Download Workshop 10 - The Crisis Intervention Association of Pennsylvania

Bridging Communities:
Helping Older Adults in Crisis
Linda K. Shumaker, RN-BC, MA
Pennsylvania Behavioral Health and Aging Coalition
Aging of America…
Growth will be from 12% to 21% of the population
by 2030 –estimated 70.1 million.
Rapid growth is expected to occur among the
oldest & frailest population groups.
More diverse racially and ethnically
Will live longer
Will have multiple complex health problems
Need for the inter-disciplinary team approach!
2
The Dilemma
Mrs. Smith is an 86 year old widowed woman who lives with
her son in his home. She has been receiving services through
the county office of aging due to increasing cognitive problems
and safety concerns. She has no previous mental health
treatment history. The son noticed over several days that his
mother was becoming increasingly suspicious in the early
evening. He returned from work one evening and discovered
her in the kitchen with a knife stating that the people next door
were trying to take her money. He was unable to redirect her as
she became increasingly agitated. He contacted the County
Aging Protective Service Worker on call who directed him to
take her to the nearest emergency room.
The Dilemma
Upon arriving at the emergency room Mrs. Smith refused to
get out of the car. The son proceeded into the ER and
discussed with staff who stated there was nothing they could
do. The son once again contacted the Aging Protective Service
worker who suggested driving his mother around the block
and to attempt to re-enter the emergency room. When the
son went back to the car he had found his mother had a knife
with her and had sliced the seats in the car.
Crisis Response?
Criteria for 302?
Barriers to Care!
Patient and Family Barriers
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Isolation
Ageism – belief that depression, confusion are normal
conditions of aging
Preference of primary care
Focus on somatic complaints
Stigma
Reluctance to discuss psychological symptoms
Lack of /misinformation
Provider Barriers
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Ageism – “normal aging”
Training barriers
Focus on “medical issues”
Lack of awareness of “geriatric-specific” clinical
symptoms
Complexity of treatment issues
Reluctance to inform patients of diagnosis
Lack of access to psychiatric care
Lack of /misinformation
System Barriers
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Fragmentation
Intersystem boundaries – including exclusion of
dementia from many community mental health
programs
Time constraints
Lack of access to geriatric specific services/ treatment
Reimbursement issues – including a mismatch between
covered services and a changing system of long-term
and community based care
Cultural diversity needs
Pennsylvania’s Approach to
Collaboration
 Memorandums of Understanding (MOU)
between the Office of Mental Health and
Substance Abuse Services (OMHSAS) and
the Pennsylvania Department of Aging
(PDA) – State and County agreements
PDA & OMHSAS Memorandum of
Understanding (MOU)
The 2006 Program Directive MOU required PDA
Office of Community Services and Advocacy
and the OMHSAS to collaborate and to
develop MOUs between each county’s
MH/MR program and the county’s Area
Agency on Aging.
Pennsylvania’s Cross System Approach
2006 - Mental Health Bulletin was released
from the Deputy Secretary of Mental Health
on the rights of older adults, even those with
dementia, to receive mental health
treatment. “Service Priority – Older Adult
Population.” (Bulletin issued, February
2006.)
Pennsylvania’s Cross System
Approach
2006 – Cross System development with the
Pennsylvania Department of Aging and
Office of Mental Health and Substance
Abuse Services, of a Suicide Prevention
Strategy for Pennsylvania that specifically
addresses the needs of older adults.
Pennsylvania’s Cross System Approach
 Cross systems collaboration is necessary to
serve the older adult population.
 MOUs between behavioral health and aging
provide an agreed-upon roadmap to establish
and build collaboration.
Psychiatric Issues of Aging
 Depression/ Late Life Depression
 Caregiving and Depression
 Behavioral and Psychological or
Neuropsychiatric symptoms of Dementia
 “Anxiety-based” behaviors
The Dilemma
Mr. Johnson is an 81 year old widowed gentleman who
resides in a senior apartment building. On Friday
afternoon at 4:30 he wandered into the manager’s office,
confused and distraught over not being able to find his
wife. When the manager reminded him of his wife’s death
10 years ago, he became agitated, combative and
threatened suicide.
The Dilemma
The apartment manager contacted Mr. Johnson’s daughter
regarding her father’s confusion and suicidal comment.
Her concern was that her father collects guns and had
numerous weapons in his apartment. Due to the daughter
residing out of state, the manager also contacted the Office
on Aging for assistance. She was told to call Crisis
Intervention due to the suicidal comment. On doing so the
manager was told that he had dementia and could not be
psychiatrically hospitalized.
