Enhancing the Mental Health Delivery System for Elders in Illinois

1. Enhancing the Mental Health Delivery System for Elders in Illinois Illinois Governor’s Conference 2009 • Anne Posner, Age Options • Patty Black, Pillars • Mike O’Donnell, Executive Director, ECIAAA • Eric Weakly, Community Planner, NEIL AAA

2. Presentation Points • Background • History of Illinois Coalition on Mental Health and Aging and Geriatric Advisory Council • Description of Current System and Demonstration Projects in Illinois • Advocacy Efforts • Facilitate Discussion on Coalition Building and other local efforts

3. The Facts About Mental Health and Aging • 18-25% of older adults experience a mental health issues that is not a normal part of aging • 25% of older adults experience depression • people age 65 and older have 6 times the suicide rate of the general population • most older adults continue to go to the primary care doctor for help, but primary care physicians rarely identify issues as mental health relate • 50-70% of all primary care medical visits are related to psychological factors- anxiety, stress, depression • 40-90% of mental health problems are not detected by primary care

4. The Facts About Mental Health and Aging • as people age issues become more complex • co-occurring issues • Mental health issues from earlier in their lives that has never been diagnosed or treated- aging can make this more complex. • Barriers to service for older adults • older adults don’t tend to self identify • Stigma- not wanting to go to a mental health agency • Fee-for-service.  Most older adults do not have Medicaid and Medicare is insufficient • Homebound- most services are not available in the home.

5. History of Mental Health and Aging Coalition in Illinois

6. Illinois Coalition on Mental Health & Aging Voluntary membership organization founded in 1996; Governed by professionals in the mental health and aging networks; Regional caucuses represent North, Central, and Southern Regions of Illinois; 50 current Members include AAAs, Community-Based Behavioral Healthcare Providers, Advocates, and Consumers.

7. Coalition Functions Promotes continuing education and interdisciplinary collaboration; Plans the Annual Mental Health & Aging Conference in partnership with the Illinois Department on Aging and the Illinois DHS - Division on Mental Health. Promotes systems integration among providers of primary health care and community-based mental health and aging services. Advocates for public policies that improve access to mental health services for older adults in Illinois.

8. Geriatric Advisory Council to the Division of Mental Health • Prior to start of the Coalition, the Illinois Department of Human Services organized legislatively mandated Geriatric Advisory Council in mid-1990s • Completed needs assessment in 1997 • Developed white paper on mental health needs of older adults – 2008

9. Geriatric Advisory Council Recommendations from 1998 • Enhance diagnostic skill regarding geriatric mental health • Educate providers regarding proper medication usage (including information regarding drug interactions, side effects, and most effective medications) • Improve understanding of the most common mental health issues for seniors: • Depression and anxiety • Grief and loss • Disseminate best practices • Cross training with aging agencies needed

10. Support and fund existing mental health hcbs programs statewide Support specialized funding for direct services to older adults Support programs that provide educations and training to professional Support integration of primary care and mh Support self neglect legislation Provide mental health training to staff at nursing homes Geriatric Advisory Council Policy Paper

11. How AAAs in Illinois Use Title III for Counseling

12. How AAAs in Illinois Use Title III for Counseling • Area Two – Suburban Collar Counties • Four agencies funded for mental health counseling using III B funds. This covers half of our service area. • First agency funded in 1981 • 5859 units of service (one session) • 783 different persons • Total program budgets of $581,077 with $308,939 IIIB dollars • Covers on-going counseling for issues not covered by Medicare

13. How AAAs in Illinois Use Title III for Counseling • Area Four – Peoria area • Received state funding for joint program with local substance abuse counseling center – that funding is now ended • Continue collaboration and in-home counseling program

14. Profile of ECIAAA and PSA 05 East Central Illinois Area Agency on Aging, Inc. Planning and Service Area 05 16 counties Four Metropolitan Areas: Bloomington-Normal; Champaign-Urbana; Decatur, and Danville. 12 predominantly rural counties 143,097 Persons 60+ (ACS Estimates - 2007) 30 Community Programs on Aging serve 28,000 persons 60+ and 2,500 caregivers.

