Brief Reference Document 

Supporting the 

Mental Health Needs 

of Older Adults

Background

The proportion of older adults in the United States is rapidly increasing, in part due to longer life 

spans.1 Mental health and well-being are one component of healthy aging, and they are essential 

to a high quality of life for individuals of all ages. As the number of older adults rises, so does 

the need for mental health services and systems that meet the unique needs of this population.2

However, access to specialized mental health services for older adults is already constrained and 

may not be able to meet future demands.3 According to the 2022 National Survey on Drug Use 

and Health (NSDUH), approximately one in five adults over 50 years old experienced a mental 

health condition, substance use disorder or both in the previous year. When looking specifically 

at mental health, this data shows that approximately 14 percent of adults over 50 experienced 

any mental illness and 3 percent of adults aged 50 or older experienced a serious mental 

illness (SMI).2 This situation has been compounded by the current mental health crisis driven 

by the COVID-19 pandemic.4 In August 2020, a poll by the Kaiser Family Foundation found that 

between 25 percent and 30 percent of older adults reported anxiety and depressive disorders, as 

compared to approximately 11 percent in 2018.5 State Mental Health Authorities (SMHA) can help 

bring attention to the specific needs of this population. 

Every day, more 

than 10,000 adults 

in the United States 

turn 65.6

Fewer than 40 percent of 

older adults with mental and/

or substance use disorders 

receive treatment.7

Males over age 85 have 

one of the highest 

suicide rates in the 

nation.7

Practices and Programs That Improve Mental Health 

Outcomes Among Older Adults

Physical and behavioral health systems and organizations can implement evidence-based 

practices (EBPs) and programs to help support the unique mental health needs of older adults. 

These EBPs and programs are available for a range of mental health conditions that older adults 

may be diagnosed with, including serious mental illness (SMI), such as schizophrenia, bipolar 

disorder and major depressive disorders. EBPs to address mental health concerns among 

older adults can be based on a range of approaches to services, administered by providers 

with differing levels of training, and implemented in diverse settings. There are several factors 

to consider when selecting an EBP, such as needs and outcomes and impact, adaptation of 

practices, adherence and retention, and sustainability.

Psychotherapeutic interventions are one type of EBP that can address mental health conditions 

in older adults, such as cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and 

problem-solving therapy (PST).8, 9 These three evidence-based interventions have been proven 

to be effective in the treatment of depression in older adults, and CBT is also proven to treat 

generalized anxiety in this population.8

 In addition, there are several evidence-based programs 

that have been developed specifically for older adults. These programs are summarized below.

Substance Abuse and Mental Health

Services Administration State TA

S A M H S A S T A T E P R O G R A M 

IMPROVEMENT TECHNICAL ASSISTANCE

The Substance Abuse and 

Mental Health Services 

Administration (SAMHSA) 

developed this series to 

provide guidance to states 

related to critical issues that 

may be addressed by the 

Community Mental Health 

Services Block Grant (MHBG).

This brief reference document 

summarizes evidence-based 

practices (EBPs) that can 

support the mental health 

needs of older adults and 

discusses how states can plan 

for the implementation and 

expansion of these practices.

About the

SERIES
Practices and Programs for Older Adults With Depression and Depressive Symptoms

