Workers see silent crisis among elderly with mental health needs

There is a growing “silent crisis” among the elderly of undiagnosed and untreated mental health conditions that often spiral into other health problems and housing difficulties, according to social workers, legal services attorneys, and elder advocates.

Elderly individuals across Massachusetts are not getting services they need either because services are unavailable or older people shy away from seeking help because of stigmas attached to mental illnesses, according to several advocates who work with the elderly. Social workers told lawmakers recently they are seeing increased rates of depression and suicide — particularly among white men.

“Most seniors, the vast majority, are falling through the cracks in terms of mental health services,” said Dale Mitchell, executive director at Ethos, a nonprofit aging services organization in Jamaica Plain.

Mr. Mitchell described mental health care as the “biggest unmet” need for the elderly.

“It is an extremely frustrating situation,” he said. “I would characterize this as a crisis. However, it is a silent crisis. It is not one we see, not one we hear.”

During an oversight hearing last Thursday hosted by two legislative committees, Mr. Mitchell said lawmakers may not hear about the problem from many people in their districts. “But believe me it is a very serious problem that affects many people and it warrants much more attention than it is getting,” he said.

A lack of mental health care leads some elderly to develop other health problems, and then requires more costly medical services like nursing homes, according to Kathy Kuhn, who works at the School of Social Work, Center for Aging and Disability at Boston University.

Research shows that 30 percent of elders in the state suffer from mental health issues, with the number expected to grow in the next decade, Ms. Kuhn told lawmakers on the Mental Health and Substance Abuse and the Elder Affairs committees. The percentage of elderly who receive specialized mental health care is 1 to 3 percent, she said.

The problem will be compounded in the future as the elderly population grows, advocates said. The state’s population of 65 and older residents is anticipated to grow 82 percent during the next three decades, according to a report released last week by the Metropolitan Area Planning Council.

Elderly people living alone can feel a lack of belonging and sense of hopelessness because no one knows where or what they are doing. Some go for days without talking to another person — all of which increases their risk for suicide, advocates said.

Ms. Kuhn relayed the story of an 82-year-old Dorchester woman suffering from depression, who showed signs of being suicidal, and was on the verge of being placed in a nursing home — at state expense. Ms. Kuhn met the woman she called “Mrs. McKay” when she worked at Kit Clark Senior Services in Dorchester. Her story illustrates the need and importance of in-home mental health services, Ms. Kuhn said.

Mrs. McKay lived alone, and her only family member in the state was about to move far away.

Along with depression, Mrs. McKay had hypertension, arthritis, diabetes, and a prosthetic leg. She began spending more time alone in her apartment with no visitors, and would not even leave to collect her mail, Kuhn said. McKay refused to seek treatment at a clinic, but agreed to have a social worker visit her at home — which was Ms. Kuhn. Over time, through the home visits Ms. Kuhn convinced her to visit the Kit Clark center, where she eventually joined a quilting group and found a sense of connection.

“The women in the quilting class really started to take an interest in her,” Ms. Kuhn said.

Social workers, physicians, and elder care workers know unaddressed mental illnesses are a growing problem among the elderly, but have difficulty battling it because of stigma, lack of funding, and limited number of specialized care providers able to diagnose and treat mental illness among the elderly, according to Ms. Kuhn.

“A geriatric mental health workforce is vital,” Ms. Kuhn said, adding that clinicians need to be able to differentiate between depression and dementia.

Massachusetts has some of the best mental health programs in the country, Ms. Kuhn said, but the problem is accessing them.

Middle-income people are most at risk, according to Mr. Mitchell. They cannot afford to pay for private mental health care, and they are not eligible to receive subsidized services available to lower-income people. “They are the ones who end up going into nursing homes,” he said.

Betsey Crimmins, an attorney for Greater Boston Legal Services in the elder unit, sees people when they are on the verge of losing their housing, a situation that often stems from untreated mental health issues, she said.

“We are talking about people who have chronic mental health problems that affect every facet of their life,” she said.

Ms. Crimmins said she is often successful in helping people stay in their homes, but “what it doesn’t mean is solving the underlying problem. That is not something I am equipped to do.”

When she is not successful the options for people are bleak, resulting in either homelessness or premature institutionalization in a nursing home, Ms. Crimmins said.

Ms. Crimmins said by the time she meets her clients their mental health needs have reached a crisis point, and in the year she has practiced she has seen an uptick in the number of mentally ill elderly she represents in housing cases. “This is a growing section of our population,” she said.

Ms. Crimmins described the plight of an elderly Everett woman who was being evicted from her public housing because she caused many problems in the building, culminating in her hitting another resident in the elevator.

“When I initially met her, frankly, she was a bit frightening,” she said.

After some “medical sleuthing,” those helping the woman figured out that a steroid she was taking for a kidney transplant was affecting her mental health. Her doctor adjusted her medication, and put her on an anti-anxiety drug. She was a different woman, Ms. Crimmins said.

“The quality of her life greatly increased, and for the state, she was headed for a homeless shelter. She was probably somebody who was headed in and out of hospitals, in and out of emergency rooms, and probably a nursing home,” she said.

Ms. Crimmins said sometimes when she is not able to keep someone in their home she feels a sense of relief for the person knowing they will now get the mental health services they need if they are placed in a nursing home.

Mental Health Committee Co-Chairman Rep. Elizabeth Malia (D-Jamaica Plain) asked Ms. Crimmins if she had any estimates of the number of elderly who end up homeless. While she did not have figures, Ms. Crimmins responded, “There is no doubt in my mind that more and more elders are ending up on the streets.”

Representative Malia said what she was hearing from elder advocates “was not good news.” She said the two committees decided to hold the invitation-only oversight hearing in order to begin discussing the issues some lawmakers feel are overdue for attention.