Disease Prevention Grants Program. Its objective is to increase older people's access to programs that have proven to be effective in reducing their risk of disease, disability and injury. They have funded 13 local projects and a National Resource Center on Prevention at NCOA. The local grant projects focus on interventions in disease self-management, falls prevention, nutrition, physical activity and medication management. AOA is also working with SAMHSA on the Older Americans Substance Abuse and Mental Health Technical Assistance Center which serves as a national repository to disseminate information, training, and direct assistance in the prevention and early intervention of substance abuse and mental health problems. AOA is also a member of SAMHSA's primary care and integrated behavioral services work group which was initiated in response to the President's New Freedom Commission on Mental Health. They are combining forces around the topic of suicide and depression screening. They are also working with CMS on home and community based service delivery related to the new Medicaid waivers.

American Association for Geriatric Psychiatry - Stephanie Reed reported that the President of AAGP Dr. Christopher Colenda provided testimony last week to the U.S. Senate Special Committee on Aging at a hearing titled, Generation at Risk: Breaking the Cycle of Senior Suicide. The hearing was opened by Senators Gordon Smith and Herb Kohl. The Senators both placed a great emphasis on suicide prevention through primary care physicians and identifying potential barriers. The meeting ended with very firm statements from the Senators regarding their intention to take follow up action. Other speakers included Drs. David Steffens, Mel Kohn, Art Walaszek, and David Shern.

American Bar Association - Alzheimer's Association Medicare Project - Leslie Fried reported that she has been totally occupied with efforts related to Medicare Part D, particularly prior authorization requirements. These requirements have been very problematic and they are monitoring their use. People are being denied benefits even if drugs are on the formulary. In addition, although Part D plans are required to cover a majority of drugs in certain classes, including antidepressants and antipsychotics, and not to apply other restrictions to drugs in any of these classes if a person has been stabilized on them, vigilant monitoring of these (potentially changing) specifications is necessary.

American Counseling Association - Brian Altman reported that have been working with the American Association for Marriage and Family Therapy to pass the Senior Mental Health Access Improvement Act that allows for licensed professional counselors to receive reimbursement under Medicare Part B. As mentioned at the last meeting, it was introduced by Representative Barbara Cubin (WY) as HR5324. Since that time, the Rural Medicare bill was introduced on both sides of Congress (S3500, HR6030) and their provisions are included in both of those bills. The next step is to lobby for the support of the Senate and House. Brian asked NCMHA members to let him know if their organizations would be interested in endorsing the bill.

American Psychological Association - Diane Elmore reported that they are focusing attention on the mental health needs of older adults in disasters to assure older adults are included in disaster preparation and related legislation. Next week, APA is hosting an Advocacy Day that will include geropsychologists going to the hill to advocate for the incorporation of the Positive Aging Act into the OAA, and the Lifespan Respite Act. David Powers, who representatives both APA and Psychologists in Long Term Care, reported that the Medicare cuts are a serious issue to psychologists across the country who are providing behavioral assessments, interventions, and therapy in long term care settings and beyond. Both PLTC and APA are working on this issue. The APA/ABA Commission on Law and Aging Workgroup on Capacity Assessment in Older Adults has recently completed its second publication, Judicial Determinations of Capacity of Older Adults in Guardianship Proceedings. This document is a companion document to the Workgroup's Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers (2005). The National College of Probate Judges (NCPJ) is a cosponsor of this newest document. The next project will be aimed toward psychologists. These two documents are online at www.apa.org/pi/aging. Also, a National Training Conference in Professional Geropsychology was held in June in Colorado Springs. Its goal was to outline training models for geropsychologists.

American Society on Aging - Anita Rosen reported that CEO Gloria Cavanaugh announced her retirement from ASA, this will be a major change for the organization. ASA President Robin Golden sent invitations for an ASA Reception which is set to occur from 5:30-7:30 pm October 5th. The ASA Mental Health and Aging Network (MHAN) have an e-newsletter with great resources including the ABA/APA Capacity Assessment in Older Adults handbooks and a variety of resources on elder abuse. This coming year, at the ASA/NCOA Conference, a special session will be devoted to evidence based practice in mental health and substance abuse. The yearly Coalition track is also going to be exciting, it will be held Wednesday, March 7, 2007 from 10:30 am - 6:00 pm. Bob Rawlings is planning this track which will highlight the substantial success of mental health and aging coalitions in the states of Florida and New York. An opportunity will be provided for other coalitions to share their activities and/or seek advice on enhancing an existing coalition or forming a coalition where none currently exist. Deborah DiGilio and Willard Mays will present a symposium that summarizes successful strategies used to assure attention to mental health and substance abuse at the WHCoA.

It was also announced that The Annapolis Coalition on the Behavioral Health Workforce is selecting programs for its Registry of Innovative Practices in Workforce Development. There is an older adult category for program nominations. NCMHA members are encouraged to submit nominations.

Center for Mental Health Services - Paul Wohlford spoke about the Mental Health Transformation grants and his aging program planning efforts in conjunction with the block grant conference. Perhaps he could collaborate with NCMHA and focus on states that are moving ahead on the WHCoA and other planning efforts related to older adult mental health and substance abuse issues.

