Transcript SAN MATEO COUNTY MENTAL HEALTH FOCUS GROUP …

Transforming the System: Community Input and Feedback
Older Adults
Presented by Louise Rogers
San Mateo County Mental Health Services
7/21/2015
1
INTRODUCTION
The Mental Health Services Act has the potential to
transform how mental health services are delivered in
San Mateo County.
7/21/2015
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INTRODUCTION

As a part of the planning process, San Mateo County
Mental Health Services has sought community input
through public forums and focus groups throughout the
County.

Over 100 focus groups and community meetings were
held reaching over 1000 people.

Outreach focused on consumers and family members,
populations that are historically under-served, and
providers who work with the mental health system.
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INTRODUCTION
Focus groups and meetings were held:
 in all regions of the county;
 in the languages of under-served populations;
 at juvenile hall;
 at jail;
 at shelters;
 at board & care facilities;
 at community centers;
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INTRODUCTION
We met with:
 people who are homeless;
 people who have been victims of domestic
violence;
 pregnant and parenting teens;
 grassroots community organizations with
close ties to neighborhoods;
 advocates for families and consumers; and
 dozens of parents, family members, and
consumers, young and old.
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INTRODUCTION

The information gathered from these conversations
has been summarized to inform the workgroups on
ways to transform the system. Findings were organized
in the areas of:
 access,
 the kinds of services and supports
available, and
 strategies to foster a better quality of life.
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INTRODUCTION
Within Access we examined input in relation to:
 Stigma as a barrier to care
 Lack of understanding of the system and how it operates
 Transportation issues
 The absence of services in geographically isolated areas
 The difficulty of penetrating existing points of entry to the system
and
 The need for better public education to under-served populations
and how best to achieve an improved understanding of mental
illness and the mental health system
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INTRODUCTION
In relation to the mental health services and supports, we looked
at both the kinds of services and the way that services are
delivered with a focus upon:
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Culturally competent services
Bilingual information about the system and mental health
A more customer friendly and compassionate system
Consumer, peer and family involvement
Services in natural community settings
Integrated services and links with other systems
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INTRODUCTION
In relation to how services are delivered, we also
looked at:
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Criminal Justice partnerships
Primary Care partnerships
24-7 services and immediate crisis response and
PES diversion
Integrated treatment for dual diagnosis
Access to broader range of treatment
services
Access to alternative therapies and
treatments
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INTRODUCTION
In relation to Quality of Life issues, we looked at input in
these areas:
 Housing
 Education
 Employment
 Financial, benefit and insurance
support
 Recreation, socialization and
spirituality
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INTRODUCTION

Twenty-Two focus groups were held that either included
Older Adult consumers, family members of Older
Adults, or providers of services targeting Older Adults.

A total of 276 participants were involved in these 22
focus groups and community meetings.
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
STIGMA, SHAME & LACK OF UNDERSTANDING
OF MENTAL ILLNESS


In relation to accessing mental health services,
in 18 of the 22 focus groups, participants
identified stigma as a barrier to care.
Most comments related to feeling a sense of shame or
embarrassment about having mental health issues.
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
STIGMA, SHAME & LACK OF UNDERSTANDING
OF MENTAL ILLNESS

One consumer commented, “I don’t want
others to know about my problems. They
will think less of me.”

Another older adult commented, “If you pray for help, you
re religious and fine, but if you take a pill for help, you are
crazy. I hear it all the time.”
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
STIGMA, SHAME & LACK OF UNDERSTANDING
OF MENTAL ILLNESS

Another older adult conveyed how this sense of shame
operates as a barrier to accessing care, “Some of us are
reluctant to join groups or get into the system because we
don’t want it to get out. I am afraid of people knowing I
am getting help from you.”

And finally one senior stated, “Employers reject
individuals with mental health problems.”
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
LACK OF KNOWLEDGE ON HOW TO ACCESS
AND USE MENTAL HEALTH SERVICES

In 13 of the 22 Older Adult focus groups, participants identified lack of
understanding of the mental health system as a significant barrier to
care. One older adult stated, “I need more information about what is
available.”