Crisis Response?
Criteria for 302?
Late Life Depression
Depression and the Older Adult
 7 million adults aged 65 years and older are affected by
depression (Steinman, 2007).
 15 – 20 % of adults older than 65 have experienced
depression. (GMHF)
 Affects approximately 15 out of every 100 older adults age 65
and older – higher percentage in hospitals and nursing homes.
 Affects more older adults in medical settings, up to 37% older
patients in primary care – approximately 30% of these patients
have major depression the remainder have a variety of
depressive syndromes that could also benefit from medical
attention (Alexopoulos, Koenig ).
Depression and the Older Adult
Chronically ill Medicare beneficiaries with
depression have significantly higher health care
costs than those with chronic disease alone
(Unützer, 2009).
Depression in Older Adults
 Causes may be physical, social, or psychological in
origin, including:
 Specific events in a person's life, such as the death of a spouse, a
change in circumstances, or a health problem that limits
activities and mobility
 Medical conditions - Parkinson's disease, hormonal disorders,
heart disease, or thyroid problems
 Chronic pain
 Nutritional deficiencies
 Genetic predisposition to the condition
 Chemical imbalance in the brain
Depression and the Older Adult
 Individuals who get depressed for the first time in later life
have a depression that is related to medical illness
 Untreated depression can lead to disability , worsening of
other illnesses, institutionalization, premature death and
suicide (GMHF)
 Community surveys have found that depressive disorders
and symptoms account for more disability than medical
illness
 With proper diagnosis and treatment more than 80% of
individuals with depression recover and return to normal
lives (GMHF)
Late Onset Depression
 Depression occurring for the first time in late life
– onset later than age 60
 Usually brought on by another “medical illness”
 When someone is already physically ill,
depression is both difficult to recognize and treat
 Greater apathy/ anhedonia
 Less lifetime personality dysfunction
 Cognitive deficits more pronounced
 May be a precursor to dementia
Depression
 Major Depressive Episode
 Depressed mood
 Loss of interest or pleasure
 Appetite disturbance
 Insomnia or hypersomnia
 Psychomotor agitation or retardation
Depression
 Major Depressive Episode
 Fatigue or loss of energy
 Feelings of worthlessness or guilt
 Decreased concentration indecisiveness
 Thoughts of death or suicide
 Impaired level of functioning
Older Adults at Risk for Depression
Those with co-morbid disorders
Frail elderly
Older adults residing in care facilities
Caregivers of older adults
 Isolated older adults
Depression and Dementia
 Depressive symptoms of various intensity occur in
approximately 50% of demented patients
 Symptoms can include:
 Abrupt loss of interest, increased irritability,
refusal to eat, crying, and sudden
deterioration in skills (Rovner)
Psychiatric Issues in Dementia
- Depression
 Depression:
Behavioral symptoms of depression includes:
appetite changes, sleep disturbance,
irritability/ agitation, refusal of “care”, inability
to make a decision, social isolation, withdrawal,
tearfulness, and sad mood.
Depression and
Alzheimer’s Disease
 Depression that can occur with AD may be different
than other depressive disorders in that the
neuropathology of AD plays a role in the development
of depression
Olin, Katz, Lebowitz, et al “Provisional Diagnostic Criteria for
Depression of Alzheimer Disease: Rationale and Background,”
American Journal of Geriatric Psychiatry, 2002
Depression, Suicide and
Older Adults
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NIMH - Older adults with depression are at risk for suicide. In
fact, white men age 85 and older have the highest suicide rate
in the United States.
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American Association of Suicidology - Suicide rates for elderly
males are the highest risk at a rate of 29.0 per 100,000 (2010)
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The Centers for Disease Control and Prevention 2012 statistics
state 51 out of every 100,000 white men over 85 (the old-old)
were at the greatest risk of suicide. The national average for
all ages was 12. 6.
Suicide in Older Adults
 APA – 20% of Older Adults who committed suicide
saw their physician within the prior 24 hours, 41% in
the past week and 75% within the past month
 The risk of depression in the elderly increases with
other illnesses and when ability to function becomes
limited.
Hybels CF and Blazer DG. Epidemiology of late-life
mental disorders. Clinics in Geriatric Medicine,
19(Nov. 2003):663-696.
