Collaborative Care: Setting Milestones in Mental Health

When it comes to delivery of mental health services across the age groups, older adults are likely to get the short end of the stick. Although great advancements have been made in the reduction of mortality rates and improvement of health and overall well-being, mental health care providers continue to predominantly exclude older adults. This is a major public health concern that not only threatens the United States, but the entire world.

For most Americans, old age is an important phase when they want to remain jovial and adventurous like before. Since people are now living longer and healthier than before due to the advancements in the field of medicine, it has caused a dramatic increase in the proportion of the older population. The World Health Organization (WHO) has predicted that the growing global population of older people will almost double from 12 percent to 22 percent between 2015 and 2050.

On the one hand advancements in the field of medicine have proven to be a boon for older adults, on the other far too many older adults have to deal with difficult life situations and mental illnesses that affect their ability to draw out the most from life. Considering such a contradictory situation, it calls for greater commitment from both government and private organizations to develop policies and mental health services that are particularly aimed at older adults coping with the symptoms of mental illnesses.

Collaborative care – a remedy for depression in old

Old age is often accompanied by the weakening of organs and deterioration of mental sharpness. Moreover, compared to the youngsters older adults are more prone to developing problems like depression, anxiety and dementia. Other physical and social factors, such as loneliness, lack of appropriate facilities and support, etc., further accentuate the risk of developing mental disorders.

Such conditions usually arise due to other health complications, major life stressors, or the use or cessation of certain medications. Therefore, older adults require an approach that is different from the standard approach used for screening mental disorders. Until recently, collaborative care for older adults was believed to be capable of alleviating the symptoms of only the severe cases of depression. However, a recent study published in the Journal of American Medical Association (JAMA) suggests that older adults with subthreshold depression can also benefit from collaborative care.

Simon Gilbody, Ph.D., University of York and colleagues had randomly assigned 705 older adults with subthreshold depression (as per the Diagnostic and Statistical Manual of Mental Disorders -IV (DSM-IV)) into two groups for delivering depression treatment.

One group received the usual care from their physician, while the other received collaborative care and primary care. The patients in the collaborative care group had participated in six 30-minute sessions spanning over seven to eight weeks that focused on the need to address the behavioral repercussions of depression, such as the lack of social interaction and absence of rewarding activities. Some key findings of the study are as follows:

  • Progression of subthreshold depression did not vary between the two groups at the four-month mark; however, at the 12-month mark, it reduced greatly for the collaborative care group compared to the usual care group (15.7 percent versus 27.8 percent).
  • The collaborative care group also witnessed improvement in anxiety, functional status and more compared to the usual care group.

These findings suggest that short and relatively cost-effective methods can alleviate subthreshold depression in older adults before the disorder becomes severe. However, before widening the scope of collaborative care among all forms of depression, there is a need for conducting more studies and researches.

Seek collaborative care to leverage benefits

Oftentimes, older adults in the U.S. do not receive mental health services for their problems. Various factors, such as denial of the problem, inadequate funding, and other barriers like the existence of stigma around mental illness prevent the deliverance of treatment to those who need it the most.