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Psychosocial Interventions for Older Adult Populations Mental Illness in Arizona

Older Adult Populations

Arizona is experiencing a significant demographic shift, with the number of of Arizonans age 65 and older is expected to increase 174 percent from 883,014 in 2010 to 2,422,186 in 2050. And here;s the projection of Arizona’s Population age 65 and Older by Race/Ethnicity, 2010 – 2050. 

Arizona Population 65 and older

This growth in the older adult population brings with it an increased need for behavioral health services tailored to address serious mental illness (SMI) in later life. SMI, which includes conditions like schizophrenia, bipolar disorder, and severe major depression, presents unique challenges for older individuals and the systems that serve them.

The Impact of SMI on Older Adults

Increased Health Risks and Mortality

According to SAMHSA, this population faces a range of heightened risks:

  • Reduced life expectancy of 10-25 years compared to the general population.
  • Higher rates of chronic physical health conditions like diabetes, cardiovascular disease, and respiratory illnesses.
  • Greater likelihood of placement in nursing homes or other long-term care facilities.

This notes that disparities in health outcomes can be attributed to a combination of factors, including the direct effects of SMI, side effects of psychotropic medications, lack of access to preventive medical care, and unhealthy lifestyle behaviors.

Barriers to Accessing Effective Treatment

Older adults with SMI also encounter significant barriers in accessing mental health care suited to their needs. The SAMHSA guide highlights several contributing factors:

  • Lack of training in geriatrics among mental health professionals.
  • Fragmented systems of care that fail to coordinate behavioral health, physical health, and aging-related services.
  • Limited coverage of essential services under Medicare and other insurance providers.
  • Lack of transportation and mobility challenges that make it difficult to attend office-based treatment.

Evidence-Based Interventions for Older Adults with SMI

To address the complex needs of older adults with SMI, the SAMHSA guide recommends several evidence-based psychosocial interventions that have demonstrated effectiveness in improving mental health outcomes, functioning, and quality of life.

Assertive Community Treatment (ACT)

Assertive Community Treatment ACT
ACT is a comprehensive, team-based approach that provides individualized, community-based support to older adults with SMI. Key components of ACT include:
  • 24/7 availability of multidisciplinary teams, including psychiatric prescribers, nurses, social workers, and other mental health professionals.
  • Intensive case management and care coordination to address behavioral and physical health needs.
  • Direct provision of services, rather than referrals to other providers.
  • Low client-to-staff ratios to allow for frequent contact and support.
The SAMHSA guide cites several studies showing that ACT can reduce hospitalizations, improve housing stability, and increase engagement in treatment for older adults with SMI.

Cognitive Behavioral Social Skills Training (CBSST)

Cognitive Behavioral Social Skills Training CBSST

CBSST is a skills-based intervention that helps older adults with SMI build coping strategies, strengthen social connections, and increase participation in meaningful activities. The program combines cognitive behavioral therapy techniques with social skills training modules tailored to common challenges faced by older adults.

Research highlighted in the SAMHSA guide has shown that CBSST can lead to significant improvements in social functioning, community living skills, and psychiatric symptoms, with effects sustained up to 2 years post-treatment.

Integrated Illness Management and Recovery (I-IMR)

I-IMR takes a holistic approach to helping older adults manage both SMI and co-occurring physical health conditions. The program teaches self-management skills for mental and physical health in an integrated format, with a focus on strategies for older adults. Participants work with an I-IMR specialist and a nurse care manager to set individual recovery goals, learn symptom management techniques, and coordinate needed medical and mental health services.

The SAMHSA guide reports that I-IMR has been associated with improvements in self-management of illnesses like diabetes and heart disease, increased use of preventive healthcare, and reductions in hospital admissions for older adults with SMI.

Opportunities for Expanding Psychosocial Interventions in Arizona

To meet the growing need for psychosocial interventions that can improve mental health outcomes for older adults with SMI, Arizona will need to take deliberate steps to build system capacity and remove common barriers to treatment engagement.

Developing an Aging-Competent Behavioral Health Workforce

A critical component of expanding access to effective interventions is ensuring that Arizona’s mental health workforce has the knowledge and skills needed to serve older adults with SMI. Potential strategies include:

  • Incorporating geriatric mental health content into graduate training programs for key behavioral health professions, including psychiatry, psychology, social work, and psychiatric nursing.
  • Developing specialized geriatric training tracks and fellowship programs to build a pipeline of providers with expertise in treating older adults with complex needs.
  • Providing continuing education and technical assistance to help existing mental health providers integrate age-appropriate screening, assessment, and intervention techniques into their practice.

Promoting Integrated Care Models

Older adults with SMI often have complex medical and behavioral health needs that can be most effectively addressed through integrated, coordinated systems of care. Arizona should explore opportunities to implement and sustain models that bring together mental health, primary care, and aging services, such as:

  • Co-location of behavioral health specialists in primary care clinics and senior centers.
  • Multidisciplinary care teams that include mental health providers, nurses, and care coordinators.
  • Collaborative care approaches that use integrated electronic health records and regular case reviews to facilitate communication and joint treatment planning.

Improving Accessibility and Engagement in Treatment

To ensure that evidence-based psychosocial interventions reach older adults with SMI, Arizona must also work to address common barriers to treatment access and engagement. Potential strategies include:

  • Expanding transportation assistance and mobile treatment options for older adults with mobility limitations.
  • Providing education and outreach to help older adults and their families understand the benefits of treatment and reduce stigma around seeking mental health care.
  • Offering flexible service delivery models, such as in-home sessions and telehealth, to increase convenience and reduce logistical barriers.

Conclusion

As Arizona’s population ages, the need for effective, age-appropriate behavioral health services for older adults with SMI will only continue to grow. How? Well, just by going through the PDF attached below. By investing in workforce development, promoting integrated systems of care, and implementing evidence-based psychosocial interventions like ACT, CBSST, and I-IMR, Arizona can support recovery and improve the quality of life for this vulnerable population.

While expanding these services will require sustained effort and targeted resources, the potential benefits are significant. By helping older adults with SMI maintain their independence, engage in meaningful activities, and manage co-occurring health conditions, effective treatment can reduce healthcare costs, minimize caregiver burden, and enhance the well-being of individuals, families, and communities across Arizona.

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Nirvana Recovery