Consumer Supporter News May - June, 2000

Mental Health Services for Older Americans Lacking

By Judy Leaver, Senior Consultant for Affiliate Relations

Today's Americans who are over 65 years of age are the people about whom Franklin D. Roosevelt said "This generation of Americans has a rendezvous with destiny." Destiny in terms of mental health treatment does not currently look promising for this age group or the 20% of Americans who will be 65 or older by 2030.

The age of 65 as the demarcation between old and young is a somewhat arbitrary one. Gerontologists now attempt to divide old age into two groups: early old age from 65 to 74 years and advanced old age, 75 and above. The 75 and 85 plus age groups are the fastest growing segments of the US population.

Today older people constitute 13% of the population, but their use of mental health services falls far below that. They account for only 7% of inpatient services, 6% of mental health centers', and 9% of private psychiatric care. Less than 3% of all Medicare reimbursement is for psychiatric treatment of older consumers.

Yet it is estimated that 18-25% of elders are in need of mental health care for depression, anxiety, psychosomatic disorders, adjustment to aging and schizophrenia. Tragically, the elder suicide rate of 21%is the highest of all age groups.

The first person elders turn to for help with problems which may require mental health treatment is their primary care physician. Interestingly, a 1990 study of elder suicides in Chicago found that 84% of them had seen their primary care doctors within the previous 30 days. 20% had seen them within 24 hours of their suicide.

One reason for the disparity between service needs and utilization is pervasive ageism in western culture particularly. It is the sacrifice of older people by our society for the sake of "productivity" and of the youthful image that the working world feels compelled to project. A society that places great emphasis on youth and the importance of looking young does not lend enthusiastic support to better mental health care for the geriatric population.

Other reasons include the stigma associated with mental illnesses, unresponsive service systems, the disparity in reimbursement rates for psychiatric care and the lack of organized consumer support for this age group.

There is good news in regard to elder consumer organizing. The Center for Mental Health Services is supporting the development of a new senior consumer advocacy organization that will advance the needs of this age group in the near future. For more information on this group, contact Brian Coopper, Director of Consumer Advocacy at NMHA at 703-837-4788.

Cultural Competency Focus is on Older Americans

By Ellen Alderton, NCSTAC

Two NCSTAC mini-grant sites are addressing the question of providing adequate mental health services to older Americans. The Mental Health Association of Southeastern Pennsylvania (MHA SEPA) has launched the Mental Health/Aging Advocacy Project while the Mental Health Association in Aiken County, South Carolina has established an Elder Task Force.

"Statistics show that one in four older adults are in need of mental health services while only five or six percent of these people actually receive services," says Tom Volkert, project director for the MHA SEPA initiative. "So there's a very large gap between the number of folks who need services and the number who actually take advantage of mental health services."

MHA SEPA's efforts will focus on addressing this disparity and on challenging ageism and prejudice against mental illness by promoting advocacy for and among older Americans. "We think that the solution is to overcome some of the barriers that keep people from getting the help they need," says Volkert. "It's been proven that older adults are as receptive to treatment as anybody else." Moreover: "The cost of neglect is not cheap. It results in greater disability and greater physical health problems and even death -- with the suicide rate being the highest among older adults."

MHA SEPA's program aims to help people gain the knowledge to open the doors to treatment. So far, the project has recruited six older adult leaders who are currently being trained in the fundamentals of advocacy such as public speaking and knowledge of the local mental health system. "The advocates are excited about the project and they've been talking to each other even apart from my conversations with them," says Volkert.

These six leaders are now going forth in the community and offering presentations on mental health, aging and advocacy to various organizations - including senior centers and church groups - in the Philadelphia and Delaware areas. They will also be attending a Pennsylvania Mental Health and Aging Coalition meeting in Harrisburg.

One by- product of these efforts will be a trainer's manual on mental health aging and advocacy. Additionally, information about the entire project will be made available on the internet at www.mhaging.org.

