Providers' Perceptions of Barriers and Facilitators to Geriatric Mental Health Care

Background and Purpose: Prior mental health services research has sought the perspectives of older adult consumers, caregivers, and mental health clinicians to understand the complex issues affecting service access, utilization and retention in treatment of older adults with late life depression. However, there has been limited attention focused on 1) the potential systems-specific perspectives of aging services versus mental health service-based providers with respect to the identification of barriers and facilitators to treatment and 2) the identification of treatment facilitators specific to contemporary suburban regions. This study aimed to identify similarities and differences in how aging and mental health providers conceptualized barriers and facilitators to geriatric mental health treatment.

Methods: A purposive sample of 31 key informants (18 aging service providers and 13 mental health providers representing 20 human service agencies in a suburban metropolitan county) participated in 4 structured concept mapping sessions. Concept mapping participants generated sets of brainstorming statements on service barriers and facilitators. Participants individually organized each statement into conceptually similar categories and then rank-ordered each statement in importance on a 5-point Likert scale. Multidimensional scaling and hierarchical cluster analysis were employed to generate 4 distinct concept maps on aging provider barriers/facilitators and mental health provider barriers/facilitators. The maps are graphic representations of the data, permitting cross-comparisons. Scaling stress values ranged acceptably from .24 to .31.

Results: Both aging and mental health groups ranked the severe shortage of geriatrics-trained professionals as the most important barrier. Regarding facilitators to treatment, the mental health group ranked improving services and access to homebound older adults and their caregivers as highest in relative importance, whereas the aging group ranked geriatrics-related training and education of health and human service providers as the facilitator highest in relative importance. The aging group uniquely identified high cost of living and housing barriers as workforce service delivery issues specific to this suburban metropolitan region.

Conclusions and Implications: Aging and mental health groups identified several barriers and facilitators in common, though there were some differences in both the conceptualization of specific barriers and in the relative importance ranking of specific barrier themes. Findings suggest systems-specific perspectives of providers should inform programmatic responses to older adults' mental health access and treatment.