 Associated with late-onset depression
Assessing Suicide Risk
(SAD PERSONS)
S ex
(Male)
Age
(Elderly or adolescent)
Depression
Previous Suicide
Ethanol
Abuse
Rational
Thinking loss (psychosis)
Social
Support lacking
Organized
Plan commit suicide
No
Spouse (divorce>widowed>single)
Sickness
Physical illness
Older Adults who take their own
lives are more likely to have
suffered from a depressive illness
than individuals who kill
themselves at younger ages
Depression and the
“Nursing Home”
 Occurrence 10 times higher than those elderly residing in
the community (Rovner)
 NIMH – April 2002 – up to 50% of nursing home residents
are affected by significant depressive symptoms
 Associated with distress, disability and poor adjustment
to the facility (Rovner)
 Most common cause of weight loss in long term care
(Katz)
The Dilemma
Mr. Johnson is an 82 year old gentleman who resides on a
dementia unit at a local nursing home. He was recently
placed there due to his wife’s inability to care for him as
her health concerns have worsened. One evening shortly
after his admission Mr. Johnson became agitated as his
wife was leaving the unit. He yelled that he needed to take
care of her and go home with her. He threatened the staff
verbally and became physically intimidating.
The Dilemma Cont.
The staff attempted to redirect him, but Mr. Johnson
became belligerent, stating they don’t know what they
are talking about and his wife is sick. The staff were
concerned about the other residents on the unit
becoming upset or even getting injured. The medical
director of the facility instructed the staff to contact
crisis intervention or take the resident to the
emergency room. EMS had difficulty upon arriving, as
Mr. Johnson would not get on the stretcher to go in the
ambulance. Crisis intervention was contacted to come
to the facility.
Crisis Response?
Criteria for 302?
Neuropsychiatric or
Behavioral and Psychological
Symptoms of Dementia
“Dementia”
 Irreversible chronic brain failure.
 Loss of mental abilities.
 Can involve memory, reasoning, learning
and judgment.
 All patients with dementia have deficits, but
how they are experienced depends on their
personality, style of coping and their
reaction to the environment.
Psychiatric Symptoms of Dementia
 Dementia is the greatest risk factor for the
development of psychotic symptoms in the
older adult population.
 Dementia process itself and;
 An increased vulnerability to delirium
Brown, FW. “Late-life Psychosis: Making the Diagnosis
and Controlling Symptoms.” Geriatrics 1998.
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
• Affects up to 90% of all individuals with
dementia over the course of their illness
• Causes: psychological, social and biological
factors?
• Recent research has emphasized the role of
neuropathological and genetic factors
underlying the clinical manifestation.
Psychiatric Symptoms of Dementia
 More than half of individuals with dementia experience
psychotic symptoms during the course of their illness.
 Delusions are the most common (up to 70%)
• House is not their house
• Spouse not their spouse (Capgras syndrome)
• Infidelity
 Hallucinations (up to 50%) – usually visual
• Lewy Body Dementia up to 80% experienced visual
hallucinations, usually early on in the disease.
Brendel, R., and Stem, T. “Psychotic Symptoms in the
Elderly,” Primary Care Companion, Journal of Clinical
Psychiatry, (2005); 7 (5): 238-241.
Psychiatric Symptoms of Dementia
 Hallucinations and delusions are commonly
associated with aggression, agitation and
disruptive behaviors.
 Psychotic symptoms are associated with
more caregiver distress.
 Associated with institutionalization.
 Psychotic symptoms disappear in the more
advanced stages of the disease.
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Symptoms of disturbed perception, thought
content, mood or behavior that frequently occur in
persons with Dementia
 BPSD are treatable!
