MEETING MINUTES
National Coalition on Mental Health and Aging
April 23, 2007

Deborah DiGilio, Chair of the National Coalition on Mental Health and Aging and Director of American Psychological Association Office on Aging called the meeting to order and reviewed the proposed agenda. There were 28 NCMHA members in attendance.

Election of 2007 - 2009 NCMHA Officers

Alixe McNeill, National Council on Aging representative and Nominating Committee Chair, reported that the Nominating Committee had a conference call on April 12th and prepared the following slate: Deborah DiGilio, American Psychological Association, Chair (2nd term), Bob Bernstein, Bazelon Center for Mental Health Law, Vice Chair (2nd term), Anita Rosen, ASA/CSWR, At-Large (2nd term), Laurie Young, Older Women's League, At-Large (2nd term), Robert Tiller, National Council on Aging, At-Large (1st term), Mildred Reynolds, Depression and Bipolar Support Alliance, Consumer Representative (2nd term), Bob Rawlings, Oklahoma Mental Health and Aging Coalition, State/Local Coalition Representative (2nd term), and Willard Mays, National Association of State Mental Health Program Directors/American Society on Aging, Past Chair (2nd term). The membership voted to approve the slate. Thanks were given to Alixe McNeil for her two terms (four years) of commendable service as an NCMHA Officer. Deborah noted that the Coalition will be losing most of its elected officers in two years, so others should consider serving as future officers.

Consideration of Requests for Membership

NCMHA considered requests for membership from three organizations: The National Association of Mental Health Planning and Advisory Councils; the National Association of County Behavioral Health and Developmental Disability Directors; and the National Association of Preadmission Screening and Resident Review (PASSR) Professionals. The membership voted to accept and welcomed its newest members. These new member organizations be allocated time for a brief presentation at the next NCMHA meeting.

Update on Current Legislative and Regulatory Issues

Jim Finley of the National Association of Social Workers provided the update. The federal budget cycle is running behind. This is a problem because there may not be money for new programs that were authorized toward the end of last year such as the Lifespan Respite Act and Title I of the Positive Aging Act (that was included in the reauthorization of the Older American Act). A budget resolution is needed for programs to go forward. Committees try to report out in May/June and the Senate Committee on Appropriations Committee could be done in July but this has not happened in many years. It is hoped that Title II of the Positive Aging Act (S982; HR1669) will be included in the SAMHSA Reauthorization. This reauthorization traditionally serves as an omnibus vehicle for a variety of mental health and aging programs needing funding. SAMHSA Reauthorization is a painfully slow process, often taking 3-4 years. There is a May 8th hearing scheduled with new SAMHSA Director Terry Kline, PhD. Another major issue is the Medicare Part B provider/physician payment schedule. There is a planned 9-10% cut by statute in January 2008. In terms of Medicare parity, Representative Stark's HR 1663 would eliminate the discriminatory co-payment for Medicare, enable social workers to direct bill for services delivered to nursing home patients, and include Marriage and Family Therapists as Medicare providers. Representative Stark plans to mark up the bill and get it out of the Ways and Means Committee by late May. Representative Patrick Kennedy's bill is more limited, focusing solely on the 50-50 co-payment. Parity is alive but there is trouble in the Senate, where it would need to be approved almost unanimously. The House is optimistic and wants to mark it up soon.

The Physician Quality Reporting Initiative (PQRI) will evaluate and offer additional compensation for Medicare Part D providers based on their performance in meeting predetermined quality indicators. Currently there is only one indicator for mental health - conducting medication checks to ascertain patient compliance with a medication regimen. There is currently a rather elaborate process underway to identify meaningful clinical performance indicators. There is a multitude of problems inherent with pay for performance. Providers who work with complex and hard to reach underserved populations are in a bind. Multiple risk factors and or co-morbid health conditions are not taken into consideration. Currently there are 74 approved measures. Behavioral health providers need to increase the number of measures to receive a financial bump. At the end of this month new measures will be announced (not for behavioral health yet). It will be a perpetual cycle of codifying new measures.

Long-Term Care Insurance is one of Senator Kennedy's top three priorities. CLASS Act will automatically enroll all working Americans in a long-term care insurance policy. It would be an employee benefit with a fixed dollar payroll deduction. One would have to opt out of the program. The data on auto-enrollment overwhelming shows that a large proportion of individuals do not take action to opt out of a program once they have been enrolled. There are economic justice issues as well, including no coverage for domestic partners and no needs test at either the contribution or benefit end. These payments would be able to be used in the community in addition to institutional care settings.

