(MAMHC)

SAVE THE DATE

Conference and Annual Meeting

RISK AND  SAFETY BEHAVIORS: CHALLENGES IN SERVICE DELIVERY FOR ELDERS

Keynote Speaker: Dr. Rick Reamer

April 30, 2010

Hogan Conference Center
Boston College
Worcester Mass.
508-799-8030




NEW ELDER MENTAL HEALTH BENEFIT AT ASAPs

MAMHC MEETING WITH THE STATE AND STEVE BARTELS  11/14/08

Dr. Steve Bartels( from Dartmouth College) presented research and conclusions from his experience about organizing elder mental health services and programs. It was intended that participants would use this session to move forward in Masschusetts.

Some of his ideas include the following:This generation of elders will seek help(including mental health)from their MDs first and for some exclusively.


Engagement by primary care(MDs) is essential along with their integration in an effective delivery system.
Integration by MDs is rare.


His research demonstrates that when integration happens there are better outcomes for elders.


That integration seems to be more effective under certain circumstance(for ex.- when the primary and mental health services are provided at the same time ,in the same place, and are connected to each other).



It is probably more effective to involve MDS to work with their peers around this issue.

He recommends training people on specific tasks and problems rather than having many highly trained sepcialists.

Consider using current funding in creative ways rather than always looking for new funding.

MAMHC and state agencies will continue to meet and consider how to follow-up.




ANNUAL CONFERENCE: BEST PRACTICES FOR ELDER MENTAL HEALTH

HOLY CROSS COLLEGE - WORCESTER MASS.

Held On: October 24,2009

BEST PRACTICES FOR ELDER MENTAL HEALTH

TOPICS INCLUDED:

HOARDING BEHAVIORS

ORGANIZING AND FINANCING FOR ELDER MENTAL HEALTH SERVICES

ADVOCACY

CONSUMER PERSPECTIVE

Over 100 people attended and indicated they left with a lot of useful information from this gathering. They appreciated the combination of the clinical, planning, and advocacy elements.

MASS STATE BUDGET AND ELDER MENTAL HEALTH

NEWS FLASH:

Cutbacks in Mass 2009 Budget

Governor Deval Patrick of Mass announced on 10/15/08 cutbacks to the 2009 State Budget. Revenues for this fiscal year have been very low. If this continues there may be additional cutbacks which will impact services

Protective services and ECOP were protected. ELDER MENTAL HEALTh lost almost half of its funding.

We expect to know more in January 2009 if there will be addtional decreases in funding,

Mass 2009 Budget

Line item(9110-1640) for demonstration projects was under funded.Thru efforts via DPH and their funding for suicide prevention the difference was made up. The demonstration projects should have enough funding to continue their work for this fiscal year.

. This funding reflects an initial step in the right direction.

The goal in future fiscal years is to fund both the above line item in EOEA's budget($3.985 million)and line item 5046-1000 in DMH's budget(2 million). The funding should be sufficient to provide on-going services for elder mental health.

Call 617-722-2000 or click : www.wheredoivotema.com to get your Rep and Senator's name

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Introduction

This state-wide coalition in Massachusetts serves to:

Advocate for the development of and access to appropriate mental health services for elders.

There are similiar coalitions in other States around the nation.

MAMHC is a voluntary association of local coalitions and agencies which serve elders. It has:

1. Organized an annual conference.
2. Met on a regular basis jointly with the Mass Department of Mental Health(DMH) and the Executive Office of Elder Affairs(EOEA).
3. Advocated successfully with DMH to examine the impact around the State of its Emergency Psychiatric Service Plan(ESP) on elders.
4. Advocated successfully for the State to implement a study of the level 2 PASSAR(the Federally mandated review of new nursing home residents with an identified psychiatric diagnosis).
5. Developed a guidebook and resource about elder mental health thru a grant from (SAMHSA-Substance Abuse and Mental Health Services Administration).This resource is now accessible with this link.
   

MAMHC AIMS TO :

1. Include geriatric mental health in the State Plan
2. Secure funding for elder mental health services
3. Educate the public about elder mental health.
4. Train providers about elder mental health issues.

On this page you willl find:

Information about the coalition's efforts, requests for your particpation, and links elsewhere

If you have information about another State which has a similiar coalition or have some questions then contact us at:

Jim Callahan

413-592-5199

jcallahan@hawthornservices.org

 

MASSACHUSETTS

WORCESTER

 

ELDER MENTAL HEALTH  BENEFIT AT ASAPS( beginning in 2008)

ASAPS who contract with a community mental health center(CMHC) may refer and coordinate those services for clients who are in the home care program.

Services may include:



Diagnostic services

Individual Therapy

Couple/Family Therapy

Group therapy

Case Consultation

Emergency Services

Re-evaluation

Procedures have been develped to establish consistency, continuity, and accountability for all referrals.

