Mental illness often goes underdiagnosed and undertreated within the older adult population, and this is a growing concern as more Americans begin to join this demographic, specifically the Baby Boom generation, who have higher rates of psychiatric disorders than previous generations of older adults.
A recent review in the Journal of Aging and Social Policy summarizes the current state of mental health as it relates to aging, citing some reasons why mental health care for older adults is lacking in the United States, and pointing to opportunities for potential collaboration and improvement. The authors present a history older adult mental health care to the present day, stating it is far from a single system of care, rather, it is “a hodgepodge of discrete care systems backed by private, voluntary, and public powers.”
Other than a brief period during the 1960s and 1970s, the responsibility for mental health administration has been held by states and various private health care organizations. Although most of the mental health care provided to older adults in the United States is funded by the national public through Medicare and Medicaid, this care is operated by state and private agencies whose models for care and methods of assessment and treatment vary widely.
Generally, older adults with mental health disorders are the least likely age group to receive specialty mental health care. This is problematic because mental health assessment and treatment is more complex for older adults, due to the higher rates of dementia and other medical problems. The lack of a coordinated system of mental health care for older adults means that many are treated by providers who do not specialize in their needs.
Despite the problems resulting from the complexity of the situation, there are some areas where care provision has improved, and where potential collaborations might emerge. Our understanding of the various causes and pathways of dementia is rapidly improving, and with it, our assessment of older adult mental health issues is leading to new treatments. The authors point to research that has shown that informal, ground-level collaborations between health care providers in some communities in the United States has led to increased use of mental health services by older adults. This informal collaboration may be a beginning in the development of formally coordinated responses at the national level, although the current cost-cutting climate is far from conducive to such collaboration. Overall, this article offers a useful summary of developments in older adult mental health care.