Geriatric Mental Health

This website is designed to provide you with Geriatric Information and Resources, as well as updates on the Office of Mental Health’s Geriatric Service Demonstration Programs.

In 2011, the first of the post-war “baby boom” generation (those born between 1946 and 1964) will reach the traditionally defined “old” age of 65 years. This “elder boom” will result in a doubling of the number of older adults from 35 million in 2005 to 70 million by 2030. In New York State, the number will increase over 50% from 2.4 million to 3.7 million. The number of older adults with mental illnesses in the United States will also double increasing from 7 million to 14 million and will increase more than 50% in New York State from 480,000 to 740,000. Only 20-25% of the elderly with mental illness currently receive services from mental health professionals while others prefer to be treated by their primary physician or their illness goes undiagnosed.

This dramatic increase in the number of older adults that will require mental health services raises concerns about the ability of health, mental health, and aging services to provide adequate access to services that respond to the unique needs of older adults in a coordinated way. Additionally, the projected growth of cultural minorities in the older adult population from 16% to about 25% and the projected 5% decrease in the proportion of working age adults present even greater challenges.

As part of the growing attention and interest at all levels of government to advance geriatric mental health care and prepare for the impending elder boom, New York State enacted the Geriatric Mental Health Act on August 23, 2005. The law, which took effect on April 1, 2006, authorized the establishment of (1) an Interagency Geriatric Mental Health and Chemical Dependence Planning Council, (2) a geriatric service demonstration program, and (3) a requirement for an annual report to the Governor and the Legislature.

22 Grants Awarded To Integrate Health Care for the Elderly

The New York State Office of Mental Health (OMH) has conditionally awarded 22 grants to integrate physical and behavioral health care in either behavioral health care settings (Model 1) or physical health care settings (Model 2) to assist older adults with mental health and/or substance use disorders in New York State.  These awards were made as the result of a Request for Proposals (RFP) made in accordance with Section 7.41 of the Mental Hygiene Law, which calls for OMH to establish a geriatric service demonstration program.

Consistent with the RFP, the awards will be made in two phases, each with different contract starting dates:

5 Phase I Awardees with an Anticipated Contract Start Date of 10/1/11:

• Interborough Developmental and Consultation Center – Model 1

  Interborough plans to pilot an integrated physical and behavioral health care program for the elderly at their Flatbush outpatient mental health clinic.  This site has high concentrations of older Russian immigrants seeking integrated care.  A bilingual nurse practitioner will be hired to work in collaboration with a physician to provide integrated care, which includes physical exams; health wellness groups; complex care management; integrated physical and behavioral health treatment plans; and additional services.

• Clubhouse of Suffolk – Model 1

  In collaboration with Family Residences and Essential Enterprises and the Institute for Wellness and Recovery of New Jersey, the Clubhouse of Suffolk’s Personalized Recovery-Oriented Services (PROS) program will operate an integrated health care program for adults aged 55 or older with a serious mental and/or substance use disorder.  A physician and a nurse practitioner will perform on-site primary care including screening and physical exams.  Peer wellness coach mentors will be trained to engage members in healthy lifestyle choices, with an emphasis on coaching for the prevention and management of metabolic syndrome.

• Mercy Medical Center – Model 1

  Mercy Medical Center in Garden City will renovate on-site clinic space to conduct physical examinations, add a physician’s assistant and support personnel, and reorganize existing procedures to integrate the delivery of care provided by both physical and behavioral health staff.  As the newest addition to staff already well versed in the integrated delivery of care, the part-time physician’s assistant will inform the development of treatment plans and ultimately help ensure improvement of outcomes such as medication adherence, and treatment of hypertension, diabetes, heart disease, asthma, and obesity.

• Flushing Hospital Medical Center – Model 1

  Flushing Hospital’s outpatient mental health clinic will implement an integrated health care program that will enable their older adult patients to access primary care services at the clinic.  The hospital plans to hire a full-time nurse practitioner who will focus on preventive care and the interrelationship between a patient’s medical and psychiatric illnesses.  A project management team from the Departments of Psychiatry, Addiction Services, and Ambulatory Care will implement the program, which is expected to reduce the impact of chronic diseases that result in avoidable medical and psychiatric hospitalizations.

