Treating Psychiatric Illness



Treating Psychiatric Illness

Introduction

Elderly Adults with Psychiatric disorders are less likely to be diagnosed as having a mental disorder or to receive needed mental health treatment than younger adults. This unmet need is likely due to factors such as under recognition by providers; transportation and access difficulties; reluctance of practitioners to diagnose psychiatric disorder; reluctance of the elderly to accept the diagnosis of a psychiatric illness; difficulties disentangling coexisting medical? psychiatric? and social morbidity; and the 50% copay requirement for mental health services under current Medicare legislation. (Roca, 1987, 741-745)

No single solution is likely to address these many issues? but earlier recognition of disorder and improved delivery of services are 2 approaches that may reduce unmet need. One program developed to address lack of access to care is the a Community Treatment model? which relies on mobile treatment teams and has well-established efficacy in young and middle-aged adults. Another innovative model? the Gatekeeper approach seeks to increase the likelihood that elderly persons with potential psychiatric disorders are identified and referred to mental health service for assessment by training people who work in the community? such as bank tellers? mail carriers? and meter readers. Its innovation is the use of these community workers as "case finders." This study prospectively examines the effectiveness of a treatment model that combines principles of the Assertive Community Treatment and Gatekeeper models. This program? entitled Psychogeriatric Assessment and Treatment in City Housing (PATCH)? targets elderly persons living in urban public housing developments. The PATCH intervention model has 3 elements: (Roca, 1987, 741-745)

(1) the training of indigenous building workers? such as managers? social workers? groundskeepers? and janitors? to identify those at risk for psychiatric disorder; (2) the identification and subsequent referral of potential cases by these workers to a psychiatric nurse; and (3) psychiatric evaluation and treatment in the residents' homes. Psychiatric nurses are the primary service providers? with psychiatrists serving as supervisors or consultants. This study was designed to determine whether the PATCH program could reduce psychiatric symptoms among elderly residents needing care and enable them to remain in public housing. This population was chosen because rates of psychiatric disorder among elderly public housing residents are 50% higher than matched individuals living in the community and because this psychiatric morbidity predisposes residents to adverse outcomes such as eviction and termination of lease. (Roca, 1987, 741-745) We have previously reported that 26.9% of residents of public housing for the elderly in Baltimore?(Ormel, 1993, 385-390) Md? had a psychiatric disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders? Revised Third Edition (DSM-III-R) (TABLE 1) and that 58% of those meeting criteria for needing mental health care are receiving no treatment. (Ormel, 1993, 385-390)

METHODS

Six public housing developments for the elderly in Baltimore? Md? served as study sites. Each was a large urban apartment building that provided no on-site psychiatric care. The study was approved by the institutional review board of the Johns Hopkins School of Medicine and was conducted between 1992 and ...