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Release: July 24, 2002

Conference aims to improve mental health care of older adults

Providing care to older adults with mental illnesses is a growing need in Iowa, with nearly 20 percent of citizens over age 55 experiencing mental disorders that are not part of normal aging. In addition, obstacles to providing services are numerous, including stigma surrounding mental illness, lack of funding, access barriers and fragmentation in service delivery systems for older adults with mental illness.

To help overcome those obstacles, experts in the University of Iowa Department of Psychiatry have organized a conference for health care professionals to learn new ways to work together to provide improved care for people with mental and emotional disorders in later life. The one-day conference, "Training to Enhance Service Delivery to Older Adults with Mental Illness," will be hosted in conjunction with four community colleges and experts in those communities. The sites include Southwestern Community College in Creston (July 25); Iowa Lakes Community College in Emmetsburg (July 26); Northeast Iowa Community College in Dubuque (July 29); and Indian Hills Community College in Ottumwa (July 30). The program is funded by a nearly $100,000 grant from the Iowa Department of Human Services.

"We hope the conference will stimulate interest and enthusiasm in local communities, and move people toward making changes to better provide mental health services to older adults across Iowa," said Marianne Smith, UI advanced practice nurse in psychiatry and program leader for the grant. "The group of older adults who will need this assistance is only going to increase in the years to come."

The program will train professionals, paraprofessionals and community members who work in aging services, health services, mental health delivery and funding agencies that affect mental health service delivery for elders. Older adults and their families, along with mental health consumers, were recruited to participate in the planning committees at each site.

"The conference gives aging services providers, mental care providers, community service agencies and funding sources a chance to sit at the same table," Smith said. "This kind of dialogue can help improve systems of care, particularly by keeping the focus on the strengths of individual communities."

Smith said she expected about 200 people to sign up for the training. However, more than 300 individuals already have enrolled, and all sites but Emmetsburg are filled to capacity. Individuals who cannot attend the conference are encouraged to review presentations online at Follow-up programs, open also to people who cannot attend the conference, will be offered through the Iowa Communications Network (ICN) in August.

"In many situations involving older adults and mental health, it's the action of one person that makes the difference in whether innovative models are implemented," Smith said. "It's encouraging to see so many people enroll in the training. We hope they will find the time and energy to take additional steps when the conference is over. We realize everyone is under pressure to 'do more with less.'"

Smith emphasized that training alone is not enough to change service delivery systems, but it often is a necessary first step.

"Training is a stimulus for change. It gets people thinking. The greatest barrier to change in delivering mental health services, particularly to older adults, is lack of funding," Smith said. "However, if you don't provide mental health promotion, prevention and treatment services, you ultimately will have to provide the most expensive form of service, which is when people reach a point of crisis and have to be institutionalized."

Older people often do not use traditional services. As a result, alternative models that provide access to mental health care are very important.

"Access involves psychological access so that people are comfortable using the services, as well as financial and geographical access so that people can afford to use the services and to physically get to them," Smith said. "Access also involves what we call longitudinal access, meaning that the services will be there for a long time and that you count on them."

A problem with grant-funded mental health services is that when the funding cycle ends, often so does the program itself. In addition, the Medicare system has unequal coverage policies, for example, no outpatient drug coverage, and has been identified by the American Association for Geriatric Psychiatry as a problem in providing consistent, comprehensive mental health care for elders.

Smith said she hopes that the conference will strengthen ways communities can provide services over the long run to older people with mental health care needs.

"Even if funding is not available now, we're prudent to start planning. We can create collaborative models that are acceptable to adults who need the services so that when funding does become available, we will be prepared," she said. "If you believe in value, then you want to help these older adults who built the state of Iowa. They're the backbone of what has happened here, and they deserve quality care and a high quality of life."

A panel of local experts will address local issues and needs for each of the four conference sites, and local planning committees have built support for these programs. In addition to Smith, the UI-based program also will draw on the expertise of five other speakers: Colleen Brems, UI advanced nurse practitioner in the Adult Outpatient Psychiatric Clinic and Senior Care Outreach; Kathleen Buckwalter, Ph.D., UI associate provost for health sciences and professor of nursing; Brian Kaskie, Ph.D., UI assistant professor in health management and policy; Paul Mulhausen; M.D., a geriatrician and UI assistant professor of internal medicine (clinical); and Peter Zevenbergen, executive director of Wyandotte Center in Kansas City, Kan., a community mental health center that provides services to mentally ill persons of all ages.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at