1. Iowa Coalition on Mental Health and Aging June 22, 2010 June 22, 2010 Lila P.M. Starr Adult Mental Health Specialist Chairperson, NASMHPD Older Person Division Iowa Department of Human Services 1305 E. Walnut Hoover Building, 5 th Floor Des Moines, IA 50319 515-281-7270 Lstarr@dhs.state.ia.us

2. WELCOME To The…

3. ICMHA Mission The ICMHA exists to expand and improve mental health care for older Iowans so that they can live, learn, recreate, engage in meaningful activities and access appropriate services in the communities of their choice.

4. Olmstead Anniversary, Today!

5. Partners in today’s training

6. ICMHA Goals

7. Please Join the ICMHA You have the opportunity to sign up to be a member, join a workgroup, and receive periodic e-mail updates, training announcements, and meeting notices You have the opportunity to sign up to be a member, join a workgroup, and receive periodic e-mail updates, training announcements, and meeting notices There is NO COST to join There is NO COST to join Sign up and view the many excellent resources found on our website: www.icmha.org Sign up and view the many excellent resources found on our website: www.icmha.org www.icmha.org National Coalition on Mental Health and Aging: www.ncmha.org National Coalition on Mental Health and Aging: www.ncmha.orgwww.ncmha.org

8. These Ten things come to you from NASMHPD Older Persons Division These Ten things come to you from NASMHPD Older Persons Division The National Association of State Mental Health Program Directors: representatives from each State Mental Health Authority, who are the Commissioner designees to work on policy and practice issues around Mental Health for older citizens, make up the Older Persons Division The National Association of State Mental Health Program Directors: representatives from each State Mental Health Authority, who are the Commissioner designees to work on policy and practice issues around Mental Health for older citizens, make up the Older Persons Division Ten Things You Need to Know about Mental Health for Older Adults

9. #1 Co-Occurring Medical Illness is the Rule, Not the Exception Among older adults with depression, approximately: Among older adults with depression, approximately: 1 / 5 suffer from heart disease 1 / 5 suffer from heart disease 1 / 5 have diabetes 1 / 5 have diabetes 2 / 5 have arthritis 2 / 5 have arthritis 1 / 2 have hypertension 1 / 2 have hypertension Outcome: The presence of these chronic medical conditions complicates identification and treatment of depression and other mental illnesses in older adults

10. Co-Occurring Medical Illness is the Rule, Not the Exception

11. #2 Older Adults Take Multiple Medications and their Bodies Handle the Medication Dosages & Substances Differently than Younger Bodies

12. Older Adults Take Multiple Medications…

13. #3 Mental & Physical Functioning Varies Widely Among Older Adults of the Same Age

14. Mental & Physical Functioning Varies Widely Among Older Adults of the Same Age

15. #4 Importance of Coordination and Collaboration between Behavioral Health, Aging, & Medical Health Providers

16. Importance of Coordination and Collaboration For older adults with mental illness, in may be unrealistic to add another complicated layer of self management by adding mental health care, psychotherapeutic medication management, the psychiatrist, and the mental health case manager For older adults with mental illness, in may be unrealistic to add another complicated layer of self management by adding mental health care, psychotherapeutic medication management, the psychiatrist, and the mental health case manager Older adults with mental illness often fail to receive appropriate and effective treatment within fragmented delivery systems. Older adults with mental illness often fail to receive appropriate and effective treatment within fragmented delivery systems.

17. Importance of Coordination and Collaboration

18. #5 Family Members & Other Social Supports are Critical to Successful Treatment Many older adults receive informal caregiving services from family members Many older adults receive informal caregiving services from family members Daughters, Daughters-in-Law, Spouses, and Sons contribute to caring for older family members Daughters, Daughters-in-Law, Spouses, and Sons contribute to caring for older family members Friends, neighbors, and other community members provide essential services and often act as an early warning system for vulnerable and isolated elders. Friends, neighbors, and other community members provide essential services and often act as an early warning system for vulnerable and isolated elders. Family members may be important providers of Transportation, Activities of Daily Living, Medication Management, and Medical Care Scheduling Family members may be important providers of Transportation, Activities of Daily Living, Medication Management, and Medical Care Scheduling These family members should be included in treatment planning. These family members should be included in treatment planning.

19. Family Members & Other Social Supports

20. #6 Maintaining Independence and Aging in Place is a Commonly Held Value Older adults want to “age in place” to the extent that is possible. Older adults want to “age in place” to the extent that is possible. Treatment of Depression should support the independent community functioning of the individual Treatment of Depression should support the independent community functioning of the individual This should include a discussion regarding the potential risks of continuing to live at home, both with and without services. This should include a discussion regarding the potential risks of continuing to live at home, both with and without services. The desire to remain at home can be a real motivator for making needed changes. The desire to remain at home can be a real motivator for making needed changes.

