Suicidality in nursing home residents: Part I. Prevalence, risk factors, methods, assessment, and management.

Professional psychologists often work in nursing home settings. As the number of older adults in nursing homes increases, the number of psychologists providing care to this population will likely increase as well. Even though literature has suggested that nursing home residents have a high rate of mental disorders, the literature investigating suicidality in this population is scarce. Our discussion includes two articles. This article (Part 1) summarizes types of suicidal behavior, prevalence, risk factors, methods, screening/assessment, and management issues. The second article (Part 2) describes indirect self-destructive behavior, ethical concerns, involving staff and family members, Medicare information, public policy, and suggestions for training/continuing education offerings. Because few psychologists receive training in geropsychology, this information can help clinicians who serve nursing home residents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving Medicare coverage of psychological services for older Americans.

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Geriatric Mental Health Policy: Impact on Service Delivery and Directions for Effecting Change.

The treatment of mental health problems in older adults has advanced considerably over the past several decades. Nevertheless, the mental health needs of the nation's elderly population remain substantially unmet. This article identifies the significant but previously neglected role of regulatory policies and administrative practices in limiting the use and provision of geriatric mental health services. Such factors are the least recognized and understood by psychologists, although they are the very factors on which psychologists can have the most potential influence. This article subsequently identifies salient legislative proposals and regulatory developments, while addressing the importance of advocacy on agenda setting and policy change. The final section provides specific proposals and mechanisms at micro and macro levels for improving the geropsychology service system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health services give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public–private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community mental health service use by older adults with dementia.

We considered the role of community-based public mental health services in providing care to older persons with Alzheimer's disease and other forms of dementia, and examined service outcomes within California's county-based public mental health system over a 3-year period. Treated prevalence rates, repeat service use rates, and service mix patterns were regressed onto individual, market, and contextual variables across 25 counties over 12 observation periods. The number of older adults with dementia who used community mental health services increased slightly over the observation periods, and service use was associated with age and Medicaid status. Service outcomes also were affected by complementary mental health and aging service systems within each county, as well as the poverty rate and location of the county. Future research is needed to clarify how administrative policies and service management practices contribute to increasing community mental health service use by persons with dementia. In the meantime, these findings can help program administrators and service providers understand the role of community-based mental health services in providing care to persons with dementia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Polypharmacy and older adults: A role for psychology and psychologists.

The literature and clinical experience confirm polypharmacy as an important contributor to avoidable morbidity and mortality among older adults. Sociocultural factors, along with the interplay among aging, physiology, chronic disease, and the medicines that seniors take play important roles in clinical presentations, conclusions drawn, interventions planned and implemented, and health care outcomes. Knowledgeable psychologists can help reduce the number and severity of common geriatric syndromes (e.g., falls and mental status changes) that our nation's elders suffer due to inappropriate polypharmacy. Providing high quality psychological services includes developing collaborative relationships with medication prescribers and participating in interdisciplinary teams, even if loosely defined (as is often the case at the community-based, independent practitioner level of care). Informed psychological interventions (including dynamic, cognitive, and/or behavioral) can effectively modify many older adults' medical and other health concerns, reducing the need for and risks associated with taking multiple medications. Participating in research, public education, and advocacy efforts in order to enhance the quality and effectiveness of the health care and services that older adults receive are also vital roles for psychology and psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Local Medicare policies: A pathway for providing mental health services to older adults.

Inconsistent local Medicare service coverage policies constitute one of the most prominent barriers encountered by mental health professionals who provide services to older adults. In this study, the authors analyzed the scope and delineation of local Medicare policies for 19 types of psychiatric and psychological services in 2003 and again in 2006. Results indicated policies now exist for all Medicare services in all the states, and many of the local policies provide definitive statements to guide practice. However, some policies lacked delineation and variability persists from one region to the next. While researchers ascertain how local policies can impact service outcomes, providers should form issue networks and resolve current problems such as the inequities surrounding service documentation requirements and the lack of guidance in providing mental health care to older persons with dementia. Given that the Medicare administrative structure will undergo substantive changes in the next five years, there is an exceptional opportunity for providers to address these problems successfully and pave a pathway for providing specialty mental health services to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recommendations about the knowledge and skills required of psychologists working with older adults.

This article is an initial attempt to furnish recommendations for the skills and knowledge psychologists need to work competently with older adults. We use two levels of competence across seven broad areas that are most relevant for professional practice. The fast competence level is that required of general psychologists who provide some professional services to older adults; the second level is that needed by more specialized experts in the field for practice and training. This article is not fashioned as a "how to" document and is not intended to disenfranchise anyone. Recommendations are proposed that delineate the types of competence needed for specific geropsychology activities that are relevant to a variety of settings providing mental health services to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Angiocardiographic digital still images compressed via irreversible methods: concepts and experiments

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.     

Psychotherapy in long-term care: I. Practical considerations and the link to policy and advocacy.

