[Congressional Record Volume 156, Number 117 (Wednesday, August 4, 2010)]
[Senate]
[Page S6738]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Mikulski):
  S. 3698. A bill to amend the Public Health Services Act to provide 
for integration of mental health services and mental health treatment 
outreach teams, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Ms. COLLINS. Mr. President, I am pleased to join my colleague from 
Maryland, Senator Mikulski, in introducing the Positive Aging Act, 
which will help to increase older Americans' access to quality mental 
health screening and treatment services in community-based care 
settings.
  The legislation we are introducing today is particularly important 
for states like Maine that have a disproportionate number of older 
persons. Fifteen percent of Maine's population is 65 or older, and, 
with the highest median age, Maine is the ``oldest'' State in the 
nation. Moreover, our percentage of older adults is increasing, and, by 
2036 more than 1 in 5 Mainers will be over the age of 65.
  One of the most daunting public health challenges facing our nation 
today is how to increase access to quality mental health services for 
the more than 44 million Americans with severe, disabling mental 
disorders that can devastate their lives and the lives of the people 
around them.
  What is often overlooked, however, is the prevalence of mental 
illness among our Nation's elderly. Studies have shown that more than 1 
in 5 Americans aged 65 and older experience mental illness, and that as 
many as 80 percent of elderly persons in nursing homes suffer from some 
kind of mental impairment. Particularly disturbing is the fact that the 
mental health needs of older Americans are often overlooked or not 
recognized because of the mistaken belief that they are a normal part 
of aging and therefore cannot be treated.
  While older Americans experience the full range of mental disorders, 
the most prevalent mental illness afflicting older people is 
depression. Ironically, while recent advances have made depression an 
eminently treatable disorder, only a minority of elderly depressed 
persons are receiving adequate treatment. Unfortunately, the vast 
majority of depressed elderly don't seek help. Many simply accept their 
feelings of profound sadness and do not realize that they are 
clinically depressed.
  Moreover those who do seek help are often underdiagnosed or 
misdiagnosed, leading the National Institute of Mental Health to 
estimate that 60 percent of older Americans with depression are not 
receiving the mental health care that they need. Failure to treat this 
kind of disorder leads to poorer health outcomes for other medical 
conditions, higher rates of institutionalization, and increased health 
care costs.
  Fortunately, important research is being done that is developing 
innovative approaches to improve the delivery of mental health care for 
older adults by integrating it into primary care settings. This 
research demonstrates that older adults are more likely to receive 
appropriate mental health care if there is a mental health professional 
on the primary care team, rather than simply referring them to a mental 
health specialist outside the primary care setting. Multiple 
appointments with multiple providers in multiple settings simply don't 
work for older patients who must also cope with concurrent chronic 
illnesses, mobility problems, and limited transportation options. The 
research also shows that there is less stigma associated with 
psychiatric services when they are integrated into general medical 
care.
  The Positive Aging Act builds upon this research and authorizes 
funding for projects that integrate mental health screening and 
treatment services into community sites and primary care settings. 
Specifically, the Positive Aging Act of 2010 would authorize the 
Substance Abuse and Mental Health Services Administration to fund 
demonstration projects to support integration of mental health services 
in primary care settings. It would also support grants for community-
based mental health treatment outreach teams to improve older 
Americans' access to mental health services. To ensure that these 
geriatric mental health programs have proper attention and oversight, 
it would mandate the designation of a Deputy Director for Older Adult 
Mental Health Services in the Center for Mental Health Services, and it 
would also include representatives of older Americans or their families 
and geriatric mental health professionals on the Advisory Council for 
the Center for Mental Health Services. Finally, it would require state 
plans under Community Mental Health Services Block Grants to include 
descriptions of the states' outreach to and services for older 
individuals.
  We are fortunate today to have a variety of effective treatments to 
address the mental health needs of American seniors. The Positive Aging 
Act will help to ensure that older Americans have access to these 
important services. I therefore urge my colleagues to sign on as 
cosponsors of the legislation, which has been endorsed by a number of 
mental health and senior organizations, including the Alzheimer's 
Association, the American Geriatrics Society, the American Psychiatric 
Association, the American Psychological Association, the American 
Association for Geriatric Psychiatry, and the National Alliance on 
Mental Illness.
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