In South Carolina, MHA in Aiken County is aiming to improve mental health service delivery to elderly residents in that area through its Elder Task Force. Meeting the needs of the elderly is particularly important in this region, which was recently voted one of the top ten places to retire. "We have a huge retired population here, as well as resident citizens who have simply grown old here," explains Constance Shepard, project director.

The Aiken task force has laid out an ambitious work-plan, which entails forming a consortium of all elder-serving agencies in the area as well as family members, caregivers, consumers and other interested parties. This consortium will undertake a review of current services to the elderly in Aiken County in order to determine what the unmet needs of this group are. This evaluation process should be completed soon; at which point the Elder Task Force can turn its attention to designing new and better services. The task force is also conducting public education.

"We are trying to educated people about community services, about safety, crime prevention and depression," says Shepard. "One of the biggest problems seniors face is in being separated from family and friends and the consequent isolation. We are particularly concerned because it is too easy to confuse the problems of simply being old with being depressed. Mental illnesses can be harder to detect among older Americans."

Training will be offered to elder-serving agencies, family members, seniors, caregivers and health care professionals regarding older American's mental health needs, available services and how to access such services.

"We want to educate providers and make them aware of the elderly culture," says Shepard." One of the main concerns of seniors in Aiken County is the quality of assisted living programs. "There are eight to ten of such programs in our community," says Shepard. Public education will also be focusing largely on depression and isolation, as well as the problem of suicide. "We will be working together with a suicide prevention task force in our community and launching a combination campaign - with print and media -- on suicide prevention."

A leading organization in the task force is the Aiken-Barnwell Mental Health Center (ABMHC), the public, outpatient mental health provider for Aiken County. ABMHC will review task force recommendations, prioritize services to be offered, and determine the appropriate level of funding to be dedicated to elder mental health services. Its new program will be launched around December 2000.

"Our work with the Mental Health Center is going really well," Shepard reports. "We already have our second meeting with the entire task force planned and we will bring in a speaker to do a training with eight different agencies in community." Churches, mental centers, private providers, the local council on aging, the housing authority, and seniors' clubs will all attend the training.

Resources for Older Americans Organizations:

Meals on Wheels Association of America 1414 Prince Street, Suite 202 Arlington, VA 22201 (703) 548-5558 http://www.projectmeal.org

National Asian Pacific Center of Aging Melbourne Tower, Suite 914 1511 3rd Avenue Seattle, WA 98101 (206) 624-1221 http://www.napca.org

National Association of Area Agencies on Aging 927 15th Street NW, 6th Floor Washington, DC 20005 (202) 296-8130 http://www.n4a.org

National Association of Nutrition and Aging Services Programs P.O. Box 9007 Grand Rapids, MI 49509-0007 (800) 999-6262 http://www.nanasp.org

National Association of State Units on Aging 1225 I Street NW, Suite 725 Washington, DC 20005 (202) 898-2578 National Council on Aging 409 Third Street SW, 2nd Floor Washington, DC 20024 (202) 479-1200 http://www.ncoa.org

National Council of Senior Citizens 8403 Colesville Road, 12th Floor Silver Spring, MD 20910 (301) 578-8800 http://www.ncscinc.org

National Caucus and Center on Black Aged, Inc. 1424 K Street NW, Suite 500 Washington, DC 20005 (202) 637-8400 http://www.ncba-blackaged.org

National Hispanic Council on Aging 2713 Ontario Road NW Washington, DC 20009 (202) 265-1288 http://www.nhcoa.org

National Indian Council on Aging 10501 Montgomery Blvd. NE Albuquerque, NM 87111 (505) 292-2001 http://www.nicoa.org

Older Women's League 666 11th Street NW, Suite 700 Washington, DC 20016 (202) 783-6686 http://www.owl-national.org

Reports Available on the Internet

A Profile of Older Americans

America's Social Fabric (AARP)

Age Characteristics in Rural America From the Rural Policy Research Institute

Center on the Demography of Aging, John Hopkins University

Guide to Choosing A Nursing Home-Health Care Financing Administration

Medicare Reform: Leading Proposals Lay Groundwork, While Design Decisions Lie Ahead, February 29, 2000 GAO Report.

