Enhancing the Mental Health Delivery System for Elders in Illinois

1
Enhancing the Mental Health Delivery System for
Elders in Illinois

• Illinois Governors Conference 2009
• Anne Posner, Age Options
• Patty Black, Pillars
• Mike ODonnell, Executive Director, ECIAAA
• Eric Weakly, Community Planner, NEIL AAA

2
Presentation Points

• Background
• History of Illinois Coalition on Mental Health
  and Aging and Geriatric Advisory Council
• Description of Current System and Demonstration
  Projects in Illinois
• Advocacy Efforts
• Facilitate Discussion on Coalition Building and
  other local efforts

3
The Facts About Mental Health and Aging

• 18-25 of older adults experience a mental health
  issues that is not a normal part of aging
• 25 of older adults experience depression
• people age 65 and older have 6 times the suicide
  rate of the general population
• most older adults continue to go to the primary
  care doctor for help, but primary care physicians
  rarely identify issues as mental health relate
• 50-70 of all primary care medical visits are
  related to psychological factors- anxiety,
  stress, depression
• 40-90 of mental health problems are not detected
  by primary care

4
The Facts About Mental Health and Aging

• as people age issues become more complex
• co-occurring issues
• Mental health issues from earlier in their lives
  that has never been diagnosed or treated- aging
  can make this more complex.
• Barriers to service for older adults
• older adults dont tend to self identify
• Stigma- not wanting to go to a mental health
  agency
• Fee-for-service.  Most older adults do not have
  Medicaid and Medicare is insufficient
• Homebound- most services are not available in the
  home.

5
History of Mental Health and Aging Coalition in
Illinois
6
Illinois Coalition on Mental Health Aging

• Voluntary membership organization founded in
  1996
• Governed by professionals in the mental health
  and aging networks
• Regional caucuses represent North, Central, and
  Southern Regions of Illinois
• 50 current Members include AAAs, Community-Based
  Behavioral Healthcare Providers, Advocates, and
  Consumers.

7
Coalition Functions

• Promotes continuing education and
  interdisciplinary collaboration
• Plans the Annual Mental Health Aging Conference
  in partnership with the Illinois Department on
  Aging and the Illinois DHS - Division on Mental
  Health.
• Promotes systems integration among providers of
  primary health care and community-based mental
  health and aging services.
• Advocates for public policies that improve access
  to mental health services for older adults in
  Illinois.

8
Geriatric Advisory Council to the Division of
Mental Health

• Prior to start of the Coalition, the Illinois
  Department of Human Services organized
  legislatively mandated Geriatric Advisory Council
  in mid-1990s
• Completed needs assessment in 1997
• Developed white paper on mental health needs of
  older adults 2008

9
Geriatric Advisory Council Recommendations from
1998

• Enhance diagnostic skill regarding geriatric
  mental health
• Educate providers regarding proper medication
  usage (including information regarding drug
  interactions, side effects, and most effective
  medications)
• Improve understanding of the most common mental
  health issues for seniors
• Depression and anxiety
• Grief and loss
• Disseminate best practices
• Cross training with aging agencies needed

10
Geriatric Advisory Council Policy Paper

• Support and fund existing mental health hcbs
  programs statewide
• Support specialized funding for direct services
  to older adults
• Support programs that provide educations and
  training to professional

• Support integration of primary care and mh
• Support self neglect legislation
• Provide mental health training to staff at
  nursing homes

11
How AAAs in Illinois Use Title III for Counseling
12
How AAAs in Illinois Use Title III for Counseling

• Area Two Suburban Collar Counties
• Four agencies funded for mental health counseling
  using III B funds. This covers half of our
  service area.
• First agency funded in 1981
• 5859 units of service (one session)
• 783 different persons
• Total program budgets of 581,077 with 308,939
  IIIB dollars
• Covers on-going counseling for issues not covered
  by Medicare

13
How AAAs in Illinois Use Title III for Counseling

• Area Four Peoria area
• Received state funding for joint program with
  local substance abuse counseling center that
  funding is now ended
• Continue collaboration and in-home counseling
  program

14
Profile of ECIAAA and PSA 05

• East Central Illinois Area Agency on Aging, Inc.
• Planning and Service Area 05
• 16 counties
• Four Metropolitan Areas Bloomington-Normal
  Champaign-Urbana Decatur, and Danville.
• 12 predominantly rural counties
• 143,097 Persons 60 (ACS Estimates - 2007)
• 30 Community Programs on Aging serve 28,000
  persons 60 and 2,500 caregivers.