• Southeast Nassau Guidance Center – Model 1

  Southeast Nassau Guidance Center will hire a nurse practitioner with a specialty in gerontology and a medical case manager.  Operating within the model of a person-centered healthcare home, the nurse practitioner and other specialty staff will assess and medically monitor adults aged 55 or older receiving treatment in the agency’s mental health clinic.  Expected positive outcomes include health physicals completed for all program participants, improvements in medication compliance, and a substantial decrease in the medical hospitalization rate and medical emergency room visits of program participants.

17 Phase II Awardees with a Contract Start Date of 7/1/12:

Central New York Field Office Region

• Adirondack Medical Center – Model 2

  Adirondack Medical Center will integrate behavioral health care services for adults aged 55 or older at their primary health clinics located in Essex, Franklin, and Hamilton counties.  A Licensed Clinical Social Worker with the “R” privilege (LCSW-R) will be hired and co-located at the clinics, completing assessments and consulting with care team members.  The medical home care team consists of primary care providers, a care coordinator, nutritionist, a doctor of pharmacy, psychiatrist, and a health educator.  Adirondack Medical Center anticipates a sustainable model that will improve health outcomes for the target population.

• Cayuga Counseling Services – Model 2

  Cayuga Counseling Services will provide behavioral health services to residents of the Mercy Health and Rehabilitation Center and the Cayuga County Nursing Home.  A licensed psychiatric nurse practitioner will provide medication consultation services, and a licensed therapist will provide therapy for adults 55 years of age and older.  Expected outcomes include the alleviation of symptoms of depression, anxiety, and psychosis, and improving the quality of life of those who live in these elder care settings.

• The Family and Children’s Society – Model 2

  In collaboration with United Health Services Hospital, the Family and Children’s Society plans to integrate behavioral health services into two primary care health settings in Broome County.  A senior clinical social worker will be hired as the project coordinator and will also conduct behavioral health assessments, help develop integrated treatment plans with primary care providers and their patients, provide brief therapy as needed, and make appropriate referrals.  Project services include case management.

Hudson River Field Office Region

• Bassett Medical Center – Model 2

  Bassett Medical Center will integrate behavioral health care services for adults aged 55 years or older at three of their primary care clinics in Schoharie County, which are located in Cobleskill, Middleburgh, and Sharon Springs.  An on-site bachelor’s level social worker or psychologist will develop an assessment tool kit of screening instruments, train the primary care teams how to use them, and initiate assessments.  An on-site LCSW-R will complete the assessment process, in collaboration with the primary care teams, and provide behavioral health treatment services, including counseling.

• Hudson Valley Mental Health – Model 1

  Hudson Valley Mental Health will partner with Hudson River HealthCare, an Article 28 health facility, to integrate physical health care into their outpatient mental health clinics.  The agency will begin by integrating care at its Dover Plains site, where physical health care visits will be provided by a nurse practitioner.  A half-time bilingual social worker, who will work with clients regarding their physical health care needs, will also oversee gatekeeper outreach efforts in the community and conduct support groups.  The project plans to utilize teleconferencing as needed to connect behavioral and physical health care prescribers.

Long Island Field Office Region

• Mental Health Association of Nassau County – Model 1

  In partnership with the Family and Children’s Association and NuHealth (Nassau University Medical Center), the Mental Health Association of Nassau County will co-locate a physician at their behavioral health site in Hempstead and at the Family and Children’s Association’s outpatient mental health clinic in Roosevelt.  The expectation is that the co-location of a primary care provider in these settings will allow them to function as health homes for their consumers.  For mental health consumers aged 55 or older, the goals are to improve overall health, promote recovery, foster independence, and reduce public expenditures.

New York City Field Office Region

• Lincoln Medical and Mental Health Center – Model 2

  Lincoln Medical and Mental Health Center plans to use an enhanced chronic care model for the integration of care in their medicine and geriatric outpatient practices.  The model co-locates a full-time Licensed Clinical Social Worker (LCSW) and a consulting psychiatrist with primary care staff in the primary care setting and uses a collaborative, integrated, holistic approach to more effectively identify and treat behavioral health disorders among older patients.  The program will target 1,000 patients aged 55 or older with both chronic and mental health conditions.

