Academic journal article Generations

A Perilous Arc of Supply and Demand: How Can America Meet the Multiplying Mental Health Care Needs of an Aging Populace?

Academic journal article Generations

A Perilous Arc of Supply and Demand: How Can America Meet the Multiplying Mental Health Care Needs of an Aging Populace?

Article excerpt

Working in the specialty of geriatric mental health care can offer many meaningful opportunities to serve diverse elders in a wide range of care settings.

The growing rate of mental health problems among older adults is of concern to practitioners and policy makers because of its comorbidity with physical illness and disability, and its impact on quality of life and well-being (Gellis, 2006). As we anticipate the proportion of adults ages 65 and older growing from 12.4 percent in 2000 to 20 percent by 2030, the number of older adults with mental illness is expected to double to 15 million (American Association of Geriatric Psychiatry, 2010). The growing number of oldest-old adults with mental health needs will exacerbate the current shortfall of healthcare providers who have geriatric mental health expertise, raising critical questions about who will care for elders' psychosocial and mental health needs.

Geriatric social workers and psychiatrists are educated to promote the mental and psychosocial well-being of older adults and their family caregivers. Although other professions also serve elders' psychosocial needs, this article focuses on social work and psychiatry. Both professions are concerned with the prevention, assessment, and treatment of mental disorders, when practiced in community and institutional settings, under private and public auspices. Social work, with its ecological or person-inenvironment perspective, and commitment to social justice for historically disadvantaged elders, is most likely to provide care coordination, interventions to empower older clients and modify their environment, and advocacy for policy-level changes. With their medical training, psychiatrists are most likely to offer the medical management of older adults with neuropsychiatric disorders, including the appropriate use of psychotropic medications. Regardless of settings or treatment approaches, both professions face a shortage of providers with competencies to meet the psychosocial needs of older adults and their family caregivers (Institute of Medicine, 2008).

An additional concern is that both professions are less diverse in racial and ethnic backgrounds than the older population they serve, and the population in general (NASW, 2006a, 2006b). This gap between the cultural and ethnic background of the workforce and those served will grow with the projected increased diversity of elders by 2030. Both professions are also lower paid compared to other specialty areas, suggesting the need for fiscal incentives as well as educational strategies that recruit students "early in the pipeline" to pursue advanced preparation to promote older adults' well-being.

The Geriatric Social Work Workforce

The shortage of geriatric social workers was recognized as early as 1987, when it was predicted that 60,000 to 70,000 geriatric social workers would be required to meet older adults' needs by 2020, a projection documented again in 2004. Yet less than 10 percent of that projection is currently available (NIA, 1987). The demand for geriatric social workers will increase 45 percent by 2015, faster than the average of all other occupations. Geriatric social work ranks as one of the top twenty careers in terms of growth potential (Bureau of Labor Statistics, 2002, 2004). Despite the promising job market, recruiting social workers to geriatrics remains a challenge for the majority of social work programs nationally.

Such recruitment challenges are intensified by the increasing gap between supply and demand of geriatric social workers. In fact, recent graduates are less likely to work in aging than those who graduated in the 1970s (Bureau of Labor Statistics, 2004). In 2001, only 3 percent of the more than 150,000 members of the National Association of Social Workers (NASW) identified gerontology as their primary area of practice (Rosen and Zlotnik, 2001). By 2005, this had increased, but only to 9 percent of a sample of licensed NASW members. …

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