Improving Mood-Promoting Access to 

Collaborative Treatment (IMPACT)10, 

11, 12

Program to Encourage Active, Rewarding 

Lives (PEARLS)13

Healthy IDEAS (Identifying 

Depression, Empowering Activities 

for Seniors)14, 15

• Collaborative care management

• One-year phased intervention

with varying session frequency

depending on the phase

• Administered in outpatient and

other community settings

• Can be administered by noncliniciansa

• Can be adapted to diverse

patient populations for a variety of

behavioral health conditions

• Education and skills training

• Six to eight sessions over a four to five

month period

• Administered in community-based settings

• Can be administered by non-clinicians

• Flexible and adaptable, depending on

needs

• Screening, education, and

community care management

• Program components are

delivered over a three-to-sixmonth period

• Administered in the home or

other private setting

• Administered by non-clinicians

and care managers

• Incorporates four evidencebased components

Practices and Programs for Older Adults With SMI 37 c

Integrated Illness Management and 

Recovery (I-IMR)1, 16, 17, 18, 19

Helping Older People Experience Success 

(HOPES)1, 20

Cognitive Behavioral Social Skills 

Training (CBSST)1, 21

• Education and skills training

• Weekly individual or group

sessions conducted over an eightmonth period (around 40 sessions)

• Administered in community mental

health centers

• Administered by clinicians and

related paraprofessionals

• Intended for older adults who

have co-occurring chronic health

conditions

• Social skills training

• Seven modules, each with six to eight

skills, completed over a two-year period

• Can be offered in a variety of clinical and

non-clinical settings

• Clinician administered

• Developed for older adults in mental illness

treatment

• Social skills training

• 24 or 36 weekly two-hour group

therapy sessions

• Administered in a variety of

inpatient, outpatient, and other

settings

• Clinician administered

• Flexible and can be individually

tailored

2
Practices and Programs for Older Adults With SMI 37 c

Functional Adaptation Skills Training 

(FAST)22, b

Assertive Community Treatment (ACT)1

• Social skills training

• Six areas, each taught in four

120-minute group sessions (24

total sessions)

• Administered in board and care

facilities or outpatient psychiatric

clinics

• Administered by clinicians and

related paraprofessionals

• Designed for adults age 40 or

older who have schizophrenia or

schizoaffective disorders

• Team-based model

• Participants can receive 24/7 support for as long as they need services

• Administered in community-based settings

• Team consists of 10-12 providers from multiple disciplines (case managers,

clinicians, etc.)

• Designed for adults with SMI who face challenges engaging with traditional

outpatient services

*Notes:

a Although the IMPACT program can be administered by non-clinicians, a licensed clinician is required for supervision.

b The FAST intervention was made into a culturally tailored version for Spanish-speaking individuals known as Programa de Entrenamiento para el

Desarrollo de Aptitudes para Latinos (PEDAL).

23

c Psychosocial Interventions for Older Adults With Serious Mental Illness Resource Guide on evidence-based interventions that support older adults 

with SMI 37

The Importance of Integrated Approaches to Care

To address the mental health needs of older adults, SMHAs must invest in programs that ensure this population has access to EBPs. 

Behavioral health integration efforts can strengthen the delivery of these services to older adults, as they often require care that spans 

a variety of providers and systems. These systems include mental illness and substance use services, primary and specialty medical 

care, rehabilitation and long-term care facilities, aging services, home care, housing, and transportation.1 An integrated and coordinated 

approach to care is key to supporting the behavioral health needs of older adults.1 Integration efforts are a vital component of the 

Department of Health and Human Services (HHS) strategy to improve access to behavioral health services, and HHS has developed 

a roadmap for system coordination and integration.24 Integrating behavioral and physical health care is one of the five priority areas 

identified in SAMHSA’s Strategic Plan.36 States can support integration efforts for older adults through: 25

Supportive policy and 

regulatory frameworks

Workforce development Funding for information 

and technology

Financial and contractual 

incentives

One framework for supporting the integration of age-friendly, evidence-based care for older adults is the 4Ms for Behavioral Health 

(4M-BH). The E4 Center of Excellence for Behavioral Health Disparities in Aging developed this framework for use by mental health 

and substance use disorder services clinicians in diverse settings. Based on the original 4Ms of an Age-Friendly Health System (What 

Matters, Medication, Mentation, and Mobility), developed to address older adults’ health needs in hospitals and primary care settings, 

the 4M-BH outlines four interrelated, evidence-based elements of high-quality care for this population.1, 26 Much like the original 4Ms, 

the 4M-BH provides a flexible framework for clinicians with little-to-no geriatrics training to effectively assess and act on the unique 

mental health and substance use services needs of older adults. The 4M-BH framework was developed using a consensus panel of 

psychologists, social workers, and psychiatrists, who identified a wide range of possible additions and modifications to the framework 

for behavioral health clinicians, then streamlined to the essential elements required with every older adult in a behavioral health setting. 

