Providers of Mental Health Services-Now and in the Future
Abramson, Tobi A., Halpain, Maureen, Generations
Mental Health and Mental Illness in Later Lft
A problem of supply, demand, and quality.
How will providers of mental health services respond to the burgeoning of the older adult population that is expected in this country within the next ten to twenty years -especially considering that a disproportionate increase in the number of older people suffering from mental illness is also expected (Jeste et al., 1999)? According to Gatz and Finkel (1995), if even the present prevalence rates of mental illness are applied to the projected demographic growth, then at least 75 million aged individuals will be likely to suffer from mental health problems requiring services.
The same sociodemographic factors-such as the aging of the baby boom and changes in morbidity and mortality rates-will have a striking effect not only on the demand for mental health services, but also on the supply of professionals and others available to provide them. For example, the current group of workers will reach retirement age after the year 2011, leaving a dearth of professionals in all fields. Consequently, a great shortage of professionals who are willing to work with older adults, trained to provide services, and competent to meet the projected population's mental health needs is anticipated.
The current supply of professionals, specialists, and resources is not suffident to meet the present or future demands of the aging population. Many of the psychiatrists, psychologists, social workers, nurse practitioners, family therapists, and primary care physicians who provide mental health services to older adults actually lack the specialized training and skills needed to effectively treat mental illness in this population. According to Halpain and colleagues, (i999), the number of mental health specialists in geriatrics and gerontology is quite small, given the current and future need. If one looks at the statistics for the four main professional groups who provide mental health care (psychiatrists, psychologists, social workers, and nurses), then current (and projected) numbers of trained specialty professionals fall short. These professions are in different stages of growth and development with regard to certification, membership in professional organizations, and training programs that would prepare them to respond to the needs of an aging older population.
Psychiatry. Of the 35,000 U.S. psychiatrists, approximately 5,000 list geriatric psychiatry or geriatrics as one of their three primary interests (Gatz and Finkel, 1995). As a way of responding to and anticipating the growth of the older population, the American Board of Psychiatry and Neurology began to offer a board certification for the subspecialty of geriatrics in 1990. According to Halpain and colleagues (i999), recent counts showed that some 2,400 psychiatrists had received their board certification in geriatric psychiatry. In terms of professional organizations and training programs, there are approximately i,500 members of the American Association for Geriatric Psychiatry and a total of 49 accredited geriatric psychiatry fellowship programs in the United States.
Psychology. Out of the approximately 155,ooo psychologists, anywhere from 200 to boo (Gatz, Karel, and Wolkenstein, iggi; National Institute on Aging, 1987) would qualify as geropsychologists (those who devote at least half of their practice to older adults and their families). Recently, the American Psychological Association established a geropsychology subdivision within the larger Division of Clinical Psychology. At the inception of this division, there were 238 members.
Social work. The demand for more competent social workers working in aging will also continue to increase significantly in coming decades (Rosen and Zlotnik, 20oi). The National Association of Social Workers has approximately 155,000 members of which only about 5,000 indicate aging as their primary area of practice (Rosen and Zlotnick, 2ooi). …