Mobile mental health team reaches minorities

Mobile Mental Health Team Reaches Minorities

The typical caseload of the Mobile Geriatric Outreach Team at Pacif Clinics mental health center in Pasadena, California, is 50 to 60 seniors. And the percentage of Hispanic and black clients served is about equal to their proportion of the population in surrounding Los Angeles County.

These statistics indicate that Pacific Clinics is achieving two goals that have eluded many mental health centers--serving a significant number of older people and reaching minorities.

It is estimated that between 15 and 20 percent of older adults could benefit from mental health counseling, yet statistics show that only about 4 percent of those 60 and older receive help from mental health professionals.

One reason for this is the older generation's reluctance to ask for help. Many older people accept feelings of depression and anxiety as a natural consequence of aging. They may not realize that these problems are not inevitable side effects of growing old or that new medications and effective therapies are available.

A mental health professiional at Pacific Clinics notes that "seniors are fearful of being labeled as mentally ill and view treatment for emotional difficulties as a precursor to hospitalization." If these attitudes are true of the elderly, they are even more persistent in minorities.

The Ethnic Minority Task Force in Los Angeles County estimates that 44 percent of Latinos in the County, 29 percent of Asian Pacific elders, and 51 percent of blacks live in impoverished conditions, putting them at high risk of mental illness. Yet these are the very groups that have been especially underrepresented at out-patient mental health clinics.

Determined to improve outreach to older people, particularly seniors from minority groups, Pacific Clinics used county block grand funds in 1985 to establish the Mobile Geriatric Outreach Team. The unit includes an Hispanic clinical social worker, black psychiatric nurse and two white professionals--a psychologist and a psychiatrist who mainly prescribes and monitors medications. The bi-lingual team serves 16 communities in the West San Gabriel Valley where one third of the residents are Hispanic.

There are no fees for the team's services, and all evaluation and ongoing counseling are provided at the senior's homes (private homes account for 70 percent of the team's visits) or at senior centers and retirement and nursing homes. The mobile team makes it possible for older adults who re unwilling or too ill or frail to go to an outpatient clinic to benefit from mental health care.

Close cooperation with the aging network has been crucial in reaching older adults. Senior centers have been very helpful in identifying cases. Through work with the L.A. County Department of Mental Health Older Adult Task Force, community education and networking, the team has developed ties with Area Agencies on Aging, senior centers and other organizations. These groups have made strong efforts to refer clients to the mobile team and to advocate for this type of innovative mental health care.

The team, however, could not rely on the aging network alone for Latino referals. Special outreach strategies were devised for the Latino community. Local hospital staffs and private physicians as well as other Latino professionals were informed about the team's services. Team members have found that Latinos are more willing to accept help in dealing with loss, anxiety, depression and emotionally charged family situations when they are referred by their primary care physicians. T.V. spots in Spanish, work with local churches and home/school coordinators have also been helpful in reaching Latino seniors.

The importance of special outreach is illustrated by the case of Mrs. Garcia. She had been married for 45 years when her husband suddenly died of a heart attack. Mrs. Garcia found it difficult to get back into her old life style. Every day seemed the same. She was not longer interested in volunteering in her church group or going to the Women's Club that she had belonged to for 30 years.

In the past, she had been so active in community projects tht she was seldom home before five. Now the thought of leaving her home brought a feeling of anxiety and doom. Over the past year, she had become so anxious about driving her car and having an accident that she stopped using it.

At night she found it difficult, if not impossible, to get to sleep. If she did, it was only for a brief time. She would find herself awake waiting for the sun to come up.

Mrs. Garcia, who was also eating poorly and had lost 20 pounds, had been seeing her physician twice a month since her husband's death. Although the physician thought her symptoms were related to her grief, he ran a series of tests to rule out physical disorders. The results were negative, and he then recommended tht Mrs. Garcia make an appointment with one of his colleagues who was a psychiatrist.

Mrs. Garcia explained that her fear had become so overwhelming that she was virtually unable to leave her home to see him and would be unable to handle the anxiety of visiting someone she did not know.

Her doctor remembered hearing about Pacific Clinics Mobile Team from a member of the Area Agency on Aging staff. He contacted the Mobile Team, and a date was set for the first meeting with Mrs. Garcia.

Two members of the Team interviewed Mrs. Garcia at her home. The initial evaluations indicated that prior to the death of her husband, Mrs. Garcia had no history of emotional problems. After discussing the case further, the Geriatric Team concluded that Mrs. Garcia was suffering from depression and agoraphobia (an abnormal fear of being in open or public places).

The team psychiatrist was called in to evaluate Mrs. Garcia for possible use of medication, and an anti-depressant was prescribed. Counseling in Spanish was started to help Mrs. Garcia to deal with the death of her husband--to verbalize her feeling of loss and abandonment. As the medication took effect, she was now able to sleep at night and her appetite improved. Within a month, Mrs. Garcia could leave her home for short trips and at the end of the second month, she was driving again. By the fourth month, Mrs. Garcia had resumed most of her past functioning and her medication was stopped. Counseling was reduced to twice a month and eventually ended.

Mrs. Garcia's case illustrates why out-reach programs are absolutely essential in reaching older adults, especially Latinos. It is imperative that community mental health centers and programs serving the elderly work together to develop innovative services to reach older people with mental health care--particularly seniors from minority groups.

Andres H. Hernandez is the Licensed Clinical Social Worker on the Mobile Geriatric Outreach Team at Pacific Clinics in Pasadena, Calif., and Dr. Craig Schweon is the Director of Adult Services at the Clinics.

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