15. Senior Wellness Coalitions in Area 05 ECIAAA established Mental Health & Aging Coalitions in FY2001; Broadened scope of Coalitions to include Senior Wellness in Area Plan for FY08-09-10; Build public awareness about healthy aging Improve access to holistic health care – mind, body, and spirit; Disseminate evidence-based interventions.

16. Senior Wellness Coalitions in Action Interdisciplinary referrals and teamwork; Improve access to mental health assessments, diagnostic services, and treatment; Screenings for depression, anxiety, dementia; Build self-determination, client acceptance, and resolution of ethical dilemmas; Disseminate evidence-based Medication Management Improvement System

17. Senior Wellness Coalitions in Action Promote multi-disciplinary case work in response to reports of elder abuse, domestic violence, and self-neglect; Improve community-based planning to address the mental health needs of seniors; Promote collaboration with providers of primary health care and long-term care. Regional conferences for continuing education for professionals in mental health and aging.

18. Regional Coalition Building • Regional Mental Health & Aging Conference held on October 27, 2009 at Lake Land Community College • Sponsored by Moultrie County Counseling Center • Funded in part by the Lumpkin Family Foundation • Attended by 75 professionals from the mental health and aging networks in East Central Illinois (Area 05) • Sheila Greuel presented an introduction to PEARLS • ECIAAA supports formation of a Regional Coalition on Mental Health and Aging for Area 05

19. Current Innovative Efforts in Service Delivery

20. Older Adult Wraparound • Located at Pillars – serving near west suburban Cook County • Unique aspects • Comprehensive spectrum of services • Defined planning process • Involves older adult and family • Community services and natural supports • 50+ with multiple needs in multiple domains • Meet with clients in their home • Comprehensive approach so clients don’t fall through cracks in the system • (add slide of contact information)

21. Client Team leader Family Therapist physician Senior case manager Visiting nurse Neighbors Friends Clergy Others as requested or needed Older Adult Wraparound Team

22. BRIGHTEN • Bridging Resources of an Interdisciplinary Gero-mental Health Team via Electronic Networking • SAMHSA Grant • Located at Rush University on near west side of Chicago • Identified as an at risk community by Chicago Department of Public Health based on socio-economic and health status indicators

23. BRIGHTEN • The county health system is strained • Concept is to identify older adults with mental health needs • Train psychologists and social workers to provide specialty geriatric evidence based services – provide base of support for client and base of support and training for providers

24. BRIGHTEN • Unique aspects • non-traditional interdisciplinary team • Occupational therapy • Physical therapy • Dietician (most widely used team member by clients and families) • Chaplains • Nurses • Connected through use of e-mail and telephone for virtual staffings

25. Innovative Programs in Illinois • Chicago • White Crane Wellness Center • Funding through Chronic Disease Self Management Program – AoA approved evidence based program) NCOA – www.healthyagingprograms.org • Senior center with innovative programs • Comprehensive, holistic, community-based approach to chronic disease prevention • Provide culturally and linguistically appropriate health and wellness services • Sponsored by Covenant Methodist Senior Services - http://www.cmsschicago.org/services_daycare.asphttp://www.whitecranewellness.org/

26. Innovative Programs in Illinois • Counseling Center of Lakeview (north side of Chicago) • Day Program – psychosocial rehabilitation • 21st Century Seniors • Up to 5 days per week • Human service professionals • Art therapy • holistic, prevention, wellness, self-sufficiency, relationship building, groups, education • Also have home based program • http://www.cclakeview.org/adult_psr.html

27. Innovative Programs in Illinois • Tele-psychiatry project in western Illinois • Able to enter more non-traditional sites such as senior centers and assisted living facilities • Initial positive results – seniors have not seemed to mind the electronic aspect of the service, some positives in distance

28. Gero-Psychiatric Initiative Began in 2001 Pilot Program authorized by state law An award-winning best practice for the delivery of mental health services to older adults in collaboration with the Aging Network Currently operating in four PSAs in Illinois: Southwestern Illinois (08); Midland(09); Southeastern Illinois (10); and Egyptian (11).

