Senior mental health: Too many pills, not enough services?

Got depression or anxiety? There’s a pill for that. But, while seniors seem to be receiving plenty of mental health medications, a recent report shows that older adults are not always receiving the supportive mental health services that often accompany a mental health diagnosis.

Older adults are more than twice as likely to be taking antidepressants and other psychotropic medications compared to younger adults, yet are half as likely to receive their mental health services from a psychiatrist, according to an article in the Journal of the American Geriatrics Society. The study assessed data from the National Ambulatory Medical Care Survey, the first national effort to study how mental health services and treatments differ for those age 65+ compared to younger adults.

The study reviewed data from more than 100,000 outpatient visits between 2007 and 2010, narrowing the data pool to visits where a patient received outpatient mental health services and/or received a prescription for a psychotropic drug.

“Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients,” says Donovan Maust, MD, MS, an assistant professor in the University of Michigan Department of Psychiatry and the lead researcher in the study, in a university research update. “In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care.” 

The results have geriatric psychiatrists concerned about the risks for older adults who may not realize that antidepressants and anti-anxiety medications can react differently in older bodies than in younger ones. Then add the issue of polypharmacy and possible interactions with other medications—most seniors take at least seven different medications per year, with many taking 12 or more—and the risks increase.  As one example, anti-anxiety drugs can disturb the effectiveness and balance of anticoagulants and drugs to control hypertension—two of the most common types of medications taken by those over 65.

Using local mental health services

A recent National Council on Aging webinar, “Integrating aging services and behavioral health,” offers several resources for senior care providers who want to bring greater access to mental health services to their residents:

1. Make use of community mental health centers (see a list at

2. See if there is a federally qualified health center in your area. These facilities provide comprehensive services. (

3. Hire a local mental health professional at your facility, either full time or part time. Many certified mental health professionals are reimbursable under Medicare.

4. Partner with private practitioners who can provide Medicare-reimbursable services at your site. Many nursing homes use this option to provide mental health services on a contract or consultant basis.

Source: NCOA webinar

“While it’s still true that we have patients who are not getting treated for mental health concerns, these data suggest that we also need to be mindful of the possibility of overtreatment, especially given the changing balance of risk and benefit as patients age,” Maust says. “Collaborative care efforts in primary care that seek to create structure and support for these patients, along with appropriate reimbursement for this type of service, could be key.”

So why are so many older adults missing out on the benefits of mental health services? “It can be challenging to engage older adults in seeking mental health care,” explains Kimberly Williams, chair of the National Coalition on Mental Health and Aging. Many areas offer mental health services at the state and/or county level, but most of the service providers aren’t well versed in working with older adults, she adds. “Reach out and develop collaborative relationships,” she suggests. “It’s a great opportunity for cross-training.”

In addition, many senior care communities do screenings, but aren’t always diligent about following up with referrals and support programs, she adds.

The biggest hurdles may be access and reimbursement. Although most private insurers provide integrated or rider-based services for mental health, many local mental health providers struggle to play well with Medicare’s reimbursement system. However, about half of U.S. states have created coalitions for mental health and aging, Williams says. “They can help you develop collaborative programs and find ways to optimize reimbursement.”

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