Many older adults experience unique changes/losses in their physical, social, and financial status. These changes often contribute to increased stress, depression, anxiety, and substance abuse. Yet, few older people seek the services of psychologists, psychiatrists, social workers or mental health counselors; or visit a mental health center for help.

Many older people, as well as their family members, tend to stigmatize mental healthproblems and mental health services. Also, many do not define their problems from a mental health/psychological perspective, instead seeking the physical basis for experienced problems. Thus, they take their problems to family physicians, masked as physical problems. In turn, many physicians overlook the potential emotional basis for presenting problems among elders, and treat the physical correlates of stress and emotion. Research data support the conclusion that mental health problems are overlooked in up to one-half of all older patients seen. Also, studies suggest that untreated mental health problems increase health care costs by as much as 50% in some instances.

Mental health practitioners experienced in working with older people report that the unique circumstances of older adults require specialized services offered by specially trained providers. Specialized services presented by specialized staff (trained in aging and mental health issues and practices) have been found to draw a greater number of older patients in comparison to traditional services offered by "traditional" staff.

Further complicating the care of older adults in Florida is the absence of a state policy addressing the mental health needs of older adults. In the 1980's the state provided funding for community treatment of older adults being discharged from state hospitals. The legislature changed this, however, when funding for these age-specific programs was reduced substantially in the early 1990's. This situation has continued in spite of at least four committees, task forces, or commissions, during the past 12 years that have recommended changes, the most recent being the "Florida Elder Mental Health Task Force" in 1997.

The absence of state policies addressing the mental health needs of older adults has been a national problem. In recent years, some states have addressed this issue by creating statewide coalitions of diverse consumers, providers, local officials, agency representatives, assorted professionals, and aging advocates, etc. Broad based, grassroots advocacy groups have facilitated public and legislative education, provided advice and consultation to policy makers, and assisted in drafting legislation.

The birth of the Florida Coalition for Optimal Mental Health and Aging began in May 1998, at a meeting hosted at the Louis de la Parte Florida Mental Health Institute (FMHI) of the University of South Florida, during which 22 stakeholders from all over the state drafted a mission statement, identified key stakeholders to build a successful coalition, and designed a process to build membership. A membership drive was conducted over the next six months. Over 200 people from a wide variety of agencies and interests across Florida have asked to join.

The first official meeting of the Coalition was held on October 21 and 22 in Tampa, with over 100 participants in attendance including legislators, academicians, physicians, mental health consumers, advocates, staff from state agencies, clergy, and providers of aging, mental health, and substance abuse services.

The meeting was chaired by Drs. Larry W. Dupree and Marion Becker of FMHI. Mr. Bob Rawlings of Oklahoma's Mental Health Program Office, who has helped build 13 other states' coalitions, was the guest speaker and consultant.

Participants approved the following mission statement for the Coalition:

The Florida Coalition for Optimal Mental Health and Aging provides opportunities for individuals, professionals, consumers, researchers, government and private organizations to work together to improve the availability and quality of mental health and substance abuse services for older Floridians and their families through training, education, research and increased public awareness

Based on preliminary surveys mailed to the membership, the Coalition developed five work groups covering the following themes:

• Legislation/Policy
• Treatment or services in long term care
• Community-based treatment/services
• Professional level education/training
• Public education and media

Each of the five workgroups consisted of between 12 to 20 members, with two facilitators recording the issues and solutions generated by the group members. Each group also elected a chair to serve as spokesperson to report results back to the large coalition meeting. Group members identified and prioritized the most critical issues relevant to their category and proposed action plans to address these issues. The top priorities for each of the five workgroups are as follows:

Legislative/Policy Work Group (Chair: Carol Waters, Executive Director, East Central Florida Memory Disorder Clinic, Melbourne). This group identified 3 issues:

1. Coordinate the Coalition's work with the Florida Legislature
2. Monitor or review legislative & state plans for inclusion/exclusion of mental health and aging issues and communicate with the full coalition
3. Educate legislators about mental health and substance abuse issues in aging through legislative briefings or seminars, legislative breakfasts, policy or position papers, as issue platform; etc.