15
Senior Wellness Coalitions in Area 05

• ECIAAA established Mental Health Aging
  Coalitions in FY2001
• Broadened scope of Coalitions to include Senior
  Wellness in Area Plan for FY08-09-10
• Build public awareness about healthy aging
• Improve access to holistic health care mind,
  body, and spirit
• Disseminate evidence-based interventions.

16
Senior Wellness Coalitions in Action

• Interdisciplinary referrals and teamwork
• Improve access to mental health assessments,
  diagnostic services, and treatment
• Screenings for depression, anxiety, dementia
• Build self-determination, client acceptance, and
  resolution of ethical dilemmas
• Disseminate evidence-based Medication Management
  Improvement System

17
Senior Wellness Coalitions in Action

• Promote multi-disciplinary case work in response
  to reports of elder abuse, domestic violence, and
  self-neglect
• Improve community-based planning to address the
  mental health needs of seniors
• Promote collaboration with providers of primary
  health care and long-term care.
• Regional conferences for continuing education for
  professionals in mental health and aging.

18
Regional Coalition Building

• Regional Mental Health Aging Conference held on
  October 27, 2009 at Lake Land Community College
• Sponsored by Moultrie County Counseling Center
• Funded in part by the Lumpkin Family Foundation
• Attended by 75 professionals from the mental
  health and aging networks in East Central
  Illinois (Area 05)
• Sheila Greuel presented an introduction to PEARLS
• ECIAAA supports formation of a Regional Coalition
  on Mental Health and Aging for Area 05

19
Current Innovative Efforts in Service Delivery
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Older Adult Wraparound

• Located at Pillars serving near west suburban
  Cook County
• Unique aspects
• Comprehensive spectrum of services
• Defined planning process
• Involves older adult and family
• Community services and natural supports
• 50 with multiple needs in multiple domains
• Meet with clients in their home
• Comprehensive approach so clients dont fall
  through cracks in the system
• (add slide of contact information)

21
Older Adult Wraparound Team

• Client
• Team leader
• Family
• Therapist
• physician

• Senior case manager
• Visiting nurse
• Neighbors
• Friends
• Clergy
• Others as requested or needed

22
BRIGHTEN

• Bridging Resources of an Interdisciplinary
  Gero-mental Health Team via Electronic Networking
• SAMHSA Grant
• Located at Rush University on near west side of
  Chicago
• Identified as an at risk community by Chicago
  Department of Public Health based on
  socio-economic and health status indicators

23
BRIGHTEN

• The county health system is strained
• Concept is to identify older adults with mental
  health needs
• Train psychologists and social workers to provide
  specialty geriatric evidence based services
  provide base of support for client and base of
  support and training for providers

24
BRIGHTEN

• Unique aspects
• non-traditional interdisciplinary team
• Occupational therapy
• Physical therapy
• Dietician (most widely used team member by
  clients and families)
• Chaplains
• Nurses
• Connected through use of e-mail and telephone for
  virtual staffings

25
Innovative Programs in Illinois

• Chicago
• White Crane Wellness Center
• Funding through Chronic Disease Self Management
  Program AoA approved evidence based program)
  NCOA www.healthyagingprograms.org
• Senior center with innovative programs
• Comprehensive, holistic, community-based approach
  to chronic disease prevention
• Provide culturally and linguistically appropriate
  health and wellness services
• Sponsored by Covenant Methodist Senior Services -
  http//www.cmsschicago.org/services_daycare.asp
  http//www.whitecranewellness.org/

26
Innovative Programs in Illinois

• Counseling Center of Lakeview (north side of
  Chicago)
• Day Program psychosocial rehabilitation
• 21st Century Seniors
• Up to 5 days per week
• Human service professionals
• Art therapy
• holistic, prevention, wellness, self-sufficiency,
  relationship building, groups, education
• Also have home based program
• http//www.cclakeview.org/adult_psr.html

27
Innovative Programs in Illinois

• Tele-psychiatry project in western Illinois
• Able to enter more non-traditional sites such as
  senior centers and assisted living facilities
• Initial positive results seniors have not
  seemed to mind the electronic aspect of the
  service, some positives in distance

28
Gero-Psychiatric Initiative

• Began in 2001
• Pilot Program authorized by state law
• An award-winning best practice for the delivery
  of mental health services to older adults in
  collaboration with the Aging Network
• Currently operating in four PSAs in Illinois
  Southwestern Illinois (08) Midland(09)
  Southeastern Illinois (10) and Egyptian (11).

