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Title: Aging, Mental Health, and Substance Abuse in Florida Presentation to the Florida Substance Abuse and


1
Aging, Mental Health, and Substance Abuse
in Florida Presentation to the Florida
Substance Abuse and Mental Health
CorporationLarry W. Dupree, Ph.D.Florida
Coalition for Optimal Mental Health and Aging
December 9, 2004Tampa, FL
2
Florida Demographic TrendsFlorida faces a
steadily increasing and aging population. -
the oldest state in the nation (median age of
38.4 vs 34.9 for the U.S. in 1997)  -
percentage of elders exceeded that for the
nation (18.5 versus 12.7).  Floridas
percentage represents more than 2.7 million
persons age 65 and above - Approximately 46
are age 75 or older.  Percent of increase for
adults age 65 from 1990 to 1998 was 15.2.
 Floridas population aging is likely to
continue
3
Comparisons of estimates of disorders versus
actual numbers of older Floridians served.
Figures for FY 1998-99
4
Kip (2000) has estimated 1-year (1998) Florida
prevalence rates for persons age 65 and older.
  22.6 for mental illness 11.3 for substance
abuse 4.9 mental illness and substance
abuse 5.1 severe mental illness 2.4
severe and persistent mental illness  Estimated
17.3 of all prevalent cases 55 and older have
severe mental illness (SMI).  Kip indicates
that the estimated rate of SMI is used as a basis
for establishing definite need for mental
health services
5
Proportion of Adults Treated in Publicly Funded
Mental Health Services in FloridaFiscal Year
2001-2002
Ages 18-59 91
Ages 60 and Older 9
Source Policy Services Research Data Center
(2003) Louis de la Parte Florida Mental Health
Institute
6
Mental Health Service Use for Older Adults
Florida is among the lowest in the U.S.
  • Outpatient services rank 45th for ages 65-74
  • Slightly better for age 75 ranking 32nd
  • Inpatient rate ranked 35th for ages 65-74

7
If you cant find elders in traditional
behavioral health services, where can you find
them?
  • Community-based, isolated elders
  • Protective services clients
  • Aging services clients
  • Residents in assisted living facilities
  • Nursing homes residents
  • Patients in primary care practices
  • Patients in emergency rooms

8
 In Florida, there were a total of 2,376
licensed ALFs in 1998  Annual number of
residents is estimated at 133,550.  Kip (2000)
estimates that the prevalence of mental illness
in ALFs lies somewhere between 31 (41,400)
and 56 (74,780) with greater likelihood being
closer to the latter rate.
Assisted Living Facilities
9
In 1998, there were an estimated 82,096 nursing
home beds in Florida nursing homes. Estimated
138,575 annual nursing home residents   an
estimated 78,156 persons with mental illness in
Florida NHs each year  with 12.5 receiving
mental health services  This compares to an
estimated 21.5 of residents with a diagnosed
mental disorder, and 14.3 without a diagnosis,
receiving mental health services in the National
Nursing Home Study.
Nursing Homes
10
Depression is Prevalent in Seniors
  • 15-25 of community-dwelling older adults report
    significant depressive symptomatology
  • 20-40 of medically compromised older adults
    evidence depression
  • Additional 9-30 of community dwelling elders
    report significant depressive symptoms
  • - 25-60 of residential LTC clients- yet
    reportedly, under diagnosed- poor screening, if
    any

11
Consequences of Undetected/Untreated
DepressionDepressed Elders Use much more
health care Incur twice the medical costs
Make many more ER visits Have a much greater
number deaths after heart attack Have a much
higher incidence of stroke  
12
Consequences of Undetected/Untreated Depression
(cont.)
  • Higher death risk
  • self neglect, suicide, alcohol abuse, interaction
    with physical problems
  • In older women
  • 7 mortality rate over 7 year period in women
    with no depression
  • 17 mortality rate for women with 3-5 symptoms
  • 24 mortality rate in those with 6 or more
    symptoms.
  • Depressed hospital patients twice as likely to
    die within
  • two years (does not have to be a major
    depression).
  • Had its greatest effect on those with
    cardiovascular disease

