Mental Health Services
Access To Services
The older population underutilizes mental health services. Older adults represent nearly 13 percent of the U.S. population but account for only approximately 6 percent of those served by community mental health centers and only 5 percent of the clinical hours of psychiatrists (Colenda and van Dooren). Use of mental health services is affected by availability, appropriateness, eligibility, and affordability of services. Mental health services may be available, but not appropriate to the lifestyles, physical capacities, and social attitudes of older adults. Ethnic minorities are especially underserved, in part due to language and/or other cultural barriers. Older adults living in rural or inner-city areas are more likely to be isolated from mental health services.
Mental health coverage by Medicare, Medicaid, and private insurance is generally more limited than coverage for other health care services. A national movement to improve parity, or equality, in mental health coverage led to federal legislation (the Mental Health Parity Act of 1996), and ultimately to expanded Medicare and private insurance coverage. At the turn of the twenty-first century, continuing growth and changes in the managed care industry make the future of mental health care uncertain. The effects of managed care on mental health service access, quality, and outcomes are being studied. Meanwhile, an aging, expanding, and increasingly diverse older population will create new demands for mental health services.
KATHRYN B. MCGREW
COLENDA, C. C., and VAN DOOREN, H. "Opportunities for Improving Community Mental Health Services for Elderly Persons." Hospital and Community Psychiatry 44 (1993): 531–533.
FOGEL, B. S.; FURINO, A.; and GOTTLIEB, G. L. Mental Health Policy for Older Americans: Protecting Minds at Risk. Washington, D.C.: American Psychiatric Association, 1990.
KART, C. S., and KINNEY, J. M. The Realities of Aging, 6th ed. Boston: Allyn and Bacon, 2001.
SMYER, M. A., and QUALLS, S. H. Aging and Mental Health. Malden, Mass.: Blackwell Publishers, 1999.
STRAHAN, G. W., and BURNS, B. J. "Mental Illness in Nursing Homes: United States, 1985." Vital Health Statistics Series 13, no. 105 (1991).
U.S. Bureau of the Census. Aging in the United States: Past, Present, and Future. July, 1997. Available from www.census.gov
U.S. Surgeon General. Mental Health: A Report of the Surgeon General. 1999. Available from www.surgeongeneral.gov
ZARIT, S. H., and ZARIT, J. M. Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. New York: Guilford Press, 1998.