Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities

In 1999, the U.S. Supreme Court declared in Olmstead v. L.C. that unnecessary segregation of people with disabilities in institutions is a form of discrimination that violates the 1990 Americans with Disabilities Act (ADA). This decision has a significant impact on older adults who have serious mental illnesses. Frequently consigned to nursing homes due to lack of community-based care, many older adults with mental illnesses could live successfully in their communities, and even in their own homes, with appropriate services and supports.

The lack of appropriate long-term care affects all older Americans. Those with serious mental illnesses are particularly vulnerable. They face the double burden of being elderly in a youth-oriented culture, and of having a disease that is still poorly understood and accepted. Yet older adults with serious mental illnesses are people first. They are mothers and fathers, grandparents and great-grandparents, and sisters and brothers.

Community-based services for older adults come in many forms: A nurse may visit every week or so to check an older adult’s health and medications; senior center staff may connect the person with a counselor; the letter carrier may call a community team when she suspects a crisis; a peer may visit to share experience, hope, and advice. These services and supports keep people in the community, and help those who have recently been in a hospital or nursing home make a successful transition back to the community.

Unfortunately, in many communities, fragmented service systems leave the individual, or more likely a caregiver or advocate, to negotiate among providers of mental health, elder care, and home health care services. Frequently, individuals fall through the cracks and their caregivers don’t know where to turn.

To help communities plan for services for people of all ages, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services has created the National and Statewide Coalitions to Promote Community-Based Care under Olmstead project for people with serious mental illnesses. This report, Community Integration for Older Adults with Mental Illnesses: Overcoming Barriers and Seizing Opportunities, is the third in a series produced by the Olmstead project. The first addressed adults with mental illnesses and the second dealt with children with emotional and behavioral disorders.

Specifically, this paper describes the characteristics and service needs of older adults with serious mental illnesses, barriers to community integration, prevention interventions, and successful program and system practices. It also profiles several successful programs. Ultimately, the paper answers the basic question: How can we best keep older adults with mental illnesses in the community?