Council on Social Work Education - Anita Rosen, who also represents CSWE, described their efforts to train gero-competent social workers. On February 2-4th, in conjunction with the CSWE's Building Leaders in Social Work Education Seminar, there will be the 2007 Gero-Ed Forum, Infusing Gerontology Across the Classroom and Field: Planning, Implementing and Resourcing in Charleston, SC.

Depression and Bipolar Support Alliance - Mildred Reynolds reported that they are involved in World Mental Health Day to be held in October. This year's focus is Building Awareness - Reducing Risks: Suicide and Mental Illness. On a personal note, Mildred reported that within her own senior residence, there have been incidences of suicide and this has increased the salience of this issue for residents. She is planning their first leadership conference on depression and suicide which will target breaking down stigma. National Depression Screening Day also takes place in October. They are also working very hard to represent older adults and are hoping to develop a program that be used within continuing care retirement communities.

Geriatric Mental Health Alliance of NY - Kim Steinhagen reported that the Geriatric Mental Health Act of New York had passed and $2 million was allotted to demonstration programs. Their Interagency Geriatric Mental Health Council has met twice. It consists of seven state departments and six other organizations. It is co-chaired by the Commissioner of the Office of Mental Health and the Director of the Office for the Aging. At the first meeting, it was decided to break into three workgroups to address issues such as screening, treatment, community integration and workforce issues including both council and community members. At the second meeting, the work groups provided recommendations relating to mental health screenings in community settings. Currently they are developing an RFP for the demonstration programs. It is hoped that the demonstration programs will be selected by the end of the year.

Maryland Coalition on Mental Health and Aging - Kim Burton, Director of Older Adult Programs reported that they received a $200,000 grant to provide statewide training to assisted living providers on mental health, aging, and dementia issues. As reported at the last meeting, they were able to pass legislation in Maryland that mandates mental health training of workers in assisted living facilities and this grant will allow the training to occur. They are very close to mandating this same training in long term care settings. Kim reported that they are going to evolve a stakeholder network and strengthen those that already exist. They will be sending three representatives to the National Association of State Mental Health Program Directors meeting who will then serve as regional trainers.

National Council on Aging - Alixe McNeill described some of the projects they are working on in addition to the National Resource Center on Prevention funded by AOA described by Diana Lawry. Their Center for Healthy Aging is a national resource center for aging service providers, AoA Evidence Based Disease Prevention Grants Program grantees, and others interested in healthy aging programs. They also assist community-based organizations serving older adults to develop and implement evidence-based programs on health promotion, disease prevention and chronic disease self-management. They will be funding 12 more states and have a new focus on medication management through case management programs.

National Mental Health Association - Dianne Dorlester reported that their attitudinal survey that is completed every five years includes questions specific to older adults. This past year, they did a significant amount of work related to Medicare Part D. They distributed 10,000 consumer workbooks to all ages with a focus on dual eligibility in an effort to educate the public. She is excited to be the new NMHA representative to NCMHA as she has worked in the aging field in the past, as a director of assisted living facilities in Maryland, and is very committed to being back at the table.

National Mental Health Consumer Organization - Laura Spiro distributed a handout regarding this new organization. She reported that this organization was formed by mental health consumers and survivors to ensure that they play a major role in the development and implementation of health and mental health care and social policies at the state and national levels. The Coalition embraces the disability movement's motto, "Nothing about us without us." Laura reported that they will collaborate with other advocacy groups to ensure that consumer rights policies continue to move towards full participation and community integration. The Coalition consists of 28 states and the District of Columbia and they are in alliance with three federally funded consumer-run centers: the Consumer Organization and Networking Technical Assistance Center, the National Empowerment Center, and the National Mental Health Association Consumers' Self-Help Clearinghouse. For further information, visit http://www.NCMHCSO.org.

Older Women's League - Laurie Young reported that the Older Women's League is currently working with the National Mental Health Association to look at attitudes related to mental health and aging. They are also working with allied health professionals on mental health issues and are work with libraries to disseminate materials for Older Americans Mental Health Week. They are also working with the National Association of Area Agencies on Aging to explore other settings that might provide opportunities to educate older adults on mental health issues. OWL will also be releasing a study of effective depression programs in the public health sector for older adults.

Pennsylvania Behavioral Health and Aging Coalition - Linda Shumaker reported that they are working on increasing their membership. They are working closely with the Pennsylvania Department of Aging and the Office of Mental Health. They have recently hired a part time paid Director.

State and Local Coalition Representative to the Executive Committee and Member at Large - Bob Rawlings described state efforts in Oklahoma. They just completed a caregiving conference offered in a church setting that included many mental health professionals presenting workshops. They are planning a January legislative hearing to address the issues of grandparents raising grandchildren. In Oklahoma, 61.8% of grandparents are involved in raising grandchildren to some degree. In North Oklahoma - 70% of children are being raised by their grandparents. They also have one of the highest rates of incarcerated women which fuels this issue. Bob also shared information about www.OpenOffice.org. It is a wonderful resource for individuals and small organizations, from which one can download free program that will allow one to open pdf, excel and other files. It is a multiplatform and multilingual office suite compatible with all other major office suites, whose products are free to download, use, and distribute.


Adjournment

The meeting was adjourned at 12:30 p.m. The next NCMHA meeting will be held on Thursday, January 11th 2007, from 9:30 am 3:30 pm at the offices of the American Psychological Association in its 6th floor Boardroom.