Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Translating collaborative models of mental health care for older adults: using Iowa's experience to inform national efforts

The Patient Protection and Affordable Care Act supports the translation of collaborative models of mental health care, but how the act will affect older adults remains unclear. The authors examined a sample of older Medicare beneficiaries and evaluated how individual characteristics, local service supplies, and other contextual features corresponded with the identification of older persons with psychiatric diagnoses and their access to specialty mental health care providers. Older adults presented a variety of psychiatric disorders, and their access and use of specialty mental health care related to age; sex; diagnosis; supply of mental health, health, and long-term care providers; and whether an older person lived in a rural area. Translation of collaborative models should consider a range of psychiatric conditions, adjust for varying local provider supplies, and consider the challenges in establishing collaborative care within rural areas.     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

Community need for university-based mental health services: identifying the top 5

The purpose of this study was to determine the community need for mental health and health promotion services provided by advanced practice nursing faculty at a small university in the midwestern United States. Fifty participants from a three-county service area were selected to complete a needs assessment survey. Survey results indicated strong community need for primary mental health services for low-income residents, older adults, pregnant women, and families with children. Mental health services (particularly for depression), health promotion, wellness information, and primary mental health care were among the leading areas of need. In addition, low-cost mental health services were identified as the most significant need, which was magnified in the underserved, Hispanic population.     

Attitudes and beliefs about mental health among African American older adults suffering from depression

Depression among older adults is a major public health concern leading to increased disability and mortality. Less than 3% of older adults utilize professional mental health services for the treatment of depression, less than any other adult age group. And despite similar rates of depression, African Americans are significantly less likely to seek, engage and be retained in professional mental health services than their white counterparts. Cultural differences in the way depression symptoms are manifested, defined, interpreted and labeled may in part explain some of these racial differences in help-seeking behaviors. Focus group methodology was utilized to identify and explore attitudes and beliefs about depression and mental health treatment utilization among 42 older African Americans who had recently suffered a major depressive episode. Thematic analysis of identified six overarching themes: (a) perceptions of depression, (b) the African American experience, (c) seeking treatment as a last resort, (d) myths about treatment, (e) stigma associated with seeking treatment and (f) culturally appropriate coping strategies. We discuss implications for practice, education and research.     

Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Providing nursing leadership in a community residential mental health setting

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

Meeting the mental health needs of elderly clients

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.     

Midlife and Older Gay Men Living with HIV/AIDS: The Influence of Resiliency and Psychosocial Stress Factors on Health Needs

HIV/AIDS research has mostly focused on younger gay men. This cross-sectional study originated from a larger study of 316 respondents to include a subsample of 38 midlife and older gay men living with HIV/AIDS. The study explores physical and mental health utilization rates, including physical and mental health status. Resiliency, internal health locus of control beliefs, and psychosocial stressors of age and sexual orientation discrimination, stigma, and internalized homophobia were also examined. A total of 65.8% of the HIV/AIDS participants received no mental health services the past year, despite reporting higher mental health distress. Of those reporting an HIV status, 10.5% indicated having no health visits in the preceding year and more delays in seeking care when needed and unmet health needs for which services were not sought. Participants reporting higher resiliency indicated less mental health distress and better health access indicators. Stigma and internalized homophobia negatively affected resiliency. Implications for practitioners working with midlife and older gay men are provided.     

Elders and the courts: judicial policy for an aging America

This article examines how trial courts should address complex issues of an aging society. More older people, living longer, will enter courthouses with underlying problems that will impede effective access and court processes and will require judges to enhance linkages with community health, mental health, and social services providers. The article analyzes how court systems perceive these issues and explores how they have begun to address them. It concludes with an argument in support of innovative new approaches to assist courts in responding to emerging issues of older adults.     

The physical, mental, and social health status of older Chinese: a cross-national study

This article reports data on 16 indicators of the physical, mental, and social health status of older Chinese living in Beijing, Guangzhou, and Los Angeles. Both the frequency distributions of these indicators and their factor structures are different among the three cities. These differences may have implications for the planning of public health services. Either they are the result of differences in the way in which people in each of these cities think about illness or they are the result of differential experiences with disease. Although these data cannot resolve this issue, both the frequency distributions and the severity ratings for nine chronic diseases also differed markedly among the three cities.     

Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Elders and the Courts

Abstract

This article examines how trial courts should address complex issues of an aging society. More older people, living longer, will enter courthouses with underlying problems that will impede effective access and court processes and will require judges to enhance linkages with community health, mental health, and social services providers. The article analyzes how court systems perceive these issues and explores how they have begun to address them. It concludes with an argument in support of innovative new approaches to assist courts in responding to emerging issues of older adults.     

Police encounters among a community sample of children and youth accessing mental health services

Generally, within the Canadian context, scholarship on police encounters with persons living with mental illness has focused on the experiences of adults and not children and youth. In this article, we present preliminary work of a secondary data analysis of intake statistics collected over a 5-year period (2009–2014) and a thematic content analysis of qualitative intake notes collected over a 2-year period (2009–2011) about police involvement among a community sample of children and youth accessing mental health services. Of 8,920 intakes completed, 1,449 children and youth, birth to 24 years old, had had police involvement at the time of accessing mental health services. Over the 5 years, the average number of young people with police involvement at the time of accessing mental health services was 16%, or one in six children and youth. Analysis of the qualitative intake notes revealed two main reasons for police involvement: (1) support in the home for a distressed child, and (2) concerns about a child’s conduct and behaviors in the community. The implications for social work practice and future research are discussed.     

Issues in mental health care benefits: the costs of mental health parity

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.     

Referrals, language proficiency, and enrolment for children's mental health services

Alberta Health Services maintains a database of children, adolescents and adults referred to the child and adolescent mental health and psychiatry intake service. In this study, we sought to systematically assess the impact, if any, of English language proficiency on enrolment of children for mental health services. Specifically, we assessed the extent to which children referred for mental health services were enrolled. In doing so, we categorized our sample (12,143) as English Proficient (EP), or Less English Proficient (LEP). Overall, we found that LEP children were significantly less likely to be enrolled compared to EP children. This disparity in enrolment was only present when other variables were not taken into account. English Proficiency is an important factor for some subgroups.