MASSACHUSETTS ELDER MENTAL HEALTH BUDGET INITIATIVE FOR 2007-8

CONTEXT/HISTORY

The Commonwealth of Massachusetts has not yet had a history of policy direction, programming initiatives, or of budget items dedicated to elder mental health services. For the first time a Coaliton(Mass Aging and Mental Health Coalition) has been meeting with the administrative arms of government(Department of Mental Health[DMH} and the Executive Office of Elder Affairs{EOEA}).From those discussions the MAMHC developed the following:

PROPOSAL

The MAMHC supports a line item in the Commonwealth's FY 2009 Budget in order to begin to address elder mental health with an integrated and comprehensive approach.

Funds could potentially be used for but not be limited to the following:

1.Compensate therapists since they are not reimbursed by Medicare for travel time .Many elderly clients will not go to the office of a therapist or to a mental health clinic.

2. Assist Medicare B beneficiaries who must pay a 50 % co-pay for psychotherapy services(other Medicare B services have a 20% co-pay). This higher co-pay acts as a deterrent to psychotherapy services.

3. Develop out-reach services for isolated elders. Members of this cohort tend to become depressed and may not receive or access services until much later. it is important to identify and to serve this population in order top prevent deterioration and institutionalization.

4.Provide travel for elders to get to therapy or other related services

.5. Organize mobile serivces to bring therapy or other appropriate services and programs where elders are located

.6. Provide education for the general public to reduce stigma associated with elder mental health. Elders and families experience this stigma

 

NEXT STEPS

A specific proposal has been developed by MAMHC which has been submitted to the Massachusetts Legislature for its session which begin in January, 2007 and continues thru 2008.

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PROPOSED(fiscal year)2009 BUDGET LINE ITEMS

The MAMHC has submitted two line items to the Massachusetts Legislature for the fiscal year 2098 budget. Below is a background statement followed by the two line items(one for EOEA and one for DMH).

ACTION STEP:

PLEASE CONTACT YOUR MASS STATE REPRESENTATIVE/SENATOR AND ASK THEM TO MAKE THESE LINE ITEMS(9110-1640 and 5046-1000)BUDGET PRIORITIES.

 

NARRATIVE EXPLANATION

This request was developed by members of the Mass Mental Health and Aging Coalition, which includes Mass Home Care, Mass Association of Older Americans, Mass Councils on Aging, National Association of Social Workers(Mass Chapter)and geriatric mental health providers. The appropriation for this account was $350,000 in FY 2007. The projects funded in FY 2007 were for direct mental health services, medication adherence, and improving outreach skills of frontline workers. Grants began effective February 1, 2006.

Chronic mental illness has been found to be a significant predictor of nursing home admission. As many as 20% of older adults in the community and up to 37% in primary care settings experience symptoms of depression. Nearly 17% of older adults misuse or abuse alcohol and medications; and although the majority (87%) of older adults see a physician regularly about 40 % of those who are at risk do not self-identify or seek services for substance abuse problems and are unlikely to be identified by their physicians. 8.5% of seniors on MassHealth have a chronic mental illness. Older adult males have the highest suicide rate of any age group with a rate almost six times (65 per 100,000) the suicide rate of the general population (10.6 per 100,000). The number of older adults with mental illness is expected to double to 15 million in the next 30 years. Almost two thirds of older adults with a mental disorder do not receive needed services. Most will never be diagnosed, more will never be treated. Among those who are treated, most will receive poor quality care.

The financial and social cost of unrecognized and untreated or poorly treated mental illness among older adults is high. Depression and other psychiatric conditions contribute to: (1) premature nursing home admission; (2) higher medical costs through more frequent visits to physicians; (3) delayed recuperation from chronic somatic illness – like cancer, strokes, and heart disease; (4) increased use of emergency medical services;
lowered employment productivity by family caregivers; (6) caregiver depression and
premature death; and (8)suicide.

The stigma surrounding the receipt of mental health treatment is one significant, and key, barrier to identifying and treating mental health conditions among older men and women. Older adults often do not want to be identified with the traditional mental health system

.
There is no state program that addresses the needs of elders with significant mental health problems that put them at risk of requiring institutional care. Neither the Department of Mental Health, nor the Executive Office of Elder Affairs have adequately addressed elder mental health resources. Mental health is currently not a home care purchased service. A survey of ASAP directors in 2005 regarding mental health services had the following findings:

• 
  95% of ASAPs expect their staff to work with elders who have a mental illness, even though care managers are not specifically assigned to work with this population
• .
  90% of ASAPs reported that they did not have specific staff assigned to work with elders experiencing mental health concerns.
• 
  86% of ASAPs indicated that they did not have a follow up plan to assist an elder who had a confirmed MH concern
• .
  68% of ASAPs did not have a formal procedure to deal with an elder’s mental health challenge.
• 
  As many as 7,668 elders (19% of caseload) have mental health needs.

