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By the time Elizabeth Hathaway sees patients, they are usually having a mental health crisis. Many have dementia and have begun exhibiting aggressive or delusional behavior that caregivers can’t manage.
Some of these crises could have been avoided, she believes, if they’d only had access to care earlier—when symptoms like anxiety, apathy, depression and psychosis first emerged.
“Though we can’t reverse the dementia ... those are symptoms that we do have ways to address,” says Hathaway, a psychiatrist who works primarily with geriatric patients and is affiliated with Franciscan Health Crawfordsville, northwest of Indianapolis.
Hathaway advocates for boosting the number of geriatric psychiatrists who can evaluate older adults with psychiatric or behavioral symptoms. It’s one of several ideas presented to a commission that is examining ways to improve mental health care for Hoosiers 55 and older.
The Indiana Behavioral Health Commission will deliver a report with recommendations on how to improve access to care to the Indiana General Assembly in October. Lawmakers will then decide next year whether to fund recommended programs and policies.
In a meeting last January, Chair Jay Chaudhary says, the commission zeroed in on a few key issues: inadequate provider workforce, stigma around mental health problems and social isolation.
AARP Indiana is helping to shape the group’s recommendations, led by a concern that older adults’ behavioral health challenges are often overshadowed by their physical ones.
“It is important that the infrastructure and policies are in place to tackle those challenges,” says Jason Tomcsi, who is AARP Indiana communications director and serves on the commission.
The Indiana Behavioral Health Commission first formed in 2020 to assess mental health services for all Hoosiers and make recommendations on how to improve the state’s delivery system. That led to the launch of the state’s 988 suicide and crisis hotline and expansion of mental health clinics that are required to provide counseling and other services to anyone in need.
As the commission began to wrap up its work, several members wanted to continue efforts to improve mental health care specifically for older adults, says Chaudhary, who is also director of the state Division of Mental Health and Addiction.
“We all ... agreed that this group would be a good focus and something that does not get enough attention,” he says.
Exploring solutions
The commission was revived last year under a sweeping health law that included $100 million in funding for mental health services. It is being chaired by Chaudhary again and includes four legislators and eight representatives from provider and advocacy groups.
The commission is also examining the needs of two other groups—youths and individuals with intellectual and developmental disabilities.
Among its concerns is expanding the behavioral health workforce.
One way to do that: boosting support of mobile integrated health units, says AARP’s Tomcsi. AARP Indiana supported the funding of such a unit in Gary, which will respond to calls from caregivers or anyone in the community witnessing a behavioral health crisis, and would like to see more across the state.
The commission is also exploring ways to promote careers in geriatric behavioral health at universities, which would help to grow the state’s workforce in the long term.
More immediately, enhancing resources for primary care doctors—such as by adding geriatric psychiatrists to CHAMP, the statewide mental health consult line for providers—could help fill the gap, Chaudhary says.
Focus on nurses
AARP also supports ending the requirement that advanced practice registered nurses have contractual agreements with physicians.
The requirement can be a financial and administrative burden, hampering nurses’ ability to provide care to the full extent of their training, Tomcsi says. Nurses with specialized training can diagnose, treat and prescribe medications for mental health and substance abuse disorders.
The contractual requirement can be particularly limiting for nurses who serve patients in rural areas, says Leslie Oleck, a retired advanced practice registered nurse from Carmel, who worked in the psychiatric field for more than 40 years. It can be difficult to find someone to collaborate with because physicians are already overburdened and don’t have the time, Oleck says.
Learn more about the Indiana Behavioral Health Commission and its work here.
Carina Storrs, a New York–based journalist, covers aging, health policy, infectious disease and other issues.
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