Another consumer mentioned that a clearinghouse or single point of
entry would facilitate understanding the system.
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Finally, one older adult warned, “Technology is more a barrier than a
tool for improving access. Many of us don’t use computers and those
that do need help using it. And the phone systems with lots of options
only confuse us. Make it simple.”
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
OUTREACH AND EDUCATION FOCUSING ON
NEIGHBORHOODS LEADERSHIP, CULTURAL
INTERMEDIARIES AND COMMUNITY FORUMS

In seventeen Older Adults focus groups, participants
identified the need for the mental health system to
try some different approaches to outreach and
community education.

One senior noted that, “There should be a mental health table at
EVERY fair in the community. Community education should
never take a day off.”
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
OUTREACH AND EDUCATION FOCUSING ON
NEIGHBORHOODS LEADERSHIP, CULTURAL
INTERMEDIARIES AND COMMUNITY FORUMS

While many seniors commented on the
need to educate the general public in
order to address issues of stigma and
access, still more seniors talked about
the need to educate medical system.
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ACCESS: LACK OF KNOWLEDGE OF MENTAL ILLNESS AND MENTAL HEALTH SYSTEM
OUTREACH AND EDUCATION FOCUSING ON
NEIGHBORHOODS LEADERSHIP, CULTURAL
INTERMEDIARIES AND COMMUNITY FORUMS

“It is critically important that the entire medical
community receive training in mental health issues.
It starts with primary care where seniors go first for
care, but then we wind up with referrals to all kinds
of specialists, labs, radiology sites, etc. and these people
need to understand our situation and be able to help us.
This includes the clerks, receptionists and appointment people.”

And another senior noted, “Too often, if I get confused, they act like
this is my problem and I have to figure it out. If I could figure it out, I
wouldn’t be confused.”
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ACCESS: POINTS OF ENTRY NEED TO BE EXPANDED AND IMPROVED
AREAS OF THE COUNTY ARE DISTANT FROM SERVICES AND LACK
AN ADEQUATE LEVEL OF SERVICES

Eight of the 22 focus groups identified as a barrier an insufficient
level of services in different regions of the county with one family
member indicating that “there is a significant disparity in the
level of field work and follow-up that is conducted in different
regions.”

A member of a Chinese-language focus group indicated that
“there is no Chinese Services office in Daly City, we have to go
to San Francisco.”
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ACCESS: POINTS OF ENTRY NEED TO BE EXPANDED AND IMPROVED
TRANSPORTATION IS A BARRIER TO CARE

While only called out in ten of 22 focus groups, when it was
mentioned, the issue was identified as a very significant barrier.
One consumer underscored this need. “A lot of us don’t have
someone to take us to appointments and the clinics are a long
way away.”
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“Transportation is a huge issue and more is needed
than just a voucher for taxis or bus passes. Many
older adults need an escort and those who don’t
speak English need an escort who speaks their native
language.” This was a point made several times.
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ACCESS: POINTS OF ENTRY NEED TO BE EXPANDED AND IMPROVED
TRANSPORTATION IS A BARRIER TO CARE

Finally, as an extension of the need for escort support,
several consumers and providers also underscored the
need for escorts to remain with consumers at many
kinds of appointments, particularly medical
appointments.

Escorts could serve as advocates and to help clarify
instructions from medical personnel and to navigate
the appointment process, etc.
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ACCESS: POINTS OF ENTRY NEED TO BE EXPANDED AND IMPROVED
EXISTING ACCESS POINTS ARE DIFFICULT TO PENETRATE

What was more troubling to Older Adult consumers
and providers was the difficulty of penetrating the
system itself, one older adult stated, “There is just
too much paperwork and the system is difficult to
penetrate without a lot of effort. It should be easy.”

Across age groups, but especially among older adults, there was
a perception that the points of access were not only challenging,
but that the personnel could be rude or unsympathetic. One
provider mentioned, “The mental health access number is a
barrier. People are rude. They ask you whether the patient is
really “crazy.”
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ACCESS: POINTS OF ENTRY NEED TO BE EXPANDED AND IMPROVED
EXISTING ACCESS POINTS ARE DIFFICULT TO PENETRATE

A theme that recurs throughout the focus groups with older
adults was the need for closer coordination with the primary care
system. A provider commented, “Many older adult go first to
primary care for all their health needs. Yet too many primary
care doctors are unaware of mental health resources and my not
have mental health issues on their radar.”