Treatment/Services in Long Term Care Work Group (Chair: Grace L. Daley, Consultant and Trainer, Largo). This group identified 4 issues:

1. Need for improved funding and research on costs for maintaining an older person in the community
2. Need for improving training programs
3. Importance of continuity of care
4. Impact of managed care on the long term care system

Treatment/Services in the Community Work Group (Chair: Frances L. Henry, Clinical Nurse Specialist, Florida State Hospital, Quincy) identified five issues:

1. Stigma of mental health problems and treatment
2. Inadequate funding (tax) base
3. Lack of client resources to purchase services
4. Need for ongoing (staff) training
5. Access to care

Professional Education/Training Work Group (Chair: Gregory Paveza, School of Social Work, University of South Florida) identified 4 issues:

1. Mandatory training in aging and mental health for all levels of staff
2. Improve the image of elders to combat ageism
3. Increase resources and incentives in training to encourage workers to remain in the field
4. Address issues of social isolation

Public Education/Prevention/Media Work Group (Co-Chairs: Greer Peters, Director, Outpatient Services, Manatee Glens Community Mental Health Center, Bradenton; and Charles Boardman, Elder Education/Intervention Specialist, Palm Harbor). This group identified 5 issues:

1. The stigma of mental illness
2. The need to develop a general consensus of the legislators and public that the need exists for education, prevention, and early intervention of mental health problems
3. The need for widespread education for service providers about mental health issues
4. Advocate with state legislators regarding mental health issues to increase state funding
5. Identification and referral of older persons needing mental health services by health care/aging service professionals, providers and other community members

A detailed report, including the action plans, time frames, etc. for each workgroup, can be found through the Coalition's Web site or by writing the Coalition co-chairs.

At the end of the October meeting, a steering committee was formed. It consists of the co-chairs (Dupree and Becker), workgroup chairs (Waters, Daley, Henry, Paveza, Peters, Boardman) and several facilitators chosen by the co-Chairs and workgroup chairs. (The list is available on the Web site). This group will oversee the Coalition until bylaws are voted upon and formal elections are held. Also, the Department of Aging and Mental Health of FMHI will provide continuing administrative and informational support.

Bylaws Being Drafted
Recently, through telephone conferencing, the Steering Committee drafted bylaws for our Coalition. These were modeled after bylaws used in Oklahoma, as provided by Bob Rawlings. The Florida Coalition's bylaws describe how new members can join, officers are elected, and voting takes place. According to these bylaws, all individuals attending the first annual meeting in October 1998, are considered charter members of the Coalition. Coalition members will soon vote on the acceptance of the bylaws through mailed ballots. Highlights of the bylaws are that:

• Members shall be those government and private organizations and/or persons including professionals, consumers, and researchers interested in mental health/substance abuse and aging
• Application for membership must be approved by the Steering Committee.
• Each individual has one vote. Organizations are nonvoting members, but may designate a single representative with voting privileges.
• The Coalition shall meet at a place and date fixed by the Steering Committee
• The Coalition will elect officers for the positions of Chair, Vice-Chair, Secretary, and Treasurer, each serving a two year term, with re-election possible for a second two year term.
• The Steering Committee will consist of the Officers of the Coalition, Task force/work group Chairs, and other officers deemed appropriate by the Steering Committee. They'll serve a two year term, with a second term possible.
• The Steering Committee will appoint a nominating committee of 5 Coalition members to establish a slate of candidates for various offices.

Workgroups
Several of the Coalition Workgroups have met since the Coalition meeting in October to continue working on action plans, or to take steps in implementing plans. The next Coalition Newsletter will provide an update.

Comprehensive Mental Health and Substance Abuse Services Act for Older Adults
On January 11, in a conference call meeting, the Coalition's Steering Committee endorsed a "Comprehensive Mental Health and Substance Abuse Services Act for Older Adults." It states that

"in order to achieve access to quality comprehensive mental health and substance abuse treatment for older adults, the Florida Coalition for Optimal Mental Health and Aging recommends the creation of a Comprehensive Mental Health and Substance Abuse Services Act for Older Adults. This act would also include provider and staffing criteria and standards, as well as development and implementation of demonstration models. Independent evaluation shall occur, and based upon the findings and conclusions of the evaluation, the financial strategies and best-practice models that are proven to be effective shall be implemented statewide."

The proposed legislation was discussed at a recent Steering Committee meeting on February 5th hosted at FMHI. More information on the legislation will be mailed to Coalition members and described in the next newsletter as well.

The next meeting of the entire coalition will take place on October 19 and 20, 1999 in Tampa at the Holiday Inn on Fowler Ave. More details will be provided in the next newsletter and on the Web page.

If you have written comments or contributions for the next issue of the "Florida Coalition for Optimal Aging and Mental Health Newsletter" please send them to the Editor:

Larry Schonfeld, Ph.D.
Professor
Department of Aging and Mental Health
Louis de la Parte Florida Mental Health Institute
University of South Florida
Tampa, FL 33612-3899
email: schonfel@fmhi.usf.edu
FAX: (813) 974-1968.