Summary of comments received in 1998 from Aging service agencies for each county (roughly divided into the various Mental Health service areas in our region) in the Egyptian Area Agency on Aging thirteen county region in Illinois (Alexander, Pulaski, Massac, Johnson, Pope, Hardin, Gallatin, Saline, Franklin, Williamson, Perry, Jackson, Union).

Some comments are from the thirteen county case management and elder abuse services agency, Shawnee Alliance for Seniors, and some are from our individual county focal point senior centers, which provide congregate and home delivered meals, information and referral services, and other social services for older people.

Comments from the county focal point agencies are in general from the directors of those agencies. The senior centers deal with a wide variety of seniors from the quite healthy to the frail elderly.

Comments from the case management agency are from individual case managers who assess and provide case management services for frail seniors. The Case Management agency deals with many complex crisis situations, including elder abuse and neglect, and in general the seniors they work with are more frail than those served elsewhere.

These responses are taken from individual questionnaires and grouped by county for easy reference. Each dot point is a comment taken from a separate questionnaire.

What is working?

• Counseling services are readily available.
• At present time only one or two clients are receiving services. These clients have been in system for long period of time.

What is not working?

• Need more services for substance abuse issues.
• Mental Health does not do home visits. Clients do not want to go to Mental Health Center.

How do you handle referrals to Mental Health Centers?

• Referrals are made by phone and followed up by mail.
• Written referrals or phone calls.

How well does this referral process work?

• Works well.
• No referrals have been made recently. If telephone calls made, Mental Health wants to schedule appointment for client to come to office.

What is the biggest need or problem you see in provision of mental health services to older adults?

• One need would be for clients who are older adults to receive in home counseling.
• Availability of in home services. At our assisted living unit (in Ullin, IL) it might be helpful to have someone offer more services to clients in their home.
• Home visits need to be made. Some clients would be more comfortable in their own home.

What are training needs?

• Need to be trained on the best ways to put together a plan of care for specific mental illnesses.
• Signs and Symptoms.
• Workshop attended at Choate Mental Health. In service training was held.

Are you interested in participating in a demonstration project?

• Yes.
• Yes.
• May be interested, would need more information.

What is working?

• Many problems with this local agency.
• The client must go to agency and request service.
• Office is close.
• They didn't do their job, they try to get out of it. Finding any excuse not to do.

What is not working?

• They refer most older people back to us, slow to respond, and never very willing to respond.
• It appears as if agency doesn't truly want to help. The elderly are not always physically able to seek help and for long periods of time. The regular M.D. is top priority than seeking help for themselves mentally or emotionally. If elderly are going to spend time and their limited energy it will be for physical needs rather than for mental health and also because the social acceptance for their age era is not great.
• As with all things the elderly person needs to also realize there is a need. Perhaps with some involvement from a mental health service the elderly client will seek more services on higher level, or begin to leave the home to seek help.
• Some elderly also have others in their lives who are significant and are in need and the client will need services in dealing with the needful significant other.
• We make home visits and mental health services should also. Aging in place has several facets, mental health is one. If we are to address this we should address all facets. There is a cooperation issue with mental health agency. They also indicate there are separate guidelines for them.
• Mental health agency refers most of the older clients back to Shawnee Alliance for Seniors. They do not respond right away, wait until the last minute to do anything, and then sometimes it is a referral back to Shawnee Alliance for Seniors.

How do you handle referrals to Mental Health Centers?

• Phone calls and then written referral to follow.
• Phone calls and/or written requests.
• Phone call 1st then written referral.
• Verbal directly to PAS agent.

How well does this referral process work for you?

• Good, if they follow through.
• Uncertain. We never received a response back. When I callthe party is unavailable or there is anyone who can help.
• Okay if they follow through.
• She appears not to want them (Note: this refers to PAS agent referred to in question above).

What is the biggest need or problem you see in provision of mental health services to older adults?

• They always find a way to diagnose a client with Alzheimer's Disease when there actually has a mental illness.
• In home psychiatric help.
• Stigma by the elderly to mental health services. Problems with client that have been diagnosed with mental illness but hospital changes to Alzheimer's Disease when hospitalized.

What are training needs?

• Uncertain.

Are you interested in participating in a demonstration project?

• Yes.
• Yes!!!
• No.

Other comments?

• Many older clients go in hospital with mental illness but then are diagnosed with Alzheimer's Disease so Shawnee Alliance for Seniors will do screening. (note: the screening referred to here is the screening that takes place in acute care hospitals when someone is to be sent to a nursing home. Shawnee Alliance for Seniors does nursing home pre-screening in order to be sure people understand any alternatives to nursing home care that may be available to them. The implication here would be that the Case Manager sees a mental illness diagnosis as the probable primary diagnosis, but Alzheimer's is the diagnosis patient comes out of hospital with.)
• Nursing home pre-screenings that are done at Psyche ward in Harrisburg, IL usually are referred to Shawnee Alliance for Seniors. Mental illness client will then be diagnosed with Alzheimer's Disease. (Staff comment that Shawnee Alliance for Seniors responds faster, and has less problems.)
• My personal opinion is that our mental health agency is worthless.

