Etta Smith-Wells, LISW-S MH Supervisor Benjamin Rose Institute on Aging (BRIA) Eldercare Services Institute, LLC Fairhill Road Cleveland, Ohio

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1 Ethics of providing Behavioral Health Care to Older Adults Etta Smith-Wells, LISW-S MH Supervisor Benjamin Rose Institute on Aging (BRIA) Eldercare Services Institute, LLC Fairhill Road Cleveland, Ohio 44120

2 MISSION STATEMENT. Our goal is to enhance the lives of older adults with mental illness by providing holistic mental health care, enabling them to live in their homes or in the least restrictive environment.

3 What Makes Us Different We are the largest and oldest community-based mental health program for older adults in the state. Our services are provided to clients in their own homes (no matter where they call home). We work with caregivers and their family members. We serve all of Cuyahoga County We provide a treatment approach focusing on the entire person.

4 Goals of Benjamin Rose Institute on Aging Mental Health Program To provide seamless, quality care to the Mental Health population 55 years and older. To provide Case Management services in a manner that best serves our clients. Ensure the continuation of the mission of BRI.

5 BRIA Connects Members to Services Needed to Remain in the Community 5

6 We have a collaborative relationship with a wide variety of hospitals and providers. We provide a Specialized geriatric mental health assessment. We include family members of the elder, but in some situations the only family may be; A Neighbor or YOU!

7 Services with BRIA Partial Hospitalization Connections to PCPs / Psych Specialists Mental Health Case Management Counseling Adult Day Medication Compliance Geriatric Case Management 7

8 It s Essential to have a Care Manager who Really understands the Population Functional Mental & Behavioral BRIA provides care and care management for the most complicated patients Chronic / Medical Mental Health Case Management Geriatric Case Management Partial Hospitalization Counseling 8

9 Surgeon General Report The elderly population is projected to grow rapidly between present day and 2030 as the 76 million baby boomers reach 65 years of age. By 2030, older adults will account for 20% of the nation s people. With the growth of the older population, the need for geriatric mental health services will increase. 9

10 Diversity In addition, the older population will be much more diverse in regards to: Generational cohort Gender Minority status Income Living arrangements Physical and Mental Health 10

11 Mental Health The most common disorders are: Anxiety disorders; Phobias Obsessive-compulsive disorders Severe cognitive impairment Mood disorders; Depression Issues such as anxiety, depression, memory loss or dementia may complicate the older adult ability to recognized their mental health issues for which they need to seek help. 11

12 Mental Health cont. Dementia is the irreversible deterioration of intellectual ability; which is often accompanied by emotional disturbance. Dementia afflicts as many as 7% of Americans over the age of 65 and 30% over age 85. People with dementia often suffer from depression, paranoia and anxiety. 20% of people over 55 suffer from mental disorder. 12

13 ONSET of Mental Health Disorders Some have suffered from serious and persistent mental illness most their adult life. Others have had periodic episodes. Substantial number of older adults experience mental health disorders for the first time late in their life. These problems are frequently intensified by bereavement or losses which often occur more often in old age. 13

14 Onset cont. Today s older Americans grew up during a time when there were; Institutionalized in asylums Electroshock treatment Other treatment approaches OUTCOME Fear!!!! 14

15 STIGMA While considerable progress has been made in the understanding of mental disorders, the social stigma attached to mental illness and the treatment of most conditions continue to place the moral identity of the individual at risk. Mental health remains stigmatized in our society, resulting in individuals living with mental disorder often being shunned by others or treated with less compassion than those living with equally serious physical disorders. 15

16 Stigma cont. Denial of problems Access barriers Fragmented and inadequate funding for mental health services Lack of collaboration and coordination among primary care and mental health physicians Lack of geriatric specialists. 16

17 Medication Most older people have at least one chronic condition which they take medication for; Arthritis Hypertension Heart Disease Cataracts Diabetes 17

18 Medication cont. Older people metabolize medications differently due to physiological changes which makes them vulnerable to side effects of psychotropic medications. They are more likely to take medications for medical disorders, prescribed by other physicians, such as PCP. This place them at risk for unintentional medication interactions. 18

19 Because in These Circumstances, Seeing is Believing Over the phone they sound NORMAL Laying Eyes on Someone at HOME is Critical 19

20 Medication cont. Older adults with cognitive impairments may have difficulty managing their medications, remembering appointments and providing accurate details of medications to their physicians. The coordination between health services and psychiatric services is critical in the treatment of older adults. 20

21 Ethical Responsibility The ethical complexity derived from the way in which psychiatric disorders affect a person s experience and sense of self are: Mental illness influences Beliefs Feelings Perceptions Behaviors Motivation across time 21

22 Ethical Responsibility It is the practitioners ethical obligation to help the client make choices from sound medical practices. Professional codes of ethics reinforce the duty to continue to provide service in spite of funding, insurance, etc. We (social workers, clinicians, doctors, etc.) are ethically obligated to the people. 22

23 Ethical Responsibility Respect client autonomy to determine what transpires to his or her body and mind. Informed consent is the most recognized ethical responsibility The patient must be given enough information to make an intelligent choice. 23

24 Seeking Services Due to co-existing conditions, older adults are significantly more likely to seek and accept service through their primary care physician for mental health care. Older American underutilize mental health services for various reasons: Stigmas surrounding mental health diagnoses Denial of symptoms Access barriers, such as transportation, finding a suitable physician, etc. 24

25 Summary Need for more reform in the mental health system. Treatment of mental disorders is currently subjected to lesser or inequitable standard of care as compared to the treatment of physical impairments. Persons with pre-existing disorders are more likely to need a particular treatment that optimally balances benefits and risks. 25

26 Summary, cont. There need to be coordination of service providers to include a holistic treatment for those suffering from a mental illness; Client Family/Friends Primary Physician Psychiatrist Mental Health Provide Etc. Implement and Develop Geriatric Course studies in University/School Social Work Medical Psychiatric

27 Summary, cont. Recruit more specialized Geriatric Professional across all spectrum Serious mental health disorders are chronic conditions and susceptible to deterioration with disruption in care.

28 THE END