July 2, 2013—Advocates for the elderly and disabled believe they scored an important victory this legislative session that will pave the way toward creating new mental health and addiction services for an increasingly aging population.
They succeeded in having a “budget note”—something written into an agency budget that directs state agencies to take specific actions, reforms or generate reports that might inform future legislation and policy—included in the Oregon Health Authority and Department of Human Services budgets, which are expected to be approved by the Legislature later this week.
Both agencies are instructed to inform the 2015 Legislature with the plans or actions they'll take in response to a report generated by a legislative work group that will analyze the availability of mental health and addiction services for seniors and people with disabilities.
“That was a real victory,” said Jim Davis, who co-chaired the work group and lobbies on behalf of United Seniors of Oregon and the Oregon State Council for Retired Citizens. “This essentially puts their feet to the fire.”
The inclusion of the budget notes comes on the heels of a final report created by the Legislative Work Group on Senior and Disability Mental Health and Addictions, which was formed by the Senate’s Health Care and Human Services committee toward the end of the 2011 legislative session.
That committee made 11 recommendations on how the state can increase services to seniors suffering from mental illness and addiction problems, as well as increase the work force that provides those services. Some of the recommendations include:
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Developing counseling, education, outreach, suicide prevention and case management programs within the state’s existing community, public and private mental health systems that care for seniors with mental health and addiction problems,
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Increasing the state’s mental health service programs to provide treatment for seniors with severe mental illness, such as schizophrenia and bi-polar disorder,
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Creating an education campaign that increases the public’s knowledge of how mental illness and substance abuse affects seniors, as well as the problems seniors face with prescription drug abuse, and,
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Developing a “gatekeeper program” involving people that regularly interact with seniors, including family members, friends, neighbors, postal workers and grocery clerks.
The committee’s recommendations are extensive and broad in scope because there is a dearth of mental health and addictions services in Oregon specifically for seniors. According to the work group’s report, seniors comprise less than 3 percent of the population served by the state’s community health programs, and less than 1 percent of those covered by addiction programs. “Treatment of the elderly is almost non-existent,” the report concludes.
At the same time, between 17 and 30 percent of suicides are committed by seniors, and seniors purchase approximately 30 percent of prescription drugs, which, Davis said, are often abused.
The presence of serious mental health and addiction issues can intensify many life adjustments and transitions that seniors make, including changes in their financial situation, relationships, physical appearance, the ability to live independently and making plans for appropriate care giving. Those stresses can, in turn, cause seniors to develop depression, anxiety and sleep problems.
Seniors often hesitate to seek services because of stigma, and fear losing independence. “It’s something that people don't want to talk about,” said John Bartholomew, director of Oregon’s chapter of the Alzheimer’s Association.
Davis and others said that the problem will worsen as the baby boomer generation ages, while Bartholomew said the population of elderly people suffering from dementia (the gradual loss of cognitive functioning) is “growing rapidly.”
The number of Oregonians with Alzheimer’s grew by 33 percent between 2000 and 2010, according to data collected by the Alzheimer’s Association, equating to approximately 76,000 people. By 2025, Bartholomew said, that number is expected to climb over 110,000. “That’s pretty significant,” he said.
When severely mentally ill people begin living in nursing homes and use other senior services, staff “aren’t aware of how to deal with them,” Davis said. Oftentimes, mentally ill seniors will turn to their primary care doctor, who may be unable to recognize the presence of a mental illness or addiction.
“I wouldn't say our medical system is set up to deal with that,” Bartholomew said. “It’s really complicated. They need a really good medical team.”
Senate Bill 823, sponsored by Senate President Peter Courtney (D-Salem), would substantially increase funding for community mental health programs, and require that all community health centers be staffed with a geriatric specialist. However, that bill appears to be dead, most likely because it requires $637.5 million in additional state spending.
Over the next few months, Davis intends to form a coalition with other work group members and begin meeting with legislative and agency leadership. The effort to implement the various recommendations will be a “multi-year” and a “meticulous, strategic” process, he said.
Image for this story by U.S. Pacific Command (CC BY-NC-ND 2.0) via Flickr.
Amanda Waldroupe can be reached at [email protected].