 BPSD can result in:
Suffering
Premature Institutionalization
Increased Costs of Care
Loss of quality of life for the person and caregivers
Finkel et al 1996
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Hallucinations (Usually visual)
 Delusions
• People are stealing things
• Abandonment
• This is not my house
• You are not my spouse
• Infidelity
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Misidentifications
• People are in the house
• People are not who they are
• Talk to self in the mirror as if another
person
• Events on television
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Depressed Mood
 Anxiety
 Apathy
•Decreased social Interaction
•Decreased facial expression
•Decreased initiative
•Decreased emotional responsiveness
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Wandering
• Checking
• Attempts to leave
• Aimless walking
• Night-time walking
• Trailing
• Excessive activity
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Verbal Agitation
•Negativism
•Constant requests for attention
•Verbal bossiness
•Complaining
•Relevant interruptions
•Irrelevant interruptions
•Repetitive sentences
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Verbal Aggression
• Screaming
• Cursing
• Temper Outbursts
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Physical Agitation
•General Restlessness
•Repetitive Mannerisms
•Pacing
•Trying to Get to a Different Place
•Handling Things Inappropriately
•Hiding Things
•Inappropriate Dressing or Undressing
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Physical Aggression
•Hitting
•Pushing
•Scratching
•Grabbing Things
•Grabbing People
•Kicking and Biting
Behavioral and Psychological or
Neuropsychiatric Symptoms of Dementia
 Disinhibition
•Poor Insight and Judgment
•Emotionally Labile
•Euphoria
•Impulsive
•Intrusiveness
•Sexual Disinhibition
The Dilemma
Ms. Moore, 73, was admitted to the geriatricpsychiatry unit from a local personal care home for
withdrawal, decline in personal hygiene, poor
appetite and disorientation. Upon admission it was
determined that her symptomatology was due to
pneumonia. She quickly responded to treatment,
was discharged back to the personal care home
however shortly after readmission she fell and
fractured her hip. She became suspicious of medical
providers and refused to go in the ambulance.
The Dilemma
Ms. Moore, who suffers from schizophrenia, retired
from state government at 69 and resided at home
with her mother until her death 3 years ago. After
her mother’s death she was hospitalized, re-stabilized
on medication and discharged to a small, local,
personal care home. Ms. Moore functioned well until
her recent medical illness and subsequent hip
fracture. Discharge planning for rehabilitation also
became difficult as long term care facilities were
hesitant to take a patient with a psychiatric diagnosis.
Crisis Response?
Criteria for 302?
Hoarding Behaviors
Characteristics of Compulsive
Hoarding Behaviors
o Excessive acquisition and retention of
“apparently” useless things and animals.
o Cluttered living spaces that limit activities for
which these spaces were designed.
o Significant distress or impairment is caused by
the hoarding behaviors.
Frost and Hartl (1996)
Hoarding Statistics
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It is a hidden problem.
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Estimates are that hoarding behaviors effects between 2 5% of the population!
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Recent research states there is no gender differences.
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Though it is thought to begin in adolescence, due to the
progressive nature of hoarding behaviors there are
increasing problems as individuals age.
Risk Factors for Hoarding
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Age –begins in adolescence
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Stressful life event often precedes behavior
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Lower socioeconomic income
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Tendency to be single or divorced
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Hereditary issues – 50 – 80% of individuals who had
hoarding behaviors had first degree relatives who were
considered “pack rats” or hoarders.
Risk Factors for Hoarding
o Stressful Life Events –
• Some individuals develop hoarding behaviors after
experiencing a stressful life event such as a motor
vehicle accident, death of a love one, sexual abuse,
rape or witness to a crime.
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Behavioral Research Therapy 1996; 34:341-350.
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Behavioral Research Therapy 2005; 43:269-276.
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Journal of Anxiety Disorders January 2005; 675-686.
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Clinical Psychiatry News, June 2006.
Risk Factors for Hoarding
o Stressful Life Events Cont.
 Significant correlation of hoarding in females to a
history of interpersonal violence; 76% compared to
32% in the general populations (Tolin and Meunier et
al., 2010).
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Childhood adversities
 Parent with psychiatric symptoms
 Homebreak-ins
 Excessive physical discipline
(Samuels, Bienvenu, et al., 2008)
Co-Morbidity
 Depression – 57%
 Anxiety - Generalized, Social, Posttraumatic
Stress
 Obsessive Compulsive Disorder
 Attention Deficit Hyperactivity
 Dementia
Individuals Who Have
“Hoarding Behaviors”
 Have significant emotional attachment to items.
 Feel the items they collect will be needed or will
have value in the future.
 Feel safer when surrounded by the things they
collect!
Hoarding Research
 Functional imaging suggests the medial prefrontal
area of the brain plays an important role.
 PET Scans show lower than normal activity in the
anterior cingulate gyrus. This area is associated with
such tasks as focused attention and decision making.
Hoarding and the DSM 5
Now considered a distinct disorder
Previously was a Subtype or symptom of Obsessive
Compulsive Disorder
Hoarding behaviors may also seen in individuals
with Generalized Anxiety Disorder, Social Phobias,
Schizophrenia, Dementia, Eating disorders and
Mental Retardation
Those with significant hoarding symptoms are more
likely to suffer from co-morbid depression
DSM 5 Hoarding:
 Persistent difficulty discarding or parting with
possessions, regardless of their actual value.
 This difficulty is due to a perceived need to save the
items and distress associated with discarding them.
