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Following is a synthesis of the key themes that emerged from the surveys and data analyses:
- There is little recognition of the unique needs of older persons in existing mental health and substance abuse policies and systems.
- Older persons, their families, and health and social service providers often deny or don’t recognize mental health and substance abuse problems among older people.
- Mental health problems are pervasive and often go untreated in nursing and residential care facilities, as well as at home.
- It is very difficult to determine the full range of available resources and unmet needs because older persons with mental health needs are not tracked as a special population. This is true statewide and regionally.
- The responsibility for needs assessment, budgeting, program development, and delivery of publicly-funded mental health services is dispersed throughout DHS and DMHMRSAS. Also, the lack of coordination creates confusion, and results in barriers to service for both providers and consumers. This is also true at the state and regional levels.
- Older persons with both mental illness and dementia present a significant challenge to the service system especially when they have difficult behaviors.
- Services cannot be analyzed or compared because definitions and delivery methods vary from department to department, region to region, and provider to provider.
- Accurate and up-to-date information about mental health services for older persons in Maine is difficult to access or is not available
- Not all services are available statewide. The most significant needs include:
- Making psychogeriatric teams services available statewide, and expanding services to include substance abuse services.
- Home-based mental health and substance abuse services;
- Case management;
- Additional professionals with expertise in geriatrics;
- More training and support relating to geriatric issues for service providers and for caregivers;
- Mental health services for older persons for whom English is not a primary language, or who are hearing impaired;
- Substance abuse services specifically for older persons.
- Persons with late-onset mental illness are less likely to access traditional mental health services than those with chronic mental illness. Poor health, impaired mobility, and lack of social supports make it difficult for older persons to use traditional mental health services.
- Medicare’s low reimbursement rates and restrictions in private insurance policies limit the availability of mental health services for older Mainers.
- Medicare is a federally-administered program and data were not analyzed. However, Medicare may be significantly underutilized; despite its limitations, it is an important potential source of payment for services.
- Based on Medicaid claims data, approximately 86% of older consumers with a mental health diagnosis receive psychotropic medication without counseling or other supportive services. In addition, many older persons are receiving psychiatric medications without a diagnosis.
- There are no substance abuse services tailored to or funded specifically for older adults by DMHMRSAS’s Office of Substance Abuse (OSA).
- Services provided at home alleviate access barriers, and appear to be effective in helping older Mainers with depression and anxiety, and other mental illnesses.
- Cultural awareness should be part of all existing programs and program development efforts.