29. Gero-Psychiatric Initiative Supports Gero-Psych Specialist(s) in 5 predominantly rural locations; Specialists are qualified mental health professionals, e.g., LCSWs; Hosted by community mental health centers; Access to a psychiatrist – board certified in geriatric psychiatry (minimum of 10 hours per month); Outreach to, and treatment for older adults; Referral to, consultation with, and cross-training for professionals in the fields of mental health and aging.

30. Support parity in coverage for mental health services, e.g., Wellstone Act and MIPPA; Support for mental health services as part of comprehensive national health care reform; Support increases in federal appropriations for all OAA programs; Support long-range planning and appropriations for community-based mental health and aging services in Illinois. Advocacy Issues

31. Long Range Goal for State Funding • The Coalition advocates for the annual appropriation of $2,750,000 in state funds to: • Implement the Gero-Psychiatric Initiative statewide, and • Allocate grant assistance to qualified community-based organizations to provide mental health services to older adults.

32. Mental Health & Aging Summit The Illinois Coalition on Mental Health & Aging convened the first Mental Health & Aging Summit on June 29, 2009 in Chicago. Co-Sponsored by the Geriatric Advisory Committee to the DHS Division on Mental Health. Theme: “Building an Equitable System for Older Adults: Making Recovery Real for Seniors.” Hosted by the Community Mental Health Council in Chicago

33. Summit Participants • Illinois Coalition on Mental Health and Aging • Illinois Geriatric Advisory Committee • Illinois Department of Human Services/Division of Mental Health • Illinois Department on Aging • Illinois Association of Area Agencies on Aging • Mental Health America of Illinois • National Alliance on Mental Illness of Illinois • Association of Community Mental Health Authorities of Illinois • Chicago Senior Services/Area Agency on Aging • Illinois Council of Case Coordination Units • Illinois Association of LTC Ombudsmen • Community Mental Health Council, Chicago • Rush University Medical Center Older Adult Program • Family Alliance • Central Illinois Agency on Aging

34. Summit Take-Away Messages Although the State of Illinois faces a growing fiscal deficit, the Mental Health and Aging Networks have an abundance of wealth in human resources; The fine art of “juggling”, i.e., the connectivity of physical and mental health Emerging needs across generations, e.g., treatment of depression and prevention of suicide;

35. Summit Take-Away Messages Fundamental belief in the connection of mind, body, and spirit; Cultivate the “resiliency” of older adults; Promote consumer choice and personal recovery; Speak up, speak out, and get organized! Raise the mental health needs of older adults before the State Planning Council on Mental Health.

36. Summit Take-Away Messages • Fight the “tyranny of low expectations;” • Link the mental health needs of older adults to national health care reform; • Uphold the following principles: • person-centered; • recovery-based; • evidence-based; • quality; and • equity.

37. Summit Take-Away Messages • State budget cuts in behavioral health care will result in more persons with mental illness who are: • Homeless • Incarcerated • Visiting Hospital Emergency Rooms • Admitted to Long-Term Care Facilities • Victims of Self-Neglect • Victims of Suicide

38. Summit Take-Away Messages The value of community-based programs in the Aging Network that promote nutrition, wellness, fitness, meaningful activities, and social interaction for older adults; The role played by Case Coordination Units in conducting comprehensive assessments and care planning to link older adults to mental health diagnostic services and treatment.

