Abstract:

Among the unintended consequences of the sweeping deinstitutionalization efforts affecting long-stay psychiatric hospitals in the United States were the numbers of aged persons with severe mental disorders discharged after having sometimes spent many decades within the inpatient system. Living in varied community settings, they were newly presenting for care to some mental health agencies unused to serving often-frail elders. At the same time, aging services were facing the need to offer supports for clients burdened with depressive and psychotic symptoms due to dementing illnesses. Thoughtful leaders within the aging and mental health fields came to the conclusion that there needed to be cross-training for professionals in order for seamless and strategic care to be available, insofar as possible, for those needing it.

One such initiative in Philadelphia, Pennsylvania was the creation of a program in mental (now behavioral) health and aging. The sponsors at the start and now were the Philadelphia County Office of Mental Health and Mental Retardation (now the Philadelphia Department of Behavioral Health and Intellectual disAbility) and the Philadelphia Corporation for Aging, the local Area Agency on Aging established by the Older Americans Act in 1973. These two entities have consistently underwritten the training so that participants can take part without having to pay. Initially nine weeks and offered primarily to those in aging and mental health centers, the training has grown over time to a fifteen-week curriculum for anyone in Philadelphia serving aging persons or those with developmental disabilities or severe and persistent mental disorders. Participants in this expanded outreach have included professionals working in medical clinics, centers for intellectually disabled persons, visiting nurse associations, hospices, and prisons, among the many settings represented by those in our trainings. Graduates of the program meet monthly throughout the academic calendar, with topics and speakers chosen by the group at the start of each year.

This presentation will examine the history of the training curriculum used in the Philadelphia program, one we believe can serve as a model for regions grappling with many of the same care issues that we have encountered. We will explore the formation of the program, its theoretical and practical emphasis and development over the years, ethical concerns, the organization of material and case-based group work, and current and future goals for further enhancement. The rationales for the choices we have incorporated and refined over the years will be presented. It is our hope that this presentation will be a springboard for discussion about the needs of those who are aging and living with mental disorders, and the best training practices for the many committed professionals who serve them.

Keywords:

Aging, Mental Health, Dementia, Training.