Table is continued from previous page

3
4Ms Behavioral Health (4M-BH) Framework of an Age-Friendly Health System

 What Matters Medication Mentation Mobility

Align care with the 

patient’s interests, goals, 

and preferences. Address 

social determinants of 

health.

Review medications and 

side effects to minimize 

adverse events and 

to reduce impact on 

cognition and mobility. 

Screen for substance use 

and treat SUD.

Identify and treat mental 

health and cognitive 

concerns. Include family 

caregivers as needed.

Assess for fear of falling 

and create a basic 

mobility plan to improve 

function and mental 

health.

When planning integration efforts, states can consider convening 

an internal team, consisting of leaders and other representatives 

of key departments, agencies, and organizations, that is led by a 

designated individual responsible for coordinating and directing 

efforts.27 Together, this group can help to define a model of 

integrated care, use data to identify needs and opportunities, 

develop cross-agency partnerships, and make sure the proper 

partners are represented and engaged.27 Ideas to support 

integration can be found at the SAMHSA-supported National 

Center of Excellence for Integrated Health Solutions. 

In addition to supporting integration efforts, it is particularly 

important that states develop supportive policy and regulatory 

frameworks to improve mental health care for older adults, since 

the addition of language that requires or recommends the use 

of EBPs to policies can be a critical factor to increase access to 

EBPs in public systems.28 Other things states can do to facilitate 

mental health care for this population include expanded funding 

for EBPs, public awareness of EBPs, community engagement 

and ability to implement EBPs, leadership support for EBPs, and 

data monitoring and evaluation capacity.28

Healthcare Coverage for Older Adults

Medicare is a federal health insurance program that provides 

access to Affordable Care to older adults. Medicare coverage 

options and premiums are dependent upon an individuals’ 

preferences, needs and income. The following type of coverage 

options are available for eligible individuals who wish to enroll: 

Original Medicare (includes Part A and Part B), Part D, Medigap 

or Medicare Advantage. The Medicare and You Handbook 2024

provides additional information about Medicare coverage.31

In 2022, approximately 19 percent of the U.S. population was 

covered by Medicare, and according to a survey conducted 

by the Kaiser Family Foundation approximately 17 percent of 

Medicare recipients in 2020 were in “fair or poor health”. 32 33 

Medicare provides coverage for behavioral health services, such 

as counseling, medication management, opioid use disorder 

treatment and psychiatric hospitalization. Starting on January 

1, 2024, mental health counselors and marriage and family 

therapists, are Medicare provider types that can bill independently for the diagnosis and treatment of mental illness. The Commonwealth Fund published a report in January 2022 comparing 

the mental health needs of older adults in the U.S. with those in 

other high-income countries. The study found that 26 percent of 

Medicare beneficiaries in the U.S. who reported having a mental 

health condition missed or delayed treatment because of costs. 

Although it is the main payer of services for older adults, gaps and 

limitations exist, including fewer available providers for behavioral 

health care than for physical health care.34, 35

Summary

Behavioral healthcare is a vital component of the overall health 

and well-being of older adults, and there is a demonstrated 

need to expand mental health services and systems to meet the 

unique needs of this population. States have a role in expanding 

access to critically needed evidence-based services and 

supports for older adults through behavioral health integration 

efforts and policy development that promotes the use of such 

practices and programs.