What is working?

• Private pay service.
• It only works if you can convince the older person to go to the office of Human Services (the local mental health agency.)
• PAS agent is very helpful.
• If the client makes it to the hospital, then mental health will respond and do an appropriate evaluation.
• Franklin County: Nothing.
• Williamson County: Very little.

What is not working?

• No in home services are available, no transport is available, medication monitoring not available.
• Getting Human Services workers to put forth a little extra effort in dealing with difficult clients.
• We need caseworkers from mental health to see homebound clients or clients that refuse to go to mental health agencies in the clients home.
• Non-responsiveness to clients needs refuse to make any home visits; acting non-concerned about clients needs. They go over their entire job description on the phone in order to say sorry, we don't do that.
• Franklin County: Everything.
• Home visits are needed in this area. Our older clients is an age group that is most unwilling to go to a facility to talk to someone. But, I feel we could get them help if we had mental health personnel to go to their homes. It is also almost impossible to get help for clients at risk unless it is a crisis situation.

How do you handle referrals to Mental Health Centers?

• I schedule the appointment and transport.
• Call in.
• Refer only if and after the person is in emergency room of a hospital.
• Don't have any.
• We call Human Services in West Frankfort.

How well does this referral process work?

• We were told to be at the appointment at 7:45. We were there, no one else was. We waited 45 minutes. When the client reported he did not want to wait anymore, the receptionist reported it would be considered a failed appointment! No one considered a 45 minute wait inappropriate. At other times we have been given a 2 week delay in appointment. At other times we've been told no services were available due to chronic health condition.
• Okay, if client is willing to go to the mental health Center.
• That is okay but it can take a few hours sometimes, to arrive. (Note: this refers to when client is in the hospital ER.)
• It doesn't.
• Not well, unless there is family that can follow up. Then bottom line is Can you get them to come in?

What is the biggest need or problem you see in provision of mental health services to older adults?

• No in-home service available, lack of transportation. Lack of knowledge regarding older adults from mental health professionals.
• A big need for counselors to make a home visit if for nothing else but just a one time evaluation of the client.
• Home visits and getting mental illness diagnosis.
• THEY REFUSE TO MAKE HOME VISITS IN CASES OF EMERGENCY AND PEOPLE TOO ILL TO SEEK HELP!
• Home visits.
• A definite program for our older adults, one with ongoing provisions for home visits when needed. More meetings or training with our direct service staff and the Mental Health Network. Hands on problem solving for both sides.

What are training needs?

• How to access mental health services for our clients.
• Mental illness vs. dementia.
• They need to recognize that older adults were raised in a culture where it was stigmatized to get mental health treatment, and they would be more accepting of mental health services if performed in their private secure homes.
• Don't know because there are no services.
• How to recognize when a referral to mental health is needed. Then understand from mental health agency point of view on laws and rules they have to abide by.
• Can we get help we feel is needed or is it only on paper that we have mental health services for older adults?

Are you interested in participating in a demonstration project?

• Yes.
• No.
• Only if they'll try providing in-home assistance.
• Yes.
• This sounds like a job for Shawnee Alliance! If we can assist, we are very willing.

Other comments?

• The mental health needs of older adults are not being met. To my knowledge only one counselor in this area works specifically with older adults and provides in-home service. The lack of trained personnel is a major hindrance when dealing with older adults mental health needs. In addition (psychiatric?) medications are expensive. Older adults do not receive assistance through Circuit Breaker for these medications. (Circuit Breaker is a state program for low to moderate income seniors which helps pay for heart, diabetes, and certain other medications.)
• Furthermore, crisis centers of older adults are not available, nor is short term placement to regulate medication. Womens centers are not set up to meet needs of people with ambulatory difficulty, or chronic medical problems.
• Elderly people need to have help in their own homes, where they will feel safe and comfortable, in order to receive optimal mental health services. They are either too ill or frail or afraid to go out and get help.

(This also includes one survey that covers Gallatin and Saline as well).

What is working?

• We have two fine mental health agencies in our area.
• Hardin: As to my memory, haven't dealt with them.
• Hardin: Never used.
• Pope: Was very receptive and went and spoke with client about services.
• Counseling and group therapy.

What is not working?

• The reluctance of older adults to recognize and accept that there is a need for mental health services and then to accept services.
• PAS agents screenings!

How do you handle referrals to Mental Health Centers?

• We either give the name of the facility to the client or family member or we make the referral ourselves.
• Phone call with hand referral to follow.
• Have not had any.

How well does this referral process work?

• Fine.
• Good.

What is the biggest need or problem you see in provision of mental health services to older adults?

• We are a rural area and there seems to be a real resistance to acceptance of mental health counseling services.
• Mental health always finds a way to diagnose client with Alzheimer's Disease when actually there is a mental illness.
• In-home services.

What are training needs?

