Older adults are one of the fastest-growing demographics in the nation and in New York State. There are currently about 4.6 million New Yorkers who are 60 years of age or older and another 4.2 million between the ages of 45 and 59.
Individuals with wisdom and life experience are a gift to younger generations. Ensuring that they have access to the best health care and support, including behavioral health, is vital to be sure that older adults continue to contribute to their communities and share their many talents.
Older adults are at risk of developing mental health challenges and substance use disorders as well as other chronic physical health conditions. Unfortunately, many older adults, as well as healthcare professionals, often minimize or ignore behavioral health issues, considering them to be an expected consequence of aging.
It is true that aging brings life changes that can impact our emotional well-being. The death of close friends and loved ones, for example, and the feelings of grief and loneliness these losses cause can lead to social isolation, depression, and anxiety. Facing and managing a serious illness or serving as a caregiver for a loved one with an illness can also impact the mental health of older adults.
Ann Sullivan, MD
Commissioner
NYS Office of Mental Health
The problem is widespread, and according to the World Health Organization, approximately 14 percent of adults aged 60 and over live with a mental illness, the most common of which are depression and anxiety. Mental health and substance use challenges are further exacerbated by the increasing need to navigate multiple service systems and the trauma many experience in applying for and potentially being denied critical benefits that make aging in place possible.
The good news is that help is available for older adults, especially here in New York, which in 2017 became the first state in the nation to enroll in the World Health Organization (WHO) Global Network for Age-friendly Cities and Communities and its U.S. affiliate — the AARP Network of Age-Friendly States and Communities. The designation is awarded to municipalities that incorporate age-friendly concepts into their policies, programs, and procurement guidelines, such as support for healthy aging and aging in place. Age-friendly housing policies, for example, not only help to ensure adequate housing for older adults but also provide opportunities for social participation, transportation, recreation, and access to healthcare.
However, New York was working to expand access to effective behavioral health care and aging support services long before its designation as an age-friendly state. In 2005, the State enacted the Geriatric Mental Health Act to address parity in the planning and coordination of, and access to, behavioral health, long-term care, and aging-related services. The law established the Interagency Geriatric Mental Health and Substance Use Disorder Planning Council, which promotes collaboration between state agencies and other stakeholders to support older adults in addressing their holistic, cross service-system needs. The Council includes my fellow commissioners and staff from the Office for the Aging, the Office of Addiction Services and Supports, the Department of Veterans’ Services, the Office for People with Developmental Disabilities, the Justice Center for the Protection of People with Special Needs, and the Department of Health, as well as advocates and stakeholders appointed by the Governor, Assembly, and Senate.
The Geriatric Mental Health Act also mandated funding to establish the Geriatric Service Demonstration Project, which funds community-based programs that support older adults by focusing on:
- community integration,
- improved quality of treatment in the community;
- integration of aging services and behavioral health services;
- workforce development programs and the use of Peer Support;
- family and caregiver support;
- cultural minorities and Veterans as specialized populations; and
- ongoing staff training initiatives.
Since OMH began awarding Geriatric Service Demonstration grants, organizations throughout the state have developed integrated models of care for older adults with mental health challenges, substance use, and aging-related needs. The grants are helping to expand access to services that integrate behavioral health treatment as well as aging services, with an emphasis on reaching older adults who are residing in community living situations who may be unconnected or inconsistently connected to services, may have diagnosed, undiagnosed or subacute behavioral health needs, or have chronic medical conditions.
The Geriatric Demonstrations have been very effective at breaking down siloed service systems by establishing local triple partnerships between mental health, substance use, and aging providers. Some of the clients who have benefited from these programs have graciously agreed to share their success stories below. (Details have been changed to protect their identities and personal information.)
Addressing Wholistic Wellness of Caregivers
One client is an 85-year-old woman living in senior housing and experiencing multiple emergency room
visits for physical and mental health challenges. She was also a caregiver for her husband, who was experiencing early-onset dementia. She suffered from anxiety, depression, caregiver burnout, and a lack of community resources.
A Geriatric Service Demonstration Grant Program funded by the Office of Mental Health helped her connect with a Health Home Care Coordinator, a therapist from a community-based clinic, and a home care aide, all of whom helped her manage her chronic health conditions. The program’s Registered Nurse and Social Work Intern provided her with information about her anxiety and the importance of taking her medication with daily phone call reminders.
When her case was first opened, she was visiting the Emergency Room 4-5 times a week due to her anxiety and caregiver stress. After receiving person-centered support in connecting with ongoing services to support her holistic wellness, her visits were reduced to 1-2 times a month to receive critically needed treatment for her chronic physical health condition.
Building Coping Skills and Resiliency During COVID-19 Pandemic Lockdown
Another older adult benefited from a local Geriatric Service Demonstration program. She was actively suicidal after placing her husband in an Assisted Living Facility. When her husband was placed on Covid restrictions, her condition worsened because she was unable to see him. She was hospitalized for suicidal ideation; however, staff from a local community provider supported by the Geriatric Service Demonstration program were able to meet with her weekly and provide phone support between visits. She learned coping skills to manage her depression symptoms and created a safety plan and a list of supports.