13
Among those ages 55 older 1.0 used illicit
drugs 37.5 used alcohol 9.4 were binge
alcohol users 2.3 were heavy alcohol users
14
Admissions Age 55 or Older by Primary Substance
at Admission 1994-1999(DASIS Report December
2001)
  • Primary substances in 1999
  • 76.1 Alcohol
  • 12.6 Opiates
  • 4.5 Cocaine
  • 1.3 Marijuana
  • 0.7 Sedatives/Tranquilizers
  • 0.6 Stimulants
  • 4.1 Other

Source 1999 Treatment Episode Data System (TEDS)
15
Older Floridians Rarely Receive Treatment
  • There are 3.5 million Floridians age 60
  • If we use estimates of 2 -10 of alcohol abuse
    among community-based elders
  • Then between 70,000 and 350,000 elders in Florida
    abuse alcohol
  • Yet in 98/99, elders represented only 676 of
    30,000 adults in Florida treatment programs
  • 2.2 unduplicated cases were 60
  • Thus, 1 to 9 out of every 1,000 older Floridians
    in need of treatment for alcohol problems
    actually receive treatment.

16
The Proportion of Older Adults Treated in
Publicly Funded Substance Abuse Treatment
Services in FloridaFiscal Year 2001-2002
Ages 60 and Older 2
Ages 18-59 98
Source Policy Services Research Data Center
(2003) Louis de la Parte Florida Mental Health
Institute
17
The Florida BRITE ProjectBRief Intervention
Treatment For Elders
  • An evidence-based approach to identifying older
    adults with substance abuse and related problems
  • Recognizes that most elders with such problems
    are rarely served by the traditional systems of
    services
  • Funded by the Florida Department of Children and
    Families

18
The Florida BRITE ProjectAgencies involved in
the three counties
Gulf Coast Community Care
Broward County Elderly Veterans Services
Coastal Behavioral HealthCare
19
The Florida BRITE Program
  • Focus on helping underserved elders
  • Minorities
  • Low Income
  • Isolated, withdrawn individuals
  • Non-traditional substance abuse referral
    sources to identify hidden abusers
  • Screen where elders are more likely to be found
    or interviewed
  • In their own homes
  • Elder-specific living, centers
  • Brief Interventions and/or Brief Treatment

20
FLORIDAA number of groups/committees have looked
at the issues
  • 1987 ADM and AAS commissioned regional
    meetings to identify barriers and problem
    solve
  • 1989-90 A Task Force of provider representatives
    convened at HRS
  • 1990 An independent Blue Ribbon Task Force on
    the Mental Health Needs of the Elderly
    (sponsored by FCCMH)
  • 1994 DOEA and ADM jointly sponsored the Florida
    Elder Mental Health Task Force
  • - began in spring 1996, with a report
    in 1997.
  • 1997 Florida Policy Exchange Center on Aging
    (USF)
  • 1998-99 FL Coalition for Optimal Mental Health
    Aging
  • 2000-01 FL Commission on MH and SA

21
Florida Commission on Mental Health and Substance
Abuse - Older Adult Workgroup Findings
  • The current service systems are fragmented and
    limited for elders with MH or SA problems
  • No unified system of care
  • Many gaps in the system
  • Meager resources for elders
  • Elders under-utilize mental health and substance
    abuse services more than other age-groups
  • Mental health and substance abuse problems are
    rarely detected because of lack of appropriate
    assessment and ageism.
  • Few providers trained to work with older adults.
  • No comprehensive MH policy for elders
  • No state agency is taking the lead in this area

22
  • Older Adult Workgroup Findings - continued
  • The unique treatment related needs of elders have
    not been addressed.
  • There is an absence of effective advocacy at all
    levels for elder MH and SA issues.
  • Stigma and ageism continue.
  • Public funds are not dedicated to the broad
    mental health needs of elders.
  • - older adults are poorly represented among
    those receiving care.

