At least 5.6 million to 8 million--nearly one in five--older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation. For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas. Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE MENTAL HEALTH WORKFORCE FOR GERIATRIC POPULATIONS
• Reviewers
• Preface
• Acknowledgments
• Summary
  • A VULNERABLE AND UNDERSERVED POPULATION
  • THE GERIATRIC MH/SU WORKFORCE: TOO FEW AND NOT PREPARED
  • WORKFORCE IMPLICATIONS OF MODELS OF GERIATRIC MH/SU CARE
  • RECOMMENDATIONS
• 1. Introduction
  • STUDY SCOPE
  • METHODS OF THE STUDY
  • CONTEXT FOR THIS REPORT
  • FEDERAL INFLUENCE ON THE GERIATRIC MH/SU WORKFORCE
  • REFERENCES
• 2. Assessing the Service Needs of Older Adults with Mental Health and Substance Use Conditions
  • MH/SU CONDITIONS IN OLDER ADULTS
  • PREVALENCE OF MH/SU CONDITIONS IN OLDER ADULTS
  • PREVALENCE OF MH/SU CONDITIONS IN SIX SUBGROUPS OF THE OLDER POPULATION
  • COEXISTING PHYSICAL HEALTH CONDITIONS AND COGNITIVE IMPAIRMENT
  • IMPACT OF MH/SU CONDITIONS
  • USE OF MH/SU SERVICES BY OLDER ADULTS
  • FACTORS THAT COULD AFFECT THE FUTURE MH/SU SERVICE NEEDS OF OLDER ADULTS
  • SUMMARY OF FINDINGS AND IMPLICATIONS FOR THE GERIATRIC MENTAL HEALTH WORKFORCE
  • REFERENCES
• 3. The Geriatric Mental Health and Substance Use Workforce
  • DEFINING THE GERIATRIC MH/SU WORKFORCE
  • ESTIMATING WORKFORCE SUPPLY AND DEMAND
  • REVIEW OF THE GERIATRIC MH/SU WORKFORCE
  • SHORTAGE OF GERIATRIC MH/SU PROVIDERS
  • RECRUITMENT OF GERIATRIC MH/SU SPECIALISTS
  • INADEQUATE PREPARATION OF THE GERIATRIC MH/SU WORKFORCE
  • TRAINING THE GERIATRIC MH/SU WORKFORCE
  • PROMOTING THE ROLE OF DIRECT CARE WORKERS IN GERIATRIC MH/SU CARE
  • EMPOWERING OLDER ADULTS AND THEIR FAMILIES
  • FINDINGS AND CONCLUSIONS
  • REFERENCES
• 4. Workforce Implications of Models of Care for Older Adults with Mental Health and Substance Use Conditions
  • ORGANIZATION OF THE CHAPTER
  • THE CHRONIC CARE MODEL
  • CARE DELIVERY MODELS FOR GERIATRIC MH/SU
  • MODELS OF MH/SU CARE FOR OLDER NURSING HOME RESIDENTS
  • IMPLICATIONS FOR THE GERIATRIC MENTAL HEALTH WORKFORCE
  • CONCLUSIONS
  • REFERENCES
• 5. In Whose Hands? Recommendations for Strengthening the Mental Health and Substance Use Workforce for Older Americans
  • LOCUS OF RESPONSIBILITY
  • INVESTMENT IN HUMAN CAPITAL
  • BUILDING BLOCKS OF INFORMED WORKFORCE PLANNING
  • REFERENCES
• Appendix A Abbreviations and Acronyms
• Appendix B Public Workshop Agenda
• Appendix C Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers
• Appendix D IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008)
• Appendix E Committee Biographies

This study was supported by Contract No. HHSP23320042509XI between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

Suggested citation:

IOM (Institute of Medicine). 2012. The mental health and substance use workforce for older adults: In whose hands? Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.