Can the Nation Support Boomers' Mental Health Needs?
A new report concludes that boomers with depression and drug addiction will soon overwhelm the health care system
The mental-health needs of the baby-boomer generation are destined to overwhelm the country's health care system in the years ahead, according to a troubling new government report.
The study by the Institute of Medicine of the National Academies in Washington, D.C., says that as many as 1 in 5 Americans age 65 and older has a mental-health or substance-abuse problem — 5.6 million to 8 million seniors in all.
And it's going to get much worse: The number of Americans who are 65 or older is expected to rise from about 40 million to 72 million by 2030 — and the next generation of seniors, all of them baby boomers, already has higher rates of mental illness and drug abuse than the previous generation.
As a result, the study concludes, millions of boomers may be unable to find mental-health professionals trained to help them.
"There'll never be enough geriatric psychiatrists or geriatric medicine specialists to take care of this huge wave of people," Dr. Paul Kirwin, president of the American Association for Geriatric Psychiatry, told the Associated Press.
With the health-care industry focusing its resources on the physical needs of aging boomers, "the burden of mental illness and substance abuse disorders in older adults in the United States borders on a crisis," writes Dr. Dan Blazer of Duke University, who chaired the panel that produced the report. "Yet this crisis is largely hidden from the public and many of those who develop policy and programs to care for older people."
Experts commenting on the report bemoaned that even today, people over 65 are undertreated for mental illness, partly because those conditions may be connected to, or overshadowed by, other health concerns.
Too few medical professionals are properly trained to recognize and treat mental disorders in seniors in the context of other health concerns. But insufficient treatment of these issues has other ramifications. People with untreated depression, for example, tend to be less likely to control diabetes, high blood pressure and other physical woes, leading to more expensive treatment overall.
The shortage of professionals trained to deal with mental health and substance use, or MH/SU, among older Americans is just one piece of a looming crisis in geriatric medicine, including a critical shortage of primary-care geriatricians in the United States, as Next Avenue recently reported.
"Across the workforce, there is little, if any, training in geriatric MH/SU," the new report states. "MH/SU specialists are not trained in geriatrics, and geriatric specialists are not trained in MH/SU. Primary care and other essential providers are not trained in either area."
The new report suggests that all health workers who deal with older patients — including primary care physicians, nurses, physicians' assistants and social workers — receive basic training to recognize mental illness and substance abuse and provide basic care. The authors also recommend changes in how Medicare and Medicaid pay for mental health services as well as stricter licensing requirements for health workers and additional government financing for training programs.
The report's dire conclusion:
For decades, policymakers have been warned that the nation's health care workforce is ill-equipped — in numbers, knowledge and skills — to care for a rapidly aging and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity and lack of basic competence and core knowledge in key areas. These past calls to remedy inadequate training and to reverse serious shortages of personnel for MH/SU care have gone unheeded.
The breadth and magnitude of the problem have grown to such proportions that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action.