Our goal is to provide geriatric mental health and support services for elders in the Massachusetts whose MH impairments threaten their ability to live in the least restrictive setting. Our proposal is to create a mental health program which uses a specially-trained workers to respond to MH issues, and has the capacity to arrange for not only personal care services for physical impairments, but the ability to purchase (out of line item 9110-1630) mental health services. Like the current protective services program, MH services should be available without regard to income, so that referrals from community sources, such as hospitals, doctors, COAs/senior centers, could be enrolled in a consistent, care managed program statewide, with uniform intake, assessment and service delivery. This would create a system of services for elders dealing with mental health issues.

“At risk” for the purposes of this program shall be defined as individuals who have, or are at significant risk of depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; alcohol or drug abuse; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding; institutionalization due to a mental illness. Services will include: geriatric mental health care management, geriatric mental health clinical assessment, crisis stabilization; in-home treatment engagement services, community-based and in-home mental health and substance abuse services, medication monitoring and compliance assistance; counseling; supportive day and adult day health services; peer support; and family and caregiver education.

The initial “engagement” phase is critically important in the MH context, since many elders will perceive the need for mental health services as a stigmatizing failure on their part, and will be reluctant to seek or use supports. The ASAPs will need to use geriatric MH care managers to establish initial relationship, or to work with other community contacts that have already engaged the elder, to establish the relationship needed to explore MH services. In addition to direct therapeutic services, the MH program requires the underwriting of this geriatric MH care manager, who is also responsible for securing any collateral services or supports that the elder needs in addition to MH services.

Each elder in this program will benefit from an interdisciplinary team made up of the geriatric care manager, the mental health service providers, and other community resources. Service plans built around the consumer’s needs shall be developed by this team. The geriatric caremanager will be responsible for arranging all the collateral housing and support services necessary to ensure that the elder is able to remain living in the least restrictive setting appropriate to his or her needs.

**We are proposing in this account to serve 500 elders in FY 2009. This would require 16 geriatric care managers, each with an active caseload of 30 clients per worker, at a cost of $40,000 + 25% fringe benefits + 20% overhead/supervision x 16 workers = $960,000. Purchased MH services, not counting any home care purchased services from item 9110-1630, would average $5,000 per elder, or a total of 500 x $5,000 = $2,500,000. In addition, we are proposing $150,000 for consumer-oriented public education regarding mental health; $125,000 for cross-disciplinary training of appropriate mental health specialty staff and aging service agency staff; and $250,000 for competitive grants to councils on aging and senior centers for geriatric mental health outreach to elders residing in the community.

**We are also requesting a second line item in the DMH budget that would be used to develop critical MH services currently not available to the elderly: geriatric mental health clinical assessment, crisis stabilization; in-home engagement and treatment services, medication monitoring and compliance assistance; counseling and psychotherapy; supportive day and adult day health services; peer support; family and caregiver education; assertive community treatment; and community residential services.

Total appropriation requested: $3,985,000 in line item 9110-1640 and
$2,000,000 in line item 5046-1000

 

MA Aging & Mental Health Coalition Proposed FY ’08 Geriatric Mental Health Line Items

Executive Office of Elder Affairs 9110-1640

For the Geriatric Mental Health Services program of regionally-based, collaborative geriatric mental health services for the elderly, as a component of the home care program under Chapter 19A, including contracts for care management services with aging service access points or other qualified entities for the home care program. Said program shall include geriatric mental health care management, geriatric mental health clinical assessment, crisis stabilization; in-home treatment engagement services, community-based and in-home mental health and substance abuse services, medication monitoring and compliance assistance; counseling; supportive day and adult day health services; peer support; and family and caregiver education. Geriatric mental health services shall be provided without regard to functional impairment level and income, to elders who have, or are at significant risk of depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; alcohol or drug abuse; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding; institutionalization due to a mental illness. All treatment plans written under this program shall be developed by an inter-disciplinary team comprised of staff from an aging services access point, mental health service providers, councils on aging, senior centers, and other agencies providing services to the elder, as appropriate. Treatment plans shall be developed in consultation with the elderly person requiring mental health services or an appropriate representative of said person. The executive office of elder affairs shall establish, by regulation, financial eligibility guidelines which provide a procedure for reimbursement by elderly persons for all or part of the cost of mental health services. If it is determined that the elderly person in need of mental health services has resources from any governmental program or private insurance policy to pay for part or all of said services, funds from this item shall be used as the payer of last resort or to supplement such other payments, as appropriate. If it is determined that an elderly person does not have sufficient resources to pay for mental health services, no reimbursement for any such costs shall be charged to the elderly person; provided that not less than $150,000 shall be expended for consumer-oriented public education regarding mental health; provided further that not less than $125,000 shall also be expended for cross- disciplinary training to upgrade the skill and knowledge of appropriate mental health specialty staff and aging service agency staff; provided further that not less than $250,000 shall be contracted on a competitive basis with councils on aging and senior centers for geriatric mental health outreach to elders residing in the community.……..…$3,985,000

