Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities

As the aging population in this country continues to increase, so, too, does the need to provide appropriate, accessible, community-based services to older adults with serious mental illnesses. These individuals, by virtue of their age, comorbid medical illnesses, poverty, and isolation, are vulnerable to being unnecessarily or prematurely institutionalized, or to being kept in institutions when their conditions do not warrant custodial care.

Numerous fiscal, service system, clinical, and societal barriers make it difficult for older adults with serious mental illnesses to access appropriate care in the community. Not the least of these is stigma, which attaches both to mental illnesses and to older adults. A chronically underfunded mental health system, fiscal disincentives in both Medicaid and Medicare, and a lack of community-based alternatives also place older adults at risk for out-of-home placement.

In spite of, or perhaps because of, these barriers, communities around the country have developed innovative prevention and treatment interventions that address the multiple and complex needs of older adults with serious mental illnesses. A major focus of these interventions is coordination of all the programs and services that older adults require. Because many older adults have comorbid medical conditions and they prefer to receive their treatment in primary care settings, the integration of mental health treatment into primary care settings receives special emphasis.

The vision of the Substance Abuse and Mental Health Services Administration, which oversees Olmstead planning for people with serious mental illnesses, is “a life in the community for everyone.” This goal closely mirrors the vision articulated in the Final Report of the President’s New Freedom Commission on Mental Health, which emphasizes that all people with mental illnesses should have access to effective treatment and supports to enable them to live, work, learn, and participate fully in their communities.

Though progress has been made in the care of older adults with serious mental illnesses, much remains to be done to achieve the fundamental systems transformation envisioned by the New Freedom Commission and to support full community integration. In the past, communities may have wanted to further integrate older adults with mental illnesses into community life. Today, the Olmstead decision and the New Freedom Commission provide specific guidance for accomplishing this goal.