Mental Health: A Report of the Surgeon General

Older Adults Organization Formed

By Brian Coopper, Director of Consumer Advocacy, NMHA

Over thirty older adults and advocates came together in Washington, D.C. over the weekend of May 12th through 14th, 2000 to work towards the development of a new consumer organization specifically targeting the mental health needs of older adults. The meeting, sponsored by the U.S. Center for Mental Health Services and facilitated by representatives of the Judge David L. Bazelon Center for Mental Health Law, led to the formation of the American Older Adults Mental Health Consumers Association.

As the large number of "baby boomers" reaches their older years, the issue of the mental health needs of older adults will become more prominent in our society. The reasons why older adults feel they needed a separate organization vary. Culturally speaking, some participants felt the mental health needs of older adults are so substantially different than those of other adults, that an organization with a dedicated focus was needed to assure that these needs were not overlooked. Others felt the national organizations representing older adults and people with mental health needs had not adequately prioritized the older adult population.

Barbara Huff, Executive Director of the Federation of Families for Children's Mental Health, spoke to the audience about the history of the Federation of Families and the challenges that are inherent in bringing a new organization to fruition. Margeau Gilbert and Ingrid Komar of the Bazelon Center spoke about successful fundraising and program development. Brian Coopper, Director of Consumer Advocacy at the National Mental Health Association, spoke about the types of technical support the Consumer Supporter TA Center offers to any organization that supports consumers and the high level of support the new organization could expect.

Paolo del Vecchio, senior policy analyst at the Center for Mental Health Services, outlined the eight basic values he sees as driving services for people with mental health needs: dignity & respect; mutual support; diversity; education/empowerment; social action & advocacy; strengths-based approach; responsibility; and person-centered/person-directed choice and self-determination.

As a result of the meeting, a set of by-laws and a committee structure was developed, and a number of individuals have accepted responsibility in getting the organization going. A founding board of directors was named, and officers were elected. John Piacitelli of Tacoma, WA was elected President, and Hikmah Gardiner of Philadelphia, PA was elected Vice President.

It is an exciting time for the birth of this new organization, and the NCSTAC wishes them well! A follow-up article with more details is forthcoming; in the meantime, you can contact Mr. Piacitelli at 253-582-2789 or piac@u.washington.edu for further details.

Voter Empowerment to be Broadcast on the Web

Able TV, a web-based broadcast service focusing on disabilities coverage filmed the entire fourth regional voter empowerment training on June 7 in Washington, D.C.

Forty representatives from twenty different states took part in the now tried and true NCSTAC training session. The training team included Ken Steele, the project founder, Joseph Glazer of the MHA in New York , Christine Simiriglia of the MHA in Southeastern Pennsylvania, and Lee Ann Browning-McNee of the National Mental Health Association's communications department. Jim Dickson of the National Organization on Disability commended the NMHA and Ken Steele on their pioneer efforts to reach out to Americans with mental illness.

The training webcast can be found at www.abletv.net.

Voter Empowerment Moves Forward in Buffalo

By Ellen Alderton, NCSTAC

"We're in this for the long haul," says Timothy Maggio of Action for Mental Health in Kenmore, New York. "We're going to be doing this forever." Alice Wile, who sits on the Voter Empowerment Committee agrees: "This is an ongoing project, not a one-time thing."

Maggio and Wile are discussing Action for Mental Health's Voter Empowerment Project, an effort aimed at both registering and educating mental health consumers in the greater Buffalo area. Action, an entirely consumer-run organization, has established a working committee of twelve people who plan registration events, produce public education materials, and seek to build a constituency of voters with mental illness.

The committee will remain active beyond the 2000 presidential elections. As far as Maggio and his colleagues are concerned, political participation is an ongoing process, not a one-time affair.

The team has developed an informational how-to packet for conducting a voter empowerment drive. The packet includes scripts for on-site registration presentations, scripts for contacting service providers by telephone, and even a form letter for contacting agencies by mail.

Members of the Voter Empowerment Committee register voters by going out to area clubhouses in teams of two. So far, Action has registered some 300 individuals in the Buffalo area.

