As many of our readers know by now, our 2011 Annual Report features our work to address the mental health needs of older Americans. You can view the report online here, and we have begun running blog stories and associated videos that try to capture the experience of older people with mental illness who have benefited from foundation-sponsored programs. I am very proud of this work and the report.

It is just icing on the cake that shortly after the release of our mental health–focused annual report, the Institute of Medicine (IOM) released its examination of related workforce issues, called "The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?" The report explicitly frames itself as a follow-up to the 2008 Hartford Foundation co-sponsored IOM report, "Retooling for an Aging America: Building the Health Care Workforce." The new study committee included many friends of the Foundation — including its Chair, Dan Blazer, who served with distinction on our Beeson Advisory Committee for many years; Chris Callahan, an early Beeson scholar and aging research leader at Indiana University (a Center of Excellence); Kitty Buckwalter, the recently retired director of our Center of Geriatric Nursing Excellence at the University of Iowa; and long-time colleagues Fred Blow and Steve Bartels of the University of Michigan and Dartmouth, respectively.

I greatly respect the fellows of the IOM who produced the report and I agree with their recommendations (listed below) — how could I not? The new recommendations are essentially rephrasings of the recommendations of the 2008 Retooling report, focusing on the subset of the geriatric health care workforce serving patients with mental health/substance needs. I hope that this time government and professions leaders will listen. I hope that the workforce provisions of the Affordable Care Act will be funded (and expanded) and I hope that as a society we will make the shift in workforce training and deployment that we need to support the well-being and independence of older adults.

But I have to admit to feeling the same ambivalence about this report that I experience when people take special notice of our mental health work. I can't help but think that separating out our work on mental health for special praise (or sometimes disapproval) reflects either an internalization of the persistent stigma around mental illness or a willful blindness to the realities of aging and health. People's needs don't fall into simple mental health versus physical health categories. Especially in late life, all kinds of health are connected: care must be continuous, comprehensive, coordinated, and geriatrically expert.

Therefore, how could we NOT be concerned about mental illness — in just the same way that we are concerned with cardiovascular disease, diabetes, and Alzheimer's disease. Mental illnesses are just as real and unfortunately just as common as many of the other chronic illnesses that complicate older adults’ lives. All of our work is about improving the health of older adults, regardless of the profession or disease/syndrome/condition under consideration. I very much doubt that the members of the new IOM report’s committee (or anyone else) would be pleased if there were to be major investments in geriatric mental health workforce, but the rest of the geriatric workforce was left behind. Let’s implement not only these recommendations, but those from Retooling as well so we can offer integrated, coordinated mental AND physical health care to all older adults.

Summary Recommendations

1. Congress should direct the Secretary of the Department of Health and Human Services (HHS) to designate a responsible entity for coordinating federal efforts to develop and strengthen the nation's geriatric mental health substance use (MH/SU) workforce.
2. The Secretary of HHS should ensure that its agencies — including the Agency for Healthcare Research and Quality, Administration on Aging, Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), National Institute on Drug Abuse, National Institute on Mental Health (NIMH), and Substance Abuse and Mental Health Services Administration (SAMHSA) — assume responsibility for building the capacity and facilitating the deployment of the MH/SU workforce for older Americans.
3. Organizations responsible for the accreditation, certification, and professional examination, and state licensing boards should modify their standards, curriculum requirements, and credentialing procedures to require professional competence in geriatric MH/SU for all levels of personnel that care for the diversity of older adults.
4. Congress should appropriate funds for the Patient Protection and Affordable Care Act workforce provisions that authorize training, scholarship, and loan forgiveness for individuals who work with or are preparing to work with older adults who have MH/SU conditions. This funding should be targeted with curricula in geriatric MH/SU and directed specifically to the following types of workers who make a commitment to caring for older adults who have MH/SU conditions: [pretty much everybody]
5. HHS should direct a responsible entity (as described above) to develop and coordinate implementation of a data collection and reporting strategy for geriatric MH/SU workforce planning. Data collection and reporting should including the following: [condition, population/subgroup, services used, provider types.]