Older adults who experience mental health 

conditions may be at an increased risk of 

substance misuse and/or SUD.29 Substance 

misuse and SUD are particularly concerning 

for older adults, as they often experience 

physiological and mental changes associated with 

aging, like cognitive decline.29, 30 These changes 

can make older adults more susceptible to adverse 

drug reactions, especially those between alcohol 

and many medications that are used to treat 

mental health conditions, as well as other harms.29, 

30 In addition, signs of substance misuse and/or 

SUD may mimic changes associated with aging, 

making these conditions difficult to detect in this 

population.29, 30 As a result, older adults with SUD 

are often underdiagnosed and undertreated.29

Healthcare providers who work with older adults, 

and especially those who work with older adults 

who experience mental health conditions, should 

screen all older adults for substance use, misuse, 

and drug-drug interactions.29

4
Resources

Resource Name Description

Websites

Center for Collaborative Mental 

Health Research

The Center for Collaborative Mental Health Research is comprised of an interdisciplinary 

team of researchers and clinicians who help to develop, evaluate, implement, and 

disseminate interventions that maximize the functioning, health, and quality of life of people 

who have mental illness. 

E4 Center of Excellence for 

Behavioral Health Disparities in 

Aging

The E4 Center of Excellence for Behavioral Health Disparities in Aging provides training 

and technical assistance for community-based implementation of EBPs for older adults. 

The E4 Center has created a library of resources for healthcare providers and communities 

to meet the mental health and SUD needs of older adults and their families, along with 

technical assistance, including toolkits on partnership development and the business case 

for older adult mental health and SUD service provision.

National Coalition on Mental 

Health and Aging

The National Coalition on Mental Health and Aging is a national organization with members 

from the private and public sectors who have expertise in the areas of mental health and 

aging and collaborate on initiatives to improve the quality of services available to this 

population.

Older Adults and Mental Health

(NIMH)

This National Institute of Mental Health (NIMH) website contains information about older 

adults and mental health, particularly depression, and includes warning signs, the latest 

news, resources, and how to find help.

SAMHSA Resources for Older 

Adults

SAMHSA has a number of products for serving older adults with mental disorders and 

SUDs that can be useful to clinicians, other service providers, older adults, and caregivers.

Toolkit: State Strategies to 

Support Older Adults Aging in 

Place in Rural Areas

This toolkit was developed by the National Academy for State Health Policy and highlights 

state initiatives to help older rural adults age in place. This can be achieved by increasing 

services that help people remain in their homes, expanding and professionalizing the 

caregiver workforce, improving transportation access and services, and reforming the 

delivery system.

Working With Older Adults: 

What Mental Health Providers 

Should Know

This American Psychological Association (APA) publication provides psychologists and 

other healthcare practitioners with resources, tools, and information to enhance their work 

with older adults. It also summarizes the guidance offered in the 2013 APA Guidelines for 

Psychological Practice With Older Adults, which is currently being updated and will be rereleased in 2024.

5
Resource Name Description

Reports

Building and Sustaining Effective 

Behavioral Health Care for 

Older Adults: Strategies and 

Considerations

This toolkit was developed by the E4 Center of Excellence for Behavioral Health Disparities 

in Aging and highlights key engagement and sustainability strategies that will help advance 

efforts to improve behavioral health outcomes among older adults.

Get Connected Toolkit SAMHSA designed this toolkit for organizations that provide services to older adults. 

It offers information and materials to help understanding the issues associated with 

substance misuse and mental illness in older adults, and also contains materials to 

educate older adults.

Growing Older: Providing 

Integrated Care for an Aging 

Population

This SAMHSA report for clinicians explains approaches to providing integrated care to older 

adults living with SUD and mental illness. It highlights the importance of assessing patients 

for cognitive deficits and adapting behavioral interventions to improve treatment outcomes.

Integrated Care for Older Adults 

with Serious Mental Illness and 

Medical Comorbidity: Evidencebased Models and Future 

Research Directions

This research brief provides a summary of evidence-based integrated models of care that 

address the mental and physical health needs of older adults with SMI.

