Mental Health and Mental Illness in Later Life: The Ecology of Theory and Practice

Theoretical and practical concerns shape our conceptualizations of mental health and mental illness later in life. Together, these concerns form an ecology of theory and practice, shaping our expectations of later life and our efforts with an din behalf of older adults. Introduces a series of article which highlights several aspects of mental health and mental illness in later life to provide an understanding of the challenges faced by the aged in maintaining mental health.

Aging and Mental Health: Business as Usual?

Cautions that in developing training models in mental health and aging, psychologists must not overlook what experience has taught them about mental health intervention or what they know already about older adults. It is suggested that a life-span developmental view complements a community and preventive approach to the mental health needs of the elderly. Creation of a separate subspecialty of clinical geropsychology will not effectively serve older adults. What is needed is a synthesis ofalready existing expertise in areas such as life-span development, clinical psychology, and community psychology. This synthesis provides a conceptual foundation and set of intervention approaches on which to base training programs in mental health and aging.

Mental Health Problems and Aging: A Short Quiz.

The mental health needs of older adults remain largely unmet. This gap is due, in part, to a lack of adequately trained professionals and paraprofessionals. The sixteen-item quiz presented in this article has two purposes: 1) to present an overview of salient empirical and theoretical issues in the area of mental health and aging, and 2) to promote discussion of these topics. Each item is documented with supporting literature. In addition, average scores, item difficulties, and item-to-total correlations are presented for two groups of undergraduate students.

Training in Mental Health: Evaluation of the Telephone Conference Network

The Telephone Conference Network, sponsored by The Pennsylvania State University's Coordinating Council for Health Care, is designed as a cost-effective format for providing inservice training in geriatric mental health for individuals who serve the elderly. Institutions which subscribe to the Telephone Conference Network are equipped with a conference speaker and telephone hook-up providing a two-way line of communication, and may choose from a variety of inservice programs. Mailed evaluations were completed by participants (N=73) in the "Skills to Manage Moods" program, a series of four 1-hour sessions designed to teach participants the skills needed to help patients cope with depression and to deliver the program to others. The majority of respondents reported high levels of satisfaction with the Telephone Conference Network system and the specific program in which they participated. Although 85 percent reported that they would be able to use the skills learned in the program on the job, 50 percent reported that they would not be interested in teaching these skills to others. The convenience and efficiency of the Telephone Conference Network were the most frequently mentioned strengths of the system, while the physical facilities and the program delivery format adopted by the individual institutions were the most frequently mentioned weaknesses. These data suggested several recommendations for Network subscribers and for professionals offering telephone conference programs, including ensuring optimal class enrollment and adequate physical facilities, and participant involvement in program implementation.

Assessing Nursing Assistants' Knowledge of Behavioral Approaches to Mental Health Problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

The Mental Health System and Older Adults in the 1990s

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns.

Mental Health and Aging: Progress and Prospects

This volume originally appeared as an issue of the ASA journal, Generations. It contains contributions by prestigious writers in the field of gerontology, who present current concepts in research and clinical practice on mental health and aging. This book provides the latest perspectives on assessment and prevention techniques, depressive and anxiety disorders, the aging brain and neuroimaging, family therapy, and adult day care.

The Provision and Use of Mental Health Services in Nursing Homes: Results from the National Medical Expenditure Survey

Data from the Institutional Population Component of the National Medical Expenditure Survey were used to provide national estimates of annual mental health service provision and use in nursing homes. In addition, the relationship between service provision and setting characteristics such as ownership, size, Medicaid certification, and chain status was examined. Although more than three quarters of residents with a mental disorder resided at a nursing home that provided counseling services, fewer than one fifth actually received any mental health services within the year.

Mental Health Services for Nursing Home Residents: What Will It Cost?

The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered.

Determinants of the Use of Specialist Mental Health Services by Nursing Home Residents

This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals.

Use of Mental Health Services by Persons With A Mental Illness in Nursing Facilities: Initial Impacts of OBRA87.

To identify mental health service use patterns in nursing facilities subsequent to nursing home reforms in the Omnibus Budget Reconciliation Act of 1987.

Mental Health and Aging at the 2005 White House Conference on Aging: Two Steps Forward, One Step Back

Success! At the 2005 White House Conference on Aging, three-quarters of the 1,200 national delegates voted to improve “recognition, assessment, and treatment of mental illness and depression among older Americans.” This resulted in mental health being ranked as #8 of the final 50 WHCoA policy resolutions resulting from the conference. Joining this resolution in the “top ten” were two resolutions intimately tied to hopes for addressing the mental health needs of older adults—at #6 “Support Geriatric Education and Training for Health Care Professionals, Paraprofessionals, Health Profession Students and Direct Care Workers,” and #9 “Attain Adequate Numbers of Healthcare Personnel in All Professions Who are Skilled, Culturally Competent, and Specialized in Geriatrics.”

Aging and mental health in the decade ahead: What psychologists need to know

Until relatively recently, most psychologists have had limited professional involvement with older adults. With the baby boomers starting to turn 65 years old in 2011, sheer numbers of older adults will continue to increase. About 1 in 5 older adults has a mental disorder, such as dementia. Their needs for mental and behavioral health services are not now adequately met, and the decade ahead will require an approximate doubling of the current level of psychologists' time with older adults. Public policy in the coming decade will face tensions between cost containment and facilitation of integrated models of care. Most older adults who access mental health services do so in primary care settings, where interdisciplinary, collaborative models of care have been found to be quite effective. To meet the needs of the aging population, psychologists need to increase awareness of competencies for geropsychology practice and knowledge regarding dementia diagnosis, screening, and services. Opportunities for psychological practice are anticipated to grow in primary care, dementia and family caregiving services, decision-making-capacity evaluation, and end-of-life care. Aging is an aspect of diversity that can be integrated into psychology education across levels of training. Policy advocacy for geropsychology clinical services, education, and research remains critical. Psychologists have much to offer an aging society