• Working with older adults to help them see the need, value and reduce the stigma of accepting mental health services.

Are you interested in participating in a demonstration project?

• Yes.
• Possibly.

Other comments?

• Counseling service has an outreach program where they will go to the home and provide counseling. However it is not utilized much by the elderly. They do respond also to crisis calls.
• Mental health agency did have this in-home service but their staff person which handled it is no longer working there and they have no plan to rehire. They said in 2 years they only had 5 clients and only 2 were elderly. They said they had a great deal of publicity on the availability of the service at the time.

What is working?

• Group Therapy

What is not working?

• (There is no response to this question.)

How do you handle referrals to Mental Health Centers?

• Have not had any.

How well does this referral process work?

• (There is no response to this question.)

What is the biggest need or problem you see in provision of mental health services to older adults?

• In-home services.

What are training needs?

• (There is no response to this question.)

Are you interested in participating in a demo project?

• Possibly.

What is working?

• Not much contact with counseling center.

What is not working?

• (There is no response to this question.)

How do you handle referrals to Mental Health Centers?

• Have not had any.

How well does this referral process work?

• N/A

What is the biggest need or problem you see in provision of mental health services to older adults?

• Funding for in-home visits.

What is working?

• Not sure. Not often that follow-up is received from local mental health agency. The counselor needs to get releases so the Aging case manager can also be active in clients plan of care.
• The day program and the CILA program (independent living) seem very effective.
• There is a counseling center, but many seniors have little access if they don't drive.
• I believe that the home visits work well with most of our clients, mainly due to the privacy clients receive in their own homes. I feel that the elderly population are a proud group of people and can be intimidated by going to an actual mental health facility for help.

What is not working?

• Referrals are not followed up as reported by clients. Initial visit should be handled by experienced professional not intern. Not enough pressure to accept counseling.
• We need more in home counseling with more aggressive counselors.
• Clients who have experience with counselor feel that it has little, if any, positive effect for them.
• Communications. We need more public awareness.

How do you handle referrals to Mental Health Centers?

• Phone call with follow-up written referral.
• Usually a phone call followed with a written referral.
• I call the counseling center, or have the family do so, to make referrals.
• Our Outreach Department has a great rapport with Dan (mental health counselor). If Dan is unable to assist he always makes the right contacts to help our clients.

How well does this referral process work?

• Difficult to reach counselor. Usually leaves voice mail, often no return call, must keep calling to verify due to often out (both commenter and mental health counselor).
• Fairly well.
• Adequate.
• Very well.

What is the biggest need or problem you see in provision of mental health services to older adults?

• Reluctance of elderly to accept mental health counseling due to stigma. Many not willing to admit to problems, and lack of adequate mental illness background of Aging case manager.
• The services do not seem to be aggressive enough. I have made referrals and if the client is reluctant or non-compliant the mental health agency doesn't pursue the client.
• Poor access to counselor (phone tag). I have only spoken with him on one occasion that I can recall. He is very difficult to catch.
• Getting the elderly to get mental health assistance when they need it. It is difficult for many to accept the fact that they need it.

What are training needs?

• Realistic approach to getting client to accept counseling. More aggressive approach to seeing reluctant clients.
• More information on the effects of aging on ones mental health. Other ideas to get older people to access mental health without feeling embarrassed or ashamed to do so. Also how to identify more clients in need of help.

Are you interested in participating in a demonstration project?

• No.
• No.
• Yes, yes, yes.
• Yes.

Other Comments:

• Unless the elderly or older persons are in a desperate situation they seldom ask to speak with a mental health counselor. I would like to see more community involvement so that people would get help at an earlier time. Prevention programs for persons that could help better prepare them for concerns and issues they will later face, e.g., loss of spouse, health problems, etc. If we could get started at earlier time in their lives (older persons) I feel people would be less likely to wind up in a desperate or threatening situation.

What is working?

• (There is no response to this question.)

What is not working?

• No communication between the two.

How do you handle referrals to Mental Health Centers?

• Generally do not contact mental health center due to no follow-up on their part.

How well does this referral process work?

• (There is no response to this question.)

What is the biggest need or problem you see in provision of mental health services to older adults?

• Mental Health says it is an aging process without considering mental health issues.

What are training needs?

• Similarities and differences in the aging process and mental illness, or mental health issues.

Are you interested in participating in a demonstration project?

• Yes.

What is working?

• Day treatment for those who will attend seems beneficial.

What is not working?

• Seems to be a problem as far as services and the fees, example: client would have to be private pay for day treatment. they do not have a schedule except for Department of Public Aid fee.

How do you handle referrals to Mental Health Centers?

• Usually by phone call followed by written referral.

How well does this referral process work?

• Well.

What is the biggest need or problem you see in provision of mental health services to older adults?

• Services are only provided at counseling office or in hospital ER.

What are training needs?

• Understanding drug interactions. Identifying differences in depressive and other mental illness and their tendencies and characteristics.

Are you interested in participating in a demonstration project?

• (There is no response to this question.)

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