Mental health services and outcome-driven health care.

Mental disorders and mental symptoms often go untreated in both chronic care and primary care settings. However, they covary with functional disability. They are likely to impair social and occupational function in medical outpatients and to cause excess instrumental and cognitive disability in frail older persons. In both groups, they are frequent and often remediable. The costs of untreated mental disorders are often shifted to caregivers and to society in general. To ensure adequate mental health care requires a reorientation of medical care toward optimizing function and well-being as well as longevity. Such a reorientation will necessarily entail more attention to treatable mental disorders. Research is needed to (1) develop firm knowledge on which to base integrated medical and mental health treatment and (2) evaluate the potential economic benefits of combined care. Incentives must be changed if such a paradigm of care is to prosper.     

Elder health programs in state health agencies.

Due to the rapid rise in the population of those aged 65 and older, public health programs that target this group merit special attention. State health agencies can play leading roles in providing and coordinating elder health programs by identifying needs and formulating guidelines in collaboration with federal, local, and private organizations. The Massachusetts Department of Public Health initiated the Elder Health Programs Unit in 1988, with a mission to assist elders in maintaining their highest level of functional status in community settings and to provide opportunities for older adults to take greater responsibility for their own health. The extent of involvement in elder health programming of other state health agencies outside of Massachusetts is not well documented. Through the distribution of a national survey, we set out to determine how many state health agencies offer elder health services.