Community mental health and the elderly: service and training approaches

There is a growing gap between needed and available mental health services for older adults. This article discusses the training needs, personnel shortages, and lack of effective service programs and proposes some strategies for dealing with the problems. There is a lack of adequate methods for identifying and referring frail elderly persons in need of mental health services. Services that are currently available to the elderly are identified along with factors that may influence their use by older adults and other service personnel. There are shortages of mental health professionals with special training and experience in gerontology and geriatrics, and clinical geropsychologists. An innovative and practical service model that was developed to coordinate and integrate the identification and treatment of frail, community-dwelling elderly is presented. Various aspects of the program that include outreach and case management approaches, the integration of student volunteer activities with those of special volunteer corps within public housing and specially trained paraprofessionals, telephone reassurance programs, and a system of layered supervision are described. Comparisons are made between this Coordinated Agency Resources for Elderly Services (CARES) model and existing service delivery programs. A three-tiered approach to training and coordinating the activities of trained mental health personnel: (a) paraprofessionals and volunteers, (b) middle-level professionals and (c) supervisory professionals within an integrated system is proposed. Specific roles and functions of personnel at each level are described. The summary discusses the potential of the proposed strategies for dealing with the problems created by the shortage of personnel and services. It suggests some time frames within which the strategies could be operationalized.