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20 <br />MENTAL HEALTH TASK FORCE REPORT <br />65f AGE GROUP <br />UNC <br />UNC has three psychiatrists who specialize in geriatrics. Clients can get appointments at UNC, but <br />follow-up psychotherapy is limited because the teaching practice focuses on medication <br />management. There are no licensed psychologists or social workers to provide evidence-based <br />interventions as an adjunct to medication. <br />• No mental health staff in geriatric psychiatry or the geriatric medicine clinic focuses on caregivers to <br />provide behavioral recommendations to mitigate patient's symptoms. Caregiver education and <br />behavior training is not reimbursed by Medicare or private insurance. <br />Community Providers <br />^ There are very few mental health practitioners outside of the university system who specalize in geriatric <br />mental health. Few therapists have specialized skills or interest in the geriatric population. <br />^ Few mental health practitioners accept Medicare. Those who do often limit the number of Medicare clients <br />they accept in their client mix. At any given time, which therapist will accept a new Medicare client is <br />unknown. This makes referrals difficult and time consuming. <br />^ Home and Community Block Grant funding in local aging agencies can pay for mental health counseling, <br />but this is only theoretics/since no aging agency in the state uses the funding for this service. Instead <br />HCCBG funds are traditionally used for in-home aides to assist with personal care and other functional tasks <br />with the goal of postponing nursing home placement. <br />Public Mental Health System <br />^ OPC pays $20,000 to 3 private MH providers to incentivize acceptance of Medicare, <br />^ NC MH/DD/SA has one program for geriatric mental health. They provide "Geriatric Care Specialist Teams" <br />that usually consist of a nurse and a social worker who provide mental health education and consultations to <br />long-term care staff in assisted living facilities and nursing homes in a few counties. The use of designated <br />personnel in facilities has met with mixed reviews at best. <br />^ Individuals who experience late-life mood disorders and/or dementia do not receive public mental health <br />services because they have insurance (Medicare) -even though it is infrequently accepted by mental health <br />providers. <br />Barriers to Successful Geriatric Mental Health Care <br />^ For people 65+ there is a heightened sense of stigma about mental health issues. Therefore, diagnosis <br />and acceptance of a mental health treatment is rare. <br />^ Geriatric depression estimates in the 65+ community dwelling population range from 16%-32%. <br />^ Mood disorders are often under-diagnosed -partially due to the priority of other acute and chronic illness <br />and partially due to stigma and the lack of skilled geriatric providers. <br />^ Most geriatric patients seek treatment in a primary care setting. Most primary care physicians do not have <br />time to address psychiatric issues, and when they do so, they rely solely on medication, but few 65+ patients <br />take psychotropic medications consistently. In fact, 68% of the 65+ population in primary care practices stop <br />taking anti-depressant medication within 4 weeks of starting it. <br />18 <br />