Older Adults Mental Health Services in Iowa

Older Adults & Mental Health Services in Iowa

OVERVIEW The Business Case n n The Historical Record n Vision for the Future

THE BUSINESS CASE n Demographic imperative n Service Use n Quality of life n Financial inefficiencies

Increasing Number of Older Iowans

Mental Illnesses among Older Iowans

SERVICE USE n Community based services n Nursing homes & other residential settings

Community based care n Specialty clinics – CMHCs n Inpatient psychiatric hospitals n Primary care n Community hospitals

County-based mental health Parkview Center, Sac City

Kaskie et al. Study (2007) n Few CMHCs target programs towards older adults n Little use of CMHCs by older adults n Not a lot of specialty contact (< 20% see a specialist in outpt setting)

Inpatient Psychiatric Care

Buckwalter UIHC Study Admission status n 65% Mood Disorder n 35% Dementia n 50% Mixed n

Kaskie et al. (2007) n Not a lot of specialty inpatient care

Primary Care

Kaskie Medicare Study n Most common place to obtain care n More than 70% of MH visits in a generalist outpatient office

Community Hospitals

Kaskie Medicare Study n Second most common place to obtain care n Nearly 20% of MH visits in a generalist inpatient and outpatient services

Emergency Care n Not coded

Care for Co-occurring Dx n 1 out of 5 = MH dx only n Very little co-occurring MH dx n 4 out of 5 = MH + other DX

Oakland Estates, Oakland

Mental Illnesses in Nursing Facilities

Targeted efforts n Third most common place to receive TX n Dementia Special Care n 65 Specialized Care Units n 1, 200 beds

QUALITY OF LIFE

Suicide Rate by Age Per 100, 000 Older people: 12. 7% of 1999 population, but 18. 8% of suicides. (Hoyert, 1999)

October 7, 2000 (AP) Actor Richard Farnsworth, a former stuntman and twotime Academy Award nominee, died of a self-inflicted gunshot wound Friday night. He was 80.

EXPENDITURES Total Medicare Expenditures: $211. 4 Billion n Total MH Expenditures: $1. 2 Billion (0. 57%) n Outpatient Mental Health: $ 718 Million (0. 34%) n CMS, 2001

Iowa Expenditures

Inefficiencies

Depression in Older Adults and Health Care Costs Unutzer, et al. , 1997; JAMA

Monthly Person Costs by Age: Severe Mental Illness

C Dy ard sr iac hy m ia O s ste oa rt hr iti s Di ab et es H yp er te ns io n PD CO Al zh De eim m er Ce en 's re tia br ov as cu la r De pr es sio H n ea rt Fa ilu re en ia ph r Sc hi zo New Hampshire Total Monthly Costs Person Over Age 65 $4, 000 $3, 500 Medicaid Medicare $3, 000 $2, 500 $2, 000 $1, 500 $1, 000 $500 $0

Medicare Expenditures on Alzheimer’s Disease n AD complicates treatment of coexisting conditions n Inability to manage care n Hospitalized AD patients stay longer, cost more

HISTORICAL EFFORTS

NATIONAL MOVEMENT

2004 – Program Initiative

2005 White House Conference

Positive Aging Act Reintroduced n May 31, 2005 – Last Wednesday, Senators Hillary Rodham Clinton (D-NY) and Susan Collins (R-ME) and Representatives Patrick Kennedy (D-RI) and Ileana Ros. Lehtinen (R-FL) announced the introduction of the Positive Aging Act of 2005 to improve access to mental health services for America’s senior citizens.

IOWA FORUMS n Quick Fixes (1998) n Iowa Mental Health Forum (2000) n Mental Health System (2001)

Quick Fixes (1998)

Key Findings public mental health system is in transition…. n increased use of managed behavioral healthcare to administer services…. n

Problems n older adults are not involved in managed behavioral healthcare… n data is difficult to obtain…

Mental Health Forum (2000)

Organizational Chart (2000)

Mental Health Forum (2001)

Older Adults Roundtable n Many persons did not know where to seek help. n Dementia should be included in mental health care n Implement multi-disciplinary treatment approaches

Training Efforts (2002) Training to Enhance Service Delivery to Older Adults with Mental Illness Lila Starr, Project Officer Funding Period: April 15, 2002 to September 30, 2002

Four Training Sessions (N=268) v. Creston v. Dubuque v. Ottumwa v. Spencer

Iowa Public Health Conference Mental Health and Aging: Programs and Services in the State of Iowa Ames, IA 2003

Iowa Department Human Services Collaborative Models of Mental Health Care Pilot Programs Lila Starr, DHS 2004

THE IOWA COALITION ON MENTAL HEALTH AND AGING n April, 2005 n Three Workgroups n www. icmha. org

