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Prediction: Older Adult Mental Health Needs Will Exceed Available Services
Carrie Steckl, Ph.D.: Tue, Feb 12th 2013
I have a confession to make: I once planned on becoming a practicing geropsychologist. Ever since my first job as a nursing assistant in my hometown nursing home, I've focused on helping older adults through my work. But after receiving my Ph.D., I decided to focus on serving elders through community outreach programs instead of through private practice or a position at a hospital or clinic.
I worked for the Alzheimer's Association for several years, which included the provision of caregiver support groups and one-on-one care consultations. The work was extremely rewarding, but the emphasis was a bit different than the clinical assessment and treatment of older adult mental health problems such as depression and anxiety.
While I don't regret my career choices, I do wonder how I and others like me may have contributed to a current conundrum regarding the ability to meet the ever-growing mental health needs of our elders. According to a recent article in The New England Journal of Medicine, up to 8 million Americans over the age of 65 experience mental health or substance abuse problems, yet only 1800 geriatric psychiatrists exist to treat them. The future looks even bleaker: By the year 2030, it's estimated that there will be less than 1 geriatric psychiatrist per every 6000 older adults with mental health or substance abuse disorders.
Yikes. How can this be? Unfortunately, ageism still exists and for many aspiring psychiatrists, psychologists, and other mental health professionals, working with older adults just doesn't seem as appealing as working with children or other populations. In fact, according to the American Psychological Association, a mere 4.2% of psychologists focus on geropsychology in their clinical work.
The authors of the article, Bartels and Naslund, describe this oncoming gap between older adult mental health needs and available services the "silver tsunami." Pretty catchy, and also pretty scary. What can we do about it? They make several creative suggestions:
- Train across disciplines. Instead of increasing the number of professionals that specialize in geriatrics (still a noble goal, but one that has been unsuccessfully met for decades), provide geropsychology training to existing professionals who work with (or will work with) older adults in addition to other age groups. This might include primary care physicians and general mental health counselors.
- Expand lay community health services. This model has already been shown to work in other countries and among diverse populations. It entails training lay people in basic mental health principles so they can identify people in their communities with mental health challenges and provide basic support and referrals.
- Capitalize on technology. The landscape is fertile for employing telehealth services and Internet-based screening and intervention tools in order to reach older adults who don't have access to face-to-face mental health programs.
- Increase funding. Not only is it critical to continue funding for geropsychology training and programs; it's also crucial to fund research on mental health treatment modalities for older adults. Sadly, many current mental health treatment studies exclude older adults from research samples.
Finally, the authors contend that mental health care must be recognized as a fundamental component of general geriatric healthcare. I couldn't agree more. And part of me wishes that I had gone into clinical practice after all.
Bartels, S. J., & Naslund, J. A. (2013). The underside of the silver tsunami: Older adults and mental health care. The New England Journal of Medicine, Advance Online Access. DOI: 10.1056/NEJMp1211456
Books on Aging and Mental Health - Carrie Steckl, Ph.D. - Feb 13th 2013
Thank you for your comment! Here are a couple of books from authors well-versed in the mental health issues facing older adults:
- Mental Disorders in Older Adults, 2nd Ed. (2011) by Zarit and Zarit
- Ageing and Older Adult Mental Health: Issues and Implications for Practice (2011) by Ryan and Coughlan
I hope this helps! Thank you for your dedication to providing quality mental health services to older adults.
resourses for psychologists. - Kerry Hitzke - Feb 13th 2013
Thank you for your thought provoking article. I am a psychologist in private practice in brisbane Australia and I see the same trend here. Could you please recommend some specific authors/researchers/books that I could access to give me a better idea of how to cater for this population? Thank you.