By Willard Mays
NCMHA Executive Committee At-Large Member
Former Chair of the NCMHA
Indiana Coalition on Mental Health and Aging
Beginning in 1961, a White House Conference on Aging (WHCoA) has been held every decade. Although it was known then that older adults with mental health needs were a very underserved population, the early conferences paid little attention to the issue. There was very little advocacy at the time, and what did exist, lacked coordination. Following the 1981 Conference, a committee was formed, chaired by former U.S. Secretary of Health, Education and Welfare Arthur Flemming, to develop strategies on how to implement the few mental health recommendations that came out of the Conference. That committee’s report helped lay the groundwork for things to come.
In 1985 the National Institute of Mental Health held an invitational conference on older adult mental health. The National Association of State Mental Health Program Directors (NASMHPD) attended and, as a result, formed an aging division, now known as the Older Persons Division (OPD). Each state mental health agency designated a representative, and annual meetings began. This organization brought together state and federal policy makers and fostered relationships that led to future collaborations such as conferences, increased federal grants, and older adult technical assistance centers.
The idea of state coalition building began to emerge at about the same time. The state aging and mental health agencies in Michigan collaborated on a joint program: Building Ties: A Mental Health and Aging Project. The program staff provided consultation and training for local planning councils to develop, implement, and coordinate older adult mental health services. The program was a remarkable success and was shared nationally through many publications and conferences.
The first known state mental health and aging coalition was organized in 1990 in Oklahoma. Bob Rawlings, with the Oklahoma mental health agency, worked with advocates, consumers, and other agencies and organizations to establish the coalition. The Oklahoma coalition is still active, has thrived, and has served as a model for many state and local coalitions that have followed.
In 1991 the AARP hosted a meeting of agencies and organizations interested in older adult mental health. As a result, the National Coalition on Mental Health and Aging (NCMHA) was formed and Larry Rickards, PhD, representing the American Psychological Association, was elected as the first chair. A forum was created where national organizations, governmental agencies, advocates, and consumers could come together to discuss mental health and aging issues, work collaboratively, and make necessary recommendations to the appropriate policy makers.
As the coalition building concept began to grow, the Substance Abuse and Mental Health Services Administration (SAMHSA) provided grants to the AARP Foundation and NASMHPD to promote the development of state and local mental health and aging coalitions. Regional training events were held in Indianapolis, IN and Albuquerque, NM, that initially included 20 states. A third grant later added other states and local communities. On-site technical assistance was provided, and the project resulted in coalitions being formed in more than 30 states.
The NCMHA has achieved much in its history. At a meeting in 1999 there was a discussion regarding Medicare and Medicaid coverage policies that were inhibiting mental health care for older adults, especially for residents of nursing facilities. A letter was sent to the Health Care Financing Administration (HCFA) asking for a review of the barriers in the programs limiting the provision of mental health services. As a result, Coalition representatives were invited to meet with the top HCFA administrators to discuss the issues. An initial outcome of the meeting was the issuance of a memorandum from the HCFA Central Office to their regional offices clarifying coverage policies that had been misinterpreted in some regions and states. This effort also helped to establish an ongoing positive relationship between HCFA, and its successor agency, the Centers for Medicare and Medicaid Services (CMS), and the Coalition.
The NCMHA further demonstrated its effectiveness at the 2005 White House Conference on Aging. Mental health had not been identified as an issue on the pre-conference agenda. A strategy was created to make sure that mental health was going to be addressed at the Conference. National and state coalition members were encouraged to participate in their respective state’s listening session and to seek appointment as a delegate to the White House Conference. Once appointed they were encouraged to volunteer to serve on key committees, such as those addressing Medicare and Social Security. The National Coalition then convened a mini-conference at which resolutions were developed and submitted to the White House Conference planners.
The WHCoA received hundreds of resolutions from across the country, but only 50 could be adopted. The resolutions to be considered, and ultimately adopted, were determined by delegate voting. Delegates supporting the NCMHA’s resolutions worked within their state delegations and Conference committees to secure votes and the result exceeded expectations. The Coalition’s primary resolution was voted No. 8 overall at the conference. In fact, almost all the Coalition’s issues were addressed in the top 50 resolutions. The Washington Post reported that mental health was one of the top three issues emerging from the 2005 White House Conference on Aging.
In 2012 a NCMHA member served on the Institute of Medicine committee that issued the “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” consensus study report. This report clearly documented the workforce shortage and provided recommendations to address the problem. More recently the Coalition has worked with the Mental Health and Aging Network of the American Society on Aging to provide speakers, clinical and public policy sessions, and peer group meetings at the annual Aging in America Conference. The Coalition has also been actively involved in promoting the development and implementation of evidence-based behavioral health practices.
Over the years the Coalition has developed a reputation as an organization that can provide accurate and unbiased information on the behavioral health needs of older Americans. The relationships developed through the Coalition have provided opportunities to testify at public hearings, comment on proposed federal rules and regulations, serve on task forces and study committees, participate in research and disseminate findings, respond to requests for information from policy makers, etc.
Coalition members, especially the National Council on Aging, have worked with SAMHSA, the Administration for Community Living, and other agencies and organizations on the Older Adult Mental Health Awareness Day Symposium. The 5th Annual Symposium will be held on May 11, 2023. This is a free on-line event.
The National Coalition on Mental Health and Aging, and state and local coalitions, have achieved a lot, but there’s still much to do. If you would like to get involved there’s an easy first step. Go to the National Coalition’s website, www.NCMHA.org, and click on “Get Involved”. There are also many resources provided, including a list of known state and local coalitions. If you know of others, or want to start one, please contact us.