 The symptoms result in the accumulation of
possessions that congest and clutter active living
areas, and substantially compromise their intended
uses. If living areas are uncluttered, it is only because
of the interventions of third parties.
DSM 5 CONT.
 The hoarding causes clinically significant distress or
impairment in social, occupational, or other
important areas of functioning (including maintaining
a safe environment for self and others).
 The hoarding is not attributable to another medical
condition (e.g.: brain injury, cerebrovascular disease,
etc.).
DSM 5 CONT.
 The hoarding is not better accounted for by the
symptoms of another DSM 5 disorder (e.g.:
hoarding due to obsessions in Obsessive Compulsive
Disorder, decreased energy in Major Depressive
Disorder, delusions in Schizophrenia, restricted
interests in Autism Spectrum Disorder, etc.).
Assessment
 Saving Inventory-Revised tool (Frost)
 Saving Cognition Inventory (Frost, Steketee)
 Hoarding Rating Scale Assessment Tool (Frost)
 Clutter Image Rating Scale (Frost)
 Activities of Daily Living (ADL)
Treatment
 Treatment is challenging and has “mixed
success”
 Cross system collaboration helpful
 Medication
 Psychotherapy
Treatment -Therapy
 Behavioral Therapy
 Cognitive remediation
 Focus on building concrete skills
Cognitive Behavioral Therapy
 Cognitive Behavioral Therapy is the most
commonly cited approach and has been shown to
be effective up to 50% of individuals.
 Muroff, J., Steketee, G., Bratiotis, C., et al. “Group cognitive and
behavioral treatment for compulsive hoarding: a preliminary trial,”
Depression and Anxiety, 2009; 26 (7): 634-640.
 Steketee, G., Tolin, DF., “Cognitive-behavioral therapy for hoarding
in the context of contamination fears,” Journal of Clinical Psychology
2011; 67 (5): 485-496.
Treatment -Therapy
Frost and his colleagues found that 26 sessions of
behavioral therapy, including home visits, over a 7 to
12 month period helped half of the 10 hoarders who
completed a cognitive behavioral/
psychotherapeutic program become "much
improved" or "very much improved.”
Randy Frost, PhD, Israel Professor of Psychology,
Smith College, Northampton, Mass.
Community-Based Interventions
 Cross system collaborative approach
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Multiagency Hoarding Teams – (MAHT) –
coordination of public sector approaches
“Hoarding Task Forces”
Hoarding Task Forces
Key Issues
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A comprehensive, multi-agency approach best serves
the interests of the owner/ occupant.
Each agency must have an understanding of services
and capabilities of other agencies.
Hoarding behaviors can create unsafe living conditions;
action must be taken to protect life, health, and safety.
Fairfax County, Virginia Hoarding Task
Force, Annual Report, 2009
Hoarding Task Forces
Key Issues
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Significant staff resources may be required.
Enforcement, follow-up, remediation, and court action
may require many hours and there is no guarantee that
the behavior will not reoccur.
 A compassionate, professional, and coordinated
approach must be developed to provide a chance of
recovery for the owner/ occupant and the community.
Fairfax County, Virginia Hoarding Task
Force, Annual Report, 2009
Cross System Collaborative Approach
 Area Agency on Aging
 Mental Health Centers/ Providers
 Crisis Intervention/ emergency services
 Inpatient Psychiatric Services
 Department of Health
 Humane Society
 Vector Control
 Biohazard
 Private consultants – “professional organizers”
Evidenced-based Practices for
Older Adults with Behavioral
Health Issues
Evidence-based Practices for Older Adults
with Behavioral Health Issues
 Psychosocial and pharmacological treatment for
depression and dementia.
 Integrated mental health services in primary care.
 Mental health outreach services.
 Brief alcohol interventions for at-risk use.
 Family/ caregiver support interventions.
Draper, 2000; Unutzer, it al., 2001; Schulberg, et al., 2001;
Sorenson, et al., 2002; Bartels, et al., 2002, 2003
Collaborative Approaches for Older Adults
with Behavioral Health Issues
Healthy Aging Initiatives:
 “Building Healthy Communities for Active Aging” – EPA
 “The Healthy Brain Initiative” – CDC and the Alzheimer’s
Association – National Public Health Road Map to
Cognitive Health
 Chronic Disease Self-Management Program (CDSMP) –
Physical, emotional and health-related quality of life,
healthcare utilization and costs
Evidence-Based Practices for Older Adults
with Behavioral Health Issues
Depression in Older Adults

Healthy IDEAS - (Identifying Depression, Empowering
Activities for Seniors) – Integrates depression
awareness and management into existing case
management services.
