Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities

This report is designed to help State and local Olmstead coalitions understand the barriers that older adults face and learn about the innovative solutions being adopted and adapted across the country.

Most older adults (13% of the total U.S. population) with mental disorders live at home. However, among older adults with serious mental illnesses in institutions, 89 percent reside in nursing homes. Many older adults who left State psychiatric hospitals under deinstitutionalization were actually 'trans-institutionalized' into nursing homes. Community services for people with serious mental illnesses failed to materialize, and financial incentives, rather than individual needs or desires, drove placement decisions.

The Preadmission Screening and Resident Review (PASRR) provisions of the Nursing Home Reform Act of 1987 have led some States to identify people with serious mental illnesses who can be more appropriately treated in the community and plan services for them.

As a group, older adults receive only 6% of community mental health services. This population face barriers from payers, service providers, and social perceptions. Older adults with serious mental illnesses may be poorly served by managed care programs due to a lack of community support options that blend seamlessly with residential rehabilitation efforts. The plans may be structured to exclude individuals that have complex long-term care treatment needs. Many in this population remain unrecognized and untreated due to service system fragmentation and lack of coordination between mental health and primary care providers. When services are available, older adults face transportation, language, and cultural barriers. Housing options are limited and many live in facilities not designed for people with mental disorders.

For this population, caregiver stress is a risk factor for institutionalization. Specific, individualized, intensive interventions directed at relieving caregiver distress are more effective than generalized outreach efforts.

States and communities have implemented a number of evidence-based and promising practices for older adults with serious mental illnesses. These include the following:

• Routine screening and assessment by primary health care providers
  
   
• Home and Community-Based Mental Health Outreach Services
  
   
• Mental Health Treatment- pharmacological and psychosocial approaches
  
   
• Integrated Models of Service Delivery in Primary Care that enable primary care physicians to monitor all medications
  
   
• Community coalitions that coordinate the services and outreach efforts