Currently about 40 million Americans are over age 65—a number that is expected to grow to more than 72 million by 2030. Millions of baby boomers will have difficulty obtaining behavioral health treatments unless there is a concerted effort to boost the number of providers able to supply geriatric behavioral health care, according to a new report from the Institute of Medicine (IOM). Barriers to growing and strengthening this workforce are “fundamental and entrenched,” and the magnitude of the problem is so great that no single approach or isolated changes will address it, said the committee that wrote the report.

The 284-page report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? emphasizes the “conspicuous lack of national attention” to the geriatric behavioral health workforce. Federal responsibility is diffused across numerous agencies, bureaus, and departments. The committee's first recommendation is for Congress and the Secretary of the Department of Health and Human Services (HHS) to designate a responsible entity for coordinating federal efforts to develop and strengthen the nation's geriatric behavioral health workforce. The committee recommends that Congress fund the already authorized National Health Care Workforce Commission to serve in this capacity. In the absence of congressional action, the Secretary of HHS should act as soon as possible to designate an alternative body.

In addition, the report calls on HHS leaders to ensure that their agencies are working toward building a workforce of sufficient size that is trained in geriatric mental health and substance abuse care. To grow the workforce, Congress should appropriate funds to carry out the provisions in the Affordable Care Act that support loan forgiveness and scholarships for individuals who work with or are preparing to work with older adults with behavioral health problems. Organizations that accredit health and social service professional schools and license providers should ensure that all who see older patients are able to recognize signs and symptoms of geriatric behavioral health conditions and provide basic care, the committee said.

The committee also calls for redesign of Medicare and Medicaid payment rules to guarantee coverage of counseling, care management, and other types of services necessary for treating behavioral health conditions so that clinicians are willing to provide this care. “There is a fundamental mismatch between older adults' need for coordinated care and Medicare fee-for-service reimbursement, which precludes payment of trained care managers and psychiatry consultation.”

The report follows from a 2008 IOM report, Retooling for an Aging America: Building the Health Care Workforce, which highlighted the urgency of expanding and strengthening the health care workforce in general. Congress mandated that the IOM undertake a complementary study of behavioral health workforce needs. In early 2011, a 16-member IOM committee was appointed that included experts in geriatric psychiatry, substance use, social work, psychology, nursing, direct care, epidemiology, workforce development, labor economics, long-term care, health care delivery and financing, and health care disparities.

“This report is a wake-up call that we need to prepare now or our older population and their extended families will suffer the consequences,” said committee chair Dan G. Blazer, M.D., Ph.D., professor of psychiatry and behavioral sciences at Duke University Medical School.

The report is available on the IOM Web site at books.nap.edu/catalog.php?record_id=13400.