Across all focus groups, without any question the single most
consistent criticism of the mental health system is that the
system appears indifferent and uncaring precisely because its
points of access don’t work.
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HOW: ENGAGEMENT & SERVICE PROVISION NEEDS TO BE CULTURALLY AND LINGUISTICALLY COMPETENT
NEED FOR BILINGUAL, BICULTURAL, AND CULTURALLY COMPETENT
STAFF WITH KNOWLEDGE OF CULTURES SERVED

The need for culturally competent staff and staff from the same
cultures as the Older Adult consumer was mentioned in 18 of 22
focus groups.

One Latino consumer stated, “We need Spanishspeaking doctors. I went to San Mateo County
Hospital for help with depression and the doctor
didn’t speak any Spanish. How is that supposed
to help me?

Another provider added, “They should have Spanish-speaking
therapists at every clinic.”
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HOW: ENGAGEMENT & SERVICE PROVISION NEEDS TO BE CULTURALLY AND LINGUISTICALLY COMPETENT
NEED FOR BILINGUAL, BICULTURAL, AND CULTURALLY COMPETENT
STAFF WITH KNOWLEDGE OF CULTURES SERVED
 The
need for cultural competent staff extends far
beyond linguistic needs, one Spanish-speaking
consumer noted that “I have been here many years,
but I am still confused when I try to get help. Your
doctors scare me. They talk in ways I don’t
understand.”

Another theme that has crossed age groups has been the
reaction among consumers from other cultures. They do not
share the western/European paradigm that separates the
mind and body.
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HOW: ENGAGEMENT & SERVICE PROVISION NEEDS TO BE CULTURALLY AND LINGUISTICALLY COMPETENT
NEED FOR BILINGUAL, BICULTURAL, AND CULTURALLY COMPETENT
STAFF WITH KNOWLEDGE OF CULTURES SERVED

Furthermore, most Latin, Asian, and Islander cultures are far
more reluctant to discuss personal problems with others and
view their problems as family problems, not individual problems.

This perspective can be viewed as a significant
asset, as it creates the opportunity to involve a
family in providing support to a consumer, if
that family is engaged in a culturally
appropriate manner.
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR SYSTEM TO FOSTER A CONSUMER-CENTERED CULTURE

Sixteen of the twenty-two focus groups mentioned
the need for a more customer-friendly system.
This desire was expressed in a wide range of
comments.

One senior said, “The system creates mental health problems.
There are all types of lines and barriers. We need to streamline,
eliminate forms, and reduce bureaucratic barriers. Problems
fester while people are trying to cut through the red tape.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR SYSTEM TO FOSTER A CONSUMER-CENTERED CULTURE

Many, many consumers talked about being treated rudely or without
compassion, “Not only mental health staff, but social security and
primary care and other agencies all need training to be more friendly.
They act like we are criminals trying to steal services instead of being
customers.”

The theme of seniors needing escorts arises again in the context of
consumers trying to access hospital services. “We need more help at
the hospitals and clinics. Sometimes you show up and they turn you
away or tell you to come back another day, that you’ve got the wrong
day for the appointment.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR SYSTEM TO FOSTER A CONSUMER-CENTERED CULTURE

Another theme that emerged throughout older adult focus groups was
their sense of isolation and loneliness. A transformed system would
address this isolation.

One consumer stated, “People need to understand how
alone we can feel and how isolated we are. Sometimes
we just need someone to call us or to come by.”

Another consumer added, “I am alone and often am sad. Even mail can
be a form of contact. It affirms I am still here.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR CONSUMER, PEER AND FAMILY-LED
SUPPORTS AND SERVICES

Almost every focus group referenced the need for more consumer, peer,
and family involvement in supporting treatment approaches (19 of 22
focus groups).

In relation to consumer involvement, the desire for consumers to drive
their treatment planning simply did not come up with older adults as
frequently as it did with other age groups.