 Screens, educates, links to services and utilizes
behavioral approaches.
 Evidenced based Disease Self Management for
Depression – NCOA Model Health Program.
Evidence-Based Practices for Older Adults
with Behavioral Health Issues
Depression in Older Adults

PEARLS -(Program to Encourage Active Rewarding Lives for
Seniors) – Utilizes existing community-based programs.
 Problem solving treatment, social and physical activation,
PEARL’s counselor offers visitation.
 Gatekeeper Program – Trains non-traditional sources to
identify and refer older community residing elders to
services.
Collaborative Approaches for Older Adults with
Behavioral Health Issues
Outreach Programs
 Multidisciplinary outreach services takes services to
where older adults reside – home and community
based settings
 Psycho geriatric Assessment and Treatment in City
Housing (PATCH) Baltimore, MD – Gatekeeper
program with “assertive community treatment”.
Evidence-Based Practices for Older
Adults with Behavioral Health Issues
Depression in Older Adults
Interventions for Family Caregivers –
(Mittelman) – combination of counseling
sessions, support group, education and ongoing
support.
 Assists in delaying nursing home placement.
 Improved caregiver depression and health
outcomes.
Integrating Mental Health Services in
Primary Care
PRISM-E (SAMHSA) –(Primary Care Research in
Substance Abuse and Mental Health for the Elderly)
comparing two types of care models for delivery of
mental health services to older adults.
 50 clinical settings – managed care, community health clinics,
VA system and group practice settings.
 Diverse ethnic/ minority and rural/ urban populations.
 Largest study of depression and alcohol uses in older adults.
 The firsts effectiveness study of integration in older adults.
Evidence-Based Practices for Older Adults
with Behavioral Health Issues
Suicide Prevention
Supportive interventions including screening, psychoeducation and group activities.
Telephone-based supportive interventions.
Protocol driven treatment delivered by a case
manager (IMPACT; PROSPECT).
Integrating Mental Health Services in
Primary Care
IMPACT (Hartford Foundation) - (Improving Mood
Promoting Access to Collaborative Treatment for
Late Life Depression)
◦ Identification of older adults in need.
◦ 12 month access to depression care manager and
support.
◦ PCP manages anti-depressant medications.
◦ Brief psychotherapy.
◦ Case supervision by a psychiatrist.
Integrating Mental Health Services in
Primary Care
PROSPECT (NIMH) - Prevention of Suicide in
Primary Care Elderly: Collaborative Trial
◦ Sought to decrease risk factors including barriers to
accessing health care and the presence of untreated
mental illness.
◦ Identification of older adults in need.
◦ Case management links to appropriate service.
◦ Depression – care management and suicide prevention.
Collaborative Approaches for Older
Adults with Behavioral Health Issues
Colorado’s Senior Reach
 Community-involved identification of older adults who
need emotional or physical support and connection to
community services.
 70 % of seniors previously had “fallen through the
cracks”.
Collaborative Approaches for Older
Adults with Behavioral Health Issues
Colorado’s Senior Reach Cont.
 90 % who were referred have accepted mental health
services.
 Program enables individuals to access service before
serious problems arise.
 Senior Reach has found that building strong
collaborative community relationships that enhance
ongoing services to older adults is the key to prevention
of more serious problems.
Behavioral Health Needs of
Older Adults
• Multidisciplinary approach
• Consumer input
• Stakeholder-generated principles – CSP/CASSP
• Culturally competent
• All levels of interagency collaboration
• Toward the aim of dispelling stigma
• Integrated at the community level
• Continuum of care from prevention to treatment
SAMHSA Strategic plan Substance Abuse and Mental
Health Issues facing Older Adults 2001 - 2006
Resources
 Alzheimer’s Association – www.alz.org
 ADEAR (NIA) – [email protected]
 Family Caregiver Alliance – www.caregiver.org
 Geriatric Mental Health Foundation –
www.gmhfonline.org
 PA Behavioral Health and Aging Coalition –
www.olderpa.org
Resources
 Medline Plus (NIH) – www.medlineplus.gov
 American Federation of Suicide Prevention –
http://www.afsp.org/
 Pennsylvania Behavioral Health and Aging Coalition www.olderpa.org
What makes the engine go?
Desire, desire, desire.
The longing for the dance
Stirs in the buried life.
One season only,
and it’s done.
Stanley Kunitz