Dan Mareck of HRSA's Bureau of Health Professions mentioned that the Geriatric Education Centers and two other Title VII geriatric programs just had their funding reinstated for 2007 (at FY 2005 level of $31.5 million) as part of the Omnibus Appropriations Bill. The break out of funding has not yet been determined, but chances are it will be similar to the FY 2005 level. Information on these programs can be found at www.hrsa.gov/grants.

Older Americans Mental Health Week 2007

Laurie Young, Director of the Older Women's League described plans for the 5th yearly celebration of Older Adults Mental Health Week, to be held May 21-27. Laurie shared copies of their 2007 Toolkit which was developed to raise public awareness, increase community understanding of mental illness, and reduce the stigma that keeps many older Americans from seeking help. They have also developed a poster and bookmarks, which have been placed in 400 libraries across the country. They will also work with APA on a Congressional Briefing (that NCMHA has agreed to cosponsor) that will address integration of mental and physical health care, the geriatric health workforce, and elder abuse.

Also this past year, OWL conducted a nationally representative poll to assess knowledge and attitudes about mental health and aging among three different health care professions - physician assistants, physical therapists and nurse aides. One third of physician assistants and physical therapists, and two thirds of nurse aides erroneously think that it is normal for people to get depressed as they get older. More than one in five of the health professionals polled mistakenly thinks that the effectiveness of mental health treatment decreases as a patient ages. Only 21% of these health professionals know that adults 75 and older have the highest suicide rate of any age cohort. For more poll findings and to learn more about Older Adult Mental Health Week go to: http://www.owl-national.org/mentalhealthweek/index.html

SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP)

Lisa Park, Office of Policy, Planning, and Budget at SAMHSA presented on NREPP which began in 1977 within the Center for Substance Abuse Prevention as a system for identifying and promoting substance abuse prevention interventions. In 2004, NREPP was expanded to include mental health promotion and treatment programs. Each of the three SAMHSA Centers (CSAP, CSAT, and CMHS) establishes its own priority areas and populations, and then these also become the priorities for the NREPP program reviews. NREPP candidate programs are reviewed by subject experts and scores are generated across two dimensions. Consenting programs have their review/ratings posted on the NREPP website (www.nrepp.samhsa.gov) that went live in the spring of 2007. A 4-month period will occur each year (likely October to February) when new programs and practices can be submitted and reviewed for consideration for inclusion in the Registry. Also, a notice will be posted in the Federal Registry in July or August announcing the submission period. From its inception, the Older Adults Technical Assistance Center (TAC) has partnered with NREPP to assist in identifying older adult programs with potential for inclusion in NREPP.

NCMHA member organizations were asked to spread the word and encourage programs to consider submission. Reasons to submit a program for NREPP review include receiving feedback about the program from subject matter experts, increasing the visibility of the program, and adding to the growing field of older adult treatment/prevention program and practices with a strong evidence base. Programs awaiting NREPP review are IMPACT, PROSPECT and PEARLS. NREPP has gone through major revisions over the past three years. They are taking a more supportive role in the review process. Also programs now need to demonstrate a measurable intervention and a readiness for dissemination.

The question was raised: How can localities replicate these interventions if there are no funds to do so? There are no new funds available, so this is a problem. It was suggested that perhaps some of the evidence-based programs in the registry could replace less effective interventions currently be used. OAA funds can now also be used for mental health programming since the incorporation of Title I of the Positive Aging Act into the OAA reauthorization allows this. It was suggested that NREPP and SAMHSA look at the issue of translation, and think about how NREPP can move from being just a registry to really influencing practice. Lisa Park noted that SAMHSA is looking at this issue and is currently developing tool kits, including one on older adult depression, to help inform practice.

It was then discussed how there are a variety of national outcome measures for children but not many for older adults. We need to connect the pieces of what is currently going on. Dianne Dorlester of Mental Health America mentioned their National Working Group for Evidence-based Healthcare and suggested that they could perhaps offer input on this issue. There is also an effort underway in the CMS Quality Division. Perhaps a meeting should be convened on Evidence Based Practice in mental health to discuss what is being done and how much of it can be used with older adults.

SAMHSA/CMHS Aging Conference

Willard Mays of ASA and NASMHPD shared that over time, it has been observed that certain issues and population groups have been under-addressed in state mental health block grant applications. These include criminal justice, juvenile justice, and older adults. This year, when SAMHSA held its annual block grant conference for state mental health planning and data collection/management staff in May, they had both a plenary session and one of the two breakout groups on older adults. There were presentations from experts in the field and a focus on what states could do to be cognizant of and include older adults in their planning efforts. It was noted that often State Health Planning Councils look at two groups, children and adults. Often older adults are not recognized as a discrete group needing attention. It is important to encourage mental health and aging advocates to serve on state planning councils.

