As part of the growing attention and interest at all levels of government to advance geriatric mental health care, New York State enacted the Geriatric Mental Health Act on August 23, 2005.A  The law, which took effect on April 1, 2006, authorized the establishment of (1) an Interagency Geriatric Mental Health Planning Council, (2) a geriatric service demonstration program, and (3) a requirement for an annual report to the Governor and the Legislature.
The Council is to meet at least four times per calendar year to develop recommendations to be submitted to the Commissioner of the Office of Mental Health (OMH) and the Director of the State Office for the Aging (NYSOFA) regarding geriatric mental health needs. Fourteen members of the Council were appointed prior to its first meeting.A  The final appointment was still pending clearance. To support the provision of mental health services to the elderly, the Geriatric Mental Health Act called for OMH to establish a geriatric service demonstration program to provide grants, within appropriations, to providers of mental health care to the elderly.A  The program is administered by OMH in cooperation with NYSOFA. Staff training - programs which offer on-going training initiatives including improved clinical and cultural skills, evidence-based geriatric mental health skills, and the identification and management of mental, behavioral and substance abuse disorders among older adults.
Recommendations developed by three Council workgroups regarding priority areas to be addressed in the context of the demonstration projects were utilized in developing two Request for Proposals (RFPs) to invite eligible applicants to submit proposals for establishing demonstration projects. The Commissioner of OMH and the Director of NYSOFA are to jointly report to the Governor, the Temporary President of the Senate, and the Speaker of the Assembly no later than March 1, 2007, and annually thereafter, with a long-term plan regarding the geriatric mental health needs of the residents of the State and recommendations to address those needs.A  Recommendations may include those of the Interagency Geriatric Mental Health Planning Council. To address the need to improve the quality of mental health treatment available for older adults, priorities include the early identification of mental health issues, screening, assessment, and a€“ acknowledging the importance of research and translating research into practice a€“ the application of evidence-based and promising practices through interdisciplinary team work. Detect mental disorders and intervene with services before mental health problems become severe and jeopardize community tenure. Provide or make available a more detailed assessment of late life depression and intervention plans for older individuals who are screened for mental health needs. Utilize effective evidence-based interventions for late life psychiatric illnesses, such as major depression, minor depression, subthreshold depression, and generalized anxiety disorders.A  Evidence-based interventions may include medication or psychosocial interventions or their combination, such as antidepressant medication (SSRIs, SNRIs), problem solving therapy, cognitive behavioral therapy, and interpersonal therapy. Screening and referral for assessment, treatment, and support services should be available in locations such as senior apartments, assisted living, retirement communities, naturally occurring retirement communities (vertical or horizontal) and meals on wheels.


Examine models of integrated physical and mental health care for opportunities to improve care.A  Models of integrated physical and mental health care are varied and include co-located primary and mental health care, integrated teams of primary and mental health professionals, care management (including peer medical care management), training for primary care providers, and telepsychiatric support for primary care providers and specialists.
Integrated physical and mental health care is all the more important given a 2006 technical report from the National Association of State Mental Health Program Directors that concluded that people with serious mental illness served by public mental health systems died, on average, 25 years earlier than the general population.
Address the mental health needs of older adults with chronic disease.A  The unmet mental health needs of this population is a complicating factor in chronic disease management. Integrate services for older adults with co-occurring mental health, substance abuse, and chronic illness. Integrate mental health and aging services to expand mental health education, on-site screening, referral, and on-site treatment.A  Aging services programs which offer such opportunities include case management (such as expanded in-home services for the elderly), senior centers, naturally occurring retirement community a€“ supportive service programs (NORC-SSPs), and social adult day care. Support recipient wellness self-management practices that help individuals with mental illness cope more effectively and manage their symptoms, prevent relapse, reduce stress, strengthen social relationships, and support their own recovery. Include the mental health needs of older adults in discussions of long-term care reform, such as mega waiver, nursing home diversion and transition waiver, and single point of entry for long-term care services. Reflecting the focus of this annual report, the need to create services that assist older adults lead lives of dignity in the community in both rural and urban settings is a major priority.A  The importance of services and programs enabling older adults with behavioral health problems to age in their communities and prevent the unnecessary use of institutional care must be considered. Utilize new models such as telehealth and in-home screening, assessment, and treatment to increase the individual attention to personal health, mental health, and medication that is so important for service delivery to older adults.A  These models exist in New York State, particularly in home health care, naturally occurring retirement communities, and meals on wheels programs. Adapt community-based psychiatric rehabilitation models for individuals with serious and persistent mental illness to the developmental needs of older adults. Make available legal services in order to prevent eviction, obtain government entitlements, obtain home health services, and provide assistance with financial management. Make available the humane, end-of-life care needed to make continuing contact with community-based caregivers possible.


Family caregiving is a critical ingredient of community integration that itself requires care and support.A  The importance of providing respite and culturally competent psychoeducation and support for family caregivers in a variety of roles needs to be addressed. Provide culturally competent family support for minority communities.A  This is particularly important because many of these communities rarely place family members in institutions. Provide training in late life depression management for those who administer depression screening instruments to older adults.A  This is very important as the manner and methods employed to administer an instrument have significance on the validity of the screening results.
Support the effective integration of mental health and aging services by providing adequate training regarding mental health for aging services providers.
Provide ongoing training and supervision for community agencies on the implementation of specific evidence-based interventions and practices. Incorporate cultural competency, awareness, and sensitivity for a diverse and often specialized aging population in developing training or workforce development initiatives. Work with professional education programs on curricula development related to geriatric mental health.
Create incentives, such as loan forgiveness programs, for people to enter the workforce to help individuals with geriatric mental health needs.
Ongoing financial support and the development of fiscally viable program models is a critical ingredient in the creation of both core and innovative geriatric mental health services and programs that enable older adults with behavioral health problems to age in the community.
The financing mechanisms and fiscal viability of services and programs developed for older adults must be considered so that models can be replicated and sustained either by existing systems and resources, or through innovative financing models.



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