Update on 8/14/18: The California Collaborative for Long Term Care Services (and hence CHA) has withdrawn our opposition to SB 1004. We greatly appreciate the substantial revisions made to SB 1004 to include funding and provisions for increased access to mental health services for older adults.
Posted 7/25/18: The California Collaborative for Long Term Care Services of which California Health Advocates is a member, submitted this letter opposing SB 1004. This bill would limit access to Mental Health Services Act Prevention and Early Intervention (PEI) services for older adults by establishing new priorities for PEI funding that instead emphasize children and youth. Yet there is overwhelming evidence, some of which is cited in the letter below, that older adults need mental health prevention and early intervention services.
July 25, 2018
Hon. Lorena S. Gonzalez Fletcher
Chair, Assembly Appropriations Committee
State Capitol, Room 2114
Sacramento, CA 95814
Re: SB 1004 (Wiener) – OPPOSE
Dear Assembly Member Gonzalez Fletcher:
The California Collaborative for Long Term Services and Supports is comprised of 38 statewide aging and disability organizations that promote dignity and independence in long-term living. Our members include advocates, providers, labor and health insurers and collectively we represent millions of California seniors and people with disabilities, their caregivers and those who provide health, human services and housing.
We are writing in opposition to SB 1004 (Wiener), which would limit access to
Mental Health Services Act Prevention and Early Intervention (PEI) services for older adults by establishing new priorities for PEI funding that instead emphasize children and youth.
There is overwhelming evidence that older adults need mental health prevention and early intervention services:
- Mental health problems are common in older adults and associated with
risk and protective factors that differ from those active in early life.(i)
- Among older male Veterans seeking psychiatric treatment, PTSD estimates are found to range from 37 – 80%.(ii)
- Older women have been found to experience higher rates of interpersonal trauma than other age groups (72% as compared to 44-55% for women of all ages). Their experiences include intimate partner violence, impacts of childhood physical or sexual abuse, and rape.(iii)
- Depression is the most prevalent mental health problem among older
adults, associated with distress and suffering.(iv) Estimates of major
depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospital patients.(v)
- Older adults are often misdiagnosed and under-treated for mental health
conditions,(vi) putting them at risk of developing major mental disorders.
- Depression is implicated in the high rates of suicide among the older adult population.(vii)
- Approximately 1 in 10 Americans aged 60+(viii) have experienced some form of elder abuse. Established psychological effects of elder abuse include high levels of distress and depression.(ix)
The express purpose of Mental Health Services Act Prevention and Early
Intervention funding is to target services to individuals who can be treated before the development of a major mental disorder. Prevention and early intervention services that treat older adults for mental health conditions can successfully ameliorate and reduce mental distress, suffering and the development of major mental illness:
- Depression is not a normal part of aging. Depression and anxiety in older adults can be prevented from recurring.(x)
- Incidence of new mental disorders can be reduced in older adults.(xi)
- There are best practices that can be effective for preventing suicide among older adults, including Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Centers from the Substance Abuse and Mental Health Services Administration.
- According to the World Health Organization, the mental health of older
adults can be improved through mental health-specific health promotion.(xii)
Ignoring the importance of mental health PEI services for older adults also has significant cost implications for the state of California. According to the Centers for Disease Control, older adults with depression visit the doctor and emergency room more often, use more medication, incur higher outpatient charges and stay longer in the hospital.(xiii)
Geriatric mental health experts Drs. Amanda Leggett and Steven H. Zarit have said that the prevention of geriatric mental disorder is “ripe for growth and with the potential for great health and economic benefits.”xiv Given the dramatic growth in the aging population, it is exactly the wrong time to divest from older adult PEI services.
We respectfully urge the Appropriations Committee to reject the unsound policy of reducing MHSA funding for older adult prevention and early intervention services. Please vote NO on SB 1004.
Laurel Mildred, MSW
For the California Collaborative
cc: The Honorable Members of the Assembly Appropriations Committee
Hon. Anthony Rendon, Speaker of the Assembly
Hon. Brian Dahle, Assembly Minority Leader
Senator Scott Wiener