[Congressional Record Volume 157, Number 35 (Wednesday, March 9, 2011)]
[Senate]
[Pages S1508-S1509]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Ms. Mikulski):
  S. 525. A bill to amend the Public Health Service 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 
2030, more than one in five 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 
one in five 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 2011 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 broad 
coalition 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 Council 
on Aging.
  Mr. President, I ask uanimous consent that a letter of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                    March 7, 2011.
     Hon. Susan M. Collins,
     U.S. Senate, Dirksen Senate Office Building, Washington, DC.
     Hon. Barbara A. Mikulski,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senators Collins and Mikulski: On behalf of the 
     undersigned organizations, we are writing to applaud your 
     ongoing commitment to the mental and behavioral health needs 
     of older Americans and express our strong support for the 
     Positive Aging Act, which you are planning to introduce in 
     the near future. This important legislation will improve 
     access to vital mental and behavioral health care for older 
     adults by supporting the integration of mental health 
     services in primary care and community settings.
       An estimated 20 percent of community-based older adults in 
     the U.S. have a mental health problem. These disorders can 
     have a significant impact on both physical and mental health, 
     often leading to increases in disease, disability, and 
     mortality. In fact, men age 85 and older currently have the 
     highest rates of suicide in our country and depression is the 
     foremost risk factor. Evidence suggests that up to 75 percent 
     of older adults who die by suicide have visited a primary

[[Page S1509]]

     care professional within 30 days of their death. Although 
     effective treatments exist, the mental health needs of many 
     older Americans go unrecognized and untreated because of 
     poorly integrated systems of care to address the physical and 
     mental health needs of seniors.
       The Positive Aging Act takes an important step toward 
     improving access to quality mental and behavioral health care 
     for older adults by integrating mental health services in 
     primary care and community settings where older adults reside 
     and receive services. By supporting collaboration between 
     interdisciplinary teams of mental health professionals and 
     other providers of health and social services, this 
     legislation promotes an integrated approach to addressing the 
     health and well being of our nation's growing older adult 
     population.
       We commend you for your leadership and commitment to the 
     mental and behavioral health needs of older adults and look 
     forward to working with you to ensure passage of the Positive 
     Aging Act.
           Sincerely,
       Alzheimer's Association; Alzheimer's Foundation of America; 
     American Assisted Living Nurses Association; American 
     Association for Geriatric Psychiatry; American Association 
     for Long Term Care Nursing; American Association for 
     Psychoanalysis in Clinical Social Work; American Association 
     for Psychosocial Rehabilitation; American Association on 
     Health and Disability; American Foundation for Suicide 
     Prevention/SPAN USA; American Geriatrics Society; American 
     Group Psychotherapy Association; American Mental Health 
     Counselors Association; American Nurses Association; American 
     Occupational Therapy Association; American Orthopsychiatric 
     Association; American Psychiatric Association; American 
     Psychological Association; American Psychotherapy 
     Association; American Society on Aging; Anxiety Disorders 
     Association of America.
       Association for Ambulatory Behavioral Healthcare; Bazelon 
     Center for Mental Health Law; Clinical Social Work 
     Association; Clinical Social Work Guild 49; Council of 
     Professional Geropsychology Training Programs; Depression and 
     Bipolar Support Alliance; Direct Care Alliance; Geriatric 
     Mental Health Alliance of New York; Gerontological Society of 
     America; Illinois Coalition on Mental Health and Aging; Iowa 
     Coalition on Mental Health and Aging; Jewish Federation of 
     Metropolitan Chicago; Jewish Federations of North America; 
     Kansas Advocates for Better Care; Kansas Suicide Prevention 
     Committee; Mental Health America; Midland Area Agency on 
     Aging; National Alliance for Caregiving; National Association 
     for Behavioral Health; National Association for Children's 
     Behavioral Health.
       National Association of Area Agencies on Aging; National 
     Association of Social Workers; National Association of State 
     Mental Health Program Directors; National Center for Assisted 
     Living; National Coalition on Care Coordination; National 
     Consumer Voice for Quality Long-Term Care; National Council 
     for Community Behavioral Healthcare; National Council on 
     Aging; National Council on Problem Gambling; National 
     Foundation for Mental Health; New Hampshire Coalition on 
     Substance Abuse, Mental Health & Aging; Oklahoma Mental 
     Health and Aging Coalition; PHI--Quality Care through Quality 
     Jobs; Psychologists in Long Term Care; US Psychiatric 
     Rehabilitation Association; Witness Justice.
                                 ______