This article is the 1st of 2 examining 3 domains that are important to providing high-quality, evidence-based services to long-term care (LTC) residents: policy and advocacy, practical considerations, and outcome research. Older adults who reside in LTC facilities have a very high rate of mental health difficulties. Psychologists have been able to provide services to this population through Medicare since the late 1980s, resulting in an increase in psychologists who are working with LTC residents, either as part of their practice or on a full-time basis. The focus of this article is on practical considerations for therapists in LTC settings from both the published literature and personal observations (including an illustrative case example), the current policy environment, and the importance of advocacy on behalf of clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musings of a bureaucratic psychologist.

The value of having a background in both experimental and clinical psychology is evaluated from the perspective of an essentially administrative career. The opportunity to have a significant impact on major public policy issues is an important factor in choosing to become involved in a state bureaucracy. Some of the reasons why states have recently turned to managed care for mental health services are explored. The fact that psychologists have not taken an aggressive role in helping to define how public agencies should move into managed care is unfortunate, both from a public policy standpoint as well as for the future of the profession. The future role of psychologists in the changing mental health-managed care environment is also reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as Legislators: Results of the 2004 Elections.

The election results of 2004 were favorable for psychologist legislators. All of the incumbent psychologist members of Congress and state legislatures who were running for office won reelection. The retirement of 2 veteran state legislators was offset by 2 newly elected psychologists. As a group, these legislators continue to sponsor bills and pass laws that have a strong focus on mental health and human services. This reflects well the contributions that a background in psychology can offer to the formation of enlightened public policy. While this career path is not one that most psychologists will pursue, there are other avenues for participation in the political process that are readily available, including membership in the Association for the Advancement of Psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers.

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a “voice” to advocate for their support and care. This article (a) highlights several important policy areas that support the social–emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A national imperative: Public funding of psychological services.

This article discusses the history of Canadian psychology and the publicly funded health care system. Reasons are provided for the current situation, in which psychology is largely not publicly funded, and the current situation in psychology is contrasted with that history, to make the argument that modifications are possible. Different models and methods of funding, related to service providers, service recipients, and the actual services themselves are reviewed. An argument is made that public funding should be provided to clinical psychologists who provide empirically supported services to patients with diagnosable mental health problems. The article concludes with a response to some anticipated criticisms of the position taken, and ideas about political advocacy to advance the agenda of public funding of psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidality in nursing home residents: Part II. Special issues.

Professional psychologists working with suicidal nursing home residents often deal with a host of special issues that may not be relevant to other populations. This review article (Part 2 of a series) was written to acquaint professionals with the concept of indirect self-destructive behavior and dealing with ethical concerns. This article also summarizes health care systems issues, including how to involve staff and family members in assessment and management, as well as understanding Medicare/Medicaid related concerns and public policy regarding long-term care. The article concludes with information about training and continuing education offerings for psychologists who need more information about working in nursing home settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investing in our future: Unrealized opportunities for funding graduate psychology training.

Purpose: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Conclusion: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Program evaluation for organizational cultural competence in mental health practices.

Mental health practices that lack cultural competence prevent diverse clients from receiving the care they deserve. As providers and program administrators, psychologists currently have a responsibility to ensure high quality of care for diverse clients at the clinic level. This article deciphers extant empirical research, organizational theory, public policy literature, and best practices to identify which recommendations are most relevant for those in small mental health practices and clinics. The authors present 10 components for culturally appropriate care, ranging from policies and procedures to needs and satisfaction level of clients. This overview can be used to help evaluate and develop a mental health practice's ability to meet the needs of diverse clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public sector psychology in the wake of the 2005 White House Conference on Aging.

The 2005 White House Conference on Aging provides a vantage point for discussion of important public sector topics related to aging. The article points out important implications for psychologists and other health care professionals in the area of aging. After reviewing the resolutions passed by the White House Conference, there is a focus on the geriatric workforce which notes the under supply of psychologists who provide services to older adults. The efforts of professional associations are detailed with emphasis on the American Psychological Association and its collaborative efforts with the American Bar Association. These efforts deal with providing more information for lawyers and judges who deal with the topic of diminished capacity. A case example is provided to elucidate some of the important issues. The article continues with a discussion of the needs of older Veterans, the work of the Veteran's Health Administration and the recommendations by the Geriatric and Gerontology Advisory Committee. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Editorial: What will the 21st century bring? An emphasis on quality care.

Day-to-day concerns frequently take precedence over abstract concepts for psychologists practicing in the United States. However, traditional mental health services are a subset of the more generic health care environment, and changes in this environment will eventually affect the daily practice of mental health practitioners. For a profession to continue to mature and thrive, leadership must be aware of and capitalize on relevant national and international changes. In the 21st century, advances in technology and communication will affect the quality of services and will likely result in increased stress for practitioners and patients. This article reviews developments within the American Psychological Association and explores both current and potential roles that will shape the future of professional mental health practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)