The Senior Mental Health Crisis: Growing Need Calls for Urgent Action
Living with the ups and downs of COVID-19 has taken a toll on even the most mentally and physically fit among us, but the impact has been especially intense for many older adults.
With the Delta variant fueling a new wave of anxiety, seniors are once again grappling with isolation, fear and grief at a time when demand for mental health resources is growing and access is shrinking.
The pandemic’s toll on mental health
Even before the pandemic, our nation’s healthcare system was ill-prepared to meet the unique mental health needs of older adults. The senior population is expected to double by 2050 and, for the first time, retirement-age adults will soon outnumber children. This shift is placing additional strain on an already under-resourced mental health system as the need for specially designed healthcare resources, including mental health treatment, grows.
As is the case in much of our society, the behavioral health needs of seniors aren’t discussed openly. However, Americans are living longer and managing multiple health conditions that often contribute to behavioral health issues. An estimated 25% of adults 55 and older experience a mental disorder that is not considered a normal part of aging and the pandemic has only made this worse.
New research indicates people over 50 and those who report their physical health is just fair or substandard are more likely to have suffered worsened mental health during the first nine months of COVID-19.
Out-of-reach behavioral health treatment
Despite the growing need, behavioral health treatment remains elusive for many older adults. Difficulty finding a provider, inability to pay for care, or stigma associated with seeking care often cause seniors to suffer in silence or, ultimately, seek care in a less appropriate, more costly emergency setting. Consider the facts:
· America is already facing a shortage of qualified mental health professionals and that challenge is especially acute in geriatric psychiatry. According to the American Medical Association, there were only around 1,300 active geriatric psychiatrists in the U.S. in 2018.
· Finding a provider who accepts insurance — much less Medicare — is even more challenging. Poor reimbursement rates and loopholes that allow insurers to deny coverage make it difficult for providers to obtain payment for their services. As a result, many of these providers simply don’t participate. In addition, less than half of psychiatrists and behavioral health providers accept Medicare.
· Obtaining inpatient behavioral healthcare can also be difficult for seniors since many inpatient psychiatric hospitals do not treat patients with medical complexities or co-morbidities such as heart disease or diabetes.
· Medicare also caps inpatient care at 190 days over the course of a patient’s lifetime — leaving seniors with chronic or severe mental illness without resources.
The explosion of tele-behavioral health
Fortunately, the pandemic has brought mental health into sharper focus and created new opportunities to improve access to care. Among the most promising is telehealth.
While it’s hard to imagine use of this technology will continue at the explosive pace witnessed at the height of the pandemic in 2020, telehealth is proving to have more staying power for behavioral health than in other areas of medicine.
Claims for tele-behavioral health services have increased by 6,500% since the start of the pandemic. Virtual visits for anxiety are up 3,000% and up 2,500% for depression. The platform is ideal for behavioral health because physical contact is not required for treatment and patients canseek care anonymously.
The technology has also made it easier for providers to continue serving patients when COVID restrictions prevent them from being there in person. For example, a resident in a skilled nursing facility who would ordinarily have to cancel or reschedule a routine psychiatrist appointment because of possible virus exposure can now keep that appointment thanks to video conferencing. With help from nursing home staff and a slight adjustment in care delivery, treatment can continue without interruption.
Telehealth services:not a panacea
While telehealth has allowed many older adults to safely access behavioral health treatment from the safety and comfort of home, it isn’t without challenges.
Seniors often experience difficulty using telehealth services that require video. Many do not have access to a computer or smartphone, while others simply prefer in-person or audio-only care.
Furthermore, older adults are less likely to benefit from the hundreds of mental health apps that have flooded the market in recent months.
As a result, many delay seeking treatment or forego it completely.
Fighting for mental health parity
Lack of insurance coverage for mental health services is another obstacle for seniors. Despite being enacted 25 years ago, mental health parity remains an aspiration, not a reality.
Federal law requires insurers to pay for mental healthcare in the same way they cover medical and surgical care. However, the law is not widely enforced, and many insurers find loopholes that allow them to deny coverage.
In April, the General Accounting Office issued a report highlighting how Americans with mental and substance use disorders are treated differently than those with physical ailments. The report cited significant issues with providers receiving reimbursement from Medicare.
As a result of these payment issues, many providers were forced to lay off staff, reduce hours or close services during the pandemic, further reducing access for patients.
Thankfully, there appears to be renewed legislative focus on enforcing existing laws and addressing other issues that prevent vulnerable Americans — including seniors — from receiving care.
The quest for ayment reform
Chief among those issues is payment reform. Poor reimbursement for mental health services has long contributed to a significant shortage of qualified providers. These shortages are especially acute in smaller communities where many seniors reside.
Additionally, a long-standing federal provision known as the Institutions for Mental Disease or “IMD” exclusion prohibits Medicaid from reimbursing for mental health or substance-use care for adults ages 21 to 64 in hospitals or treatment facilities with more than 16 beds. The law has fueled the nationwide shortage of psychiatric beds and severely limited care for those with severe mental illness.
Meaningful payment reform would not only address the inequities of our mental health system, but also create long-term incentives to expand access to care by attracting more qualified professionals and making it easier for providers to expand services.
Preparing for the wave
There’s no doubt the challenges of the past year have created unprecedented need for mental health support. What’s more, the full impact won’t likely be felt for many years.
As our population ages, we must act now to ensure we are prepared to meet the mental health needs of seniors in the future where demand for care is likely to far exceed supply.