After six months of participation in this program, she is no longer suicidal, is active in the community, successfully caring for her home independently, and meets with her husband on a weekly basis. She said thanks to the services she received, she “now feels hopeful and happy again.”
Benefits Navigation Addresses Social Determinants of Health in Rural Communities
A third client resides in a very rural area. He lives in his own home, which is quite a distance from any stores or shopping centers. He was identified because neighbors noticed him looking for food in their garbage cans. When program staff met him, they learned it had been several years since he was able to afford oil for his furnace, electricity, food, or medical care. The team quickly began providing him with services and helped him enroll in HEAP, SNAP, Medicaid, and an electricity payment plan. Thanks to their person-centered intervention and support, Andrew is living a far healthier and self-sufficient life.
Strengthening the Continuum of Care for all New Yorkers
Governor Kathy Hochul has initiated the first State Master Plan for Aging, which is designed to ensure that
older adults can live healthy, fulfilling lives while aging with dignity and independence. The plan was first announced in the Governor’s State of the State Address and Fiscal Year 2023 State Budget and is helping state agencies coordinate existing and new policies and programs for older adults and their families. The Master Plan for Aging is expected to be finalized in early 2025 and will provide guidance for building healthy, livable communities that offer opportunities for older adults and improve access to the health and mental health care services they need.
Additionally, as part of her comprehensive $1 billion multi-year plan to overhaul the continuum of mental health care throughout the state, Governor Hochul initiated investments into programs to help older New Yorkers live healthy, fulfilling lives while aging successfully in the communities of their choice. Her plan included funding for new residential units, increased inpatient capacity, and expanded outpatient services for all New Yorkers, including older adults.
In response to the Governor’s unprecedented support for the expansion of mental health services, OMH modified two existing, successful programs to specifically target and support older adults: the Assertive Community Treatment (ACT) program and the Safe Option Support (SOS) program.
Assertive Community Treatment for Older Adults
Assertive Community Treatment (ACT) is a multidisciplinary, evidence-based, team approach to providing comprehensive and flexible treatment, support, and rehabilitation services to people of all ages. ACT teams have a low individual-to-staff ratio with professional staff, including members from the fields of psychiatry, nursing, psychology, social work, substance use, employment/education, and peers. Many services are provided by ACT staff directly and in the community where the individual lives. Recipients of ACT services often have high continuous needs that are not met in traditional site-based services.
Thanks to the Governor’s historic investment into mental health services, OMH is supporting the development of an Older Adult Assertive Community Treatment team in the Bronx. The ACT team will serve older adults who have Serious Mental Illness and have not been successfully engaged by the traditional mental health treatment and rehabilitation system in NYS. These individuals may also be high utilizers of emergency and/or crisis services, have co-occurring substance use disorders, are isolated from community supports, are in danger of losing their housing, are homeless, and/or have histories of involvement with the criminal justice system.
Safe Options Support Program: Older Adult & Medically Fragile Support Team NYC
Unfortunately, older adults are the fastest-growing group of homeless individuals. According to the U.S. Department of Housing and Urban Development, there were 13,635 adults aged 55 and older in NYS experiencing homelessness in 2023. In response to the homeless crisis, OMH is supporting the development of Safe Option Support (SOS) teams, which provide intensive outreach, engagement, and care coordination services to individuals, including older adults experiencing street homelessness and those in temporary shelter settings.
And because approximately 42 percent of current SOS clients are over the age of 50, OMH has also issued a Request for Proposals to develop an SOS Older Adult & Medically Fragile Support Team in NYC. This team will provide specialized services and support to older adults and individuals with existing chronic medical conditions who are currently unsheltered or have recently transitioned from street homelessness to housing.
Addressing the Growing Loneliness Epidemic
The ACT and SOS teams are having great success in helping older adults living with serious mental illness. However, many older New Yorkers are living with a condition that is not as easy to diagnose. Social isolation and loneliness can have a severe impact on our physical and mental health. They are associated with multiple physical and mental health challenges, including cognitive decline, anxiety, depression, cardiovascular disorders, weakened immunity, Alzheimer’s Disease, and premature death.
A recent study by the National Academies of Sciences, Engineering, and Medicine found that more than a third of adults 45 or older experience loneliness, and nearly a quarter of adults 65 or older are living in social isolation.
While the aging process does bring with it certain challenges that can impact our health, it is important to remember that effective treatment options are available that draw from the strengths of older adults and help them manage their mental health challenges, improve their quality of life, and navigate multiple service systems to build a personalized system of support. Fortunately, this is especially true here in New York State.
Ann Sullivan, MD, is Commissioner of the NYS Office of Mental Health (OMH).
