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

This issue assesses the needs of population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue.

At least 5.6 million to 8 million–nearly one in five–older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation.

CONTENTS
SUMMARY
1 INTRODUCTION
Study Scope
Methods of the Study
Context for This Report
Federal Influence on the Geriatric MH/SU Workforce
Organization of the Report
References
2 ASSESSING THE SERVICE NEEDS OF OLDER ADULTS WITH MENTAL HEALTH AND SUBSTANCE USE CONDITIONS
Mental Health and Substance Use Conditions in Older Adults
Prevalence of MH/SU Conditions in Older Adults
Prevalence of Mental Health and Substance Use Conditions in Six Subgroups of the Older Population
Coexisting Physical Health Conditions and Cognitive Impairment
Impact of Mental Health and Substance Use Conditions
Use of MH/SU Services by Older Adults
Factors That Could Affect the Future Mental Health and Substance Use Service Needs of Older Adults
Summary of Findings and Implications for the Geriatric Mental Health Workforce
References
3 THE GERIATRIC MENTAL HEALTH AND SUBSTANCE USE WORKFORCE
Defining the Geriatric MH/SU Workforce
Estimating Workforce Supply and Demand
Review of the Geriatric MH/SU Workforce
Shortage of Geriatric MH/SU Providers
Recruitment of Geriatric MH/SU Specialists
Inadequate Preparation of the Geriatric MH/SU Workforce
Training the Geriatric MH/SU Workforce
Promoting the Role of Direct Care Workers in Geriatric MH/SU Care
Empowering Older Adults and Their Families
Findings and Conclusions
References
4 WORKFORCE IMPLICATIONS OF MODELS OF CARE FOR OLDER ADULTS WITH MENTAL HEALTH AND SUBSTANCE USE CONDITIONS
Organization of the Chapter
The Chronic Care Model
Care Delivery Models for Geriatric MH/SU
Models of MH/SU Care for Older Nursing Home Residents
Implications for the Geriatric Mental Health Workforce
Conclusions
References
5 IN WHOSE HANDS? RECOMMENDATIONS FOR STRENGTHENING THE MENTAL HEALTH AND SUBSTANCE USE WORKFORCE FOR OLDER AMERICANS
Locus of Responsibility
Investment in Human Capital
Building Blocks of Informed Workforce Planning
References
APPENDIXES
A Abbreviations and Acronyms
B Public Workshop Agenda
C Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers
D IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)
E Committee Biographies