Research That Matters (January 17 - 20, 2008)

Background and Purpose: Public community long-term care (CLTC) is one of the most rapidly growing service sectors, given population aging and the societal value of maintaining independent living. Social work has played an active role in the provision of services for this population. Various federal initiatives have set goals to improve care for older adults with mental disorders. However, the capacity of the current CLTC systems in the United States to respond to mental disorders among their clients is unknown. The objectives of this study were to: 1) determine where the assessment and treatment of mental disorders fall among the priorities and concerns of each SUA; 2) examine the linkages between each state's SUA and other mental health organizations; and 3) summarize the strengths and barriers that each state's SUA encounters in the coordination of behavioral health services.

Methods: Key informant interviews were conducted with directors or another member of senior management of state units. Forty-six states participated in the study, representing a response rate of 92%. All interviews were conducted by telephone, and responses were entered into a customized database and content analyzed.

Results: Eighteen states regarded the treatment of mental disorders as a high priority; however, only 11 states reported having an organizational unit or person specifically designated for mental health detection, prevention or treatment activities for older adults. Twenty-five states reported a formal working agreement with their respective Department of Mental Health. The most common strengths among the state units were program linkages, strong programs, and their philosophy. The most common barriers were stigma, access to services, and workforce problems.

Implications: The infrastructure of the long-term care system in most states will require a significant investment in resources in order to support comprehensive services that include care for mental disorders. Gaps in service delivery may be addressed, in part, through collaborations with other departments and organizations – a strategy that many interview respondents considered to be economically and administratively viable. Given the administrative and leadership responsibilities of social workers in CLTC and Departments of Mental Health, additional research on how the kinds of skills social workers use (e.g., collaboration, planning and coordination) might help ensure better care for this population.