Seniors need behavioral health services tailored to age, ethnicity

Behavioral health programs across the country have learned that the elderly respond best to mental health outreach and services that are designed for their age and cultures, according to the panel of speakers presenting “Reaching & Engaging Older Adults in Behavioral Health,” a webinar hosted this week by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Isolation, loneliness and multiple prescription medications provide fertile grounds for depression, drug abuse and alcoholism among senior citizens. Successful behavioral health programs need to involve traditional care-chain partners (such as primary care providers and families) and nontraditional partners, including senior centers, community housing, places of worship and food banks, the panel members said.

Seniors can be tricky to engage, since they can be limited by physical challenges in getting to program sites and may feel burdened by the social stigma that often accompanies a behavioral health issue, said Kristen Barry, a member of the science team at the Administration on Aging’s Older Americans Behavioral Health Technical Assistance Center. The best strategy, she said, is to bring mental health services to places where seniors normally congregate, using a conversational, non-judgmental approach that encourages them to engage in screening.

Cultural differences

Seniors also can react to mental health engagement differently depending on ethnicity, the panel of speakers explained. Outreach strategies that work well in one ethnic community may not work as well in others.

For example, many African Americans, especially men, are very sensitive about being talked down to or being given orders, explained Patricia Pullins, LMSW, LCDC, manager at Specialized Services for Seniors, part of the Wellderly program, Houston. “The number one hurdle to engaging senior African Americans is mistrust,” she said, adding that many seem to be extra-sensitive about alcohol addiction and may have difficulty trusting authority figures. Pullins said her program had the best success when outreach efforts turned into ongoing relationships with specific counselors and included family members and local churches.

Andrea Garr, care manager at Un Nuevo Amanecer (A New Dawn), a Latino-centric mental health program in Milwaukee, said the senior Latino communities she works with have a deep need for outreach and engagement strategies that are tailored to their culture. Since many older Latinos within her organization’s region live with spoken-language and literacy barriers for materials delivered in English, seniors often use younger family members as “partners” during communication. To increase engagement and behavioral health wellness rates, the program began implementing multi-generational events and services. It also added graphics to many of its text-based materials. The program’s challenges highlighted the extreme shortage of bilingual counselors and staff within the nation’s behavioral healthcare delivery system, she added.

Even simple strategies like group events and "conglomerate meals" can have a significant impact on engagement, said Chris Kerr, clinical director at Houston’s Montrose Counseling Center, a non-profit behavioral health clinic that serves seniors in the lesbian, gay, bisexual and transgender (LGBT) communities. Domestic violence, depression and suicide risk are high among these communities, and group social events can help reverse feelings of isolation and can foster peer-to-peer encouragement. Since LGBT individuals come from a historically underserved culture that is accustomed to hiding in order to avoid discrimination, they can find it difficult to reach out for treatment, Kerr said.

The Older Americans Behavioral Health Technical Assistance Center offers many resources to help long-term care providers build behavioral health programs for residents. The center’s series of webinars and issue briefs can help caregivers with outreach strategies to increase engagement across cultural backgrounds and regions.

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