Older Adults Lack Equity for Mental Health and Substance Use Needs

Speaking today at a hearing of the U.S. Senate Special Committee on Aging, Rush University Medical Center professor Erin Emery-Tiburcio, PhD, ABPP, FGSA, told lawmakers about three key issues to consider in creating policy to address equity for older adults: access to care related to Medicare policies, the need for coordination of care for older adults who experience the most complex health issues, and the critical need for expanding the behavioral health workforce trained to work with older adults.

mentillPhoto courtesy of The Mental Elf.Senators convened the hearing, titled “Mental Health Care for Older Adults: Raising Awareness, Addressing Stigma, and Providing Support,” to examine opportunities to improve mental health services for the nation’s older adults and address gaps in services to support people with mental health or substance use disorders.?This included discussion of new bipartisan legislation to advance state efforts to integrate Medicare and Medicaid benefits, including mental health care, for individuals that receive care through both programs.

An estimated one in four older adults experiences a mental health condition, including depression, anxiety and substance use disorder, and individuals age 85 or older had the highest suicide rate in 2020, according to the committee. The opioid epidemic has also severely burdened older Americans. Almost 80,000 older adults died from an opioid overdose between 1999 and 2019.

“Not only is mental health and substance use stigma a barrier to effective screening, assessment, and treatment for these disorders,” said Emery-Tiburcio in her testimony, “but that stigma is compounded by systemic ageism at policy, provider, community, and individual levels that has resulted in severely limited access to effective care for older adults.”

Emery-Tiburcio is an associate professor of geriatric and rehabilitation psychology and co-director of the Center for Excellence in Aging at Rush University Medical Center, as well as a fellow of The Gerontological Society of America (GSA).

Regarding access to care, she said that optimal care for all adults coordinates mental and physical health care.

“This is particularly the case for older adults with disorders ranging from depression to serious mental illness to substance use,” Emery-Tiburcio said. “Unfortunately, Medicare Advantage plans have been allowed to split contracts for physical and behavioral services so that older adults cannot receive services in one coordinated setting. … Medicare Advantage plans must be required to allow for coordinated care by not separating contracts for health systems that also have behavioral health services.”

When discussing coordination of care, Emery-Tiburcio testified that more than half of adults with complex physical health needs report anxiety, depression, or emotional or psychological problems resulting from their illness. Further, a survey of recipients of long-term services and supports found that 81 percent reported unmet needs.

“Many of these services are not reimbursed by Medicaid or Medicare, yet these are exactly the services that allow older adults to remain in their homes with better quality of life and lower health care utilization,” she said. “Further, communication between health systems and the aging network is rare, thus transitions of care from the hospital or clinic to the community is where older adults fall through the cracks — or rather, chasms. It is in these chasms where chronic medical and behavioral health issues are exacerbated by lack of care. Innovative, effective programs exist and must be implemented broadly to meet the needs of older adults.”

Turning to the topic of the behavioral health workforce, Emery-Tiburcio expressed support for funding of the Geriatric Workforce Enhancement Programs (GWEPs) and Geriatric Career Achievement Awards.

“If all GWEPs were to increase focus on the mental health and substance us needs of older adults, every region of the U.S. would have access to high quality training,” she said — adding that legislation to mandate the inclusion of older adults in Substance Abuse and Mental Health Services Administration priorities is desperately needed, as well as increasing funding for training and incentives for those entering the geriatrics profession.