clear. The MH/SU needs of older adults1 are complex, typically co-occur with other health problems, and are often inadequately addressed by today’s health care system. Moreover, the health care workforce is insufficiently prepared to address the MH/SU needs of the geriatric population.

The committee agreed early in its deliberations that the effectiveness and efficiency of the geriatric mental health workforce derives not only from the skills, knowledge, and size of the workforce, but also from how care is organized and delivered. The objective of this chapter is twofold: first, to review what is known about how to optimize the capacity of the workforce to yield better outcomes, especially in light of the chronic nature of geriatric MH/SU conditions and, second, to consider the implications of such models for workforce training and deployment of health care workers.


The chapter begins with a brief description of the chronic care model—the central framework for many promising innovations in MH/SU care delivery. The next section reviews nine models of care delivery for older adults who have MH/SU conditions (Table 4-1). The committee had neither the resources nor the time to conduct a systematic review of model interventions. The nine models were selected to include common geriatric MH/SU conditions as well as the important settings where older adults often receive services. The models make clear that there is indeed an evidence base demonstrating that patient outcomes can improve with reorganization of care. Thus, the committee urges that workforce planners and policy makers should move beyond dismissive summaries that “nothing works for these patients” and consider the implications of the models for workforce education, training, credentialing, and licensure.

However, the robustness of evidence does vary across care settings and older adult populations; some published evidence had to be available in order to be included in this review. Research on effective delivery of MH/SU care is particularly lacking for older adults in nursing homes, residential treatment settings, and other congregate living arrangements as well as for prisoners, rurally isolated elders, and older adults with serious mental illnesses.

For settings with several intervention models, the committee chose the model that had the most robust evidence. For example, the Prevention of Suicide in Primary Care Elderly Collaborative Trial (PROSPECT)


1 This report uses the term “older adults” to refer to adults age 65 and older. “Mental health workforce” refers to the full range of personnel providing services to older adults with mental health and substance use conditions.

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