The tsunami that devastated Thailand and much of Southeast Asia began as a wave of 6 inches. Rolling across the vast expanse of the Pacific Ocean that small wave grew until it reached landfall and destroyed entire towns and communities, killing over 250,000 people.
A similar wave and devastation are possible for our increasing senior population with the lack of attention they are receiving in behavioral health.
By 2050, the number of people on Medicare who are 80 and older will nearly triple; the number of people in their 90s and 100s will quadruple. This fact is the tsunami that is rapidly gaining steam and could overwhelm our health care budgets not to mention the huge cost in emotional and physical pain.
The Kaiser Family Foundation found that Medicare spending rises with age and peaks at 96, declining slightly at older ages. Spending at age 96 is $16,145, more than double the per capita spending at age 70 ($7,566). A far too small part, of that spending, is on behavioral health.
Trudy Persky, MSW, ACSW, Project Director for Mental Health and Aging in Philadelphia, writing for Mental Health and Aging that, “Seniors account for only 7 percent of all inpatient psychiatric services, 6 percent of community mental health services, and 9 percent of private psychiatric care.”
Our health care system is not responding to this need. According to Mental Health America only 3 percent of seniors, in need of behavioral health, are receiving care from mental health professionals. The majority of this vulnerable population is treated by primary care.
Connecticut, with a median age of 41 years, has the sixth oldest population per capita and growing. As such, statistics such as the 3 percent of seniors getting the mental health services they need will have a severe and growing impact.
Part of this paucity in care is due in part to this population, in particular, looking at mental health as a failure or it connotes a negative stigma. For much of the greatest generation and baby boomers, the idea of needing a “shrink” is abhorrent.
The other reason is both Medicaid and Medicare, as well as insurance companies, have not updated their reimbursement for these services and better understood both the costs and potential savings from a fully integrated behavioral health system.
This disparity in reimbursement between psychiatric and medical care deters many prospective mental health professionals from considering careers in geriatric mental health.
This needs to change. There must be a better integration between mental and physical health care.
Michael Freidman, LMSW, addressed this integration in an article Physical and Mental Health Nexus:”
“Because older adults with mental or substance use disorders frequently fail to realize they have a mental health problem, don’t know where to find a good mental health professional, or may be uncomfortable seeking help from a mental health professional, physical healthcare encounters may offer the only opportunities to identify mental or substance use disorders that would otherwise go unrecognized or untreated…Fortunately, there is increased recognition among healthcare providers—and even in the new healthcare reform legislation—of the importance of integrating physical and mental healthcare.”
Our seniors should not take a back seat when it comes to behavioral health. As a country we need to provide our seniors with health care that doesn’t just keep them alive, but lets them live.
“…the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. “
— Sen. Hubert H. Humphrey
Sen. Humphrey is right.
Ed Mercadante is the chief executive officer of MedOptions, a Connecticut based company that provides behavioral health services.