By Monica E. Oss, Chief Executive Officer, OPEN MINDS 
December 12, 2024
 

A new study, The Mental Health Landscape Of Older Adults In The US (Source: Brookings.edu), reported that 11.5% of older adults have a mental illness. Slightly over 1% have a serious mental illness (SMI), and 8% have a substance use disorder (SUD).  

For reference, this is less than half of the prevalence of the population aged 18-64 years old. In that population, about a quarter of individuals have a mental illness, roughly 7% have an SMI, and 20% have a SUD. 

There are some unique characteristics of the older adult population. Non-Hispanic Black and lower-income older adults are most likely to experience mental illness and substance use disorder (SUD). Women are more likely to experience mental illness, but men are more likely to experience SUD. Those ages 85 and older are most likely to experience symptoms of depression, while adults between ages 65 and 74 are most likely to experience alcohol use disorder (AUD). 

Rates of Mental Health Care Use Conditional on Past Year Mental Health, Across Demographic Groups

Source: https://www.brookings.edu/wp-content/uploads/2024/06/20240702_CHP_Frank_OlderAdultsMH.pdf

With regard to depression, 11.8% of older adults are experiencing symptoms of depression. And 0.3% of those 65 years and older experience both SUD and symptoms of depression. In addition to depression, suicidality is also an issue. Across all age groups, men have significantly higher suicide rates than women. The most striking difference is between men and women ages 85 and older: women in this age group have the lowest suicide rate among all older adults, while men have the highest by a significant margin. Non-Hispanic older white adults also tend to have the highest suicide rate within the sample. 

Despite the need, among older adults, only 37% of those with a mental illness and 66% of those with an SMI received any type of treatment (inpatient, outpatient, prescription medication, or virtual) in the past year. Among those with SUD, only about 4% received treatment. This is consistent with data that finds that the majority of behavioral health professionals do not serve the Medicare population. 

For provider organization executive teams, these new numbers present opportunities for expansion and diversification. The current older adult population in the United States is approximately 57.8 million, according to a U.S. Census Bureau report noting the fastest growth rate for this demographic since the 1880s. If 11.5% have a mental illness and 8% met the criteria for SUD, this is a market of 6,647,000 and 4,624,000 consumers, respectively. And of that population, 4,870,000 (63%) and 4,410,000 (96%) didn’t receive treatment services for their mental illness or SUD, respectively. 

Prevalence of Past Year Mental Health Among Adults Aged 65 & Older

Source: https://www.brookings.edu/wp-content/uploads/2024/06/20240702_CHP_Frank_OlderAdultsMH.pdf

At the same time, Medicare coverage of behavioral health disorders is on the increase. Just in the past two years, we’ve seen an expansion in the types of clinicians who can provide services. Mental health counselors, addiction counselors, community health workers, as well as marriage and family therapists (MFTs) are now able to enroll with Medicare and bill independently under Medicare Part B for service. 

And the types of services that can be reimbursed have also been expanded. For digital mental health devices and apps, there are new Medicare billing codes to cover the prescription and provision of the therapy and codes for monitoring the consumer’s therapeutic response. Dual eligible individuals can now receive intensive outpatient program (IOP) services rendered by a hospital, community mental health centers, federally qualified health centers, rural health centers, or by an opioid treatment program. 

This “white space” in the health care market for serving consumers with a behavioral health disorder is on the increase. While there are 57.8 million adults over 65 in the U.S. now, in ten years, that number will be 78 million according to a US Census Bureau report.  The demographic trend is a rising tide. The adage is that a rising tide floats all boats.