23
Florida Commission on Mental Health Substance
Abuse Older Adult Workgroup (Select)
Conclusions/Recommendations Policy Establish
priority for elders and their families in the
law. Elders need to be legislatively affirmed
as a target population and fully incorporated
in planning and service deliberations.
Otherwise, there appears to be a lack of
interest and priority in establishing revenue and
services for elder initiatives.
24
Policy (cont.)Just as statewide policy has
progressively served our younger citizens, we
would expect newly established policy specific to
elders to assist in countering the problemsnoted
above by - promoting adequate, accessible,
quality care - provided by appropriately
educated/trained staff - that would be
relied upon on a continuing basis.
25
Staff Elder access rates have been shown to be
related to the age-appropriate expertise of
staff, as well as staff affinity for older
adults. Thus, MH/SA treatment services should
be delivered by staff appropriately educated or
trained in age-appropriate assessment and
interventions, as well as lifespan developmental
issues. Age-appropriate protocols and outcome
measures should be required of every provider.
This provision might be included as a contract
requirement.
26
Interagency Collaboration  Interagency
collaboration and planning relative to elder
MH/SA issues needs to be expanded. Aging,
mental health, substance abuse, health, and
ancillary services should collaborate in
establishing coordinated and comprehensive
policy/plans. The likelihood of cross-network
collaboration markedly increases.  
27
Alternative Sites/Natural Settings Provide
outreach and treatment services in both
traditional and alternative community-based
settings. Services need to be taken to elders
rather than anticipate use of traditional MH and
SA settings. Services should be delivered
wherever the client can be best reached, and in
settings elders like to use.. It is not clear
that the state plans for increasedservices and
quality care are prepared to provide expanded
services in multiple nontraditional settings.
28
Specialty Services In many instances, the
unique, age related needs and circumstances of
older adults necessitating specialized services
have been only minimally addressed. These
services need to be expanded.There is a need
for alternative service modalities for those
unlikely to seek traditional MH/SA
services.e.g., African American study on MH
care preferences
29
Mental Disorders In Older Persons We Know
Treatment Works
  • Surgeon Generals Report on Older Adults and
    Mental Health (1999)
  • Older Adults and Mental Health Issues and
    Opportunities (U.S. Administration on Aging,
    2001)
  • Yet There is A Major Gap Between Research
    Findings on Effective Treatment and Clinical
    Practice
  • And A Major Gap Between Mental Health Services
    and Expenditures and Service Need

From Bartels (2001) AAGP Conference
30
Where to go next
  • The need for specialized mental health and
    substance abuse services for elders has been
    established.
  • There are exemplary programs that demonstrate
    elders can be successfully treated.
  • We need to promote legislation and establish
    policy to promote
  • adequate, accessible, quality care
  • provided by appropriately educated/trained staff
  • that would be relied upon on a continuing basis

31
Comprehensive Older Adult Mental Health and
Substance Abuse Services Act (Proposed
Language)Directs the development of a
comprehensive plan for service delivery, and
coordination with other state agencies.
Requires data collection and analysis.
Specifies older adult target populations, and
the development of specific age-appropriate
outcome measures. Provides for standards,
services, performance measures, a service
planning process, case management, training
requirements, public education and outreach
programs.
32
        Establishes a competitive selection
process for systems enhancement services and
demonstration models and        Proposes
development and staffing of a consortium and
local oversight bodies.There is proposed a
consortium under the leadership of DCF, DOEA, the
Department of Health and AHCA in implementing
demonstration model projects.
33
CHAPTER 394 MENTAL HEALTH PART I FLORIDA
MENTAL HEALTH ACT (ss. 394.451-394.4789) PART II
INTERSTATE COMPACT ON MENTAL HEALTH (ss.
394.479-394.484) PART III COMPREHENSIVE CHILD
AND ADOLESCENT MENTAL HEALTH SERVICES (ss.
394.490-394.4995) PART IV COMMUNITY SUBSTANCE
ABUSE AND MENTAL HEALTH SERVICES (ss.
394.65-394.9084) PART V INVOLUNTARY CIVIL
COMMITMENT OF SEXUALLY VIOLENT PREDATORS (ss.
394.910-394.931)
34
Support for the Comprehensive Act Florida
Association of Counties Florida Association of
Aging Services Providers Broward Older Adult
Work Group Broward MH and SA Coalition and
more..

Florida Council for
Community Mental Health
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