Eli Lilly Seeks Nominations for Welcome Back Awards

The Eli Lilly Welcome Back Awards recognize excellence and courage in the mental health community and are designed to help fight the stigma associated with mental illness and to show others that depression is treatable. The awards program acknowledges individuals whose accomplishments in the areas of psychiatry, primary care, community service, and destigmatization have helped give new hope to those suffering from clinical depression. The program also honors those people who have overcome depression to lead fulfilling and productive lives with a Lifetime Achievement Award. Each of the five awards includes a grant of $5,000-$7,500 to the institution or charity of the honoree's choice. Visit the Eli Lilly (http://www.elililly.com/) web site for award program details and to download a nomination form or call (800) 463-6440. The nomination deadline is November 17, 2000.

250 Consumers Gather at Washington, D.C. Summit

By Brian Cooper, Director of Consumer Advocacy, NMHA

The National Mental Health Consumers' Self-Help Clearinghouse hosted Summit 2000: The Second National Summit of Mental Health Consumers and Survivors in Washington, D.C., on June 6, 2000. This event gave approximately 250 consumers and survivors a chance to gather with one another and to engage in an interactive dialogue with mental health policymakers. This gathering was a continuation of the work of the first National Summit of Mental Health Consumers and Survivors held August 25-29 in Portland, Oregon, to work toward a national consensus for action on issues building in the national arena. The first Summit, also organized and facilitated by the Clearinghouse, focused on twelve platform planks on the major topics of Advocacy, Alternative Services, Community Support Services, Financing, Force and Coercion, Forensics, Multicultural Issues, Organizing, Recovery, Research, Social Accountability, and Stigma.

Following an opening keynote speech by Sally Zinman of the California Network of Mental Health Clients on the issue of the expansion of forced treatment in California, the facilitators and co-facilitators of the previous Summit in Portland presented the highlights of the consensus statements that were developed at that time. Key representatives of organizations that have an impact on mental health policy in Washington were in attendance for the presentations. These included Bernard S. Arons, M.D., director of the federal Center for Mental Health Services; Robert Bernstein, executive director of the Judge David L. Bazelon Center for Mental Health Law; Ruth Hughes, executive director of the International Association of Psychosocial Rehabilitation Services (IAPSRS); Curt Decker, executive director of the National Association of Protection and Advocacy Systems NAPAS); Michael M. Faenza, president and CEO of the National Mental Health Association (NMHA); E. Clarke Ross, director of policy of NAMI; and Chris Koyanagi, director of policy of the Bazelon Center.

Following a lunch session with Chris Koyanagi and Mike Faenza discussing the politics of Washington, the key representatives had time to respond to the issues which had been presented in the morning. A lengthy question and answer period gave the audience a chance to further express their interests in developing greater influence in Washington, DC. One concept that has been proposed is that of a "National Desk," a central point of information and referral that could serve as a voice of the consumer/survivor movement in Washington. IAPSRS, NAPAS, NAMI and NMHA all agreed to commit resources to help support the National Desk concept.

You can listen to and view a web broadcast of the Sally Zinman's keynote session from the Clearinghouse's web site at www.mhselfhelp.org. Look for updates and discussion of the work of both Summits and the National Desk concept are also online on the Summit 2000 message board. For more information, you can also contact Marie Verna, Program Director, National Mental Health Consumers' Self-Help Clearinghouse, at 800-553-4539, ext. 292, fax: 215-636-6312, e-mail: mverna@mhasp.org.

SAMHSA Provides Community Planning Grants

The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) today announced the availability of $3.5 million to support 25 to 30 grants for community planning and consensus building around substance abuse treatment and HIV/AIDS services systems' integration. The effort seeks to provide a mechanism for state and local governments to coordinate a variety of resources and to develop plans that identify community needs in the African American, Latino/Hispanic and other racial or ethnic communities.

The one-year grants aim to support community planning and consensus development for the provision of community education, development of advisory committees or community education and training groups, provision of expert consultation and technical assistance and the evaluation or establishment of community planning systems addressing the multitude of issues linked to substance abuse and HIV/AIDS.

