Institute of Medicine Geriatric Mental Health Care Report July 2012

The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?

In July, the Institute of Medicine released a new report outlining the mental health and substance use workforce needs for the growing population of older adults in the United States. The American Association for Geriatric Psychiatry (AAGP) is pleased that the IOM report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?, documents the prevalence of mental health and substance use problems among older adults, the interaction between these issues and physical health, and the changes needed in legislation, training, and reimbursement to provide quality care for the nation's older adults.

On September 19, AAGP, the American Psychological Association, the National Association of Social Workers and the American Psychiatric Association hosted a briefing on Capitol Hill to highlight key findings and policy recommendations from the report. See the congressional briefing online, courtesy of the American Psychological Association.

"The IOM report encourages novel solutions and immediate action to coordinate federal and private efforts in providing care, promoting research and incentivizing training in geriatric mental health to adequately meet the needs of an elderly population expected to rise above 70 million people by 2030," said Paul D.S. Kirwin, MD, president of the American Association for Geriatric Psychiatry and associate professor of psychiatry, Yale School of Medicine. He noted, "The recommendations are specific, evidenced based, ambitious in their scope, and prescient for the geriatric mental health care needs of our nation."

The report notes that while geriatric mental health and substance abuse specialists are an essential part of the interdisciplinary team because they are the most experienced and well-equipped to consult and provide care for serious mental illnesses, the rate of specialized providers entering the workforce is dwarfed by the pace at which the population is growing. It is projected that the number of adults age 65 and older in the U.S. will grow to more than 72 million by 2030, and current estimates indicate 14-20 percent of the elderly population deal with mental health or substance use conditions, such as depressive disorders and dementia-related behavioral and psychiatric symptoms.

"The report underscores the complex medical and psychiatric co-morbidities that our patients experience; the importance of interprofessional health care teams, including families, as the anchoring concept for care delivery; and the ongoing evidence that our patients must have access to mental health services in primary care settings," said Christopher C. Colenda, MD, MPH, an AAGP past president. "The study committee reinforces the fact that our respective disciplines are obligated to redouble efforts to 'gerontologize' the curriculum in our health professional programs across the entire lifespan of practice and service. It is never too late to improve how we deliver evidence-based mental health services that improve function and quality of life for those who have placed great trust in our professional expertise," added Colenda, chancellor of the Robert C. Byrd Health Sciences, West Virginia University.

Given the accelerated growth of the U.S. geriatric population, AAGP shares the IOM's concerns about woefully inadequate recruitment to the field, and the projected dire consequences for both the physical and mental health of older adults. The IOM report noted that just 131 post-doctoral fellowship positions are funded in accredited training programs in geriatric psychiatry nationwide, and last year only 43% of these positions were filled.

"AAGP strongly supports the IOM recommendations for major restructuring of financial incentives to attract, train, and retain geriatric mental health professionals across disciplines (including medicine, nursing, social work, psychology, and rehabilitation)," said Joel E. Streim, MD, a past AAGP president and professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Streim also stated, "We believe that there is a critical need for the development of faculty with the expertise to conduct geriatric mental health and substance use research and to train future generations of geriatric mental health professionals."

"Training in essential competencies for the care of older adults with mental illness and substance use disorders must be provided across the workforce if it is to meet the challenges it faces and will face in the future," wrote Dan Blazer, MD, chair of the IOM Committee on the Mental Health Workforce for Geriatric Populations, in his preface to the report.

The IOM committee points out that many federal agencies, particularly within the U.S. Department of Health and Human Services (HHS), "influence the makeup, competence, and capacity of the health care workforce to deliver MH/SU services to older adults." AAGP urges public and private agencies that have the ability to make a difference to enact the recommendations of the IOM report, including the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), the National Institutes of Health, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the regulatory bodies responsible for accreditation and certification as well as the private sector.

AAGP has long been concerned about the growth and training of the mental health and substance use workforce needed to care for the nation's growing older population. This new IOM study came about as a result of AAGP's advocacy in response to the IOM's work on its 2008 report titled Retooling For An Aging America: Building The Health Care Workforce, a broad study on the geriatric health care workforce. AAGP advocated strongly for an aging and mental health study to complement the IOM’s 2008 study, and was joined in this effort by the American Psychiatric Association, the American Psychological Association, and the National Association of Social Workers. Funding for the study was approved in December 2009 and included in the Fiscal Year 2010 omnibus appropriations bill.

AAGP was pleased that a number of geriatric psychiatrists and other late-life mental health care professionals were appointed to the IOM study committee and that it was chaired by Dan Blazer, MD, an AAGP past president.


IOM web page:

Full report (PDF)

Report Summary (PDF)

IOM Press Release (PDF)

IOM Web Page for  "Retooling for an Aging America: Building the Health Care Workforce":