Integrating Older Adult 

Behavioral Health Into LongTerm Care Rebalancing

This report was developed by the National Coalition on Mental Health and Aging and 

provides long-term care rebalancing opportunities and recommendations for funders, 

including public health agencies and managed care organizations for embedding 

behavioral health services to meet the needs of the older adult population.

Older Adults Living With Serious 

Mental Illness: The State of the 

Behavioral Health Workforce

This brief, developed by SAMHSA, provides an overview of workforce issues to 

consider when addressing the needs of older adults living with SMI. Information includes 

demographics, challenges faced by the provider workforce, and ideas for strengthening the 

geriatric workforce to address SMI.

Psychosocial Interventions for 

Older Adults with Serious Mental 

Illness

This SAMHSA evidence-based resource guide provides considerations and strategies for 

interdisciplinary teams, peer specialists, clinicians, registered nurses, behavioral health 

organizations, and policy makers to understand, select, and implement evidence-based 

interventions that support older adults with SMI.

Strategies for Integrating and 

Coordinating Care for Behavioral 

Health Populations: Case 

Studies of Four States

This report was developed by the Office of the Assistant Secretary for Planning and 

Evaluation and describes different strategies used by a selection of states to improve 

integration for individuals with behavioral health conditions.

TIP 26 – Treating Substance 

Use Disorder in Older Adults

This SAMHSA TIP was updated to help providers and others better understand how to 

identify, manage, and prevent substance misuse in older adults. The TIP describes the 

unique ways in which the signs and symptoms of SUDs manifest in older adults; drug and 

alcohol use disorder screening tools, assessments, and treatments specifically tailored for

older clients’ needs; the interaction between SUDs and cognitive impairment; and strategies 

to help providers improve their older clients’ social functioning and overall wellness.

Utilizing Cross-Sector 

Partnerships to Reduce 

Behavioral Health Disparities in 

Older Adults

This toolkit was developed by the E4 Center of Excellence for Behavioral Health Disparities 

in Aging and describes the landscape of resources that influence older adults and their 

behavioral health needs and to provide meaningful guidance for partnering across sectors 

to improve outcomes for diverse older adults.

6
References

1 Substance Abuse and Mental Health Services Administration. (2021). 

Psychosocial interventions for older adults with serious mental 

illness. https://store.samhsa.gov/product/psychosocial-interventionsolder-adults-serious-mental-illness/PEP21-06-05-001

2 Substance Abuse and Mental Health Services Administration. (2022). 

Key substance use and mental health indicators in the United States: 

Results from the 2022 National Survey on Drug Use and Health. 

(HHS Publication No. PEP22-1001, NSDUH Series H-59). https://

www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-

nsduh-main-highlights.pdf

3 American Psychological Association. (2014). Working with older 

adults: What mental health providers should know. https://www.apa.

org/pi/aging/resources/guides/practitioners-should-know

4 The White House. (2022). Fact sheet: President Biden to announce 

strategy to address our national mental health crisis, as part of unity 

agenda in his first State of the Union. https://www.whitehouse.gov/

briefing-room/statements-releases/2022/03/01/fact-sheet-presidentbiden-to-announce-strategy-to-address-our-national-mental-healthcrisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/ 

5 Koma, W., True, S., Fuglesten Biniek, J., Cubanski, J., Orgera, 

K., & Garfield, R. (2020). One in four older adults report anxiety 

or depression amid the COVID-19 pandemic. Kaiser Family 

Foundation. https://www.kff.org/medicare/issue-brief/one-in-fourolder-adults-report-anxiety-or-depression-amid-the-covid-19-

pandemic/

6 U.S. Department of Health and Human Services. (2022). Aging. 

https://www.hhs.gov/aging/index.html

7 National Coalition on Mental Health and Aging. (2023). Quick facts. 

https://www.ncmha.org/

8 Source: Arean, P. A., Raue, P. J., Sirey, J. A., & Snowden, M. 

(2012). Implementing evidence-based psychotherapies in settings 

serving older adults: Challenges and solutions. Psychiatric Services 

(Washington, D.C.), 63(6), 605–607. https://doi.org/10.1176/appi.

ps.201100078 

9 Bryant, C. (2017). Psychological interventions for older adults: 

Evidence-based treatments for depression, anxiety, and carer stress. 

