Issue 3: Service Delivery And Access

Goal: Ensure that aging and mental health service delivery systems provide coordinated comprehensive approaches to meeting the broad mental health needs (including Alzheimers Disease and Related Dementias, dual diagnosis, chronically mentally ill, etc.) of the elderly regardless of living situation or geographic location.

Discussion

Despite the growing number of older people in Alaska, and despite the prevalence of diagnosable mental disorders, utilization of Alaska Psychiatric Institute and community mental health center services statewide by Alaskans age 60 and over has remained constant at 1-2% of admissions, which is half the national utilization rate for seniors. This suggests the need to examine types and availability of services, as well as service accessibility.

Many seniors view mental health care with stigma and fear. Today's seniors are not accustomed to discussing their problems and feelings with others. Moreover, the fear of being regarded as incompetent or of having a serious dementing illness leads to psychological denial and avoidance of assistance. Because many mental health problems present as physical complaints, the issues are often not correctly identified by family members, practitioners, or even the older individuals themselves. Aggressive public education could help normalize treatable mental disorders and foster a greater openness regarding problems and solutions.

Even when an older person is aware of problems and receptive to help, it does little good if no help is available, or there is no practical way to get to help. Many seniors are unable to drive, or are homebound, and require such service to come to them. Development of outreach programs for psycho-education and treatment creates advantages for both access and comprehensive assessment. Access to services in rural Alaska is another issue and revolves more around the lack of services than in urban settings.

Cost of services is problematic as well, due to poor third-party support through Medicare, Medicaid, and other insurance. Indeed, specialized services are unlikely without viable financial incentives for clinics, hospitals, and practitioners. The irony, of course, is that prevention and early intervention can delay or avert much costlier acute and long term care and preserve an individual's independence and life satisfaction.

Coordinated advocacy and planning efforts are needed to integrate mental health services into the continuum of existing community-based services for older people. Such efforts must be initiated by consumers, their caregivers, and providers alike. Broad-based community education that prepares today's middle-agers for retirement and encourages long-range life planning will also help create a more informed inter-generational life perspective.

Actions

325. Develop effective outreach and identification methods.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Senior Services, National Alliance for the Mentally Ill, Alaska, Alaska Mental Health Association, Health Consumers of Alaska, Senior Mental Health Advisory Committee

326. Ensure the availability of psychiatric or other proper consultation for seniors with mental health needs regardless of living situation or geographic location.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Senior Services

327. Develop geriatric mental health expertise within the Division of Mental Health and Developmental Disabilities and Division of Senior Services.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Senior Services

328. Include mental health resources in appropriate senior services directories and web sites.
Responsible party: Alaska Commission on Aging

329. Establish a link between the Alaska Mental Health Board and the Alaska Commission on Aging regarding service to people with Alzheimer's Disease and Related Dementias.
Responsible party: Alaska Mental Health Board, Alaska Commission on Aging

330. Analyze Medicaid reimbursement issues and develop a plan to address barriers.
Responsible party: Division of Medical Assistance, Division of Senior Services, Division of Mental Health and Developmental Disabilities

331. Explore third party reimbursement issues.
Responsible party: Division of Senior Services

332. Explore avenues for developing individual and system-level consumer advocacy and mediation methods.
Responsible party: Alaska Mental Health Board, Alaska Commission on Aging, National Alliance for the Mentally Ill, Alaska, Alaska Mental Health Association, Mental Health Consumers of Alaska

333. Develop short term critical incident/crisis intervention plans in conjunction with the community mental health system, senior service system and community emergency services system.
Responsible party: Division of Mental Health and Developmental Disabilities, Division of Senior Services