American Society on Aging/National Council on Aging Annual Meeting Report

Willard Mays and Anita Rosen discussed that American Society on Aging/National Council on Aging Annual Meeting. For the fifth year in a row, there was a full day track on mental health and aging coalitions titled, Mental Health and Aging Coalitions: Effective Approaches and Innovative Practices. The first workshop, "The Current Status of Mental Health and Aging Coalitions: Activities and Outcomes Related to Mental Health after the White House Conference on Aging," provided an update on the work of NCMHA including the successful strategies employed to assure attention to mental health and substance abuse at the 2005 WHCoA. "Mental Health and Aging Coalitions: Making a Difference at the State and Local Level" highlighted the success of the Florida and New York coalitions. "Shaping Mental Health Organizational Structure and Programs through Coalitions" featured how state leaders in Wisconsin and local leaders in Houston formed coalition working groups to address co-occurring illness and depression. Willard Mays noted that Larry Dupree received the ASA "Mental Health and Aging" 2007 Award. The award is given to an outstanding professional who has had a profound and lasting impact on the mental health of older adults through practice, teaching, research, advocacy or policy planning.

Anita noted that some changes are coming. ASA has a new President and CEO, Robert G. Stein, who began at the end of March. There will be strategic changes for the conference in terms of number and types of presentations and criteria for selection. They are trying to do some stream-lining and consolidating as the conference is a bit overwhelming. The next conference will be on March 27-30, 2008 in Washington DC. It will have a policy orientation because of its location. Abstracts will be accepted in June. In addition, the name of the NCOA/ASA Joint Conference will be changed to The Aging Conference. Anyone interested in becoming involved in the conference as part of the local arrangements or program committee is invited to follow up with Alixe or Anita.

Development of Resources for State and Local Organizations

Deborah DiGilio began the discussion by reminding the group that at the last NCMHA meeting we discussed the need to build upon the momentum generated by the WHCoA. It was discussed how to continue to work effectively and strengthen those linkages and communication channels that were so successful in putting mental health on the WHCoA agenda. At that last meeting we had discussed developing new fact sheets on key mental health issues. The initial question raised by the group was - what is the role of NCMHA? Is it to create new materials of our own or share the resources available from our member organizations? It was noted that at ASA/NCOA we learned that many groups and individuals were unaware of very useful, existing information. There is a lot already there; perhaps there is not a need to re-invent the wheel. It was decided that as a first step, we ask our member organizations to provide the names and a web links of three educational and/or advocacy materials that would be helpful to other organizations. We will then develop a resource page on www.ncmha.org. There could be a topical index or other method of organizing in a user-friendly way. This will also serve as a needs assessment of sorts - to review what is out there and identify any gaps that might be addressed by future efforts. Debbie will send an e-mail requesting materials from organizations (as soon as she completes these minutes!). NCMHA should also explore establishing subcommittees (such as one for communications/web development) to facilitate specific efforts.

It was also suggested that NCMHA consider holding its spring meeting at The Aging Conference (ASA/NCOA) in March 2008 in order to include of state and local members.

Member Updates

Maryland Mental Health and Aging Coalition - Kim Burton reported that she attended the SAMHSA/CMHS Aging Conference that Willard described. She felt there was a considerable disconnect between mental health and aging advocates and the state level workers. Many did not know the people from their own state. Everyone is very nervous that they may lose their "piece of the pie." We really need to push the demographics to make our case (look at what is happening here!). The Maryland Coalition has been working on assisted living and nursing home workforce training. They are making a video training tape and are interested in any video footage that others may have that they could use. They are partnering with the John Hopkins University Geriatric Education Center to work on workforce issues and their website will be modified to include a workforce portal. They are also a CMHS transformation grant state; so there are opportunities for older adult programming. However, they are meeting some resistance from advocates of young mentally ill patients. Kim remarked that she loves the opportunity to be able to attend NCMHA meetings.

American Society on Aging and Council on Social Work and Education - Anita Rosen will inform the Coalition when the Call for Programs for The Aging Conference comes out. CSWE is making major strides in infusing aging content into the general social work curriculum. She is reviewing applications from social worker faculty that are not geriatric social workers who will use the funding to infuse aging throughout their programs.

