Issue 2: Developing Geriatric/Mental Health Expertise

Goal: Establish a collaborative approach to developing expertise to meet the mental health needs of the elderly in all levels of care.


What is required to be of help to an older person? This is not an easy question to answer, often because aging is something most people would like to avoid. That both the client and the helper are aging at the same rate requires first and foremost that the helper be comfortable with this indisputable fact. Otherwise, our interventions will be guided by myth and prejudice and will not be helpful.

To be of help also requires time. The problems presented by older clients are invariably multifaceted and complex. Mental illness and its treatment must be understood in the context of multiple losses across all life domains, with recognition of a lifetime of behavior patterns, interpersonal relationships, social roles and expectations, personal resources, functional capacity, and attitudes toward self and others. Cursory assessment of mental health is incomplete if it is done without a comprehensive understanding of the larger picture of a person's life situation.

To be of help, one must also recognize the unique aspects of old age. Psychological and developmental theories and approaches typically do not do so. We accept that aging brings physical changes. Less is known about how older people respond to stress, loss, or other emotional demands. Each person retains their individuality over time, despite popular images of the elderly as fitting into a common mold. Carl Jung wrote of aging that "what was true in the morning by afternoon has become a lie." All who seek to help older people must accept them as individuals with unique developmental and emotional circumstances.

Alaska has minimally (at best) incorporated aging into educational curricula, professional development conferences, and field training for students and workers in the helping professions. Specialized treatment facilities and programs are scarce for older people with mental health problems. Psychiatric problems often go unrecognized, or are inappropriately treated (e.g., over-prescription of psychotropic medication) by non-psychiatrically trained physicians. Many mental health problems of the elderly are by default managed on a daily basis by persons with little or no specialized training, such as in-home care workers, nursing home personnel, or family caregivers. With the burgeoning population of older people in Alaska, the recruitment and retention of specialized geriatric practitioners is increasingly urgent.

Alaska's vast rural areas present another great challenge to the provision of competent mental health care. The residents of more than 200 remote villages receive health care primarily from health corporations located in regional centers. The regional hospitals and community mental health centers serving rural Alaska provide varying degrees of mental health services. Professionals in rural areas have few opportunities for continuing education and must rely on telecommunications to collaborate with others in the mental health field. Alaska must develop ways to expand access to mental health services in rural areas, assisting rural providers in developing flexible programs and collaborative opportunities so that elders can remain in their home communities. Existing training programs, such as the University of Alaska Fairbanks Rural Human Services program, do not offer specific senior mental health tracks.


319. Recommend and encourage higher education institutions to include geriatric mental health training in all human service and health science curricula. A position paper outlining the Alaska Mental Health Board position should be forwarded to those institutions.
Responsible party: Alaska Mental Health Board, Senior Mental Health Advisory Committee

320. Promote the recruitment and hiring of psychiatrists and other mental health professionals with geriatric knowledge within the community mental health system by requiring community mental health grantees to identify how they plan to respond to needs of seniors in their catchment area.
Responsible party: Division of Mental Health and Developmental Disabilities

321. Develop a distance education program on geriatric mental health that could result in a competency based geriatric mental health certification.
Responsible party: Division of Mental Health and Developmental Disabilities, University of Alaska Anchorage, Alaska Community Mental Health Services Association, Rural Mental Health Directors Association, Senior Mental Health Advisory Committee

322. Contact the Northwest Geriatric Institute and other qualified organizations and individuals to encourage them to provide Alaska based mental health training.
Responsible party: Alaska Mental Health Board

323. Assess and compile resources available for training and education in geriatric mental health issues and distribute to community mental health centers and senior service agencies. Develop a directory of available services and establish a clearinghouse to keep information current.
Responsible party: Professional Services Contract (Mental Health Trust Authority Revenue project), administered by Alaska Mental Health Board and Alaska Commission on Aging

324. Educate primary care providers, through professional associations (such as Alaska Medical Association, National Association of Social Workers and Alaska Psychological Association), regarding mental health needs of the geriatric population. Encourage the establishment of continuing education units on geriatric mental health. Contact coordinators for statewide geriatric conferences to encourage inclusion of mental health issues.
Responsible party: Alaska Mental Health Board, Alaska Commission on Aging, Senior Mental Health Advisory Committee