In H. Chiu & K. Shulman (Eds.), Mental health and illness of the 

elderly (pp. 481–514). Springer Science + Business Media. https://

doi.org/10.1007/978-981-10-2414-6_21

10 Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr, Hunkeler, 

E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, 

E. H., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., 

Langston, C., & IMPACT (Improving Mood-Promoting Access to 

Collaborative Treatment Investigators). (2002). Collaborative care 

management of late-life depression in the primary care setting: A 

randomized controlled trial. JAMA, 288(22), 2836–2845. https://doi.

org/10.1001/jama.288.22.2836

11 Texas A&M Health Science Center. (n.d.). IMPACT (Improving, 

Mood-Promoting Access to Collaborative Treatment) (Title III-D 

Program). https://ebc.tamhsc.edu/program/impact-improving-moodpromoting-access-to-collaborative-treatment/

12 AIMS Center, University of Washington. (n.d.). IMPACT: Improving 

Mood — Promoting Access to Collaborative Treatment. https://

aims.uw.edu/project/impact-improving-mood-promoting-access-tocollaborative-treatment/

13 University of Washington Health Promotion Research Center. (n.d.). 

Program to Encourage Active, Rewarding Lives (PEARLS). https://

depts.washington.edu/hprc/programs-tools/pearls/

14 Healthy IDEAS. (n.d.). Agency program manual: Guide to 

implementing Healthy IDEAS. https://s3.amazonaws.com/healthyideas-2/Website+Documents/Adopting+Agency+Documents/

HI+Agency+Manual+ESMV.pdf

15 Quijano, L. M., Stanley, M. A., Petersen, N. J., Casado, B. L., 

Steinberg, E. H., Cully, J. A., & Wilson, N. L. (2007). Healthy IDEAS: 

A depression intervention delivered by community-based case 

managers serving older adults. Journal of Applied Gerontology, 

26(2), 139–156. https://doi.org/10.1177/0733464807299354

16 Bartels, S. J., Pratt, S. I., Mueser, K. T., Naslund, J. A., Wolfe, R. 

S., Santos, M., Xie, H., & Riera, E. G. (2014). Integrated IMR for 

psychiatric and general medical illness for adults aged 50 or older 

with serious mental illness. Psychiatric Services, 65(3), 330–337. 

https://doi.org/10.1176/appi.ps.201300023

17 Mueser, K. T., Meyer, P. S., Penn, D. L., Clancy, R., Clancy, 

D. M., & Salyers, M. P. (2006). The Illness Management and 

Recovery program: Rationale, development, and preliminary 

findings. Schizophrenia Bulletin, 32(Suppl 1), S32–S43. https://doi.

org/10.1093/schbul/sbl022

18 Mental Health Technology Transfer Network. (n.d.). Illness 

Management and Recovery (IMR). https://mhttcnetwork.org/centers/

northeast-caribbean-mhttc/illness-management-and-recoveryimr#:~:text=Illness%20Management%20and%20Recovery%20

(IMR)%20is%20an%20evidenced%2Dbased,achieving%20

goals%20in%20their%20recovery. 

19 Pratt, S., Santos, M., Mueser, K., Bartels, S. and Meyer, P. (n.d.). 

Integrated Illness Management and Recovery manual. University 

of Minnesota, Minnesota Center for Chemical and Mental Health. 

https://practicetransformation.umn.edu/wp-content/uploads/2018/09/

I-IMR-Training-Manual.pdf

20 Pratt, S., Bartels, S., Mueser, K., & Forester, B. (2008). Helping 

Older People Experience Success: An integrated model of 

psychosocial rehabilitation and health care management for 

older adults with serious mental illness. American Journal 

of Psychiatric Rehabilitation, 11(1), 41–60. https://doi.

