August 4 - 6, 2004

Marriott Denver City Center Hotel

1701 California Street, Denver, CO 80202

REBALANCING LONG TERM CARE SYSTEMS TOWARDS QUALITY COMMUNITY LIVING

AND HEALTHY AGING

IDENTIFYING AVAILABLE RESOURCES, AND STAKEHOLDERS IN DEVELOPING

WORKABLE COMMUNITY BASED SERVICES

MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES WITH OLDER

ADULTSBUILDING PARTNERSHIPS

AT THE STATE AND COMMUNITY LEVEL

Robert D. “Bob” Rawlings

Rawlings Consulting Services

1600 Timber Ridge Road

Edmond, Oklahoma 73034

(405) 348-1129 E-Mail: okbobber@swbell.net

Initial Efforts in Mental Health Community Integration

• The Omnibus Budget Reconciliation Act of 1987 (also known as the Nursing Home Reform Act) mandated an assessment process known

as the pre-admission screen and annual resident review process (PASARR).

• The intent was to evaluate individuals going into long term care facilities to determine whether they were mentally ill or mentally retarded (developmentally disabled), whether they were a danger to self or others, whether or not they required specialized services and the level of care that was most appropriate.

• Implementation varied greatly and needed services generally were and are not being provided.

• Lack of or limited funding sources for these needed services contributed to many of the problems related to the provision of services and a positive outcome to the act.

Mental Health: A Report of the Surgeon GeneralJanuary 2000

(www.surgeongeneral.gov/library/mentalhealth)

• Mental health is fundamental to health

• Mental disorders are real health conditions

• Overall quality of life improves tremendously when a mental disorder is diagnosed early and treated appropriately.

• Mental illness is the second leading cause of disability and premature mortality.

Recommendations

• Ensure the supply of mental health services and providers

• Ensure the delivery of state-of-the-art treatments

• Tailor treatments to age, gender, race, and culture

• Facilitate entry into treatment

• Reduce the financial barriers to treatment

• Reduce the financial barriers to treatment

• Improve public awareness of effective treatment

Surgeon General’s Report

PRESIDENTS NEW FREEDOM COMMISSION REPORTMay 2003

After Reviewing the Report The American Association of Geriatric Psychiatry (AAGP) Concluded

It is imperative that the Substance Abuse and Mental Health Services Administration (SAMSHA) and other Federal agencies charged with implementing this report, address the distinct mental health issues facing our nation’s seniors. The sheer numbers of older Americans – treated by practitioners who have inadequate training, suffering from physical disease exacerbated by mental illness, taking medications that are prescribed based on inadequate science – demand attention. We owe this much to our seniors now, just as we owe it to ourselves in the future.

PROMISING PRACTICES: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems

Published 2002

THIS PUBLICATION LISTS AND DESCRIBES PROGRAMS OF EXCELLENCE SUCH AS:

• Health Aging Program, Salt Lake City, UT

• Health Enhancement Program, Seattle/King County, WA

• Little Havana Health Program, Miami/Dade County, FL

• Gatekeeper Program, Spokane, WA

• PATCH (Psychogeriatric Assessment and Treatment/Teaching in City Housing), Baltimore, MD

• Geriatric Regional Assessment Team, Seattle/King County, WA

• Kit Clark Senior Services, Boston, MA

• Over 60 Health Center, Berkley, CA

• and more

Substance Abuse Among Older AdultsTreatment Improvement Protocol (TIP) Series 26

 Frederic C. Blow, Ph.D.Consensus Panel Chair

 U.S. DEPARTMENT OF HEALTH AND HUMAN

SERVICESPublic Health Service

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse TreatmentRockwall II, 5600 Fishers Lane

Rockville, MD 20857

Aging Substance Abuse Treatment and Prevention Does it Work

Aging Substance Abuse Programs of Excellence

• Hanley-Hazelden Center, West Palm Beach, Florida and Hazelden Springbrook, Newburg, Oregon. For more information or to obtain a course syllabus on their training program contact us at (212) 420-9520 Ext. 145, or (800) 257-7810

• Larry Dupree, PhD, Professor & Chair - Dept of Aging & Mental Health, de la Parte Institute, University of South Florida, 13301 Bruce B Downs Blvd, MHC1417, Tampa, FL 33612Phone: (813) 974-1964Fax: (813) 974-1968 Email: dupree@fmhi.usf.edu

COMMUNITY INTEGRATION FOR OLDER ADULTS WITH MENTAL ILLNESS: OVERCOMING BARRIERS

AND SEIZING OPPORTNITIES

Prepared under contract between The Gallup Organization and the Division of State

And

Community Systems Development (Mental Health Block Grant Branch)

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

Soon to be released as part of a series of reports of disability populations as a result of the U.S. Supreme Court Olmstead Decision

Decision determined that it may be discriminatory to institutionalize a person with disabilities if that individual can benefit from life in the community.

New Publication To Be Released Soon Work Continues

THIS SOON TO BE RELEASED DOCUMENT CONTAINS 63 PAGES OF VITAL INFORMATION FOR DEVELOPING HOME AND COMMUNITY BASED SERVICES FOR OLDER ADULTS WHO ARE DISABLED BY MENTAL ILLNESS

• THE TABLE OF CONTENTS INCLUDE:

• A VULNERABLE POPULATION

• BARRIERS TO COMMUNITY INTEGRATION

• PREVENTION

• SUCCESSFUL PRACTICES

As a Resource Document Resulting from the Olmstead Decision

STATE AND LOCAL MENTAL HEALTH AND AGING COALITIONS

SINCE 1990 THERE HAS BEEN A NATIONAL INITIATIVE TO ESTABLISH STATE AND LOCAL

MENTAL HEALTH AND AGING COALITIONS

• ALASKA• ARKANSAS• ARIZONA• CALIFORNIA • COLORADO• FLORIDA *• GEORGIA• ILLINOIS• INDIANA• KANSAS• KENTUCKY *• LOUISIANA• MARYLAND• MASSACHUSETTS

• MISSOURI• NEW JERSEY • NEW MEXICO• NORTH CAROLINA• OHIO• OKLAHOMA • PENNSYLVANIA• RHODE ISLAND• SOUTH DAKOTA• TENNESSEE • TEXAS• UTAH• WASHINGTON• WISCONSIN

THE NATIONAL COALITION ON MENTAL HEALTH AND AGING

(www.ncmha.org)

• There are some 43 Agencies and National Professionals Organizations and at least 20 other interested individuals.

• Visit the web site and find names and contact information of coalitions across the country.

Remember – YOU DON’T HAVE TO REINVENT THE WHEEL. HELP IS AVAILABLE.

HOW TO MANUAL – Is available in MS Word on the NGA site or contact Bob Rawlings by email.

THINGS YOU CAN DO

• Involve all stakeholders, including the older adult consumer, in planning to achieve buy-in

• Include the community in planning to establish ownership and responsibility

• Look to evidenced based practices to assure positive outcomes

• It is important for direction to come from the governor’s office and include all public and private agencies, providers and consumers to assure implementation and guard against turf issues