• Henry Street Settlement – Model 2

  Henry Street Settlement will integrate health care for low income adults aged 55 or older in New York City’s Community District 3, including the Lower East Side and Chinatown, with a focus on older adults living in the Vladeck Houses Naturally Occurring Retirement Community.  Functioning as a geriatric care manager, a LCSW will be stationed at the agency’s Article 28 medical health care facility, which is located in the same building as their outpatient mental health clinic, and facilitate the integration of physical and behavioral health care and senior services.

• Heritage Health and Housing – Model 2

  Heritage Health and Housing and the Upper Manhattan Mental Health Center will partner to establish the West Harlem Integrated Health/Behavioral Health Services for the Elderly (WHISE) Program to integrate health care for older adults at both their agencies.  The program will embed a LCSW patient navigator in Heritage’s health care center and a geriatric nurse practitioner in Upper Manhattan’s outpatient mental health and chemical dependency clinics.  Both staff will screen, assess, and monitor program participants; participate in integrated planning; and facilitate the program’s care coordination team.

• Service Program for Older People – Model 1

  Service Program for Older People plans to hire a care coordinator/nurse practitioner to coordinate all medical services for their outpatient mental health and homebound clients, as well as expand the hours of their psychiatrist to work in partnership with the care coordinator.  While the program will serve adults aged 55 or older who come to the agency for behavioral health services, it especially seeks to focus on hard-to-reach groups of older adults, such as the frail homebound elderly and Spanish-speaking older adults.  Clients without medical providers will be provided them through the agency’s program partners.

• Institute for Community Living – Model 1

  Institute for Community Living will co-locate a part-time primary care provider, nurse care manager, and peer wellness coach in their outpatient mental health clinic in Canarsie to provide on-site health assessment/monitoring and care management/coordination.  The target population is elderly clients who do not have primary care providers; those who are not using primary care providers listed in their records; and those receiving treatment from multiple health providers without the benefit of care coordination.  Outreach is planned to identify underserved older adults living in public housing near the clinic.

• Comunilife – Model 1

  In an outpatient mental health clinic in the Bronx that serves primarily Latino adults, children, and families, Comunilife will establish a program of co-ordinated behavioral and physical health care management for Latino adults aged 55 or older.  A registered nurse will be added to a designated clinical team that includes a bi-lingual psychiatrist and a number of part-time social workers and therapists to address behavioral, physical, and socio-economic needs.  The aim is to improve client health literacy, medication adherence, behavior and lifestyle choices, range of services received, and overall behavioral and physical health.

• Sound View Throgs Neck Community Mental Health Center – Model 1

  Sound View Throgs Neck will provide primary health care screening, intervention, and treatment services tailored to individuals aged 55 or older with serious mental health and substance use disorders in their outpatient mental health clinics in the Bronx.  The integrated program will include the employment of primary care health professionals as well as referrals for highly complex cases to their key partner, Montefiore Medical Center.  The goal is to develop a health home model of quality and cost effective health care for a target population with a high prevalence of multiple chronic health conditions.

• Coney Island Hospital – Model 1

  Coney Island Hospital will staff a planned outpatient mental health clinic satellite at the Council Center for Senior Citizens in Brooklyn with a part-time social worker and nurse practitioner to integrate a variety of physical health services with behavioral health care.  For a multi-ethnic population of older adults that includes Jewish-Americans, Russian, and Asian immigrants, the program model was designed to improve access to care and increase adherence to treatment recommendations by providing services in familiar surroundings.

• Union Settlement Association – Model 1

  Union Settlement Association will add a full-time nurse practitioner and a part-time licensed practical nurse to the staff of their Johnson Counseling Center outpatient mental health clinic and its satellite senior centers in East Harlem to integrate health care for their clients aged 55 or older.  Working as part of a team with each client’s therapist or social worker and primary psychiatrist, the new staff will provide on-site physical health assessments, screening, monitoring, treatment, and referrals to partners and others for additional health services.