29
Gero-Psychiatric Initiative

• Supports Gero-Psych Specialist(s) in 5
  predominantly rural locations
• Specialists are qualified mental health
  professionals, e.g., LCSWs
• Hosted by community mental health centers
• Access to a psychiatrist board certified in
  geriatric psychiatry (minimum of 10 hours per
  month)
• Outreach to, and treatment for older adults
• Referral to, consultation with, and
  cross-training for professionals in the fields
  of mental health and aging.

30
Advocacy Issues

• Support parity in coverage for mental health
  services, e.g., Wellstone Act and MIPPA
• Support for mental health services as part of
  comprehensive national health care reform
• Support increases in federal appropriations for
  all OAA programs
• Support long-range planning and appropriations
  for community-based mental health and aging
  services in Illinois.

31
Long Range Goal for State Funding

• The Coalition advocates for the annual
  appropriation of 2,750,000 in state funds to
• Implement the Gero-Psychiatric Initiative
  statewide, and
• Allocate grant assistance to qualified
  community-based organizations to provide mental
  health services to older adults.

32
Mental Health Aging Summit

• The Illinois Coalition on Mental Health Aging
  convened the first Mental Health Aging Summit
  on June 29, 2009 in Chicago.
• Co-Sponsored by the Geriatric Advisory Committee
  to the DHS Division on Mental Health.
• Theme Building an Equitable System for Older
  Adults Making Recovery Real for Seniors.
• Hosted by the Community Mental Health Council in
  Chicago

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Summit Participants

• Illinois Coalition on Mental Health and Aging
• Illinois Geriatric Advisory Committee
• Illinois Department of Human Services/Division of
  Mental Health
• Illinois Department on Aging
• Illinois Association of Area Agencies on Aging
• Mental Health America of Illinois
• National Alliance on Mental Illness of Illinois
• Association of Community Mental Health
  Authorities of Illinois
• Chicago Senior Services/Area Agency on Aging
• Illinois Council of Case Coordination Units
• Illinois Association of LTC Ombudsmen
• Community Mental Health Council, Chicago
• Rush University Medical Center Older Adult
  Program
• Family Alliance
• Central Illinois Agency on Aging

34
Summit Take-Away Messages

• Although the State of Illinois faces a growing
  fiscal deficit, the Mental Health and Aging
  Networks have an abundance of wealth in human
  resources
• The fine art of juggling, i.e., the
  connectivity of physical and mental health
• Emerging needs across generations, e.g.,
  treatment of depression and prevention of suicide

35
Summit Take-Away Messages

• Fundamental belief in the connection of mind,
  body, and spirit
• Cultivate the resiliency of older adults
• Promote consumer choice and personal recovery
• Speak up, speak out, and get organized!
• Raise the mental health needs of older adults
  before the State Planning Council on Mental
  Health.

36
Summit Take-Away Messages

• Fight the tyranny of low expectations
• Link the mental health needs of older adults to
  national health care reform
• Uphold the following principles
• person-centered
• recovery-based
• evidence-based
• quality and
• equity.

37
Summit Take-Away Messages

• State budget cuts in behavioral health care will
  result in more persons with mental illness who
  are
• Homeless
• Incarcerated
• Visiting Hospital Emergency Rooms
• Admitted to Long-Term Care Facilities
• Victims of Self-Neglect
• Victims of Suicide

38
Summit Take-Away Messages

• The value of community-based programs in the
  Aging Network that promote nutrition, wellness,
  fitness, meaningful activities, and social
  interaction for older adults
• The role played by Case Coordination Units in
  conducting comprehensive assessments and care
  planning to link older adults to mental health
  diagnostic services and treatment.

