the Alcohol, Drug Abuse, and Mental Health Services block grant; the continued fear and stigma that stil haunt our conception of mental disorders; and the disorganized and fragmented system of mental health, physical health, and social services for the elderly. It is sad commentary that today's Medicare system fails to assure that older persons receive adequate and necessary mental health care. We commend Chairman Matsunaga for introducing S. 718, to eliminate some of the gaps in Medicare reimbursement for outpatient mental health care. The Subcommittee can help make a difference in another area which serves to segregate the elderly with mental and emotional problems from the health care and social service networks. Due to the financial problems and the stigma often attached to mental illness, and due to their private fears relating to it, many older people and their families are reluctant to seek mental health care. We believe that it is essential that mental health and aging services organizations work together to eliminate the myths and stigma of mental illnesses by placing them in their proper perspective, namely that mental disorders have multiple causes and can be ameliorated and treated in the same way as physical disorders. The existing network of area agencies on aging established under the Older Americans Act can help bridge the gap between the myths surrounding mental disorders and the realities of modern mental health care, and provide the link and access to both the mental health and aging services systems. The fragmentation of services to older persons is a major factor contributing to the under-service of the aged, but one that can be addressed by the Older Americans Act. As the Subcommittee is aware, there are two distinct service systems, community mental health centers and services financed by Area Agencies on Aging, which can potentially serve the psychosocial needs of the older person. Unfortunately, these systems are currently structured as separate, independent systems. There is currently little routine interaction and almost no cooperation in service delivery between the two service systems. Community mental health centers and area agencies on aging are well aware of the mental health needs of the aged, and believe there should be more cooperation between the two services networks in the delivery of needed integrated services. The amendments we are proposing to the Older Americans Act address the need for cooperation and interaction between the mental health and aging service systems at the Federal, State, and local levels. We are confident that these recommendations are an efficient and cost-effective means of improving mental health care for the elderly. In summary, we recommend: First, that Functions of the Commissioner, under Title II of the Act, be amended to include providing assistance in the establishment and implementation of programs to meet the needs of older individuals for mental health services and address the needs of older persons with such severely impairing conditions as developmental disabilities, stroke, physical and sensory impairment, and mental disorders. Second, the Title III of the Act be amended to: (a) Encourage the development of cooperative working agreements between State agencies and State departments of mental health and between area agencies on aging and local community mental health centers in meeting the mental health and social service needs of the elderly. (b) Encourage the development of cooperative working agreements between State and area agencies with other State agencies whose primary responsibilities are for individuals with mental retardation, developmental disabilities, or other handicapping conditions. (c) Assure that area and State plans include mental health services and address the needs of older persons with severely impairing conditions. Third, that the Act be amended to: (a) Include reference to older persons with special needs, such as disabilities and mental disorders (including Alzheimer's disease and related disorders), in all relevant sections. (b) Make grants available for the training of Title III service providers and nursing home care providers to meet the special services needs of elderly with mental disorders, and other severely impairing conditions. We believe that these recommendations can be implemented under the existing resources of the Older Americans Act. As these recommendations encourage planning and coordination efforts between agencies and departments, and allow for competition for grant awards, they do not require a redirection of the Older Americans Act resources or an additional appropriation for implementation. We are, however, most supportive of the Older Americans Act budget increases recommended by other groups, and believe that the valuable services provided by the Act should be expanded to meet the poorly met needs of additional older persons. We thank the Subcommittee for the opportunity to express our views on the Older Americans Act. We will continue to support this Subcommittee's efforts to improve the care of this nation's older population. We would be pleased to work with the Subcommittee in developing the amendments necessary to carry out these recommendations. I will be happy to respond to any questions that the Subcommittee may have. Senator MATSUNAGA. Dr. Eisdorfer, I am sorry, I must leave now or I will miss the vote. I may have already missed the vote, but I will have to run over to the floor. Your entire statement will appear in the record as though presented in full. [The prepared statement of Dr. Eisdorfer follows:] TESTIMONY OF Carl Elsdorfer, Ph.D., M.D. on behalf of AMERICAN NURSES' ASSOCIATION AMERICAN PSYCHIATRIC ASSOCIATION THE AMERICAN PSYCHOLOGICAL ASSOCIATION THE NATIONAL ASSOCIATION OF SOCIAL WORKERS to the U.S. SENATE, COMMITTEE ON LABOR AND HUMAN RESOURCES SUBCOMMITTEE ON AGING Hearing on the "Reauthorization of the Older Americans Act" March 31, 1987 The Honorable Spark M. Matsunaga, Chairman On behalf of the American Nurses' Association, the American Psychiatric Association, the American Psychological Association, and the National Association of Social Workers, I am pleased to present this testimony before the Senate Labor and Human Resources' Subcommittee on Aging hearing on "The Reauthorization of the Older Americans Act." We welcome this opportunity to comment on the mental health care needs of older Americans. The American Nurses' Association (ANA), comprising 53 state and territory constituent members, is the national professional organization representing the Interests of the nation's professional nurses. The purposes of the ANA are to work for the Improvement of health standards and the availability of health care services for all people; to foster high standards of nursing; and to stimulate and promote the professional development of nurses and advance their economic and general welfare. The The American Psychiatric Association is the nation's oldest medical specialty society, representing over 33,000 psychiatrists nationwide. objectives of the Association Include: Improving the treatment, rehabilitation, and care of the mentally ill, mentally retarded, and emotionally disturbed; fostering cooperation of all who are concerned with the medical, psychological, social, and legal aspects of mental health and Illness; and promoting the best Interests of patients and those actually or potentially making use of mental health services. The American Psychological Association, representing over 87,000 members, is the nation's major psychology organization. The Association works to advance psychology as a science, a profession, and a means of promoting human welfare by promoting responsive concern by the profession on a variety of social and public policy issues; disseminating psychological knowledge to enhance and increase human progress and well-being; developing -2 standards of education, ethical conduct, and professional practice; promoting research; and Improving research methods and conditions. The National Association of Social Workers (NASW) is the largest organization of professional social workers in the world, with over 102,000 members nationwide. The primary objectives of NASW Include: promoting the quality and effectiveness of social work practice; Improving social conditions through the utilization of professional knowledge and skills; and providing opportunities to work toward alleviating or preventing deprivation, distress, and strain through social work practice and social action. Our primary concern is the need for a coordinated approach to the delivery of mental health and social services to older persons living in the community. As the Subcommittee develops its amendments to the Older Americans Act, we urge that the needs of older persons with mental and behavioral disorders, and other severly Impairing conditions, become a priority issue. We believe the Act can, and should, serve as a legislative foundation for programs designed to reach many of the nation's elderly in need of Information about, and access to, mental health and social services. However, before detailing our recommendations and concerns in this regard, we believe it is Important to describe the populations with whom we are most concerned, and to point out some serious obstacles to meeting the care needs of these populations. Mental Health Needs of Older Persons: Background While most older persons are emotionally healthy individuals, it has been estimated that 10% to 28% of older Americans living in the community (2.6 to 7.3 million individuals) have mental disorders serious enough to warrant professional attention. Unfortunately, it has also been estimated |