Older Americans need action on mental health and behavioral health crises

Many older Americans face age-related mental health issues and substance abuse disorders that were exacerbated by COVID-19. This is fueling a national health crisis that requires action by policymakers, health care providers and insurers. 

Older adults commonly reported depression, anxiety and trouble with sleep during the pandemic. Since March 2020, one in five adults ages 50-80, or 19 percent, reported worse sleep patterns than before the pandemic.

The pandemic made it increasingly difficult for older Americans and people with disabilities to connect with family and friends. This may have contributed to higher substance use, dangerous overdoses, and even suicide for some people with substance use disorders.

Before the pandemic, one in four people older than 65 experienced social isolation, putting them at greater risk of loneliness, according to the U.S. Centers for Disease Control and Prevention (CDC). Research shows social isolation has the same detrimental effect on the body as smoking 15 cigarettes a day. Evidence reveals that social isolation and loneliness hinder good health — putting older adults at risk for high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease and even death.

As a gerontologist, I have seen firsthand how timely and affordable behavioral health care can have a significant impact on people’s lives. People need behavioral health care to stay healthy and, in some situations, save their lives — yet there is not a standardized package or process to address this looming problem. 

The Senate Special Committee on Aging held a hearing in May, “Mental Health Care for Older Adults: Raising Awareness, Addressing Stigma, and Providing Support,” at which committee chairman Sen. Bob Casey Jr. (D-Pa.) and ranking member Sen. Tim Scott (R-S.C.) highlighted the disparities among integrated mental health care in older Americans. 

In 2020, individuals 85 and older had the highest suicide rate of all age groups. Challenges in fragmented health care systems, systemic ageism and lack of integration between Medicare and Medicaid programs have caused roadblocks for older adults in accessing quality health care. 

The 117th Congress proposed the Mental Health Access Improvement Act of 2021, but it has not passed. It would allow mental health counselors and marriage and family therapists to bill Medicare for counseling services. The addition of counselors and marriage and family therapists would give Medicare beneficiaries access to over 225,000 licensed behavioral health providers. 

This legislation would close the gaps in Medicare to provide strengthened integration and accessibility of care, as well as more services to those in rural and critically underserved areas.  

To combat the behavioral health crisis in this country, mobilizing the behavioral health workforce is essential.

The Medicare Payment Advisory Commission (MedPAC) advises Congress on issues affecting the Medicare program, including payments to providers in Medicare’s traditional fee-for-service programs and private health plans. MedPAC is still accepting suggestions/ideas to the Medicare Physician Fee Schedule for 2023 from elected officials, private citizens, think tanks and nonprofit organizations. Any changes the fee schedule would need be voted on by the commission’s 17 members.

The Centers for Medicare & Medicaid Services (CMS) states it will change oversight and coordination rules “to ensure that behavioral health practitioners across the country can practice to the full extent of their license.” The rule proposes four major supervision and coordination changes to improve behavioral health access for Medicare patients. The rule also proposes to change the type of physician supervision required for marriage and family therapists, licensed professional counselors, addiction counselors, and certified peer recovery specialists from “direct” to “general.” In addition, the rule requires psychologists and social workers to participate in managing patient health within primary care teams. 

For the first time, Medicare is introducing a new payment plan for team-based, comprehensive management and treatment of chronic pain. CMS also proposes that opioid treatment and recovery services will be covered by mobile units, such as vans, so that Medicare recipients who live in rural areas or are homeless can access these services. It also calls for an increase in payment rates to opioid treatment programs to cover the costs of counseling services and the costs of starting the opioid drug buprenorphine via telehealth, as it does with in-person treatment.  

In a study conducted by the University of Southern California in 2021, one in 10 adults were at risk of overdose, and older Americans were more likely to use high doses of opioids than younger adults. It is important that states embrace policies that ensure older adult addiction programs are accessible, patient-centered, integrated with medical and mental health services, and offer services tailor-made to their populations to promote quality, effective and equitable addiction care.

Behavioral health care providers could make considerable progress in this country through these Medicare reforms. Policymakers, administrators, providers, insurers, patients and families need to work together to solve mental and behavioral health challenges. But Congress must act to pass the Mental Health Access Improvement Act before more older Americans suffer.

Michael Pessman is a gerontologist and community engagement coordinator at Rush University Medical Center in Chicago and a Public Voices Fellow through The OpEd Project. Follow him on Twitter @agernation.