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Enhancing the Mental Health Delivery System for Elders in Illinois

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Title: 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
20
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

33
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.

48
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 309-829-6018, 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
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