American Psychological Association - Dianne Elmore and Joslyn Smith of the Government Relations Office reported that they are preparing for the Mental Health and Aging briefing to be held next month among other legislative issues. They are also working on Lifespan Respite, Disaster preparedness, Elder Justice Act, and the Positive Aging Act. Debbie DiGilio of the Office on Aging mentioned working for psychology teachers in secondary schools and community colleges to encourage students to become interested in geropsychology and efforts to infuse consideration of aging issues throughout the Association.

American Occupational Therapy Association (AOTA) - Marian Scheinholtz reported that they are working on a number of issues specific to older adults including Medicare, psychosocial issues in stroke patients, and older drivers. They have been very involved and have many resources on older drivers. Perhaps this could be a presentation at a future NCMHA meeting. They are also working with AARP and the National Builders Association on a universal design, initiative. American Bar Association - Ellen Klem mentioned their ongoing efforts with APA on a series of capacity assessment in older adults handbooks for lawyers and judges. They are now looking to develop handbooks for other professional groups such as adult protective service workers.

Suicide Prevention Action Network (SPAN) USA - Jamie Floman, an intern with SPAN represented the organization. They continue their efforts on the Garrett Lee Smith Memorial Act for your suicide prevention and on suicide among older adults

National Association of Area Agencies on Aging - Amy Gotwals reported that their main thrust this month is to try and secure more dollars for the Older Americans Act. They are encouraging their area agencies on aging to conduct mental health activities even through there was only a 10% increase in funding for all OAA programs.

Mental Health America (formerly National Mental Health Association) - Dianne Dorlester will send out information on their Working Group on Evidence-Based Health Care. It was conceived six months ago to bring folks across the lifespan together. They are planning a major initiative to involve consumers in mental health planning and evaluation including efforts related to evidence based practices. She distributed order forms to receive free copies of Medicare Part D consumer handbooks. Dianne is interested in talking to any other organizations that would like to partner up or are interested in being involved with their Evidence Based Health Care Group.

Bureau of Health Professions/Health Resources and Services Administration (HRSA) - Dan Mareck reported that they are currently working on completing the Graduate Psychology Education (GPE) grants. The grants fund about 18 programs at $1.8 million total. Established in 2002, the program did not receive funding in 2006 but was refunding for 2007.

National Association of State Units on Aging - Mark Miller, who works with Sara Aravanis, reported on their work with the Long term Care Ombudsman Resource Center. They are also working on issues related to both younger and older individuals in assisted living with mental health issues.

Substance Abuse and Mental Health Services Administration (SAMHSA) - Lisa Park reported that in May SAMHSA will support a meeting with state and area agencies on aging in the states of Louisiana and Mississippi to follow up on Hurricane Katrina and disaster preparedness efforts. Also at the end of May there will be an announcement in the Federal Register on Community Mental Health Block Grants including a new requirement that states must specifically report what they will be doing for older adults. Lisa will send the Federal Register announcement to Debbie to send to NCMHA.

National Association of Mental Health Planning and Advisory Councils (NAMHPAC) - Stephanie Townsend informed the group about their monthly newsletter. She noted that there will be some staff changes at NAMHPAC, and someone else will probably be representing their organization at the next NCMHA meeting.

Depression and Bipolar Support Alliance (DBSA) - Mildred Reynolds expressed confusion about the alphabet acronyms for our and other mental health organizations and suggested a one page list of all would be helpful. She also suggested considering the impact that tragedies like the one at Virginia Tech may have on the older adults. Those working in older adult residences should be prepared to understand and address the potential impact on their residents.

Northern Virginia Older Adults Mental Health Work Group - Anne Marie Hermann reported that they are a strategic planning partnership looking at serious mentally ill older adults. They were able to receive $1,500,000 for this population of older Virginians. They hope to have community-based teams that would make it possible to treat those having serious issues in their own community setting.

Older Women's League (OWL) - Laurie Young informed the group that on Wednesday May 9th they will release their annual Mother's Day Report.

National Association of State Mental Health Program Directors - Willard Mays reported that they are still getting requests from people interested in establishing state and local mental health and aging coalitions. He will be going to San Diego and to Penn State (with Bob Rawlings) to meet with individuals wanting to establish local and regional coalitions. If NCMHA members know of anyone interested in developing or enhancing a coalition, there is material available to help them do so.

Next Meeting Date

The meeting was adjourned at 12:30 p.m. The next NCMHA meeting will be held on Sept 17, 2007 from 9:30 am until 12:30 pm at the offices of the American Psychological Association in its 6th Floor Board Room.