Oct 6, 2020
Mental Health and Older Adults: Important Concerns and Future Directions
“Both older adults and younger folks die by suicide, which is why mental health is a big public health issue that is often underfunded.” — Luming Li, M.D.
One of the top leading causes of death in America is suicide - making mental health a critical topic. In this week's episode, we are joined by Luming Li, M.D., and Michael Schoenbaum, Ph.D., who are helping to advance the work of prevention of mental health conditions.
Part One of ‘Mental Health and Older Adults: Important Concerns and Future Directions’
Luming Li, M.D. is an Assistant Professor at the Yale School of Medicine, Department of Psychiatry, and currently serves as the Associate Medical Director of Quality Improvement of the Yale New Haven Psychiatric Hospital. Her clinical focus is on patients with severe psychiatric conditions that require complex systems of care.
She works clinically as an inpatient psychiatrist at the transitional age, dual-diagnosis psychiatric/substance disorder units at the Yale New Haven Psychiatric Hospital, and serves as a consultant psychiatrist in the Nathan Smith Clinic for patients with HIV. She has research and educational interests in healthcare policy, hospital management, clinical redesign, leadership development, operational efficiency, and quality improvement.
Dr. Li completed a 7-year B.A./M.D. program at Rutgers/Robert Wood Johnson Medical School and residency training at the Yale School of Medicine, Department of Psychiatry. She has also served on national committees within the American Psychiatric Association (APA), including the Health Systems and Financing Committee (2017-2018), and was an APA Public Psychiatry Fellowship recipient. She is a 2019-2020 Health and Aging Policy Fellow and American Political Science Association Congressional Fellow.
Michael Schoenbaum (PhD in Economics, University of Michigan, 1995) is Senior Advisor for Mental Health Services, Epidemiology, and Economics in the NIMH's Division of Services and Intervention Research. He conducts analyses of public health and mental health service issues in support of Institute decision-making. He works to strengthen NIMH's relationships with public and private stakeholders to increase the public health impact of NIMH-supported research. He has worked extensively on expanding and improving identification and treatment of suicide risk; on improving treatment for behavioral health issues in general medical settings, and on broader implementation of the evidence-based Collaborative Care model to do so, and on facilitating the adoption of coordinated specialty care for early psychosis. Before joining NIMH in 2006, Dr. Schoenbaum was a Robert Wood Johnson Scholar in health policy at the University of California, Berkeley, from 1995-1997, and an economist at the RAND Corporation from 1997-2014 (adjunct 2006-2014).
Part Two of ‘Mental Health and Older Adults: Important Concerns and Future Directions’
Many suicides are associated with mental health and/or substance use conditions; we might all wish for better treatments. But for now, from public health or a clinical care perspective, we have to work with the treatments that exist.
There's a national conversation about the need for better mental health and substance use care because everybody is concerned that the pandemic might be increasing risk. However, the conversation may also represent an opportunity to do better in ways that we could or should have pursued before the pandemic. There are different steps and components to zero suicide, but how do we measure that it's being implemented? Everything must be aligned with the evidence.
Due to science development, there are now many ways to find people with suicide risk, which is essential because we can't help them if we can't find them. There are approaches to use evidence-based tools to accomplish what the goals are for the different steps. For example, one of the things that can be used is the Columbia Suicide Severity Rating Scale or C-SSRS. It's a suicidal ideation and behavior screening scale created by researchers at Columbia University, University of Pennsylvania, University of Pittsburgh, and New York University to evaluate suicide risk.
The Collaborative Care Model is “one approach to integration in which primary care providers, care managers, and psychiatric consultants work together to provide care and monitor patients’ progress. These programs have been shown to be both clinically-effective and cost-effective for a variety of mental health conditions, in a variety of settings, using several different payment mechanisms” (UnützerJ, et al., 2013).
“National Suicide Prevention Lifeline is a useful resource not just for people who are struggling, but also if you know someone who is struggling, you can call the lifeline to get advice about how to help other people.” — Michael Schoenbaum, Ph.D.
The good news is that our science has identified many specific practices that would let us do better if we moved from current practice to broader use of better evidence-based practices. According to recent data, more people are reaching out and connecting well with telehealth services. Therefore, more needs to be done in terms of adequately communicating about the available services.
How to Find Resources to Help with Suicide
The National Suicide Prevention Lifeline, a United States-based suicide prevention network of over 160 crisis centers that provides 24/7 service via a toll-free hotline with the number 1-800-273-8255, available to anyone in suicidal crisis or emotional distress, is an excellent place to start to know what the current status is on services. It's essential to try to reach out proactively to people whom you worry might be isolated and see how they're doing.
How to Find Resources to Help with Substance Abuse or Misuse
SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.
Also visit the online treatment locators.
And here’s info on How 2-1-1 works!
Types of Referrals Offered by 211
- Basic Human Needs Resources – including food and clothing banks, shelters, rent assistance, and utility assistance.
- Physical and Mental Health Resources – including health insurance programs, Medicaid and Medicare, maternal health resources, health insurance programs for children, medical information lines, crisis intervention services, support groups, counseling, and drug and alcohol intervention and rehabilitation.
- Work Support – including financial assistance, job training, transportation assistance and education programs.
- Access to Services in Non-English Languages - including language translation and interpretation services to help non-English-speaking people find public resources (Foreign language services vary by location.)
- Support for Older Americans and Persons with Disabilities – including adult day care, community meals, respite care, home health care, transportation and homemaker services.
- Children, Youth and Family Support – including child care, after-school programs, educational programs for low-income families, family resource centers, summer camps and recreation programs, mentoring, tutoring and protective services.
- Suicide Prevention – referral to suicide prevention help organizations.
How to Connect More with Luming Li, M.D. and Michael Schoenbaum:
Luming Li: https://www.linkedin.com/in/luming-li/
Michael Schoenbaum: https://www.linkedin.com/in/michael-schoenbaum-aa23a7b/
Connection of the NIMH to the Center for Aging, Health and Humanities
Dr. Cohen served as the first Chief of the Center on Aging of the National Institute of Mental Health (NIMH) -- the first federal center on mental health and aging established in any country. During his tenure with the federal government, he received the Public Health Service's highest honor, the Distinguished Service Medal.
The late Gene D. Cohen, MD, PhD, founded The George Washington University (GW) Center for Aging, Health and Humanities (CAHH) in 1994 and served as director until his death in 2010. In addition to founding the CAHH, Dr. Cohen served as founding Director of The Washington, DC Center on Aging, a Think Tank. He was president of the Gerontological Society of America from 1996-1997 and served as Acting Director of the National Institute on Aging (NIA) at the National Institutes of Health from 1991-1993. At GW, he also held professorial positions in Health Care Sciences and Psychiatry and Behavioral Sciences. In addition, he also coordinated the Department of Health and Human Services' planning and programs on Alzheimer's disease, through the efforts of the Department's Council and Panel on Alzheimer's Disease.
In 2019, Dr. Cohen’s work was archived as a Special Collection and University Archive at the University of Massachusetts Amherst.
About Melissa
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.