org/10.1080/15487760701853193

21 Cognitive Behavioral Social Skills Training. (n.d.). Cognitive 

behavioral social skills training. https://www.cbsst.org/

22 Patterson, T. L., Mausbach, B. T., McKibbin, C., Goldman, S., 

Bucardo, J., & Jeste, D. V. (2006). Functional Adaptation Skills 

Training (FAST): A randomized trial of a psychosocial intervention 

for middle-aged and older patients with chronic psychotic 

disorders. Schizophrenia Research, 86(1–3), 291–299. https://doi.

org/10.1016/j.schres.2006.05.017

23 Mausbach, B. T., Bucardo, J., Cardenas, V., McKibbin, C. L., 

Barrio, C., Goldman, S. R., Jeste, D. V., & Patterson, T. L. 

(2008). Evaluation of a culturally tailored skills intervention 

for Latinos with persistent psychotic disorders. American 

Journal of Psychiatric Rehabilitation, 11(1), 61–75. https://doi.

org/10.1080/15487760701853102

24 Assistant Secretary for Planning and Evaluation. 

(2022). HHS roadmap for behavioral health integration

(Issue Brief). https://aspe.hhs.gov/sites/default/files/

documents/4e2fff45d3f5706d35326b320ed842b3/roadmapbehavioral-health-integration.pdf

25 Araujo de Carvalho, I., Epping-Jordan, J., Pot, A. M., Kelley, E., Toro, 

N., Thiyagarajan, J. A., & Beard, J. R. (2017). Organizing integrated 

health-care services to meet older people’s needs. Bulletin of the 

World Health Organization, 95(11), 756–763. https://doi.org/10.2471/

BLT.16.187617

26 Institute for Healthcare Improvement. (2020). Age-friendly health 

systems: Guide to using the 4Ms in the care of older adults. https://

www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/

Documents/IHIAgeFriendlyHealthSystems_GuidetoUsing4MsCare.

pdf

7
27 Medicaid Innovator Accelerator Program. (2017). Planning a state 

approach for physical and mental health integration: Key steps and 

considerations [PowerPoint slides]. https://www.medicaid.gov/stateresource-center/innovation-accelerator-program/iap-downloads/

program-areas/pmh-integration-webinar.pdf

28 Fagan, A. A., Bumbarger, B. K., Barth, R. P., Bradshaw, C. 

P., Rhoades Cooper, B., Supplee, L. H., & Klein Walker, D. 

(2019). Scaling up evidence-based interventions in US public 

systems to prevent behavioral health problems: Challenges and 

opportunities. Prevention Science, 20, 1147–1168. https://doi.

org/10.1007/s11121-019-01048-8

29 Substance Abuse and Mental Health Services Administration. (2020). 

TIP 26: Treating substance use disorder in older adults. https://store.

samhsa.gov/product/treatment-improvement-protocol-tip-26-treatingsubstance-use-disorder-in-older-adults/PEP20-02-01-011

30 Substance Abuse and Mental Health Services Administration. (2019). 

Get connected: Linking older adults with resources on medication, 

alcohol, and mental health (2019 Edition). https://store.samhsa.gov/

product/Get-Connected-Linking-Older-Adults-with-Resources-onMedication-Alcohol-and-Mental-Health-2019-Edition/SMA03-3824

31 U.S. Centers for Medicare & Medicaid Services. (2021). Medicare & 

You 2021 [Handbook]. https://www.medicare.gov/publications/10050-

Medicare-and-You.pdf

32 U.S. Census Bureau. (2023). Income and poverty in the United 

States: 2022. https://www.census.gov/content/dam/Census/library/

publications/2023/demo/p60-281.pdf

33 Statista. (2021). Characteristics of the U.S. Medicare population in 

2020. https://www.statista.com/statistics/246650/characteristics-ofthe-us-medicare-population/

