ISMICC May Blog

SAMHSA hit the ground running in 2018, with a series of expert panels on topics relevant to 

ISMICC recommendations. Expert panels are meetings of 30 or fewer individuals with subject 

matter expertise on a particular topic or issue.

To enhance our ability to implement the recommendations and advance the vision of ISMICC, 

we have organized many expert panel meetings between March and September. For each 

meeting, we have invited two ISMICC members with subject matter expertise to participate.

1. Departments of Psychiatry: Meeting the Needs of Patients with SMI and SED. March 12, 

2018

2. Psychiatric Advanced Directives: Identifying Opportunities to Increase Utilization. March 

13, 2018

3. Civil Commitment: Policy & Practice. March 14, 2018

4. Workforce to Serve Older Adults with Serious Mental Illness. May 16, 2018

5. Implementing Screening and Early Identification of SED. June 25 & 26, 2018

6. Comprehensive Crisis Services: Structure and Standards. July 9 and July 10, 2018

7. Developing a Priority Research Agenda for SED/SMI Prevention, Diagnosis, Treatment 

and Recovery. July 23 and 24, 2018

8. Working with Faith-Based Communities. September 12, 2018

In honor of Older Adults Month, which was May, this newsletter will focus on our mid-May 

expert panel to enhance the workforce that serve older adults with serious mental illness. The 

term “older adults” refers to people 65 and older. ISMICC recommendation 2.8 encourages 

federal agencies to find ways to increase the capacity of the behavioral health workforce.

ISMICC members Clayton Chau, M.D., Ph.D., Regional Executive Medical Director of the 

Institute for Mental Health and Wellness at St. Joseph-Hoag Health, and Paul Emrich, Ph.D., 

Under Secretary of Family and Mental Health, Chickasaw Nation, attended the meeting.

SAMHSA convened experts from different behavioral health perspectives – including psychiatry, 

occupational therapy, peer support, nursing, and social work – as well as representatives from 

several federal agencies to address behavioral health workforce issues for older adults living 

with serious mental illness. The event opened with remarks from Center for Mental Health 

Services Director Paolo del Vecchio; there also was an afternoon presentation from the Chief 

Medical Officer, Dr. Anita Everett. Dr. David Morrissette attended and much of the meeting 

was planned and coordinated by Dr. Justine Larson and Eric Weakly from the CMHS State 

Grants Western Branch Chief. 

An issue brief, Older Adults Living with Serious Mental Illness (SMI), was prepared and

distributed to participants to provide background information to help frame the discussions.

SAMHSA and the invited federal agencies were interested in identifying important workforce 

issues for this population such as the training of general and geriatric psychiatrists, co-occurring 
substance use disorders for older adults with SMI, potential use of the peer workforce, and 

financing models to address workforce shortages.

Participants reviewed pre-existing recommendations and priorities established in earlier 

gatherings on this issue, including the National Academy of Sciences 2012 report The Mental 

Health and Substance Use Workforce for Older Adults: In Whose Hands? 

(http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2012/The-Mental-Health-andSubstance-Use-Workforce-for-Older-Adults/MHSU_olderadults_RB_FINAL.pdf). This seminal report 

provided key recommendations for addressing the shortage of providers serving older adults 

with behavioral health conditions.

Panelists noted, unfortunately, that workforce conditions have not changed significantly and in 

fact, may have 

grown more 

concerning. In 

addition, panelists 

noted that few of 

the report 

recommendations 

were implemented 

by Congress. As one 

attendee pointed 

out, “we [as a 

nation] fund what is 

ineffective because 

it is inexpensive rather than do things that have a larger and longer-term payoff.” Two ideas 

discussed that would contribute to reducing the gap were: 1) Providing a differential 

reimbursement for geriatric psychiatry that involves more complicated and expensive care; 

and, 2) developing and supporting demonstration projects that target workforce development.

Approaches outside the federal effort also were discussed. Improving the licensure 

requirements for professionals to include geriatric behavioral health issues and further 

developing curricula for both geriatric professionals, as well as for generalists, were among the 

ideas explored. It was acknowledged that not only is there a need for more geriatric specialists, 

but general providers such as primary care providers also need additional training on older 

adult behavioral health needs.

Many participants noted the value of connecting to the existing network of community support 

for older Americans. Senior centers were cited as untapped resources to build relationships to 

educate consumers and staff about suicide prevention, mental health, substance use and cooccurring disorders, and to address the impact of suicide on surviving friends and family (postvention).