Expanding the geriatric mental health workforce through utilization of non-licensed providers

Abstract

Objectives The rapidly growing older adult population in the United States is poised to overwhelm the geriatric mental healthcare workforce. We evaluate several policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe the costs and other considerations of implementing one approach. Method Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: 1) production of more geriatric mental health providers; 2) team-based care; and 3) non-licensed providers. We evaluate each in terms of their challenges and potential for increasing the geriatric mental healthcare workforce. Based upon our previous work, we provide real-world estimates of the costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers. Results We conclude that the use of non-licensed providers is a key component of reforms needed to allow a greater number of older adults to access needed mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers were able to do so at a lower cost. Conclusion Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, there is evidence of policy and infrastructure changes that may support this type of care-delivery model emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act.

Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults

“…As trainees rotate through these clinics that model interprofessional collaborative practice and team-based care, we expect to see improved uptake of processes that expand capacity through more effective teamwork. Team-based care that includes a variety of disciplines working to the top of their scope of practice and with expanded geriatric competency can achieve improved care of older adults without higher costs [17]. Furthermore, we believe that with the current structure of Medicare reimbursement, mentored comprehensive geriatric assessment is possible within primary care practices.…”

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

“…Research has shown that treatment by these supervised but non-licensed providers is equally effective at improving depressive symptomatology, often with substantial cost savings. 183 , 184 A major opportunity to engage the non-physician workforce exists in long-term care facilities and age-restricted and retirement communities. Although 35% of residents in such facilities experience depressive symptoms, 50 facility staff are often untrained in identifying and managing these symptoms.…”

“…The nursing and allied health workforce is more racially and ethnically diverse than that of physicians, so increased engagement with staff may provide older adults a higher degree of culturally and linguistically competent care. 184 …”

New Frontiers for Clinical Mental Health Counselors

“…Counselors are providing home-based services to older adults in much the same way that services are provided to children and families. In-home counseling that is delivered through an integrated team consisting of case managers, physicians, occupational and physical therapists, and others, has proven to be successful in improving outcomes and reducing the cost of care (Kunik et al, 2017). Clinical mental health counselors now are working in arenas that traditionally have been staffed by social workers.…”