39. Summit Take-Away Messages The need for continuity of mental health services for residents of all ages in long-term care facilities; The value of “Pioneer Practices” in improving the quality of care and quality of life for nursing home residents; The need for training, recruitment, and retention of qualified mental health professionals, especially in rural areas;

40. Summit Take-Away Messages • Greater collaboration and consultation with providers of primary health-care; • Invest more in tele-psychiatry • Cultivate “resiliency and mastery” as protective factors for persons experiencing trauma as they grow older, including: • spirituality, • personal integrity, • a sense of purpose, and • “grand connections” between generations

41. Burning Issues for 2010 • Nursing Home Safety Task Force recommendations; • State funding for community-based services for persons with mental illness and substance abuse; • State funding for home and community-based services for older adults and persons with disabilities; • State funding for IDPH nursing home surveyors and the Long Term Care Ombudsman Program; • Implementation of Money Follows the Person; • Supportive Housing for persons with mental illness and substance abuse.

42. Nursing Home Safety Task Force Website: www2.illinois.gov/nursinghomesafety Hearings held October 20 and 29, 2009 Most of 260,000 persons in Illinois diagnosed with two of the most serious mental illnesses – schizophrenia and bipolar disorder – are not living in any type of institution; nor do they belong in one. 76,500 persons in 712 licensed nursing homes in IL 14,258 persons with mental illness in nursing homes 3,911 units of supportive housing for persons with MI

43. Nursing Home Safety Task Force Persons with MI are more likely to be victims of violence (25%) than perpetrators of violence (4-13%) In 1970s, Illinois transitioned 15,000 persons with MI from state mental institutions to the community In Illinois more than 5,500 persons with MI are housed in nursing facilities designated as IMDs Licensed nursing facilities have become the last refuge for persons with serious and persistent MI Only 36% of nursing home residents with psychiatric diagnosis receive mental health visits

44. Summary of Problems Source: Testimony by Mark Heyrman representing Mental Health America of Illinois at Nursing Home Safety Task Force Hearing, October 20, 2009 Serious problems involving placement of persons with MI in nursing homes include: Inadequate intake screening and assessment Insufficient staff Staff lack training/expertise regarding diagnosis, assessment, and treatment of persons with MI

45. Summary of Problems Inadequate understanding of and monitoring of use of psychotropic medications; Inadequate government oversight of quality and quantity of mental health services provided in nursing homes; Absence of recovery focus and discharge planning; Failure of nursing homes classified as IMDs and specialized mental health units within other nursing homes to comply with Illinois MH and DD Code; and Unnecessary placement of persons with MI in nursing homes, particularly IMD nursing homes.

46. Recommendations Source: Testimony by Mark Heyrman, Chair, Public Policy Committee, Mental Health America of Illinois Recommendations include: Governor should settle the Williams vs. Blagojevich litigation to insure that only those persons who need institutional care are placed in nursing homes. IDPH should enforce the Muellner decision by enacting and enforcing specific new regulations. IDPH should hire more staff with mental health expertise to oversee nursing homes.

47. Recommendations The nine inpatient psychiatric facilities operated by the DHS Division of Mental Health should refrain from discharging persons to nursing homes unless the need for such placement is based on a condition other than a mental illness. Remove all persons from nursing homes who are there solely due to mental illness. Use the money saved from reducing the number of persons with MI in nursing homes to fund supportive housing, Assertive Community Treatment, peer support services, supported employment, and other recovery-oriented services.

48. Economic Impact of State Budget

49. Contact Information Mike O’Donnell Chairperson, Legislative Committee, Illinois Coalition on Mental Health and Aging, and Executive Director, East Central Illinois Area Agency on Aging 1003 Maple Hill Road Bloomington, IL 61705-9327 Phone: 309-829-6018, Ext. 211 E-mail: modonnell@eciaaa.org

50. Contact Information • Patty Black, Pillars, 708-354-0826, pblack@pillarscommunity.org • Anne Posner, AgeOptions, 708-383-0258, anne.posner@ageoptions.org • Eric Weakly, Northeastern Illinois AAA, 630-961-5090, eweakly@ageguide.org