Early on during the pandemic, it became clear that older patients were at greater risk of suffering the most serious effects of coronavirus, and a great deal of attention went into ensuring steps were taken to protect this population. Yet, despite the impact of stressors and social isolation caused by the pandemic, the same attention has not been given to ensuring their mental health needs are also being met. Due to a variety of barriers making them less likely to seek treatment, they are far more likely to have an unmet need for mental health treatment.
It’s time we talked about how to address the mental health crisis among older Americans and the healthcare industry’s collective responsibility to find accessible solutions.
In a recent health research survey of Americans across various demographics, we found that only 4% of baby boomers saw a therapist or psychiatrist in a typical year, compared to 16% of Generation X respondents and 20% of millennials.
A lack of mental health treatment across aging generations is an ongoing health crisis. There’s an epidemic of boomers going undiagnosed for conditions, including anxiety, depression, PTSD and more – conditions that can exacerbate heart diseases and other ailments, which become increasingly prevalent and serious with advancing age. Addressing mental illnesses could prevent complications in such conditions down the road. In our survey, fewer than 1 in 5 boomers reported having been diagnosed with anxiety or depression, compared to 41% of millennials. Nearly half of boomers, meanwhile, report having hypertension, a condition positively associated with anxiety.
Many more have unrecognized neurodivergent conditions typically diagnosed in younger patients, which were poorly understood in previous generations. Left unrecognized and untreated, such conditions can lead to co-occurring conditions and unhealthy coping mechanisms, such as substance abuse. Only approximately 1 in 100 boomers in our survey identified as having ADHD, compared with 6% of Gen X respondents and 12% of millennials. Such missed diagnoses can also be responsible for incorrect diagnoses, including practitioners mistaking symptoms of ADHD for dementia, and complicate treatment in many ways.
So what’s keeping boomers from addressing mental health?
A range of contributing factors include lingering stigma around mental health among aging generations, difficulties in finding accessible coverage – including a lack of practitioners who accept Medicare – and primary care physicians and other healthcare practitioners who hold on to anachronistic, inaccurate views of mental health as separate from physical health.
The good news is that some new tools are available to address this problem.
While most of the conversation around the recent rise of telehealth has been centered around the pandemic’s role in accelerating its adoption by medical practitioners, the rapid expansion of telehealth offerings by mental health practitioners is arguably an even more radical and transformative change emerging from the pandemic.
The embrace of telehealth options by previously reluctant mental health professionals could help those who have limited access to mental health services due to geographical proximity or mobility issues, which are particularly prevalent among aging people. It could also cut through lingering stigma around addressing mental health, which is of particular importance for older people, some of whom may be unwilling to go to a therapist’s or psychiatrist’s office in person due to privacy concerns and may feel more comfortable with telehealth counseling from their own home.
This rise in telehealth options for mental health could be part of a sea change to make mental healthcare more accessible, but it’s far from a cure-all. It is crucial for primary care practitioners to gain a better understanding of mental health and its inseparable intersection with physical health and to advocate for the importance of mental health treatment – particularly among older patients with whom they’ve established a trusted relationship. As New York Times personal health columnist Jane Brody wrote this October, “The human organism does not recognize the medical profession’s artificial separation of mental and physical ills. Rather, mind and body form a two-way street … An untreated mental illness can significantly increase the risk of becoming physically ill, and physical disorders may result in behaviors that make mental conditions worse.”
Boomers in particular place great trust in their primary care physicians to advise them on their health needs. If these practitioners embrace and de-stigmatize addressing mental health with these patients, they could be the voice that breaks through a clutter of biases and cultural baggage, while also helping them navigate access issues.
Stigma isn’t the only issue preventing older Americans from pursuing mental health treatment. Many struggle to find therapists that accept Medicare. A recent Wall Street Journal article outlines the issue, explaining that low reimbursement rates and additional administrative burdens keep many mental health professionals from accepting Medicare. At the same time, loopholes for coverage provided at the state and local government level within the Mental Health Parity and Addiction Equity Act of 2008, as well as lack of enforcement of its policies and the mental health parity aspects of the Affordable Care Act, have left many others with inadequate coverage.
While the rise in telehealth mental health services can help address some of these issues by extending the geographical range for coverage, demand for Medicare-covered mental health treatment far exceeds the number of practitioners accepting Medicare. For those considering beginning a relationship with a mental health practitioner, this poses a significant barrier that could prevent mental health treatment. For those who have existing relationships covered through private insurance, it could mean the difference between continuing treatment and deciding to drop it upon switching to Medicare.
Hopefully, this failure in providing adequate, accessible coverage will be remedied with future reforms. Until then, it’s up to other areas of the healthcare sector to fill the gap.
There’s a role for everyone to play in ensuring the mental health crisis is adequately addressed. Private insurers offering supplemental coverage to seniors must incorporate mental health treatment as a core offering. Digital health networks have a responsibility to help make mental health treatment accessible to everyone, to emphasize the importance of mental health – especially to senior patients who are less likely to be knowledgeable about the subject – and treat it as an equally important aspect of individuals’ health and wellbeing.
New digital mental health offerings, whether they be affordable telehealth therapy options or new digital tools like mental health apps, need to ensure they’re doing everything they can to reach aging populations and the primary care physicians they trust, rather than predominantly targeting younger generations. When designing these services, they also need to ensure they’re straightforward, accessible and approachable for all audiences.
As we gain an understanding of the intersection of physical and mental health, we can’t afford to ignore the vital role of mental health in preventative care and overall well-being and we must take a collective responsibility in ensuring everyone receives the mental health services they need.
Jacqueline Lovelock is managing director, healthcare at R/GA. R/GA is an innovation consultancy combining global expertise and diverse skill sets to deliver business transformation, customer experience and marketing transformation across various industries such as healthcare, retail, finance and more. R/GA is part of The Interpublic Group of Companies (NYSE:IPG).
Erik Oster is associate director, marketing and communications at R/GA, editor of R/GA’s editorial content platform FutureVision and author of R/GA’s Future of Health Experiences report. He was previously senior editor, agencies at Adweek.