34 Gunja, M. Z., Shah, A., & Williams II, R. D. (2022). Comparing Older 

Adults’ Mental Health Needs and Access to Treatment in the U.S. 

and Other High-Income Countries. https://www.commonwealthfund.

org/publications/issue-briefs/2022/jan/comparing-older-adultsmental-health-needs-and-access-treatment

35 Bennet, M. F. (2021). Better mental health care for Americans 

Act summary. https://www.bennet.senate.gov/public/_cache/

files/1/4/14bbbf61-ea04-4045-ba1f-df31bdf87da7/6029E5281758B

18690051CD129AA808A.better-mental-health-care-for-americansact-summary.pdf

36 Substance Abuse and Mental Health Services Administration. 

(2023). Strategic plan: Fiscal year 2023-2026. (Publication No. 

PEP23-06-00-002). Substance Abuse and Mental Health Services 

Administration, National Mental Health and Substance Use 

Laboratory. https://www.samhsa.gov/about-us/strategic-plan

37 Substance Abuse and Mental Health Services Administration. (2021). 

Psychosocial interventions for older adults with serious mental 

illness. (Publication No. PEP21-06-05-001). Substance Abuse 

and Mental Health Services Administration. https://www.samhsa.

gov/resource/ebp/psychosocial-interventions-older-adults-seriousmental-illness

8
Supporting the Mental Health Needs of Older Adults

Acknowledgements 

This Issue Brief was prepared for the Substance Abuse and 

Mental Health Services Administration (SAMHSA) under 

contract number HHSS283201700019I_75S20322F42003 

(Ref. No. 283-17-1903) with SAMHSA, U.S. Department 

of Health and Human Services (HHS). Michelle Gleason 

served as contracting officer representative.

Disclaimer

The views, opinions, and content of this publication are 

those of the author and do not necessarily reflect the views, 

opinions, or policies of SAMHSA. Listings of any nonfederal 

resources are not all-inclusive. Nothing in this document 

constitutes a direct or indirect indorsement by SAMHSA 

or HHS of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be considered as such.

Public Domain Notice

All material appearing in this publication is in the public 

domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is 

appreciated. However, this publication may not be 

reproduced or distributed for a fee without the specific, 

written authorization of the Office of Communications, 

SAMHSA, HHS.

Recommended Citation

Substance Abuse and Mental Health Services 

Administration (SAMHSA): Supporting the Mental Health 

Needs of Older Adults. Rockville, MD: Center for Mental 

Health Services, Substance Abuse and Mental Health 

Services Administration, 2024.

Originating Office

Division of State and Community Systems Development, 

Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 5600 Fishers Lane, 

Rockville, MD 20857.

Nondiscrimination Notice

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) complies with applicable Federal 

civil rights laws and does not discriminate on the basis 

of race, color, national origin, age, disability, religion, or 

sex (including pregnancy, sexual orientation, and gender 

identity). SAMHSA does not exclude people or treat them 

differently because of race, color, national origin, age, 

disability, religion, or sex (including pregnancy, sexual 

orientation, and gender identity). 

La Administración de Servicios de Salud Mental y Abuso 

de Sustancias (SAMHSA) cumple con las leyes federales 

de derechos civiles aplicables y no discrimina por motivos 

de raza, color, origen nacional, edad, discapacidad, religión 

o sexo (incluido el embarazo, la orientación sexual y la 

identidad de género). SAMHSA no excluye a las personas 

ni las trata de manera diferente por motivos de raza, 

color, origen nacional, edad, discapacidad, religión o sexo 

(incluido el embarazo, la orientación sexual y la identidad 

de género).

Released 2024

Brief Reference Document

Substance Abuse and Mental Health

Services Administration

State TA S A M H S A S T A T E P R O G R A M I M P R O V E M E N T 

TECHNICAL ASSISTANCE

SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes.

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov

Task Order No. HHSS283201700019I_75S20322F42003 • Reference# 283-17-1903