Western New York Field Office Region

• Family Services of Chemung County – Model 2

  Family Services of Chemung County will develop a menu of behavioral health screening, assessment, and clinical services – provided on a contractual basis – to enhance the physical health care services of primary care providers.  In the first year of the grant, these services will be provided for a target population of Medicaid eligible adults aged 55 or older enrolled in a designated managed care practice based on the medical home model, and with additional providers in the second and subsequent years.  The intent is to create a sustainable model of better integrated services with multiple funding.

• Monsignor Carr Institute – Model 1

  For clients aged 55 or older at their outpatient mental health and chemical dependency clinics in Erie County, Monsignor Carr Institute’s health integration program will provide health screening and assessment, as needed physical examinations, health monitoring, follow-up, and care coordination services.  The agency will hire a full-time medical assistant and contract for a part-time nurse practitioner, who will maintain regular hours at the two clinics and also consult with mental health and chemical dependency staff on treatment options.

Geriatric Service Demonstration Programs

The Geriatric Mental Health Act called for OMH to establish a geriatric service demonstration program to provide grants to providers of mental health care to the elderly. OMH solicited proposals for two types of demonstration programs – Gatekeeper and Physical Health – Mental Health Integration. In April 2007, after receiving a record number of proposals, the Office of Mental Health made nine awards throughout the state for five-year demonstration grants designed to identify and treat older adults who may be at risk for mental health problems. Subject to appropriations, these awards total approximately $2,000,000 a year.

Gatekeeper Programs

Gatekeeper Programs are designed to proactively identify at-risk older adults in the community who are not connected to the service delivery system. Gatekeepers are non-traditional referral sources who, in the normal course of their daily work, come in contact with older adults who might otherwise be isolated. Examples of Gatekeepers include postal workers, utility meter readers, police officers, firefighters, senior center personnel, etc. Gatekeepers are trained to recognize basic signs and symptoms of mental health problems that may indicate an elderly person is in need of help. Once they identify an older adult who might have such problems, they refer them to the Gatekeeper Program. This agency then provides a community response by contacting the identified individual, determining his/her level of need and offering assistance in obtaining support services.

The three Gatekeeper Programs are listed below:

• Family Services of Westchester
• Onondaga County Department of Aging and Youth: Project REACH
• St. Vincent's Hospital Manhattan and Village Care of New York

Physical Health – Mental Health Integration Programs

More than half of older people who receive mental health care receive such services from their primary care physician. The advantages of treatment in a primary care setting for older adults include convenience, improved coordination of mental and medical disorders, and decreased stigma when seeking help from a primary care provider rather than from a mental health provider.

The six Physical Health – Mental Health Integration Programs are listed below:

• Flushing Hospital: The Center for Lifestyle Medicine
• Metropolitan Hospital Center
• New York-Presbyterian Hospital/Weill Cornell Medical Center's Division of Geriatrics and Gerontology
• South Oaks Hospital
• University of Rochester Medical Center, the Jewish Home of Rochester, and Jewish Family Service of Rochester: GEMM Care
• Warren & Washington Counties

Though not funded with monies allocated to the geriatric service demonstration program, Greene County is implementing a Physical Health – Mental Health Integration Program at the initiative of its Department of Mental Health and participates fully in OMH evaluation, consultation, and oversight activities designed for the service demonstration projects.

Demonstration Programs in the News

• Greene County: "Greene expands reach of mental health services," Greenville Press, July 23, 2009.
• Greene County: "Greene County steps up its mental health services," The Daily Mail, May 13, 2008.
• South Oaks Hospital: “What Me Worry? ” Dan's Papers, September 12, 2008.

Upcoming Conferences

• The Medisys Behavioral Health Network at Flushing Hospital Medical Center, 10th Annual Behavioral Health Conference: "Narrative Medicine: Strengthening a Culture of Care" (PDF) on November 11th, 2011.

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Comments or questions about the information on this page can be directed to the Bureau of Program and Policy Development/ Special Populations Unit/ Division of Adult Services.