ICMHA Membership Roster Lyon Osceola Sioux O’Brien Dickinson Emmet Winnebago Kossuth Palo Alto Clay Worth Cerro Gordo Hancock Mitchell Floyd Howard Winneshiek Chickasaw Fayette Plymouth Buena Vista Cherokee Pocahontas Calhoun Sac Woodbury Ida Humboldt Webster Butler Franklin Wright Hamilton Grundy Hardin Allamakee Clayton Bremer Black Hawk Buchanan Delaware Dubuque Jones Monona Crawford Carroll Boone Greene Story Marshall Tama Benton Jackson Linn Clinton Cedar Shelby Harrison Audubon Guthrie Dallas Polk Jasper Poweshiek Iowa Johnson Scott Muscatine Cass Pottawattamie Adair Madison Warren Marion Mahaska Keokuk Washington Louisa Mills Fremont Montgomery Page Adams Taylor Union Ringgold Clarke Decatur Lucas Wayne Monroe Appanoose Wapello Davis Jefferson Van Buren Henry Lee Des Moines =10+ = 1 -9 =0

Outreach Efforts – ICMHA Regional Meetings Fall, 2007 -Council Bluffs (Southwest 8) -Dubuque (Scenic Valley) -Sioux City (Siouxland) -Waterloo (Hawkeye Valley)

IOWA COALITION ON MENTAL HEALTH AND AGING Education and Training Workgroup

PRIMARY GOALS n Increase public awareness about mental health and aging issues n Expand the supply of qualified mental health service providers

IOWA COALITION ON MENTAL HEALTH AND AGING Outreach and Clinical Services Workgroup

PRIMARY GOALS n Promote mental wellness among aging Iowans n Increase supply of qualified mental health service providers n Improve access to qualified mental health service providers n Integrate mental health services into usual places of care

IOWA COALITION ON MENTAL HEALTH AND AGING Policy & Administration Workgroup

PRIMARY GOALS n Promote mental wellness among aging Iowans n Increase supply of qualified mental health service providers n Improve access to qualified mental health service providers n Integrate mental health services into usual places of care

VISION FOR THE FUTURE

HF 2780 n In 2006, the Iowa Legislature established the Division of Mental Health and Disability Services (MHDS) within the Department of Human Services (DHS). With the enactment of HF 2780, the general assembly sought a service system for persons with disabilities which emphasizes the ability of persons with disabilities to exercise their own choices about the amounts and types of services received; that all levels of the service system would seek to empower persons with disabilities to accept responsibility, exercise choices, and take risks; that disability services are individualized, provided to produce results, flexible, and cost-effective; and that disability services be provided in a manner which supports the ability of persons with disabilities to live, learn, work, and recreate in communities of their choice.

Mental Health Systems Improvement n With the recent passage of the State's bill, the Department of Human Services (DHS) Division of Mental Health and Disability Services (MHDS) form planning workgroups. These workgroups are to make recommendations to the MHMRDDBI commission, to the DHS director, and the legislature. The legislation states: "In order to build upon the partnership between the state and the counties in providing mental health and disability services in the state, the workgroups established for purposes of this subsection shall engage equal proportions representing the department, counties, and service providers. The county and provider representatives shall be appointed by the statewide associations representing counties and community providers. In addition, each workgroup shall include a representative of the commission, the mental health planning and advisory council, consumers, and a statewide advocacy organization"

Bureau of Older Adult Mental Health Services n The Bureau of Older Adult Mental Health Services will expand improve the care provided to older Iowans with mental illnesses and co-occurring mental illness and substance use disorders. The Bureau will provide program administration and service management that reflects a commitment to principles of accountability, decency, ease of access, respect for self-determination and responsiveness to an older individual’s unique situation and personal preferences. In this manner, the Bureau will establish a compassionate and welcoming culture, and a determination to help older Iowans overcome the challenges of aging and live with dignity and safety in the communities of their choice.

BOAMHS Goal 1 n Ensure the provision of empathic and welcoming care to older Iowans with mental illnesses and co-occurring mental illness and substance use disorders a priority among policy makers, program administrators and provider organizations across the state of Iowa.

BOAMHS Goal 2 n Increase the involvement of older adult consumers, their caregivers, and the general public with improving the care of older Iowans with mental illnesses and cooccurring mental illness and substance use disorders.

BOAMHS Goal 3 n Increase the number of qualified providers of evidence based mental health and substance abuse services targeted towards older Iowans with mental illnesses and cooccurring mental illness and substance use disorders.

BOAMHS Goal 4 n Develop early identification and prevention programs targeting older Iowans with mental illnesses and cooccurring mental illness and substance use disorders.

BOAMHS Goal 5 n Increase the provision of specialty and emergency mental health services to older Iowans.

BOAMHS Goal 6 n Establish a statewide system of care in which qualified mental health providers can serve older adults with mental illnesses or co-occurring mental illness and substance use disorders through a referral or co-location process that upholds the principle of “no wrong door”

BOAMHS Goal 7 n Establish an administrative culture, which upholds principles of continuous quality improvement

Where do things stand?

THANK YOU