When it did, it was expressed more in relation to seniors feeling that
they couldn’t get the system to respond to their basic needs. They were
given meds and maybe some therapy, but they were still lonely, isolated,
and in need of practical support.
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR CONSUMER, PEER AND
FAMILY-LED SUPPORTS AND SERVICES


Given the significant level of basic home-based
support that so many seniors require, the need
for involvement of peer volunteers and family
support is significant.
Many Older Adults called for peer mentors and senior peer
volunteers, “Senior peer counselors would be very helpful. They
can understand our problems because they have lived that life.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR CONSUMER, PEER AND
FAMILY-LED SUPPORTS AND SERVICES

A provider added, “Many seniors are very isolated and also
need assistance with the simplest tasks: laundry, shopping,
house keeping, and medication monitoring. A volunteer
could support these tasks and go a long way toward
reducing isolation and loneliness.” This was reiterated
by many providers and consumers.
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR CONSUMER, PEER AND
FAMILY-LED SUPPORTS AND SERVICES

In relation to family involvement, seniors are
more eager for receiving support from family
members than were teens, but they too
wanted limits.

One senior put it best, “I want my family more involved,
but I want them to be more understanding. My daughter
treats me like I chose to have these problems just to create
problems for her.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
NEED FOR CONSUMER, PEER AND
FAMILY-LED SUPPORTS AND SERVICES

The importance of a consumer-friendly program was best
summarized by one consumer, “Caminar is my family. I don’t
know what I would do without them.”

Another consumer commented, “Services are consistently of
good quality, understanding, and acceptance from doctors
and peers.” This is a sentiment that was expressed by many
older adults and should not be lost amongst the many
suggestions for improvement.
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
SERVICES NEED TO BE PROVIDED IN NATURAL
COMMUNITY SETTINGS AND CO-LOCATED AND
INTEGRATED WITH OTHER SERVICES AND SUPPORTS

Seniors, family and providers had lots to say about
providing services in neighborhood community
settings and in integrating mental health services
with other services, particularly with primary care.

Providers tended to talk more about ‘integration’ of services.
Older Adults and family tended to describe it more in terms of
needing services to be more accessible, not wanting to have to
go from one place to another or needing services at home.
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
SERVICES NEED TO BE PROVIDED IN NATURAL
COMMUNITY SETTINGS AND CO-LOCATED AND
INTEGRATED WITH OTHER SERVICES AND SUPPORTS

Twenty of twenty-two Older Adults focus groups referenced some
aspect of services being delivered in natural settings in an
integrated manner.

One provider pointed to San Francisco for specific models, “We
need to overhaul the gero-psych program. A county program
modeled after On Lok or Institute of the Aging which are
devoted to preventative care for the elderly and works to keep
them in the community.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
SERVICES NEED TO BE PROVIDED IN NATURAL
COMMUNITY SETTINGS AND CO-LOCATED AND
INTEGRATED WITH OTHER SERVICES AND SUPPORTS

Another provider commented that, “People will not go to a
mental health clinic, but will go to a CID Parca and other
settings.” Another added, “If you bring services to the Senior
Centers, older adults are more likely to come.”

Finally, providers noted the absence of adequate coordination
and collaboration across systems, “Interagency coordination in
relation to older adults is not effective. For example, there are
significant coordination issues between Kaiser and GGRC.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
SERVICES NEED TO BE PROVIDED IN NATURAL
COMMUNITY SETTINGS AND CO-LOCATED AND
INTEGRATED WITH OTHER SERVICES AND SUPPORTS

While the need for 24-7 crisis services
was not mentioned frequently be seniors
(five focus groups of 22), one comment
was very poignant, “We need a live person
on the line when there is a crisis, not a
menu of options. ‘If you are going to use
a razor, dial 3.”
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HOW: SERVICE PROVISION NEEDS TO BE USER-FRIENDLY, CONSUMER AND FAMILY-LED AND INTEGRATED
WITH OTHER SERVICES AND SUPPORTS THAT ADDRESS THE ENTIRE PERSON
SERVICES NEED TO BE PROVIDED IN NATURAL
COMMUNITY SETTINGS AND CO-LOCATED AND
INTEGRATED WITH OTHER SERVICES AND SUPPORTS

One provider suggested more collaboration with Adult
Protective Services, “to conduct joint home visits to screen,
conduct triage and assign resources.”

