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Health July 2018

A Healthy Age

What You Need to Know About Mental Health Care

By Amy Abbott

Some facilities offer specialized programs for seniors. However, there is a distinction between patients with dementia and those with mental illness. Dementia patients generally will not improve, while patients with mental illness can make great progress with the right treatment.

One in five Americans will experience a mental illness in any given year, according to the National Alliance for the Mentally Ill. While NAMI also reports that 60% of individuals with a mental illness will not receive treatment, some will face admission, or admission of a relative to a psychiatric or mental health facility. Seniors are no exception. Anxiety, depression, and mood orders are the most common in the over-55 age group, according to the Center for Disease Control.

If a medical professional recommends mental health treatment for you or your family member, what can you expect? Likely, you will be recommended for one of four kinds of treatment – inpatient care, partial hospitalization, outpatient care, or private therapy.

The level of care determination needed for a patient is made by a licensed clinical social worker who does a clinical assessment. The assessment is reviewed by a physician or nurse practitioner, and a recommendation is made for the patient. Most assessments have no cost, but you may want to confirm there is no fee. Your insurance or Medicare may cover the assessment fee if one exists. An assessment can last up to two hours and covers issues of current and past mental health status, along with relevant medical and family issues.

Some facilities are limited in what insurance they can take, though patients who are in danger of harming themselves or others must be accepted. The Emergency Medical Labor and Treatment Act was passed in 1986 to avoid “patient dumping” in emergency rooms. EMTALA requires that psychiatric and other hospitals accept patients in emergency situations, regardless of ability to pay.

For a standard admission, know your insurance status for a hospital stay, so there are no surprises on the back end. Inpatient care, on average, can run hundreds of dollars per day, and the average length of stay in inpatient mental health facilities is five to seven days. Some facilities require that a patient’s insurance deductible be satisfied before admission. (Most communities support community mental health centers that offer care on a sliding scale of fees.)

If you or your loved one are admitted to an inpatient facility, the admission process involves a search for contraband. What this means is that psychiatric hospitals need to be mindful of what the patient brings to a unit. Anything that could be considered a weapon is not allowed, even something as small as nail scissors. Most patients on a psychiatric unit will not be inclined to violence as portrayed in the movies. However, a search of new patients is necessary for the safety of all patients and staff.

Once on the unit, patients participate in daily activities, including group therapy, exercise and recreation, and discussion with a psychiatric nurse practitioner or psychiatrist. Individual therapy is no longer the focus of most psychiatric facilities, and groups are led by therapists, licensed clinical social workers who have a specialized master’s degree. Your progress will be monitored, and a team of mental health professionals will work with you and your family on continued treatment the stay is over.

Patients are allowed visitors on limited hours. Most facilities do not offer private rooms (unless there is a physical or medical reason) because sharing space with another person is considered part of therapy.

Some facilities offer specialized programs for seniors. However, there is a distinction between patients with dementia and those with mental illness. Dementia patients generally will not improve, while patients with mental illness can make great progress with the right treatment. Patients with dementia are sometimes admitted for an evaluation of their medication.

You may be offered one of three options upon discharge, partial hospitalization, outpatient treatment or private therapy.

Partial hospitalization is a day program which mirrors inpatient programming without the overnight stay. Patients arrive in the morning and have five or six hours of therapy and eat lunch in the facility. Many psychiatric facilities offered day programs on different schedules. For example, a day program might run from 4 p.m. to 10 p.m. Bus transportation may be available from your home or a local pick-up point.

There are multiple outpatient programs offered in most communities, from those offered by traditional inpatient hospitals to counselors hosting office therapy groups. These groups generally meet for several hours, three days a week. This is another option for people who must work during treatment, with varying alternatives available in most community’s morning, afternoon, and evening. Outpatient groups may have up to 10 participants.

The final option is private therapy with a counselor. Most psychiatrists today only offer medication management so you may see your psychiatrist only periodically. Counseling sessions can be as frequently as twice or week or as little as once a month, depending on diagnosis and personal need.

Getting treatment doesn’t need to be scary if you know what to expect. Unfortunately, our country has a shortage of psychiatric providers, and depending on where you live, finding appropriate help may be challenging. Many communities have chapters of Mental Health America of the National Association for the Mentally Ill. These organizations can be great resources to you in many ways. Some offer family support groups of disease-specific support groups (i.e., bipolar, depression, etc.)

As reported by the American Association of Medical Colleges in February 2018, the U.S. is suffering from a lack of psychiatrists. The article noted that rural regions often have the greatest shortages which affect private hospitals as well as community mental health centers.


Amy McVay Abbott is a long-time hospital executive who is also a writer. She’s the author of four books, including the recent “Whitley County Kid.” Learn more about her at

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