39
Summit Take-Away Messages

• The need for continuity of mental health services
  for residents of all ages in long-term care
  facilities
• The value of Pioneer Practices in improving the
  quality of care and quality of life for nursing
  home residents
• The need for training, recruitment, and retention
  of qualified mental health professionals,
  especially in rural areas

40
Summit Take-Away Messages

• Greater collaboration and consultation with
  providers of primary health-care
• Invest more in tele-psychiatry
• Cultivate resiliency and mastery as protective
  factors for persons experiencing trauma as they
  grow older, including
• spirituality,
• personal integrity,
• a sense of purpose, and
• grand connections between generations

41
Burning Issues for 2010

• Nursing Home Safety Task Force recommendations
• State funding for community-based services for
  persons with mental illness and substance abuse
• State funding for home and community-based
  services for older adults and persons with
  disabilities
• State funding for IDPH nursing home surveyors and
  the Long Term Care Ombudsman Program
• Implementation of Money Follows the Person
• Supportive Housing for persons with mental
  illness and substance abuse.

42
Nursing Home Safety Task Force

• Website www2.illinois.gov/nursinghomesafety
• Hearings held October 20 and 29, 2009
• Most of 260,000 persons in Illinois diagnosed
  with two of the most serious mental illnesses
  schizophrenia and bipolar disorder are not
  living in any type of institution nor do they
  belong in one.
• 76,500 persons in 712 licensed nursing homes in
  IL
• 14,258 persons with mental illness in nursing
  homes
• 3,911 units of supportive housing for persons
  with MI

43
Nursing Home Safety Task Force

• Persons with MI are more likely to be victims of
  violence (25) than perpetrators of violence
  (4-13)
• In 1970s, Illinois transitioned 15,000 persons
  with MI from state mental institutions to the
  community
• In Illinois more than 5,500 persons with MI are
  housed in nursing facilities designated as IMDs
• Licensed nursing facilities have become the last
  refuge for persons with serious and persistent MI
• Only 36 of nursing home residents with
  psychiatric diagnosis receive mental health visits

44
Summary of Problems

• Source Testimony by Mark Heyrman representing
  Mental Health America of Illinois at Nursing Home
  Safety Task Force Hearing, October 20, 2009
• Serious problems involving placement of persons
  with MI in nursing homes include
• Inadequate intake screening and assessment
• Insufficient staff
• Staff lack training/expertise regarding
  diagnosis, assessment, and treatment of persons
  with MI

45
Summary of Problems

• Inadequate understanding of and monitoring of use
  of psychotropic medications
• Inadequate government oversight of quality and
  quantity of mental health services provided in
  nursing homes
• Absence of recovery focus and discharge planning
• Failure of nursing homes classified as IMDs and
  specialized mental health units within other
  nursing homes to comply with Illinois MH and DD
  Code and
• Unnecessary placement of persons with MI in
  nursing homes, particularly IMD nursing homes.

46
Recommendations

• Source Testimony by Mark Heyrman, Chair, Public
  Policy Committee, Mental Health America of
  Illinois
• Recommendations include
• Governor should settle the Williams vs.
  Blagojevich litigation to insure that only those
  persons who need institutional care are placed in
  nursing homes.
• IDPH should enforce the Muellner decision by
  enacting and enforcing specific new regulations.
• IDPH should hire more staff with mental health
  expertise to oversee nursing homes.

47
Recommendations

• The nine inpatient psychiatric facilities
  operated by the DHS Division of Mental Health
  should refrain from discharging persons to
  nursing homes unless the need for such placement
  is based on a condition other than a mental
  illness.
• Remove all persons from nursing homes who are
  there solely due to mental illness.
• Use the money saved from reducing the number of
  persons with MI in nursing homes to fund
  supportive housing, Assertive Community
  Treatment, peer support services, supported
  employment, and other recovery-oriented services.

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Economic Impact of State Budget
49
Contact Information

• Mike ODonnell
• Chairperson, Legislative Committee,
• Illinois Coalition on Mental Health and Aging,
  and
• Executive Director, East Central Illinois Area
  Agency on Aging
• 1003 Maple Hill Road
• Bloomington, IL 61705-9327
• Phone [phone], Ext. 211
• E-mail modonnell_at_eciaaa.org

50
Contact Information

• Patty Black, Pillars, 708-354-0826,
  pblack_at_pillarscommunity.org
• Anne Posner, AgeOptions, 708-383-0258,
  anne.posner_at_ageoptions.org
• Eric Weakly, Northeastern Illinois AAA,
  630-961-5090, eweakly_at_ageguide.org