Issues and Views

IGSW on IOM training-needs panel

Treatable Mental Health Problems of Older People Often Go Unaddressed

By Kathy Kuhn

KathyAlthough there have been significant advances in developing effective interventions for mental illness in older people in the past decade, treatable mental health problems of older adults too often remain unaddressed. A major reason is the lack of training in aging and mental health. According to the 2008 Institute of Medicine report Retooling for an Aging America: Building the Health Care Workforce, there is a severe shortage of practitioners who are equipped to provide services to older people. In June, I represented IGSW on an IOM panel convened to recommend ways of developing the competent, well-trained workforce that is needed.

Good training makes a difference, I know. Prior to coming to IGSW seven years ago, I was clinical director of a geriatric mental health clinic in the Boston area. The treatment team included social workers, nurses, and a psychiatrist. In the 10 years I worked there, we saw few psychiatric hospitalizations and no suicides, although the older adults we treated were at high risk and included many with significant mood disorders who had previously attempted to take their own lives. I am convinced that one of the main reasons we were able to provide quality care was a weekly clinical conference with ongoing training that was open not only to the mental health team, but also to anyone else working in the agency who was interested. Clinicians, outreach workers, adult day-health staff, and staff of the on-site senior center were all invited to attend and participate in the training. Many did, and it showed in their interactions with our clients. Fortunately, I have been able to continue this work at IGSW. We have developed a number of training programs, both online and face to face, to address the shortage of practitioners trained in mental health and aging. These programs are designed to provide practitioners with competency-based training focused on the core knowledge, skills, and values needed for effective behavioral health care.

IOM panel. The panel on which I served was one of four at a workshop convened by the Institute of Medicine to discuss ways of increasing and strengthening the geriatric mental health workforce. Congress has asked the IOM to provide an analysis of the current and projected mental and behavioral health care needs of the aging population and to make policy recommendations for meeting those needs. The panels gave providers and practitioners an opportunity to share their views to guide the IOM. Our panel's topic was "cross competencies in aging, mental health, and substance abuse in selected settings." The objective was for the IOM to hear about approaches to ensuring that people working in a variety of settings with older adults who have mental health and substance abuse problems have appropriate skills and competencies to help them. Based on IGSW's years of experience developing and providing competency-based training, I presented the following points:

• It is imperative to define mental health and aging competencies and use them to guide curricula.

• Online training is a cost-effective and efficient way to train the workforce.

• Competency-based online training allows learning to occur on the job and maximizes development of practice skills.

• Support from executives and managers in organizations is vital.

• Involvement of supervisors is critical. (Our experience is in accord with findings of the Institute of Medicine's 2008 report that geriatric specialists are urgently needed in all professions, not only for their clinical expertise, but also to train less experienced workers who provide the majority of direct services to older adults.)

• It is necessary to create viable career ladders for the aging and disability mental-health workforce.

IOM is now in the process of study and analysis, with recommendations to follow. Although it is not clear what the results will be, the fact that Congress is paying attention to this issue is significant for those older adults who need mental health care and for those workers who provide it.

Kathy Kuhn, M.S.W., is director of workforce development at IGSW.

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Copyright © 2011 Trustees of Boston University. All rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: The Institute for Geriatric Social Work, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, U.S.A.; e-mail: igsw@bu.edu.