But without question, the area in which seniors and
providers felt integration of services was most needed was
in relation to building stronger linkages with health services.
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
INTEGRATED TREATMENT FOR CO-OCCURRING DISORDERS

The need for integrated treatment of dual disorders
was identified in just under half of the Older Adults
focus groups.

One provider noted, “Older adults badly need dual diagnosis
services. They may not qualify for GGRC. They would benefit
from an ICF that provides integrated treatment services.” This
same comment was made in two focus groups and the need for
integrated dual diagnosis treatment was mentioned more
generally in 8 other focus groups.
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
BROADER AVAILABILITY OF SERVICES

Fifteen of the 22 Older Adult focus groups referenced the
need for a broader range of services. Most often
consumers stated their desire for shorter waiting lists
and more access to groups.

One consumer commented, “I always have to wait too
long when I need an appointment to talk with someone.”

Another consumer commented, “There aren’t enough groups and those
that exist have too long a waiting list. My problems don’t wait for your
lists to shrink.”
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
BROADER AVAILABILITY OF SERVICES

But the most common complaint related not to
the range of services or the desire for any one
kind of service, but rather that services for
older adults be designed explicitly for
older adults.

Many providers spoke of this and this comment captured the sentiment:
“We need services that are designed specifically for older adults, not
just clinicians who have some older adults on their adult caseload. We
need more therapists and peer counselors who specialize in older adult
services.”
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
BROADER AVAILABILITY OF SERVICES
While providers focused on transforming older adult services by developing
customized programs for older adults, consumers more often just spoke
of being misunderstood or poorly served. Comments like:
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
They don’t understand how hard it is to get to a clinic;

I forget to take my meds. I forget lots of things.

I need help with the simplest things.

More than with any other age group, good service for older
adults really does come down to “the simplest things:”
a phone call, a hand with groceries, a reminder to take meds.
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
NEED FOR CORRECT AND STEADY SUPPLY
OF MEDICATIONS

Providers commented that this choice is often
faced by consumers. Another provider pointed
out that “Older adults have difficulty
maintaining their meds. They fall out of
compliance and wind up in conservatorship. Serious
consideration must be given to how to help with
medication monitoring.”
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SERVICE AND SUPPORTS: A BROADER ARRAY OF INTEGRATED, COMPREHENSIVE THERAPIES AND TREATMENTS
SHOULD BE AVAILABLE AT A LEVEL TO MEET CURRENT DEMAND
NEED FOR CORRECT AND STEADY SUPPLY
OF MEDICATIONS

Providers also pointed to a dilemma many older adults
often face: pay for medications or food or rent or
recreation.

One consumer commented, “I can’t
afford my meds. I need financial
assistance.”
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR A PERSONAL SERVICE COORDINATOR OR SIMILAR
MECHANISM TO HELP CONSUMERS NAVIGATE MENTAL HEALTH
AND OTHER SYSTEMS TO ENSURE A HIGH QUALITY OF LIFE

Fourteen of twenty-two focus groups commented on the need
for a personal services coordinator.

As with other age groups, the need for a personal services
coordinator was most apparent when changes in services
occurred. As one consumer noted, “When you change doctors,
you can get lost. You don’t know the new person. I need help
with transitions.”
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR A PERSONAL SERVICE COORDINATOR OR SIMILAR
MECHANISM TO HELP CONSUMERS NAVIGATE MENTAL HEALTH
AND OTHER SYSTEMS TO ENSURE A HIGH QUALITY OF LIFE

One family member noted, “The people who really need help
have absolutely no chance of getting what they need. If they
don’t have a family member to push, these seniors simply are
ignored.”

A consumer noted, “I want someone, the same
person, to pay attention to me.”

The comment underscores the recurring theme that among the
most important needs of older adults is to reduce isolation, to
be noticed.
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR A PERSONAL SERVICE COORDINATOR OR SIMILAR
MECHANISM TO HELP CONSUMERS NAVIGATE MENTAL HEALTH AND
OTHER SYSTEMS TO ENSURE A HIGH QUALITY OF LIFE

Whether through a personal services coordinator
and/or through a more consistent client record system,
consumers, family members and providers have all
given a very clear message: continuity of care needs to
be an outcome for any system transformation.
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR AN ARRAY OF HOUSING OPTIONS

Housing was mentioned in 15 of 22 Older Adults focus groups.