21. Maintaining Independence and Aging in Place is a Commonly Held Value

22. #7 Prevention of Depression in Older Adults is Possible

23. Prevention of Depression in Older Adults is Possible

24. # 8 Ageism is Everywhere and Affects Treatment Expectations and Outcomes

25. Ageism is Everywhere and Affects Treatment Expectations and Outcomes

26. #9 Older Adult Depression is Associated with the Highest Rate of Suicide Older adults have the highest rates of dying by suicide of any age group. Older adults have the highest rates of dying by suicide of any age group. Overall males die by suicide at rates 4:1 over females Overall males die by suicide at rates 4:1 over females The suicide rate for people age 85+ is twice the national rate The suicide rate for people age 85+ is twice the national rate White males over the age of 85 have the highest rates of suicide White males over the age of 85 have the highest rates of suicide

27. Older Adult Depression is Associated with the Highest Rate of Suicide

28. # 10 Psychotherapy Can Be Just as Effective as Medications, but Needs to Be Individually Tailored for Older Adults Psychotherapy Works Psychotherapy Works Adaptation and modifications are necessary when working with older adults who may have hearing impairment, cognitive impairment, or medication management issues Adaptation and modifications are necessary when working with older adults who may have hearing impairment, cognitive impairment, or medication management issues Simple modifications such as repetition, breaking tasks into smaller units, speaking clearly, reducing background noise, and using appropriate names (For example, Mr. or Mrs.) can overcome some of the barriers Simple modifications such as repetition, breaking tasks into smaller units, speaking clearly, reducing background noise, and using appropriate names (For example, Mr. or Mrs.) can overcome some of the barriers

29. Psychotherapy Can Be Just as Effective as Medications, but Needs to Be Individually Tailored for Older Adults

30. RESOURCES FOR AGING AND COMMON MENTAL HEALTH AND CO-MORBID DISORDERS Websites: Administration on Aging: http://www.aoa.gov Administration on Aging: http://www.aoa.govhttp://www.aoa.gov American Association for Geriatric Psychiatry: http://www.aagponline.org American Association for Geriatric Psychiatry: http://www.aagponline.org http://www.aagponline.org American Geriatrics Society: http://www.americangeriatrics.org American Geriatrics Society: http://www.americangeriatrics.orghttp://www.americangeriatrics.org American Society on Aging: http://www.asaging.org American Society on Aging: http://www.asaging.orghttp://www.asaging.org Center for the Study and Prevention of Suicide: http://www.rochesterpreventsuicide.org Center for the Study and Prevention of Suicide: http://www.rochesterpreventsuicide.org http://www.rochesterpreventsuicide.org Geriatric Mental Health Foundation: http://www.gmhfonline.org Geriatric Mental Health Foundation: http://www.gmhfonline.org http://www.gmhfonline.org Gerontological Society of America: http://www.geron.org Gerontological Society of America: http://www.geron.orghttp://www.geron.org National Association of Geriatric Education Centers: http://www.nagec.org National Association of Geriatric Education Centers: http://www.nagec.org http://www.nagec.org National Council on Aging: http://www.ncoa.org National Council on Aging: http://www.ncoa.orghttp://www.ncoa.org Older American’s Substance Abuse and Mental Health Technical Assistance Center: http:// www.samhsa.gov/OlderAdultsTAC Older American’s Substance Abuse and Mental Health Technical Assistance Center: http:// www.samhsa.gov/OlderAdultsTAChttp:// www.samhsa.gov/OlderAdultsTAChttp:// www.samhsa.gov/OlderAdultsTAC Positive Aging Resource Center: http://www.positiveaging.org Positive Aging Resource Center: http://www.positiveaging.orghttp://www.positiveaging.org

31. ADDITIONAL RESOURCES FOR AGING AND COMMON MENTAL HEALTH AND MULTI- OCCURING DISORDERS Older Adults: Depression and Suicide Facts: http://www.nimh.nih.gov/publicat/elderlydepsuicide.cf m Older Adults: Depression and Suicide Facts: http://www.nimh.nih.gov/publicat/elderlydepsuicide.cf m http://www.nimh.nih.gov/publicat/elderlydepsuicide.cf m http://www.nimh.nih.gov/publicat/elderlydepsuicide.cf m Facts about Depression in Older Adults: http://www.apa.org/ppo/issues/olderpressfact.html Facts about Depression in Older Adults: http://www.apa.org/ppo/issues/olderpressfact.html http://www.apa.org/ppo/issues/olderpressfact.html Late-Life Depression: A Fact Sheet: http://www.gmhfonline.org/gmhf/consumer/factsheets /depression_factsheet.html Late-Life Depression: A Fact Sheet: http://www.gmhfonline.org/gmhf/consumer/factsheets /depression_factsheet.html http://www.gmhfonline.org/gmhf/consumer/factsheets /depression_factsheet.html http://www.gmhfonline.org/gmhf/consumer/factsheets /depression_factsheet.html Depression and Older Americans: http://www.nmha.org/ccd/support/factsheet.older.cfm Depression and Older Americans: http://www.nmha.org/ccd/support/factsheet.older.cfm http://www.nmha.org/ccd/support/factsheet.older.cfm

32. PLEASE JOIN ICMHA! Please remember to visit the website, www.icmha.org, and simply sign up! Please remember to visit the website, www.icmha.org, and simply sign up! www.icmha.org Or, “check off” the YES available to you today, with your sign in sheet Or, “check off” the YES available to you today, with your sign in sheet You’ll receive regular e-mails about training opportunities, meeting notices, work groups, and policy issues at state and national level You’ll receive regular e-mails about training opportunities, meeting notices, work groups, and policy issues at state and national level

33. IOWA COALITION ON MENTAL HEALTH AND AGING Lila P.M. Starr Adult Mental Health Specialist Chairperson, NASMHPD Older Person Division Iowa Department of Human Services 1305 E. Walnut Hoover Building, 5 th Floor Des Moines, IA 50319 515-281-7270 Lstarr@dhs.state.ia.us