"The integration of HIV/AIDS and substance abuse treatment services is a step in the right direction to help reduce the pressing health problems that have been identified in minority communities," SAMHSA Administrator Nelba Chavez, Ph.D., said. "We need to deal with substance abuse issues head-on in our efforts to curtail the incidence of HIV/AIDS and other sexually transmitted diseases, particularly among African American, Hispanic/Latino populations and other racial or ethnic groups."

"It is essential that CSAT provide support to allow state and local governments the ability to work hand-in- hand with organizations and agencies to design the best possible systems of care," noted CSAT Director H. Westley Clark, M.D., J.D., M.P.H. Our goal is to have these resources be the catalyst for the design of integrated systems that include substance abuse treatment, HIV/AIDS prevention and treatment, mental health, primary care and other necessary public health services."

Applications are available on SAMHSA's web site, www.samhsa.gov,as well as by calling 1-800-729- 6686. Refer to GFA Number TI 00-008. Questions on program issues should be directed to David Thompson, project officer, at (301) 443-6523. Grants management questions can be directed to Christine Chen at (301) 443- 8926. Applications are due by July 28, 2000. -end- If room, set in bold: The one-year grants aim to support community planning and consensus development

$6 Million Announced to Support Anti-Violence Coalitions

The Substance Abuse and Mental Health Services Administration's Center for Mental Health Services (CMHS) today announced the availability of $6 million for approximately 25 grants to states, territories and Native American Tribal Governments to help prevent youth violence and foster healthy youth development.

"These new grants are an essential element of the Administration's ongoing initiative to make our schools safe, and to provide healthy and challenging learning experiences so important to the growth of our children," SAMHSA Administrator Nelba Chavez, Ph.D., said. "This program builds upon the Safe Schools/Healthy Students community-based initiative and provides a key role for grantees in strengthening partnerships and coalitions that support schools and the well-being of the students."

CMHS Director, Bernard S. Arons, M.D., said, "This prevention approach gives States, Native American Tribal governments, and mental health authorities the support they need to take a leadership role in expanding the vision for children's mental health services and to foster healthy youth development."

State, local and Tribal Governments may seek funding for either of two types of grants: a two-year grant award of from $150,000 to $200,000 for developing new coalitions and partnerships with community service organizations and constituencies; and a three-year award ranging from $300,000 to $350,000 for existing coalitions and partnerships to develop resources and infrastructure to support program implementation and evaluation. Eligibility is limited to government entities.

Applications are available on SAMHSA's web site, www.samhsa.gov, as well as by calling 1-800- 729-6686. Refer to GFA Number SM 00-004. Questions on program issues should be directed to Michele L. Edwards, M.A., ACSW, project officer, 301-443-7713. Grants management questions should be directed to Steve Hudak, at 301-443-4456.

Conferences

August 11-13 - The National Depressive and Manic Depressive Association's annual conference will be taking place in Boston, Massachusetts. The theme is "Partnerships for Success." For more information, or to register, call (312) 642-7243.

September 10-13 - The NASMHPD National Association of State Mental Health Program Directors will be conducting an older adults meeting in Indianapolis. For more information, contact Roy E. Praschil at (703) 739-9333, ext. 20, or send an e-mail to roy.praschil@nasmhpd.org

September 14-16 - A National Mental Health Association regional training will be taking place in Scottsdale, Arizona. For more information, call (800) 969-NMHA.

September 17-20 - The Third North American Congress 2000 on Alcohol Abuse, Drug Abuse and Dependency will take place in Las Vegas. For more information, contact Charley Rukus at (301) 443-9286 or Charlie Williams at (301) 443-5254.

October 11-15- Alternatives 2000 will be taking place in Nashville. For more information, call (877) 408-2401.

November 11-13 - The First Annual Conference on Mental Health Care for Hispanics: Challenges in the New Millennium will be taking place in Santa Fe. For more information contact (213) 538-0225.

November 30 - December 3 - The Federation of Families for Children's Mental Health will be holding its annual conference in Washington, D.C. For more information, call (703) 684-7710 or fax (703) 836-1040.