A May housing report described the San Mateo County housing market
as continuing to skyrocket, with a 25% increase in home prices in the
last 12 months.

In this context, housing will continue to be a challenge for all
mental health clients regardless of age and given that for most seniors
their earning years are either behind them or are limited, this crisis is of
even greater concern for them.
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR AN ARRAY OF HOUSING OPTIONS

One consumer commented, “We need housing we can
afford because we can’t work.” More to the point, another
consumer noted, “You release us from the hospital with no
housing and then we are on the street. How likely are we
to survive on the street?”

One consumer suggested a flex fund, “So folks
don’t lose their housing or utilities.”
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR AN ARRAY OF HOUSING OPTIONS

But the cost of housing is only one barrier experienced by
seniors. A provider commented, “There need to be more
intermediate care housing options for mentally ill seniors
with complicated primary care issues and challenging
behaviors.”

This is another manifestation of a recurring theme that
primary care needs complicate efforts to deliver mental
health services.
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR ACCESS TO EDUCATION

Very few Older Adult focus groups discussed the need
for education and employment. More often seniors
spoke of the need for employment opportunities to
sustain their housing or their ability to pay for their meds.
 Education
was only mentioned in five focus groups with
most consumers seeking education as a way of engaging
others and reducing isolation. “It [classes] get me out
and talking with others.”
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR RECREATION, SOCIALIZATION, AND SPIRITUALITY


Older Adults focus groups mentioned the need for recreation,
socialization or spirituality more than any other issue relating
to quality of life, not surprising given how often comments
about isolation permeate older adult focus groups.
Consumers wanted recreation programs at senior
centers and peer volunteer programs for homebound seniors. In essence, they wanted to have
contact with a world that is slowly moving out of reach.
7/21/2015
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR RECREATION, SOCIALIZATION, AND SPIRITUALITY

One consumer noted that “Programs in nursing
homes should stimulate rather than depress.”
Another consumer noted, “Especially for older
adults, the need for a spiritual connection is
so important.”

One provider followed up on this theme, “Interfaith programs
should be available to provide support during difficult times.”
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QUALITY OF LIFE: THE SYSTEM NEEDS TO BE ORGANIZED AND FOCUSED AROUND HELPING
CONSUMERS ACHIEVE A QUALITY OF LIFE AT ALL STAGES OF LIFE
NEED FOR RECREATION, SOCIALIZATION,
AND SPIRITUALITY

On a less spiritual level, one consumer
said, “Help me with socializing. I could
use help getting a girlfriend.”

Taken together, what older adults expressed were to
have opportunities for engagement in almost any form,
someone to read to them, to play cards with…or to
date.
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CONCLUDING COMMENTS
ACCESS

Several themes emerged through a close analysis of 22 Older
Adults focus groups.

The need for easy access to services was referenced in a wide
variety of contexts and focus group participants were most critical
of the system’s points of entry and re-entry.

The primary barriers were the need for escort services to
accompany seniors to appointments and the sheer complexity
of the system itself.
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CONCLUDING COMMENTS
SERVICES

The primary theme concerning services was the need
for those services to be distinctly different from those
provided to younger adults. There is a strong need to
incorporate the unique needs of seniors in the service
design.

It is even more important for seniors than for other age
groups, that services be co-located, ideally with primary
care services.
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CONCLUDING COMMENTS
SERVICES

Personal services coordination could play a critical
role with seniors who need help negotiating the
system, managing their meds, and dealing with
complex insurance and eligibility requirements.
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58
CONCLUDING COMMENTS
QUALITY OF LIFE
Seniors require:
 A wider range of non-therapeutic services: help with
maintaining medication, escorts to get to appointments
and to manage them, home-based support, socialization
and recreation, and spirituality; and

A range of housing options that respond to generally
escalating medical needs as seniors grow older.
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CONCLUDING COMMENTS
Providers, family members and Older Adults youth stated quite
clearly what they need:

Easy, uncomplicated access to services;

Strong primary care-mental health ties;

The knowledge that as they age, there will be housing
options available; and most of all.

Consistent human contact
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