 

Department of Mental Health 5046-1000

For a program of regionally-based, collaborative geriatric mental health services for residents of the Commonwealth 60 years of age or older who have a serious mental illness. For purposes of this line item “serious mental illness” shall be defined as behaviors characterized by the presence of, or significant risk of: depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding. The department, in consultation with the executive office of elder affairs shall develop such services as: geriatric mental health clinical assessment, crisis stabilization; in-home engagement and treatment services, medication monitoring and compliance assistance; counseling and psychotherapy; supportive day and adult day health services; peer support; family and caregiver education; assertive community treatment; and community residential services, provided that an amount no greater than $100,000 shall be spent to develop a Massachusetts Geriatric Mental Health and Substance Abuse Intervention Plan in collaboration with the executive office of elder affairs, the department of public health, and the Massachusetts Aging and Mental Health Coalition; provided further that the department shall submit said plan to the house and senate committees on ways and means and the joint committee on mental health not later than January 16, 2008. ……….. $1,000,000

 

WORCESTER MASS

There is now a resource guide on elder mental health for Central Mass.:

A TOOL FOR HEATHLY AGING:

RESOURCE GUIDE FOR MENTAL HEALTH

It was developed by the city of Worcester's Elder Affairs Division of the Department of Health & Human Services

There is some basic information about elder mental health and healthy aging.

It also has descriptive and contact information about various agencies in the area.

For more information about the guide or to obtain a copy contact:

Elizabeth H. Connell at connelle@ci.worcester.ma.us

 

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OTHER STATES

 

MAINE

The Maine State legislature asked the State's Department of Human Services and the Department of Mental Health, and Substance Abuse to study elder mental health. Its report in 2000 was titled:

Mental Health Services for the Elderly in Maine; A Status Report

What follows are its conclusions and a summary of its recommendtions along with a link for the full report.

CONCLUSIONS:

o There is little recognition of the unique needs of older persons in existing mental health and substance abuse policies and systems.

o Older persons, their families, and health and social service providers, often deny or don’t recognize mental health and substance abuse problems among older people.

o Mental health problems are pervasive and often go untreated in nursing and residential care facilities, as well as in home care

.
o The responsibility for needs assessment, budgeting, program development, and delivery of publicly-funded mental health services is dispersed throughout DHS and DMHMRSAS. The lack of coordination creates confusion, and results in barriers to services for both providers and consumers. This is true at the state and regional levels

.
o Older persons with coexisting dementia and mental illness present significant challenge to the service systems, especially when they have difficult behaviors.

o Accurate and up-to-date information about mental health services for older individuals is difficult to obtain or is not available.

o Not all services are available statewide.

o The most significant needs include:

• 
  + Home-based mental health and substance abuse services;
  + Case management;
  + Additional professionals with expertise in geriatrics;
  + More training and support relating to geriatric issues for service providers and for caregivers;
  + Making psychogeriatric teams available statewide and expanding current services offered to include substance abuse services;
  + Supportive interpretive services for older persons for whom English is not their primary language, or who are hearing impaired;
  + Substance abuse programs specifically for older persons.

o Persons with late-onset mental illness are less likely to use traditional mental health services than those with chronic mental illness. Additionally, poor health, impaired mobility, and lack of social supports make it difficult for many older persons to use traditional mental health services

.
o Based on an analysis of Medicaid claims data, approximately 86% of older consumers with a mental health diagnosis receive psychotropic medication without counseling or other supportive services. In addition, approximately 33% of these older persons are receiving psychiatric medications without a corresponding documented psychiatric diagnosis.

RECOMMENDATIONS:

They were organized in the following categories and incuded these and other recommendations:

POLICY

There were five recommendations and among them:

Designate a single agency with the responsibility for coordinating services

MORE EFFECTIVE USE OF EXISTING RESOURCES

There were eight recommendations and among them:

Identify a lead case manager when an individual needs services from multiple systems and providers.

Encourage and support collaboration and cross-training.

QUALITY ASSURANCE

Design outcome measures and performance indicators for service proviers to reflect the special circumstances of older adults.

PUBLIC EDUCATION

There were three recommendations and among them:

Increase community education activities about positive aging an dolder persons with mental health and/or substance abuse service needs.

WITH ADDITIONAL RESOURCES

There were eight recommendtions and among them were:

Require that mental health needs be addressed in deveolping home care plans.

Provide more geriatric mental health training for people working with the elderly.

Develop Geriatric Assessment Units.

The full report can be found at: http://www.maine.gov/dhhs/beas/mhreport/mh_report.htm