Overcoming obstacles in providing mental health treatment to older adults: Getting in the door.

Abstract

Older adults significantly underutilize mental health services relative to their numbers in the population. Barriers that impede their access include physical, financial, cognitive, emotional, and attitudinal issues. This article discusses strategies for overcoming these barriers, including physical adaptations such as in-home psychotherapy and telephone sessions, use of support groups, strong community outreach, and liaisons with other professionals. Adaptations that help to increase older adults' use of mental health services are discussed, including education about treatment, nontraditional "pursuit" of clients, and use of alternative terminology. Informed consent is discussed as a special issue.Older adults underutilize mental health services. Whereas approximately 13% of the U.S. population is over age 65, only 2 to 4% of patients in mental health outpatient clinics are over 65 (Eisdorfer & Stotsky, 1977). This is so, despite the fact that overall rates of mental disorders do not seem to decrease in older age. Providing appropriate mental health services to these elders can increase their quality of life, help prevent premature institutionalization, and reduce over-

Conceptualizing mental health care utilization using the health belief model.

“…To address the psychological fears of older adults, Yang and Jackson (1998) suggest aggressive community outreach with community ''gatekeepers,'' such as social workers, pastors, and senior residence managers. By maintaining relationships with these individuals, who have already developed trusting relationships with their clients, psychologists can demystify psychotherapy with hesitant clients.…”

Public Mental Health Care Utilization by Older Adults

“…These barriers include public and professional stigma toward geriatric mental health and the efficacy of geropsychological interventions (Mackenzie, Gekoski & Knox, 1999), physicians' under-detection of mental illness in older adults (Gatz & Smyer, 1992), the medical community's over-reliance on pharmacotherapy with older patients (Kisely, Linden, Bellantuono, Simon, & Jones, 2000), a shortage of professionals trained in geropsychology (Halpain, Harris, McClure, & Jeste, 1999), limited knowledge of mental health and mental health services by older adults (Yang & Jackson, 1998), limited Medicare reimbursement (Sherman, 1996), and restrictive regulatory policies and administrative practices (Karlin & Duffy, 2004).…”

Providing Psychotherapy to Older Adults in Home: Benefits, Challenges, and Decision-Making Guidelines

“…Reducing mental illness can improve an elder's health (Zarit & Zarit, 2007) and may lengthen the duration of independent living. While mental health services provided to older adults involve many of the same approaches used with younger adults, adaptations are required (Knight, 2004;Laidlaw, Thompson, Dick-Sisken & GallagherThompson, 2003;Yang & Jackson, 1998). These include more frequent grief therapy; devoting more time for transmission of life stories; accommodating slower cognitive processes, sensory impairments and medical conditions; and overcoming this cohort's stigma against mental health services.…”